PSYC3520_Assessment3

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Dec 6, 2023

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1 C onfirmation Bias, Rationalizations, and Point of View: A Case Study In this case study, Frank conducts a subsequent therapy session with his client, Eduardo. Frank is mindful that he must document Eduardo's symptoms in a manner consistent with Major Depression to secure insurance payment while avoiding any mention of symptoms related to Dependent Personality Disorder, which is not covered by insurance. Frank asks Eduardo how he has been doing since their last session. Eduardo replies that he has not been well. He refers to himself as "misfit" who needs someone to take care of him. Despite being diagnosed with Major Depression, when Frank asks Eduardo if he has been feeling sad, he replies, "Not particularly." Every time Eduardo expresses his struggles throughout the session, Frank leads the conversation towards depression-related symptoms. Frank continues to ask Eduardo about depression symptoms, filtering out information that doesn’t support his diagnosis. Throughout their interaction, Eduardo repeatedly expresses his gratitude for Frank’s guidance and expertise, and he defers to Frank's authority. After the session, Frank reflects on his approach and acknowledges that it is not sustainable and poses risks. However, he justifies his approach by telling himself that by bending his therapeutic approach to cater to financial interests, he will be able to secure his financial stability and ultimately help more clients in the long run, referring to the decision as a “win-win.” He concludes that there is no need to second guess himself, for he is a psychologist. Confirmation bias refers to the cognitive tendency of individuals to actively seek, interpret, and remember information that aligns with their preexisting beliefs or expectations while disregarding or downplaying information that contradicts those beliefs (Baumeister & Bushman, 2020). This bias can lead to a distortion of one's perception of reality, as individuals unconsciously filter and favor information that supports their viewpoints, potentially reinforcing existing biases and hindering the objective evaluation of evidence (Baumeister & Bushman, 2020). Research Support Research Summary Mendel et al. (2011) investigated confirmation bias in psychiatrists and its impact on diagnostic accuracy. The study, comprised of 75 psychiatrists and 75 medical students, found that many participants exhibited confirmation bias when searching for new information after making a preliminary diagnosis (Mendel et al., 2011). Psychiatrists conducting confirmatory searches made wrong diagnoses in a higher percentage of cases compared to those conducting balanced searches (Mendel et al., 2011). The study concludes that confirmation increases the risk of incorrect diagnostic decisions, suggesting the need for awareness of confirmation bias and techniques to reduce it among mental health professionals. Similarly, Elston (2019) conducted a study of first-year postgraduate physicians, finding that medical decision-making is often influenced by confirmation bias in newly-practicing physicians, which can lead to instances of incorrect diagnosis. Elston (2019) concludes that although humans are hardwired for

2 confirmation bias, techniques like attempting to disprove a diagnosis and using balanced testing methods can help counter these natural biases in medical decision-making. In addition, Charness and Dave (2017) examined the impact of external factors on contribution bias, particularly financial interests. Using a game-like setup, the researchers explored whether people with financial motivations were more likely to update their beliefs when faced with new information. They introduced a scenario where some participants had a financial incentive to lean towards a particular belief while others did not. The findings revealed that financially motivated participants tended to stick with their initial viewpoints, even in the face of contradicting evidence (Charness and Dave, 2017). Further expanding on factors that contribute to confirmation bias, Chen (2021) found that a sense of uncertainty is a contributing factor. Chen (2021) also found valence was be another major contributing factor. Positive valence involves pleasure and desirability, while negative valence encompasses discomfort and distress (American Psychological Association, n.d.). According to Chen (2021), confirmation bias has fundamental underlying factors: uncertainty and valence. Research Interpretation A wealth of research has established a profound connection between confirmation bias and inaccurate diagnoses in the realm of mental health and the broader healthcare system, underscoring the pervasiveness of this cognitive bias (Mendel et al., 2011; Elston, 2019). Healthcare practitioners exhibit confirmation bias by actively seeking out confirmatory evidence while disregarding information that challenges their initial diagnosis. This inclination can have serious repercussions, as the implications of an erroneous diagnosis can be far-reaching. Elston (2019) found that confirmation bias was notably pronounced among first- year postgraduate physicians, implying that with increasing experience and exposure, this bias may gradually decrease. When examining the factors that contribute to confirmation bias, it is evident from the research that multiple social, cognitive, and emotional factors play a role (Charness and Dave, 2017; Chen, 2021). For example, financial interests significantly increase the presence of confirmation bias, illustrating the motivating external factors that drive confirmation bias (Charness and Dave, 2017). Other key factors in one’s susceptibility to confirmation bias are valence and a sense of uncertainty, which highlights the emotional influences that come into play (Chen, 2021). This suggests that various elements can shape how one processes and acts upon new information, leading to heightened confirmation bias. Application of Confirmation Bias Confirmation bias is demonstrated vividly in the case study. Frank is aware that to secure reimbursement from Eduardo's insurance, he must focus exclusively on documenting symptoms related to Major Depression while carefully avoiding any mention of symptoms associated with Dependent Personality Disorder. His conscious choice demonstrates his engagement in confirmation bias as he seeks to validate his predetermined diagnosis (Baumeister & Bushman,

