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  • The Power of Dissonance

    I am on record at that conference believing what I had read, and proposing my work was similarly effective.
    I was wrong and am perfectly willing to admit it.
    It will happen again.


    From page 9 of my book, Shallow Dive

    The discomfort I sense in my students as I lead them toward what is a new way of thinking about pain and its management is something that troubles me and, I’m certain, keeps many from incorporating Simple Contact and ideomotion into their care.

    Of course, I can only resolve this issue by first of all understanding it, and it’s clear that I haven’t done an especially good job of that over the years. But an interview I listened to recently that led me to purchase yet another book has me feeling a little more hopeful about all of this, and that leads me to introducing this thread today.

    The interview was with Carol Tavris, a social psychologist and writer who appeared on the Point of Inquiry podcast this past week. She’s recently co-authored with Elliot Aronson a book titled Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts.

    The problem I encounter is “cognitive dissonance,” defined in the book as “a state of tension that occurs whenever a person holds two cognitions (ideas, attitudes, beliefs opinions) that are psychologically inconsistent.”

    I’m pretty sure that when I say to my classes that “there is no known correlation between pain and posture,” and then add to that “no correlation between strength and pain, strength and posture and appearance and pain,” that the sense of dissonance and the mental “tension” (read anguish) all this produces commonly grows beyond their tolerance.

    What this book does is point out how all of that is remarkably common and that we will all deal with that dissonance in predictable ways, though these ways of reacting might be decidedly counterintuitive when we don’t look at all of this objectively.

    I put a quote from my book at the top of this thread that, I’m glad to say, indicates that while I am by no means immune to the trap of self-justification that dissonance theory predicts I will fall into (more about that later), I have at least in one instance quite publicly moved all the way through this situation into an admission most of us avoid at all costs – I admitted that I had been wrong.

    For me at least, this is a good starting point, and I’ve never been so grateful for having written something before, and I did it in 1994.

    Much more to come.
    Last edited by Barrett Dorko; 09-07-2010, 01:07 PM.
    Barrett L. Dorko

  • #2
    Hi Barrett,

    I recognize that passage from a chapter intro, I believe, in your book.

    I'm really looking forward to this thread. I think we all have much to learn on this. I know I do.
    Cory Blickenstaff, PT, OCS

    Pain Science and Sensibility Podcast
    Leaps and Bounds Blog
    My youtube channel

    Comment


    • #3
      As I said, I cannot help but speak of things that will lead to cognitive dissonance (CD) among those who choose to attend my workshops, and, after a day like today, I’m beginning to appreciate how difficult that can be for those who show up completely unprepared for change.

      This sort of thing isn’t unusual by any means, but that’s another thread entirely.

      In any case, Tavris and Aronson make it clear that we will seek immediately to reduce the psychological tension created by CD by making a choice, and that we will almost always choose the idea in which we have invested the most time, money and emotion. Even at this point, early in the process, the brain will automatically begin to marshal what resources it can to distort the evidence before it in a fashion that justifies the choice made.

      There are several ways that this is done and my plan at the moment is look at one at a time. The first: Justification by claiming successful clinical outcome.

      Though I do a whole bit about how outcomes are just one aspect of our clinical experience and expertise, and the most difficult to meaningfully measure at that, almost without exception therapists who are presented with an alternative theory (or, perhaps, their first rational theory of dysfunction and therapeutic method) will retreat immediately to a narrative that might be called the “I get good results doing what I do already” storyline. I think everyone reading this knows what that sounds like.

      Embracing the results you claim you have, or wish you had, or remember hearing about from favored patients or truly believe you must be having given the amount of time you’ve devoted to doing something endlessly is, well, pretty easy to do, and I’m certainly not surprised to hear this from therapists battling with the new idea I’ve placed in opposition to their reasoning and method.

      The problem, of course, is that what they claim to have in the way of success is something they have never really measured in a way acceptable to any serious investigator. Their defense is shaky at best, and, in the end, not really worth a thing as an argument against changing methods of care now that the deep model dictates we should.
      Barrett L. Dorko

      Comment


      • #4
        The counterintuitive response

        Suppose we make a choice among several possible behaviors and then are shown that this choice is neither rational nor has it led to any great deal of success. What might you expect in the way of response to new information?

