Shira Elqayam

New paradigm psychology of reasoning: An introduction to the special issue edited by Elqayam, Bonnefon, and Over

The new paradigm in psychology of reasoning is becoming increasingly established. In this editorial to the special issue of Thinking & Reasoning we introduce the paradigm and explore some of its dimensions. The old paradigm focused on binary truth and truth preservation from assumptions, whereas the new paradigm puts subjective degrees of belief centre stage, represented as probabilities. Subjective psychological value, or utility, and social pragmatics also play a central role. Dual process theories provide the algorithmic-level underpinning to these computational-level functions. The new paradigm aims to integrate the psychology of reasoning with study of judgement and decision making, leading to a much more unified field of higher mental processing.

How do physicians decide to treat: an empirical evaluation of the threshold model

BackgroundAccording to the threshold model, when faced with a decision under diagnostic uncertainty, physicians should administer treatment if the probability of disease is above a specified threshold and withhold treatment otherwise. The objectives of the present study are to a) evaluate if physicians act according to a threshold model, b) examine which of the existing threshold models [expected utility theory model (EUT), regret-based threshold model, or dual-processing theory] explains the physicians’ decision-making best.MethodsA survey employing realistic clinical treatment vignettes for patients with pulmonary embolism and acute myeloid leukemia was administered to forty-one practicing physicians across different medical specialties. Participants were randomly assigned to the order of presentation of the case vignettes and re-randomized to the order of “high” versus “low” threshold case. The main outcome measure was the proportion of physicians who would or would not prescribe treatment in relation to perceived changes in threshold probability.ResultsFewer physicians choose to treat as the benefit/harms ratio decreased (i.e. the threshold increased) and more physicians administered treatment as the benefit/harms ratio increased (and the threshold decreased). When compared to the actual treatment recommendations, we found that the regret model was marginally superior to the EUT model [Odds ratio (OR) = 1.49; 95% confidence interval (CI) 1.00 to 2.23; p = 0.056]. The dual-processing model was statistically significantly superior to both EUT model [OR = 1.75, 95% CI 1.67 to 4.08; p < 0.001] and regret model [OR = 2.61, 95% CI 1.11 to 2.77; p = 0.018].ConclusionsWe provide the first empirical evidence that physicians’ decision-making can be explained by the threshold model. Of the threshold models tested, the dual-processing theory of decision-making provides the best explanation for the observed empirical results.

Rationality in the new paradigm: Strict versus soft Bayesian approaches

The new paradigm in psychology of reasoning is a family of theories sharing common assumptions and research goals. However, there are still some issues under debate. Although authors within the paradigm broadly agree on Bayesianism as a suitable theoretical framework, approaches vary considerably in adopting Bayesian principles to rationality, creating a continuum between “strict” and “soft” Bayesianism. Stricter Bayesian approaches adopt an epistemological stance which postulates strong coherence between the normative, computational, and algorithmic levels of analysis, all of which conform with Bayesian strictures; the closer an approach is to the softer end of the scale, the less it tends to postulate such strong coherence. In stricter Bayesian models instrumental rationality, which depends on achieving ones goals, is inexorably intertwined with normative rationality, which depends on conforming to normative criteria. In contrast, soft Bayesians adopt Bayesianism for its psychological advantages, such as subjectivity, uncertainty, and degrees of belief. This drives a more descriptivist approach to rationality, in which instrumental rationality is neither defined nor justified by normative Bayesian models. The challenge for soft Bayesian approaches is to link more explicitly instrumental rationality to these psychological Bayesian features, while avoiding drawing on normative considerations such as Dutch book arguments.

Grounded rationality: Descriptivism in epistemic context

Normativism, the approach that judges human rationality by comparison against normative standards, has recently come under intensive criticism as unsuitable for psychological enquiry, and it has been suggested that it should be replaced with a descriptivist paradigm. My goal in this paper is to outline and defend a meta-theoretical framework of such a paradigm, grounded rationality, based on the related principles of descriptivism and (moderate) epistemic relativism. Bounded rationality takes into account universal biological and cognitive limitations on human rationality. Grounded rationality accepts universal constraints but adds cognitive variability: Within-individual variability (dual processing), and individual as well as cultural differences. I discuss the implications of grounded rationality to dual processing, proposing that investing limited cognitive resources in analytic processing might be less instrumentally rational for individuals with low cognitive ability.

