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Are you in Denial About your Health? | Health Risk Bias


Have you ever wondered why some individuals appear irrational and stubborn in their beliefs and attitudes towards an issue, person, or behaviour? Do you recognize yourself as someone that can appear seemingly unshakable in your self-beliefs, despite overwhelming evidence to the contrary?


This lack of willingness to countenance an alternative point of view or update beliefs in light of new evidence is not simply a personality quirk or character flaw. Its roots lie deep in our cognitive development, shaping our judgement and decision processes and providing heightened confidence in our existing beliefs. It is an evolutionary survival mechanism designed to encourage action and discourage excessive deliberation. However, as a by-product, it tends to discourage individuals from updating their schemata of established knowledge, even when faced with powerful and convincing contradictory evidence1.


In my last post, “Do Optimists Live Longer,” I highlighted the conscious biased processes often observed in optimists. As discussed in the post, this can have both a positive or negative impact on short and long-term health outcomes.


Research has shown that these ‘motivational’ processes are not the only ones that can influence an individual’s judgement and decision in relation to conflicting and potentially negative information. There are also a number of non-motivational processes that occur at the sub-conscious level which can influence attitudes and drive decision processes2. An example of a non-motivational form of bias is the “availability heuristic.” In this common form of cognitive bias, decision making is influenced by the ease in which an individual is able to recall the relevant information required to make a decision3.


In health matters, such biased or asymmetric updating of beliefs can have major long-term consequences4. Continuing to undertake high-risk behaviours while remaining in denial of its consequences or failing to undertake long-term health preventative measures is often responsible for a significant reduction in long-term health.


Established beliefs and attitudes on what is considered healthy behaviour are often formed early on in life. Parental influence, advertising, peer pressure, religious beliefs, and culture all play an important role in helping establish beliefs as to what constitutes a significant health risk and what can be downplayed as insignificant5. Moreover, these attitudes have been shown to become deeply embedded and can prove difficult to change6.


Research studies have shown that simply providing risk and lifestyle information to individuals or patients is often ineffective7. Individuals are more likely to be persuaded when shared decision making is integrated into a broader-based discussion. Up to now, this has been a much-neglected part of the doctor-patient discussion8. However, encouragingly it has been shown that by allowing an individual to first recognize their own risk behaviours and to subsequently explore the opportunities for risk reduction themselves through a process of self-awareness, adherence to lifestyle risk reduction can be significantly increased.


Rather than treating perceived stubbornness to change in health behaviour as maladaptive denial or put it down to continued poor health literacy, health professionals are moving towards an era of positive engagement with patients. This is encouraging shared decision making and promoting more proactive health behaviours. The future and consequences of patient empowerment are looking encouraging.


1. Nickerson RS. Confirmation bias: A ubiquitous phenomenon in many guises. Review of general psychology 1998;2(2):175.

2. Chambers JR, Windschitl PD. Biases in social comparative judgments: the role of nonmotivated factors in above-average and comparative-optimism effects. Psychological bulletin 2004;130(5):813.

3. Tversky A, Kahneman D. Availability: A heuristic for judging frequency and probability. Cognitive psychology 1973;5(2):207-32.

4. Sharot T, Korn CW, Dolan RJ. How unrealistic optimism is maintained in the face of reality. Nature neuroscience 2011;14(11):1475-79.

5. Redelmeier DA, Rozin P, Kahneman D. Understanding patients’ decisions: cognitive and emotional perspectives. Jama 1993;270(1):72-76.

6. Weinstein ND, Klein WM. Resistance of personal risk perceptions to debiasing interventions. Health psychology 1995;14(2):132.

7. Berry D. Risk, communication and health psychology: McGraw-Hill International, 2004.

8. Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. British Journal of General Practice 1999;49(443):477-82.