Revised 11 December 2019 Presentation 12/13/2019
Cognitive Biases: Effects on mental disorders and treatment Keith Harris, PhD
13 December 2019
Lucia Heffernan
Presentation take-aways . What are cognitive biases and heuristics? - Common cognitive biases - Why we evolved them and why they’re useful . Mismatch to the modern world - The world the mind was made for - Fine-tuning in childhood and early experience . Contributing factors in (several) mental disorders - Potential impact on treatment - Therapeutic strategies and work-arounds
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Also interesting but not addressed today . Heuristics and intuition in everyday life . The socio-cultural facilitation of (some) cognitive biases . Cognitive distortions in personality disorders . The neurological underpinnings of cognitive biases . Cognitive biases in sales and politics . The irrationality of behavioral economics . Cognitive shortcuts in other species (hominins & dolphins)
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What are cognitive biases?
- Cognitive biases are a set of automatic (unconscious) tendencies to distort perceptions or situations in a predictable direction or manner - Cognitive biases evolved because they’re useful - But in some cases, these lead to problematic inferences and maladaptive responses to reality
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Background
- The concept of cognitive biases was introduced by the cognitive psychologists Amos Tversky and Danny Kahneman in 1972
- Initially eleven “cognitive illusions” - Familiar examples: (1) Tendency to generalize from small samples (2) Misunderstanding of laws of chance (3) Overconfidence based on limited information
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Example of a typical cognitive bias
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A (partial) current list of identified biases
Ambiguity effect Ben Franklin effect Continued influence effect Anchoring or focalism Berkson's paradox Contrast effect Anthropocentric thinking Bias blind spot Courtesy bias Anthropomorphism Bizarreness effect Cross-race effect Attentional bias Choice-supportive bias Cryptomnesia Attribute substitution Clustering illusion Curse of knowledge Automation bias Compassion fade Declinism Availability cascade Confirmation bias Decoy effect Availability heuristic Congruence bias Default effect Backfire effect Conjunction fallacy Denomination effect Bandwagon effect Conservatism Disposition effect Base rate fallacy Consistency bias Distinction effect Belief bias Context effect Dread aversion
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(What’s important?) (What to attend to?)
(What’s too complex (What needs immediate or ambiguous?) action?)
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https://upload.wikimedia.org/wikipedia/commons/6/65/Cognitive_bias_codex_en.svg
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Expert Decision-Making
The Recognition-primed Decision (RPD) Model
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What our cognitive apparatus evolved to do Despite widespread claims to the contrary, the human mind is not worse than rational . . . but may often be better than rational … - Cosmides and Tooby, 1994
The issue “is not whether the cognitive feature is accurate or logical, but rather how well it solves a particular problem.” - Haselton, Nettle & Murray, 2016
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The world the mind was made for Human life until perhaps 10,000 years ago: - Small communities (e.g., hunter-gatherer bands) - Sustained personal relationships with relations and nonrelations - Minimal privacy of behaviors or feelings - The complex social dynamics found in small, intensely-bound groups - Expectations that all members contribute (no freeloaders) - Capacity for shared intentionality, and collectively-shared intentionality: close collaboration - Generalized competence along with some division of labor - Lifelong ties to an adult partner with allowance for separation and repairing (in most groups, pair-bonding) - Sense of real and meaningful connection to the immediate environment
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Need for cognitive efficiency
Early human environments presented complex cognitive demands with little tolerance for error or delay
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Why cognitive biases evolved - Signal from noise (pattern recognition) - Limited information Opportunity cost - Need for speed Assessment of Situation - Social complexity No Risk Risk - Risk aversion Actual Situation No Risk True negative False Positive - Cognitive costs - Survival of the most Risk False negative True Positive competent
Danger, perhaps mortal
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The algorithm as a modern metaphor
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Genetic susceptibility and early environment
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“Scripts” first form in childhood
- Our adult interpersonal behaviors, feelings and thoughts are often influenced by automated cognitive “scripts” that may rely on innate cognitive and emotional tendencies - These are first formed through experience and observation (shaping) in childhood - These scripts can be very useful or very problematic in adulthood - A cognitive script is a sequence of emotions, thoughts and/or behaviors elicited by specific contexts
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Clinical issues with biases and scripts Common scripts and cognitive biases can be involved in various psychiatric issues or mental disorders - Thought disorders (e.g., psychoses) - Mood disorders (i.e., depressive disorders) - Personality disorders - Phobias - Eating disorders - Etc.
