The Backfire Effect Part 2:
Combating Motivated Reasoning

Last week, I started a conversation about a problem many of us in the patient care world experience: motivated reasoning. This psychological phenomenon, in which people cling to a previous belief, despite new contradictory information, can be very troublesome. Medicine is emotional – try telling someone they have to lose a leg and wait for the normal emotional response – but the stakes are often very high, and we have to do everything we can to help our patients make the best decisions.

However, given that our recommendations may sometimes cause patients to literally believe the opposite of what we say, how do we combat this natural human response and prevent the backfire effect from occurring? Some answers to this question may be found from the world of politics.

A study conducted by the Yale Law School in 2007 revealed findings pertinent to our discussion.¹ The researchers categorized a representative sample of 5,000 Americans into four primary categories: Individualist versus Communitarian and Hierarchist versus Egalitarian. These categories were essentially world-views, moving from more conservative to more liberal. Additionally, certain world-view types held more strongly to their personal belief systems. A series of surveys were then completed regarding opinions of various political topics such as global warming. The researchers then provided information that was counter to the individual's beliefs and re-surveyed them. Briefly, the results showed that those who believed more strongly (regardless of conservative/liberal designation) were more likely to cling to their beliefs. Some of the findings from this study can be applied to our difficult to convince patient.

		Tonight's Premier Lecture is Regenerative Medicine: The Unlimited Potential of Stem Cells in Foot and Ankle Surgery Steven A. Bernstein, DPM

Determine the Strength of Your Patient's Opinions

First, determine the strength of your patient's opinions. The above study showed that those with more strongly held opinions (whether correct or not) are more likely to adhere to those opinions, despite conflicting correct information.¹ If you can gauge the strength of a patient's opinions, you can predict to some extent the likely reaction to your advice. This may also allow you to massage your message into a form that is more acceptable to the patient.

Use Family or Friends to Help Change Minds

Second, use family or friends to help change minds. This same study found people are "much more inclined to accept information about risk and danger when it comes from someone who shares their values than when it comes from someone who holds opposing commitments."¹ Coupling the patient's similar cultural norms with the fact that family is itself a strong influence can be a powerful tool in your toolbox.

Peer Support Helps

Third, you might even consider having your patient speak with another patient who underwent the same treatment. For example, while discussing a pending amputation with a resistant patient, you may have him speak with a prior patient who successfully underwent a similar amputation. This is one way in which amputation support groups are especially helpful.

Repeat, Repeat

Fourth, repetition may be highly effective to change your patient's entrenched mind. Another research study from the political realm found a "tipping point" in voters' opinions² with results that may be applicable to our medical practices. Researchers experimentally studied voter opinions of candidates. They found that in the presence of a small amount of negative information about a candidate, a voter with a previously positive memory of that candidate held that positive memory more strongly. However, as more negative information about the candidate was repeatedly brought to attention, a state of anxiety was created within the voter until he began to consider other candidates. If we apply this concept of the "tipping point" to our patients, repeated conversations about our recommendations have a better chance of leading to that "tipping point" and opening an otherwise closed mind to our recommendations.

Listen to Your Patient

Finally, in all things, actively listen to your patient. Understanding your patient's perspective, including the social situation and potential barriers to care, may help you figure out reasons for the backfire effect and provide the opening you need to convince and help your patient achieve health.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

References:

1. Kahan D, et al. The Second National Risk and Culture Study: Making Sense of – and Making Progress In – the American Culture War of Fact. Cultural Cognition Project, Sept 2007.
2. Redlawsk D, et al. The Affective Tipping Point: Do Motivated Reasoners Ever "Get It"? Political Psychology. 2010;31(4):563–593.

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