By Linda Rising
risingl@acm.org
www.lindarising.org
Research shows that we make decisions
based on how the problem is described. Clearly it cannot be
rational! This is a real blow to those of us who believe we
are rational decision-makers! The best way to use this
information, I believe, is to build on what psychologists
Daniel Kahneman and Amos Tversky call "framing" and use it
to your advantage. Framing is using a particular set of
words to present a set of facts. What’s fascinating about
framing is that framing a set of facts in different ways can
lead to different responses on the part of the target
listener.
Framing is especially powerful when it is
applied with the knowledge that we humans tend to take more
risks to avoid losses than to make gains. Here’s a classic
problem example.
Suppose you are a physician working in an
Asian village. 600 people have contracted a life-threatening
disease. There are two possible treatments. Treatment A will
save exactly 200 people. Treatment B has a 1/3 chance of saving
all 600 and a 2/3 chance that you will save no one. Which do you
choose? A or B?
The majority of respondents faced with this
problem choose treatment A, because they prefer saving a
definite number of lives for sure to the risk that they will
save no one.
Here’s another problem.
Suppose you are a physician working in an
Asian village. 600 people have contracted a life-threatening
disease. There are two possible treatments. If you choose
treatment C, 400 people will die. If you choose treatment D,
there is a 1/3 chance that no one will die and a 2/3 chance that
everyone will die. Which do you choose? C or D?
The majority of respondents when faced with
this problem choose treatment D. They would rather risk losing
everyone than settle for the death of 400.
Of course, the dilemma in the two cases is
exactly the same. Only the wording is different.
When the possibilities involve losses, we will
risk a large loss to avoid a smaller sure one. We will choose a coin
flip that determines whether we lose $200 or nothing over a sure
loss of $100. When making choices among alternatives that involve
risk or uncertainty, we prefer a small, sure gain to a larger,
uncertain one. Most will choose a sure $100 over a coin flip to win
$200 or nothing.
Let’s see how these two influence strategies can
work together to help us to be happier and healthier.
In a series of experiments described in a recent
issue of the American Psychological Association Online,
psychologist Peter Salovey and his colleagues at Yale University
investigated the effects of framing health messages. We realize that
every year, millions of dollars are spent on public service and
advertising campaigns to promote healthy behavior. Some effectively
motivate behavior change but many do not. Why? Could the answer lie
in framing? That is, not so much in the content of the messages but
in how the messages are
crafted?
Experiments were conducted using persuasive
messages designed to promote a variety of cancer prevention and
detection behaviors, such as mammography utilization, pap testing,
sunscreen use, and smoking cessation. Results from the experiments
suggest that messages framed as gains were more effective when
targeting prevention behavior, while loss-framed messages were more
effective when targeting detection behaviors.
Here’s an example of an influential gain-framed
message: "Use sunscreen to help your skin stay healthy." (Don’t say
that you will risk getting skin cancer if you don’t use sunscreen.)
Here’s an example of an influential loss-framed
message: "Without regular mammograms you increase your risk of
developing breast cancer." (Don’t say that having regular mammograms
will increase your chances of staying healthy.)
Dr. Edward Miller, dean of the medical school at
Johns Hopkins University says, "If you look at people after
coronary-artery bypass grafting two years later, 90% of them have
not changed their lifestyle. And that's been studied over and over
and over again. And so we're missing some link there. Even though
they know they have a very bad disease and they know they should
change their lifestyle, for whatever reason, they can't."
In a recent article in Fast Company
magazine (I highly recommend this publication. I always read it
cover to cover.), Alan Deutschman writes:
Look at heart patients. The best minds at Johns
Hopkins might not know how to get them to change, but Dr. Dean
Ornish at the University of California at San Francisco does. He
observes, "Providing health information is important but we also
need to bring in the psychological, emotional, and spiritual
dimensions that are so often ignored." Ornish published studies in
leading peer-reviewed scientific journals, showing that his holistic
program can actually reverse heart disease without surgery or drugs,
but the medical establishment remained skeptical that people could
sustain the lifestyle changes. So, in 1993, Ornish persuaded Mutual
of Omaha to pay for a trial. Researchers took 333 patients with
severely clogged arteries and helped them quit smoking and go on
Ornish's diet. Patients attended twice-weekly group support sessions
led by a psychologist and took instruction in meditation,
relaxation, yoga, and aerobic exercise. The program lasted for only
a year, but after three years, 77% of the patients had stuck with
their lifestyle changes -- and safely avoided the bypass or
angioplasty surgeries that they were eligible for under their
insurance coverage. Mutual of Omaha saved around $30,000 per
patient.
Why does the Ornish program succeed while the
conventional approach has failed? For starters, Ornish recasts the
reasons for change. Doctors typically motivate patients with fear of
dying. For a few weeks after a heart attack, patients are scared
enough to do whatever their doctors said. But death is too
frightening to think about, so denial returns, and they go back to
their old ways.
Patients live the way they do to cope with
emotional troubles. "Telling people who are lonely and depressed
that they're going to live longer if they quit smoking or change
their diet and lifestyle is not that motivating," Ornish says. "Who
wants to live longer when you're in chronic emotional pain?" This is
a loss-framed message, which, as you’ll remember from the
experiments above is more effective for detection, while the problem
these patients face is prevention and for that, gain-framing is more
effective.
