Cognitive debiasing 1: origins of bias and theory of debiasing

Abstract

Numerous studies have shown that diagnostic failure depends upon a variety of factors. Psychological factors are fundamental in influencing the cognitive performance of the decision maker. In this first of two papers, we discuss the basics of reasoning and the Dual Process Theory (DPT) of decision making. The general properties of the DPT model, as it applies to diagnostic reasoning, are reviewed. A variety of cognitive and affective biases are known to compromise the decision-making process. They mostly appear to originate in the fast intuitive processes of Type 1 that dominate (or drive) decision making. Type 1 processes work well most of the time but they may open the door for biases. Removing or at least mitigating these biases would appear to be an important goal. We will also review the origins of biases. The consensus is that there are two major sources: innate, hard-wired biases that developed in our evolutionary past, and acquired biases established in the course of development and within our working environments. Both are associated with abbreviated decision making in the form of heuristics. Other work suggests that ambient and contextual factors may create high risk situations that dispose decision makers to particular biases. Fatigue, sleep deprivation and cognitive overload appear to be important determinants. The theoretical basis of several approaches towards debiasing is then discussed. All share a common feature that involves a deliberate decoupling from Type 1 intuitive processing and moving to Type 2 analytical processing so that eventually unexamined intuitive judgments can be submitted to verification. This decoupling step appears to be the critical feature of cognitive and affective debiasing.

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…Clinical decision making may also be enhanced. The thought process behind clinical decision making is frequently described as having two distinct components-one that is intuitive, relying primarily on pattern recognition and rules-of-thumb, and one that is more systematic and analytical (Bate et al 2012;Croskerry et al 2013). The intuitive process is faster but more likely to introduce cognitive biases and error than the more reflective process.…”

A generalized definition of critical thinking

“…This systematic nature of our cognitive biases is sometimes expressed with the adage that we humans are predictably irrational [39]: Precisely because the heuristics of our cognition are a universal trait, we can get a grasp on how and in which situations cognitive biases can have an impact on our inferences. Furthermore, by having a grasp of the systematic nature of cognitive biases, we can engage in what is sometimes referred to as debiasing [40,41]: By way of learning about cognitive biases, we can reduce the probability of falling prey to them. In the context of critical thinking, the minimization of cognitive biases can be understood as a constant exercise in debiasing.…”

Critical Thinking Education and Debiasing (AILACT Essay Prize Winner 2013)

“…The difficulty of teaching debiasing skills that could be deployed in a strictly atomistic or individualistic way counts in favor of teaching and investing also in more collective debiasing strategies and infrastructure that would serve the latter sorts of interests. This approach will encompass teaching not just individual skills and knowledge, but skills that enable the 1 In fact the distinctions between approaches to critical thinking that we propose in the following remarks should be helpful in characterizing the kinds of clinical training strategies described by Croskerry et al (2013aCroskerry et al ( , 2013b. 2 Below, we identify some methods that would fall under IA that we believe to be relatively promising.…”

“…It is also central to some reviews on the topic (e.g., Larrick 2004), while its influence can be seen also in training contexts beyond that of a critical thinking course. An example of this latter type of context is Croskerry, Singhal, & Mamede's (2013a, 2013b approach to cognitive debiasing for clinicians' medical judgments: even though Croskerry et al record a "general pessimism […] about the feasibility of cognitive debiasing" (Croskerry et al 2013a, p. ii63), they adopt the recommendation that clinicians "must be informed and recognise the need for constant vigilance and surveillance of their [own] thinking to mitigate diagnostic and other clinical errors" (Croskerry et al 2013b, p. 6). 1 It is noteworthy that IA characterizes much of how critical thinking education treats debiasing, we contend, because when one considers the empirical evidence bearing on it, the most plausible simple view of IA is that it is-at least in most casesfalse.…”