3 2020). As financial incentive is motivating Frank, he is more susceptible to confirmation bias (Charness and Dave, 2017). Throughout the interaction between Frank and Eduardo, Frank exhibits confirmation bias by making repeated efforts to guide the conversation towards indicators of Major Depression, despite Eduardo's statement that he hasn’t been feeling particularly sad or hopeless. This filtering of information is a hallmark of confirmation bias (Baumeister & Bushman, 2020). As their interaction concludes, Frank confidently asserts that his diagnosis is on the right track, citing that Eduardo has experienced discouragement and hopelessness in the past, which are common signs of Major Depression. Frank disregards Eduardo's contradictory input, highlighting the extent of his confirmation bias, which is, unfortunately, a significant contributing factor to inaccurate diagnoses within the mental health field (Mendel et al., 2011). Demonstrating factors that may be at play in the development of Frank’s confirmation bias, it is of note that Frank displays a sense of uncertainty about the sustainability of his private practice, questioning what would happen if his practice were to fail. As uncertainty is a major contributing factor to confirmation bias, Frank’s sense of uncertainty and worry about the direction and stability of his private practice may influence his tendency to engage in confirmation bias (Chen, 2021). Additionally, valence may play a role in Frank’s confirmation bias (Chen, 2021). The financial incentive provides Frank with positive valence, as it attracts him. Furthermore, while Frank is not new to the field of psychology, he is a new private practice owner and, therefore, may experience similar pressures, responsibilities, and cognitive tendencies, which is of significance as research has found that newly practicing physicians experience a higher rate of confirmation bias (Elston, 2019). Ethical Reasoning Application Ethical Concept Rationalizations are cognitive mechanisms through which individuals construct self-justifying explanations to reconcile actions, decisions, or beliefs that might conflict with their desired self- image or ethical standards (The University of Texas at Austin, n.d.). Rationalization serves as a self-deception method and offers individuals several psychological benefits, such as protection of self-esteem, maintenance of a positive self-image, and a decreased sense of responsibility for unethical behavior (Michel & Newen, 2010). By constructing rationalizations, people can justify their actions, decisions, or beliefs that might otherwise cause discomfort or guilt (Michel & Newen, 2010). Supportive Evidence Frank demonstrates rationalization through his moment of self-reflection after the session with Eduardo. As Frank reflects on his clinical approach and acknowledges that it is unethical, he justifies to himself in order to lessen the discomfort that comes along with an unethical decision (Michel & Newen, 2010). Frank tells himself that he can help many more clients by securing his