        This is where the counterintuitive nature of what is called dissonance theory kicks in.

        Let’s back up a bit. Tavris and Aronson make it clear that dissonance motivates us, but that more often than not it doesn’t motivate us to change but rather to find ways of justifying our previous choices. The brain’s goal is to reduce the discomfort it feels when it senses conflict between old decisions and new information. This goal commonly takes precedence over the lofty aspirations of learning many claim to have. We will instinctively seek comfort and survival over the uncertainty that intellectual change may offer, and unless we realize that, methods of self-justification will rule our thoughts.

        Here’s another I commonly encounter: Justification by claiming that all new knowledge is too difficult to assimilate.

        Student/therapist: “I understand what you’re saying and I agree with it, but something keeps me from remembering any part of it for more than five seconds.”

        I hear this several times a day, and yesterday a lot more than that. Usually, the information I provide about the origins of pain and the significance of knowing how they are manifest in the patient is treated in this way. I’ve yet to hear anybody disagree with me, it’s just that they can’t remember this simple but essential thing for any length of time.

        As justifications go, this one isn’t all that bad. After all, the study of memetics explains it quite clearly. Consider this from the Wikipedia entry for “meme”: "Memeticists argue that the memes most beneficial to their hosts will not necessarily survive; rather, those memes that replicate the most effectively spread best, which allows for the possibility that successful memes may prove detrimental to their hosts."

        “Hanging onto old ideas even if you know they’re wrong is common,” I say. “After all, they’ve served you well in the past. But today we have new information that should supplant what you were taught was true in the past, and a scientist would tend to accept the new, let go of the old and modify their theory and practice accordingly.”

        The problem with this little speech is that I’m talking to therapists, and they aren’t necessarily scientists.
        Barrett L. Dorko

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        • #5
          Killing the Messenger

          Perhaps the easiest and most commonly used method of distorting evidence is what I’ll call Justification by Negative Personal Association, which is another way of saying “kill the messenger.”

          Anybody reading my work over the years knows that I’ve encountered this a lot, but I know other workshop instructors who are unfamiliar with this. Though common, I find this to be the one justification I can actually influence with a bit of power. If I’m kind and patient and display an authentic interest in the thoughts and questions of my colleagues they find it difficult to use this justification to dismiss the evidence I present and usually retreat to one of the methods mentioned earlier. Being this way isn’t difficult for me, mainly because I am that way.

          This is tricky though. I’m convinced that a scientist, in effect, draws a line in the sand. We say, “Beyond this both my credulity and interest disappears.” For me that line is drawn at the point where physical possibility and biologic plausibility are no longer part of the therapist’s theory (if they have one) and I make this clear. The person I’m speaking to begins to make a choice at this point, and I know that they might just conclude that I am “close minded” and not worth listening to. I had a woman call me “rude” (rather loudly) a while ago because I said that her description of “the healing crisis” made no sense to me. I said this gently and sincerely and, as it happened, to her alone. Ah well.

          How does an instructor avoid this? It’s easy – they never draw a line.
          Barrett L. Dorko

          Comment


          • #6
            This is a great thread, Barrett. My own experience with cognitive dissonance related to treatment paradigm after taking your course was that, although it would have been more comfortable and safe to ignore it all, it wouldn't go away. Like a mosquito. Or a little brother. So I basically had no choice but to "go there." Or find a new profession. Like library science. I've always thought it would be cool to be a librarian.



            by the way, i dropped my last name from my username due to an uncomfortable incident with internet identity (not from this site). deicded to get a little more private.
            Last edited by Julie; 10-08-2007, 02:02 PM.

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            • #7
              Edison and Tesla

              Glad so many are enjoying the thread. Tell your colleagues about it when they disagree with your sudden change in theory and method. That's why I'm writing it.

              Thomas Edison and Tesla were mentioned as potential laureates to share the Nobel Prize of 1915 in a press dispatch, leading to one of several Nobel Prize controversies. Some sources have claimed that due to their animosity toward each other neither was given the award, despite their enormous scientific contributions, and that each sought to minimize the other one's achievements and right to win the award, that both refused to ever accept the award if the other received it first, and that both rejected any possibility of sharing it.