Thinking Styles and Regret in Physicians

Background Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies) heavily influence analytical processes, while affective processes are often dependent on regret. The relationship between regret and cognitive reasoning styles has not been well studied in physicians, and is the focus of this paper. Methods A regret questionnaire and 6 scales measuring individual differences in cognitive styles (maximizing-satisficing tendencies; analytical vs. intuitive reasoning; need for cognition; intolerance toward ambiguity; objectivism; and cognitive reflection) were administered through a web-based survey to physicians of the University of South Florida. Bonferroni’s adjustment was applied to the overall correlation analysis. The correlation analysis was also performed without Bonferroni’s correction, given the strong theoretical rationale indicating the need for a separate hypothesis. We also conducted a multivariate regression analysis to identify the unique influence of predictors on regret. Results 165 trainees and 56 attending physicians (age range 25 to 69) participated in the survey. After bivariate analysis we found that maximizing tendency positively correlated with regret with respect to both decision difficulty (r=0.673; p<0.001) and alternate search strategy (r=0.239; p=0.002). When Bonferroni’s correction was not applied, we also found a negative relationship between satisficing tendency and regret (r=-0.156; p=0.021). In trainees, but not faculty, regret negatively correlated with rational-analytical thinking (r=-0.422; p<0.001), need for cognition (r=-0.340; p<0.001), and objectivism (r=-0.309; p=0.003) and positively correlated with ambiguity intolerance (r=0.285; p=0.012). However, after conducting a multivariate regression analysis, we found that regret was positively associated with maximizing only with respect to decision difficulty (r=0.791; p<0.001), while it was negatively associated with satisficing (r=-0.257; p=0.020) and objectivism (r=-0.267; p=0.034). We found no statistically significant relationship between regret and overall accuracy on conditional inferential tasks. Conclusion Regret in physicians is strongly associated with their tendency to maximize; i.e. the tendency to consider more choices among abundant options leads to more regret. However, physicians who exhibit satisficing tendency – the inclination to accept a “good enough” solution – feel less regret. Our observation that objectivism is a negative predictor of regret indicates that the tendency to seek and use empirical data in decision-making leads to less regret. Therefore, promotion of evidence-based reasoning may lead to lower regret.

Evaluation of Physicians' Cognitive Styles.

Background. Patient outcomes critically depend on accuracy of physicians’ judgment, yet little is known about individual differences in cognitive styles that underlie physicians’ judgments. The objective of this study was to assess physicians’ individual differences in cognitive styles relative to age, experience, and degree and type of training. Methods. Physicians at different levels of training and career completed a web-based survey of 6 scales measuring individual differences in cognitive styles (maximizing v. satisficing, analytical v. intuitive reasoning, need for cognition, intolerance toward ambiguity, objectivism, and cognitive reflection). We measured psychometric properties (Cronbach’s α) of scales; relationship of age, experience, degree, and type of training; responses to scales; and accuracy on conditional inference task. Results. The study included 165 trainees and 56 attending physicians (median age 31 years; range 25–69 years). All 6 constructs showed acceptable psychometric properties. Surprisingly, we found significant negative correlation between age and satisficing (r = −0.239; P = 0.017). Maximizing (willingness to engage in alternative search strategy) also decreased with age (r = −0.220; P = 0.047). Number of incorrect inferences negatively correlated with satisficing (r = −0.246; P = 0.014). Disposition to suppress intuitive responses was associated with correct responses on 3 of 4 inferential tasks. Trainees showed a tendency to engage in analytical thinking (r = 0.265; P = 0.025), while attendings displayed inclination toward intuitive-experiential thinking (r = 0.427; P = 0.046). However, trainees performed worse on conditional inference task. Conclusion. Physicians capable of suppressing an immediate intuitive response to questions and those scoring higher on rational thinking made fewer inferential mistakes. We found a negative correlation between age and maximizing: Physicians who were more advanced in their careers were less willing to spend time and effort in an exhaustive search for solutions. However, they appeared to have maintained their “mindware” for effective problem solving.