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4 financial wellbeing. To rationalize his decision, he convinces himself that his decision will ultimately be a “win-win” for himself and his clients. Frank further rationalizes his decision by concluding that because he is a psychologist and holds a place of authority, he does not need to second-guess his decision. This rationalization serves a psychological purpose to Frank, allowing him to alleviate feelings of guilt and maintain a positive self-image (Michel & Newen, 2010). Critical Thinking Application Critical Thinking Issue Point of view refers to the “place” from which one views a topic (Paul & Elder, 2013). This frame of reference shapes one’s perspective and interpretation of events, decisions, and circumstances (Paul & Elder, 2013). When one’s thinking fails to encompass various points of view, it breaches the Breadth standard established by Paul and Elder's Universal Intellectual Standards for critical thinking (University of Louisville, n.d.). As outlined in Paul and Elder's framework, nurturing critical thinking demands an exploration of alternative perspectives and an evaluation of whether all viewpoints are being considered with empathy (University of Louisville, n.d.). Furthermore, the framework emphasizes the significance of individuals questioning whether their viewpoints might overlook pertinent information. It also highlights the value of assessing whether they have diligently examined viewpoints that directly challenge their own (Paul & Elder, 2013; Capella University, n.d.). Supportive Evidence The case study illuminates Frank's point of view or frame of reference, evident through his specific emphasis on diagnosing and addressing depression. Frank failed to consider Eduardo’s point of view when he prioritized his financial incentives over Eduardo’s treatment and wellbeing, which contradicts Paul and Elder’s critical thinking framework (University of Louisville, n.d.). Frank's point of view becomes further evident in his post-session introspection. Frank does momentarily take on the point of view of an ethical therapist by recognizing that his method is morally questionable. However, he frames the situation in a positive light rather than considering the implications of his unethical behavior. By justifying his actions through rationalizations, Frank’s point of view is that he is ultimately contributing to the greater good by ensuring his financial success and the availability of his services to help more clients. In addition, Eduardo's point of view is displayed when he expresses his feelings of being a "misfit" who needs someone to care for him. His view of himself and his need for assistance influences his responses to Frank's questions and how he interacts during the session, demonstrating how point of view shapes one's worldview and impacts the dynamics of the therapeutic relationship. Eduardo frequently defers to Frank’s expertise, expressing his gratitude for Frank’s help. This demonstrates that Eduardo’s point of view is shaped by deference to authority and he perceives Frank as a knowledgeable professional. Eduardo refers to himself as a “blubbering fool,” demonstrating that his point of view is characterized by low self-esteem.

5 References American Psychological Association. (n.d.). APA Dictionary of Psychology. https://dictionary.apa.org/valence . Baumeister, R. F., & Bushman, B. J. (2020). Social Psychology and Human Nature (5th ed.). Cengage Limited. https://capella.vitalsource.com/books/9780357713754 . Capella University. (n.d.). Analytic Stage of Thinking . https://campus.capella.edu/critical- thinking/qualities-of-thinking/analytic-stage . Charness, G., & Dave, C. (2017). Confirmation bias with motivated beliefs. Games and Economic Behavior, 104 , 1-23, https://doi.org/10.1016/j.geb.2017.02.015 . Chen, J. (2021). Basic Psychosocial and Biological Contributors to Confirmation Bias. Advances in Social Science, Education and Humanities Research. https://doi.org/10.2991/assehr.k.211020.315 . Elston, D. M. (2019). Confirmation bias in medical decision-making. Journal of the American Academy of Dermatology , 82(3), 572. https://doi.org/10.1016/j.jaad.2019.06.1286 . Mendel, R., Traut-Mattausch, E., Jonas, E., Leucht, S., Kane, J., Maino, K., & Hamann, J. (2011). Confirmation bias: Why psychiatrists stick to wrong preliminary diagnoses.

6 Psychological Medicine, 41 (12), 2651-2659. https://doi.org/10.1017/S0033291711000808 . Michel, C., & Newen, A. (2010). Self-deception as pseudo-rational regulation of belief. Consciousness and Cognition, 19 , 731–744. https://doi.org/10.1016/j.concog.2010.06.019 . Paul, R., & Elder, L. (2013). Critical thinking: Intellectual standards essential to reasoning well within every domain of human thought, part 2 [PDF]. Journal of Developmental Education, 37 (1), 32–36. The University of Texas at Austin. (n.d.). Rationalizations. Ethics Unwrapped. https://ethicsunwrapped.utexas.edu/glossary/rationalizations . The University of Texas at Austin. (n.d.). Framing. Ethics Unwrapped. https://ethicsunwrapped.utexas.edu/video/framing . University of Louisville. (n.d.). Paul-Elder critical thinking framework. Ideas to Action. http://louisville.edu/ideastoaction/about/criticalthinking/framework .

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