Instead of trying to motivate them with the "fear
of dying," Ornish reframes the issue. He inspires in the patients a
new vision of the "joy of living" -- convincing them they can feel
better, not just live longer. That means enjoying the things that
make daily life pleasurable, like making love or even taking long
walks without the pain caused by their disease. "Joy is a more
powerful motivator than fear," he says. This is gain-framing at its
best!
George Lakoff, a professor of cognitive science
and linguistics at the University of California at Berkeley, says,
"Concepts are not things that can be changed just by someone telling
us a fact. We may be presented with facts, but for us to make sense
of them, they have to fit what is already in the brain. Otherwise,
facts go in and then they go right back out. They are not heard, or
they are not accepted as facts, or they mystify us: Why would anyone
have said that? Then we label the fact as irrational, crazy, or
stupid." Lakoff says that's one reason why political conservatives
and liberals each think that the other side is nuts. They don't
understand each other because their brains are working within
different frames.
When leaders are focusing on a small group of
people who have a similar mind-set and shared values, a framed
message can be more nuanced and complex, but it still needs to be
positive, inspiring, and emotionally resonant. Chairman and
publisher Arthur Sulzberger Jr. rescued
The New York Times
from crisis when former editor Howell Raines had alienated much of
the newsroom's staff. Raines had shielded a star reporter from
criticism who was later exposed for fabricating news stories. The
scandal threatened the paper's credibility. Sulzberger successfully
framed his message, "We are a great newspaper. We temporarily went
astray and risked sacrificing the community spirit that made this an
outstanding place to work. We can retain our excellence and regain
our sense of community by admitting our errors, making sure that
they don't happen again, and being a more transparent and
self-reflecting organization." Sulzberger replaced Raines with a new
top editor, Bill Keller—a respected veteran who reflected the lost
communal culture—and he appointed a "public editor" to critique the
paper in an unedited column.
Here’s a recommendation from David Baum, author
of Lightning in a Bottle: Focus your language on the
positives; talk about what you want, not what you don’t want. The
subconscious rarely can tell the difference between the two. When
you dwell on the downside, people will unconsciously begin to make
it happen. Baum tells the following story.
Recently, I went to a driving range with my
friend Rod to see who could hit the golf ball the farthest.
After several shots, I decided to use some subtle gamesmanship
to ensure victory. As Rod approached the ball, I muttered,
barely audibly, "Whatever you do, don’t hit it into the trees."
Of course, Rod shanked it straight into the woods.
Notice, it didn’t matter whether I said, "Hit
it into the trees" or "Don’t hit it into the trees." The bottom
line was, it was all about the trees. That’s all Rod’s
subconscious heard—trees.
So, always frame your language in terms of
positive rather than negative outcomes. "I’m looking forward to
a smooth transition" is highly preferable to "Let’s do our best
to avoid a rocky start." It presents an image that ultimately
will provoke the kind of supportive action you want. The
difference is subtle, but can have profound effects.
Finally, another account from a favorite recent
read, The Placebo Response, about something called "mastery."
The most important results on mastery and its
effects on healing come from studies conducted by Dr. Sheldon
Greenfield and Dr. Sherrie Kaplan and their colleagues. They looked
at patients with chronic diseases in various parts of the country.
Greenfield and Kaplan divided the subjects
randomly into two groups. The mastery group was given a special
training session. The goal was to help these patients learn to take
an active role in their clinic visits by asking more questions,
being more directive with their physicians, and achieving greater
clarity about what they wanted.
The researchers went over the charts of the
patients to identify things the patients wanted to talk about. Did
the patients know why they were taking the medications that had been
prescribed? Were there any side effects of the medications that they
hadn’t mentioned? Did they want more information about nutrition?
Then the patients were led through a practice session to prepare for
their next doctor’s visit.
The control group also had a session with the
researchers, taking the same amount of time. The focus was not on
mastery but on education. No review of their charts and no practice
sessions occurred.
The researchers had already videotaped clinic
visits with all the patients; they then videotaped the doctor’s
visit following the session. The videos showed that the patients in
the mastery group, compared both to their earlier visit and to the
control group, asked more questions and generally took more
initiative in the discussion.
In the month following the training session, the
mastery group reported that they had much less interference of their
symptoms in their daily lives. Their symptoms didn’t go away, but
they were less disruptive.
The control group did learn more about their
illness than the experimental group but over the next month, that
didn’t translate into an improvement in their health or functioning.
Both mastery and control groups expressed equal
levels of satisfaction with their clinic visits and training
sessions. The mastery group expressed a preference for future
proactive clinic visits and indicated no desire to return to the
more passive role.
The mastery patients lost fewer days from work,
had fewer limits imposed by their illness on their normal
activities, and reported that they felt healthier overall.
Measurements of bodily functions such as blood pressure and blood
sugar improved significantly more in the mastery group.
What if we all became masters of our own
destinies? I feel better just thinking about it!
Remember in your next discussion with family,
friends, colleagues, and customers, that it’s not so much what
you say as how you say it. People can change if they are
given the right kind of positive message that helps them stay in
control of their lives. Let me know if it works for you!
References
Baum, D., Lightning in a Bottle: Proven Lessons for Leading
Change, Dearborn, 2000.
Brody, H., The Placebo Response, Cliff Street Books, 1997.
Deutschman, A., "Change or Die," Fast Company, May 2005,
53-56, 59-60, 62.
"Not what you say but how you say it," American Psychological
Association Online,
http://www.psychologymatters.org/messageframing.html