              From the Wikipedia entry for Nikalo Tesla

              Yesterday while teaching I mentioned the Manual Magic thread and began thinking about a small portion of it that included some information about Nikola Tesla. He played a part in the movie The Prestige. This post came to me then.

              Edison and Tesla had one primary disagreement during the early part of the twentieth century, and due to their enormously influential presence it managed to threaten the existence of most of the technological advances of the age. Other than that it was just a minor tiff.

              They fought The War of Currents, pitting Tesla’s alternating current against Edison’s direct current for use in a system of general power distribution. Ultimately, Tesla won because his idea and methodology was far superior. His personal eccentricities bordering on the bizarre probably didn’t help his case, and there’s a lesson there for all of us. Well, not me of course.

              I bring this up in the thread because it is yet another wonderful example of dissonance theory and how even the greatest minds cannot escape our genetically acquired tendency toward self justification when an idea we’ve devoted time, money and emotional resources to is suddenly placed alongside another that opposes it.

              “Edison carried out a campaign to discourage the use of alternating current, including spreading information on fatal AC accidents, killing animals, and lobbying against the use of AC in state legislatures. Edison directed his technicians to preside over AC driven executions of animals, primarily stray cats and dogs, but also unwanted cattle and horses. Acting on these directives, there were demonstration to the press that alternating current was more dangerous than his system of direct current. Edison's series of animal executions peaked with the electrocution of Topsy the Elephant. He also tried to popularize the term for being electrocuted as being "Westinghoused" (Westinghouse was Tesla’s sponsor).”

              From “Edison’s publicity campaign” here.

              And to think – Edison was an Ohio boy.

              I think it’s clear that these men engaged in the very sort of thinking we might expect given what we now know of memetics and dissonance theory. Interestingly, I have also read of Edison finally admitting that he had been wrong. This took a while but the evidence eventually overwhelmed him and he did what we all must eventually do if we are to progress in science - he said he was wrong.

              Of course, Edison was from Ohio.
              Barrett L. Dorko

              Comment


              • #8
                Wondering

                Another instructor who contracts with Cross Country Education attended one of my classes this week. I had had some previous dealing with her a few years ago when invited to debate the merits of “alternative medicine” in a national Magazine (Advance for Physical Therapists). She took the pro and I the con.

                This is a pleasant and friendly woman, an academic and clinician, and a strong proponent of her brand of “myofascial release” and, if our debate was any indicator, a big fan of “energetic” medicine. We met civilly and with evident good will and spoke briefly of our mutual experience as teachers with this company. Quite kindly she invited me to lunch though I declined. I don’t eat lunch while teaching – I stay in the room.

                I heard not a single objection from this therapist to anything I said. She bought a copy of my book and I signed it for her, she took a copy of a monograph I’ve written titled Manual Magic with her to lunch and returned it without comment. She left early and quietly as I continued to teach.

                I can’t help but wonder what she must think but if she doesn’t come here as I had invited her to do I guess I always will wonder. The only clue I have is my observation of the way she casually tossed Manual Magic back on the front table after lunch. To me, the impact was a little loud – but I’m perfectly willing to admit that my own instincts toward dissonance reduction inflated that way beyond its reality. Maybe. I’m almost sure.

                Perhaps.


                (This post also appears on this thread)
                Barrett L. Dorko

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                • #9
                  Dissonance and Memory

                  “I have done that,” says my memory. “I cannot have done that,” says my pride, and remains inexorable. Eventually – memory yields.

                  Frederick Nietzsche

                  After my first year of teaching for Cross Country I found that I was beginning to make another visit to the same city, commonly to the same hotel. The first time this happened was in Norfolk Virginia.

                  True story: After the first hour’s lecture a young woman in the second row said suddenly, “I remember you now. I came to this course last year and we were across the hall. I didn’t realize this was the same thing.” She began to smile. “Oh yea, I never read any of that stuff you recommended. Hehehehehe.”