The collapse illusion effect: A semantic-pragmatic illusion of truth and paradox

Abstract Two Experiments demonstrate the existence of a “collapse illusion”, in which reasoners evaluate Truthteller-type propositions (“I am telling the truth”) as if they were simply true, whereas Liar-type propositions (“I am lying”) tend to be evaluated as neither true nor false. The second Experiment also demonstrates an individual differences pattern, in which shallow reasoners are more susceptible to the illusion. The collapse illusion is congruent with philosophical semantic truth theories such as Kripkes (1975), and with hypothetical thinking theorys principle of satisficing, but can only be partially accounted for by the model theory principle of truth. Pragmatic effects related to sentence cohesion further reinforce hypothetical thinking theory interpretation of the data, although the illusion and cohesion data could also be accounted for within a modified mental model theory.

Rational decision-making in medicine: implications for overuse and underuse

Abstract In spite of substantial spending and resource utilization, todays health care remains characterized by poor outcomes, largely due to overuse (overtesting/overtreatment) or underuse (undertesting/undertreatment) of health services. To a significant extent, this is a consequence of low‐quality decision making that appears to violate various rationality criteria. Such suboptimal decision making is considered a leading cause of death and is responsible for more than 80% of health expenses. In this paper, we address the issue of overuse or underuse of health care interventions from the perspective of rational choice theory. We show that what is considered rational under one decision theory may not be considered rational under a different theory. We posit that the questions and concerns regarding both underuse and overuse have to be addressed within a specific theoretical framework. The applicable rationality criterion, and thus the “appropriateness” of health care delivery choices, depends on theory selection that is appropriate to specific clinical situations. We provide a number of illustrations showing how the choice of theoretical framework influences both our policy and individual decision making. We also highlight the practical implications of our analysis for the current efforts to measure the quality of care and link such measurements to the financing of health care services.

First things first: Order bias in deontic disjunctions.

In this paper we examine the way disjunctive choices work in conversational context. We focus on disjunctive deontic rules, such as ‘you must either submit an essay or attend an exam’. According to the Gricean maxim of orderliness, a derivative of the maxim of manner, people should interpret the first-mentioned option as the one preferred by the speaker. Two experiments demonstrated order bias, a non-logical preference for the first-mentioned option in the disjunctive situations of obligatory choice and free choice permissions, but not in the non-disjunctive situation of obligatory consequences. Order bias influences interpretations of the speakers preferences, but not of the recipients preferences; it was mainly a function of the nature of the situation, while linguistic form had only limited effect. We offer a general theoretical framework for order bias as a communicative device, constraining both interpretation and generation of utterances.

Utilitarian Moral Judgment Exclusively Coheres with Inference from Is to Ought

Faced with moral choice, people either judge according to pre-existing obligations (deontological judgment), or by taking into account the consequences of their actions (utilitarian judgment). We propose that the latter coheres with a more general cognitive mechanism – deontic introduction, the tendency to infer normative (‘deontic’) conclusions from descriptive premises (is-ought inference). Participants were presented with vignettes that allowed either deontological or utilitarian choice, and asked to draw a range of deontic conclusions, as well as judge the overall moral rightness of each choice separately. We predicted and found a selective defeasibility pattern, in which manipulations that suppressed deontic introduction also suppressed utilitarian moral judgment, but had little effect on deontological moral judgment. Thus, deontic introduction coheres with utilitarian moral judgment almost exclusively. We suggest a family of norm-generating informal inferences, in which normative conclusions are drawn from descriptive (although value-laden) premises. This family includes deontic introduction and utilitarian moral judgment as well as other informal inferences. We conclude with a call for greater integration of research in moral judgment and research into deontic reasoning and informal inference.