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Thought Disorders
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Representative thought disorder indications - Illogical thinking - Loose associations or obscurity of speech - Incoherence - Tangentiality - Circumstantiality - Delusions - Poor reality contact - Unusual beliefs
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Cognitive biases in thought disorders Deficits in “theory of mind” are possibly associated with - Difficulties with attribution (e.g., “Hostile attribution bias”) - Illusion of transparency - Paranoia Cognitive impairments may underlie - Jumping to conclusions - Intentionalizing - Catastrophizing - Emotional reasoning - Dichotomous thinking - Increased need for closure - Intolerance of ambiguity
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Complications for treatment Challenges - Establishing therapeutic alliance - Cognitive processing impairments - Dearth of social-interaction possibilities - Over-reliance of patients on the treatment system General principles - Faulty cognitions in psychosis are important, comprehensible, and modifiable - Effective treatment is directed toward decreasing distress and increasing well-being
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Treatment process and goals Pre-treatment assessment - Comprehensive psych-social history and current situation - Evaluation of cognitive functioning - Consideration of patient’s family and support system - Consultation with patient’s psychiatrist (and GP if needed) Treatment aims regarding faulty cognitive biases - Map maladaptive cognitive biases onto symptoms and problems - Work on biases must be integrated with other treatments - The most malleable biases are usually addressed first
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Illustrative case: Arthur Presenting problems involving cognitive distortions - Auditory hallucinations - Delusions - Unusual beliefs Brief history - Onset in early adolescence - Social withdrawal - Family discord following onset of symptoms
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Course of care: Arthur Relevant assessment issues - Need for multiple sources of information - Patient’s limited insight - Patient’s limited investment Treatment aims regarding cognitive distortions - Therapeutic alliance - Increased tolerance for ambiguity - Decreased conviction regarding false perceptions - Develop new cognitive habits
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Paranoid perceptions in psychosis
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Depressive Disorders
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Examples of cognitive biases in depression
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Cognitive biases in depressive disorders Attentional biases - Sensitivity to the “spotlight” effect - Gaze bias (a form of attentional bias) Interpretive biases - Negative interpretation of ambiguous stimuli - Negative self-serving bias Memory biases - Increased retention of negative information - Rumination and inverted “adverse- event fading bias”
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Common symptoms in depressive disorders - Prolonged sadness - Irritable or anxious mood - Lack of interest in normal activities - Feelings of guilt, rumination, thought insertion - Sense of worthlessness - Feelings of alienation or hopelessness - Etc.
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Neurological view of maladaptive cognitions
Belzung, C., Willner, P., & Philippot, P. (2015). Depression: From psychopathology to pathophysiology. Current Opinion in Neurobiology, 30, 24–30. https://doi.org/10.1016/j.conb.2014.08.013 35
Treatment of depressive disorders Challenges - Readiness of patient to participate in therapy - Problematic attachment issues that interfere with therapeutic alliance - Many people aren’t very good at accurate introspection (insight) General approach - Cognitive-behavioral framework - Interpersonal or psychodynamic alliance
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Treatment of depressive disorders (cont’d) Pre-treatment assessment - Comprehensive psych-social history - Evaluation of client’s emotional functioning - Identification of problematic cognitive biases and scripts Therapeutic aims regarding faulty cognitive biases - Person recognizes the problematic automatic tendencies when they are triggered - Patient exerts the effort needed to modify those maladaptive scripts that are amenable to change - Patient learns to compensate for scripts that can’t be changed
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Illustrative case: Maria Presenting problems - Depressed mood - Interpersonal difficulties - Problems on the job Brief history - Distant, disengaged parents - Frequent family moves - Surreptitious self-cutting in adolescence - Dependent / avoidant personality features - Occasional lapses into emotional reactivity
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Course of care: Maria Relevant cognitive biases and scripts - Confirmation bias - Negative attribution bias - Learned helplessness Treatment aims regarding problematic cognitive biases and scripts (or schemas) - Recognize and accept cognitive distortions - Improve reality-testing skills (cognitive habits) - Develop tolerance for discomfort - Adapt real world behaviors (compensation) - Embrace a perspective of “depressive realism” 39
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Summary . Cognitive biases and “scripts” are universal - They often facilitate interpersonal skills and decision-making - Sometimes they become problematic for everyone - They can exacerbate or contribute to psychiatric conditions . Mismatch to the modern world - The human mind is quite adaptable but was initially designed for a different way of life - Our biases and scripts are fine-tuned in childhood by family & culture . Treatment considerations - It’s helpful to identify cognitive biases and scripts during treatment planning - Therapeutic change and compensations are often possible
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Questions, suggestions and feedback
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