                  I recall being fascinated by the look of horror on her coworker’s face as he sat beside her. All I could do is shake my head and think, “Great story.”

                  I discovered this past week while in New York that exactly one student in the combined workshops had been here to Soma Simple before class. It was Erica, who doesn’t really count because she was here and contributing before she got the course brochure that “strongly encouraged” people to do so. So, no one actually prepared for the course in any meaningful way whatsoever. Believe me, this is common.

                  Tavris and Aronson write a great deal about memory and its place in dissonance theory. They say, “Confabulation, distortion and plain forgetting are the foot soldiers of memory, and they are summoned to the front lines when the totalitarian ego wants to protect us from the pain and embarrassment of actions that we took that are dissonant with our core images.”

                  I would add to that, “We also conveniently forget actions we didn’t take.”

                  On the whole, the therapists in my classes are completely and utterly unprepared for anything I have to say, and now I’m beginning to see this in a new light. It occurs to me that our brains might be up to something even more effective than simple forgetting – they just arrange it so that we don’t have any dissonant knowledge to forget. All this requires are simple acts of omission; books and articles not read, an avoidance of conversations with other clinicians that might lead toward change and absolutely no preparation for a workshop that people claim they want to attend in order to help their patients. I know that their strongest defense when I point this out will be “I’m too busy.”

                  We know that ideomotion designed to relieve pain will occur before the nervous system is sufficiently compromised to actually perceive pain. Quite brilliantly, the unconscious is anticipatory and drives our behavior accordingly. Perhaps we are hardwired not to learn as well. Dissonance theory would predict this, I think, I’m almost sure.

                  See where I’m going with this? I’ve lived an ordinary life and never found that I didn’t have time to learn more about what my career entailed. I wanted to know what was happening beneath my hands and still do.

                  Often, what other therapists want to know remains a mystery to me. The real problem is that they can’t tell me though they’re sure that they once could.

                  They’ve forgotten what it was.
                  Last edited by Barrett Dorko; 12-08-2007, 02:39 PM.
                  Barrett L. Dorko

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                  • #10
                    A little review

                    I want to review a little here.

                    1) Cognitive Dissonance occurs when we hold two ideas that are psychologically inconsistent.

                    2) This makes us uncomfortable, and in an effort to return to a state of comfort(which is closely related to survival, see this thread) we make a choice between the new knowledge and our old idea.

                    3) Meme theory indicates that your choice will not necessarily be the one that helps you or makes sense – it will be the one that is strongest within you for a variety of reasons including comfort, familiarity and peer-pressure.

                    4) In order to justify your choice you will then engage in evidence distortion and/or kill the messenger, neither of which is likely to advance your knowledge base or alter your methods of care.

                    5) All of this process is driven by instinct and NO ONE is immune to it.

                    I suppose that you’re wondering what might be done to combat this, and that’s the subject of my next post.

                    Stay tuned.
                    Barrett L. Dorko

                    Comment


                    • #11
                      Barrett,
                      Very thought provoking thread. Interestingly enough, I never received a brochure for the course-I linked to it through this web site.
                      As I prepare to go into work today, I am thinking about certain patients with whom I will employ simple contact. (and how I will explain this to them as they are used to the ompt manual paradigm of jt. mobs, manip, stm and an occasional Butler-esque neural "mob" thrown in. )
                      The power to change a patients perception of what good PT is and make a difference in the way they feel and move is indeed a gift. To impart new found knowledge to your colleagues and patients is, I believe, essential for one's growth as a therapist and the profession.
                      Erica

                      Comment


                      • #12
                        Some mail today

                        Erica,

                        Thanks for the post.

                        Before I get to the methods that might be used to combat our instinctive response to cognitive dissonance I want to write a bit about the difference between being the one who gets the dissonance and the one who provides it. I think you know which role is mine, mostly. I’m reminded of a line by J.R. Ewing, the classic villain in the TV series Dallas: “I don’t get ulcers, I give ‘em.” He smiled as he said this, of course.

                        This morning I got the latest brochure from John Barnes’ Myofascial Release organization. It is precisely the same as all the ones I’ve seen in the past with one notable exception; on the front cover Barnes is no longer standing in the clouds as he has for years – in the background today there are trees. Perhaps this is in response to a portion of the discussion here where the appropriateness of this was questioned. Maybe with this new picture Barnes is saying, “No, I’m not dead.” Well, at least that’s my interpretation.

                        What interests me most about the brochure is the way in which the message of a new theory and technique is delivered. An entirely different vision of dysfunction and management is offered with prose that is supremely confident and liberally salted with unsubstantiated claims of success and properties of connective tissue it doesn’t possess. (Anybody who wants to argue about this should read the above referenced thread first)

                        Clearly, one method those on my side of the equation will use to diminish opposition is this sort of manipulative phraseology that preys upon the desire many bodyworkers have to become superheroes. The distinction between a superhero and a manual magician is clear however and is discussed here.

                        Bottom line: one way of reducing cognitive dissonance among your students is to prey upon both their ignorance and desire. There are countless examples of this sent out in the mail each day.

                        Here’s the irony. Many people attempting to break the laws of physics (or nature, if you would prefer) are eventually broken by the same laws.

                        But sometimes it takes a while for them to realize this.
                        Last edited by Barrett Dorko; 13-08-2007, 05:45 PM.
                        Barrett L. Dorko

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                        • #13
                          I find it useful to think about the examples of CD which have occurred over the years.
                          The strongest example came from David Butler's first course way back in 1990; as he talked, energetically about what was then very new pain physiology, I could feel and hear the resistance around me. Especially when he mentioned 'ultrabul****', there were looks of dismay and head shaking as the threat to comfortable kingdoms grew. These PTs had no dissonance; they were certain he was up the creek.

                          But some others felt he wouldn't lecture around the country if there wasn't some logic in it; they thought about reading, and maybe trying a few things out...

                          Out of that class of about 30, probably none used neurodynamics in their clinical work, or if they did, never talked about it. Generally, they were satisfied with their results and accepted their failures.

                          I think one has to be dissatisfied with the status quo to begin with. From there, the level of CD could be inversely proportional to the level of dissatisfaction. Of course these same folk may be more vulnerable to the power-seeking gurus, too.....

                          Of course adolescents and twenty-somethings are in a state of CD most of the time!

                          Nari
                          Last edited by nari; 13-08-2007, 10:56 PM.

                          Comment


                          • #14
                            Nari,

                            That same year I read Butler's first text and was thrilled with the insights regarding dysfunction and pain. I went on to add even more dissonance with the addition of ideomotion to self-correction of the abnormal neurodynamic, but, as yet, this seems to be something the NOI people can't assimilate.

                            Heck, they won't even discuss it.

                            Now I understand.
                            Barrett L. Dorko

                            Comment


                            • #15
                              Finally, the answer begins

                              To understand that we are structurally no different than the rest of the cosmos is to let ourselves expand into infinity.

                              Chet Raymo in Skeptics and True Believers

                              Last Wednesday on Long Island, a therapist who had run the gamut of self-justification available to her; after she could no longer deny that the person in her hands was moving correctively as I had predicted and could see that this was easily the most reasonable way of manually approaching many of the patients she had waiting back at the clinic she said:

                              “It seems too easy.”

                              I know, I know.

                              Now that I think about it, this may have been her final shot at what she considers normalcy, and I can’t really blame her for taking it.

                              If anyone reading this expects a simple, rapid method for reducing the methods of justification that retard learning to show up next, they’re probably going to be disappointed.

                              As Chet Raymo reminds us in the quote above, once we realize how we are all pretty much the same in a variety of ways we have to take responsibility for being as good as the best of us, and for many, this is more than they bargained for.

                              From page 222 of Mistakes Were Made…

                              The need to reduce dissonance is a universal mental mechanism, but that doesn’t mean that we are doomed to be controlled by it. Human beings may not be eager to change, but we have the ability to change, and the fact that many of our self-protective delusions and blind spots are built into the way the brain works is no justification for not trying…An appreciation of how dissonance works gives us some ways of overriding our wiring.

                              Tomorrow, solutions.
                              Barrett L. Dorko

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