Decisional balance sheet
A decisional balance sheet or decision balance sheet is a tabular method for representing the pros and cons of different choices and for helping someone decide what to do in a certain circumstance. It is often used in working with ambivalence in people who are engaged in behaviours that are harmful to their health (for example, problematic substance use or excessive eating), as part of psychological approaches such as those based on the transtheoretical model of change, and in certain circumstances in motivational interviewing.
Use and history
The decisional balance sheet records the advantages and disadvantages of different options. It can be used both for individual and organisational decisions. The balance sheet recognises that both gains and losses can be consequences of a single decision. It might, for example, be introduced in a session with someone who is experiencing problems with their alcohol consumption with a question such as: "Could you tell me what you get out of your drinking and what you perhaps find less good about it?" Therapists are generally advised to use this sort of phrasing rather than a blunter injunction to think about the negative aspects of problematic behaviour, as the latter could increase psychological resistance.
An early use of a decisional balance sheet was by Benjamin Franklin. In a 1772 letter to Joseph Priestley, Franklin described his own use of the method, which is now often called the Ben Franklin method. It involves making a list of pros and cons, estimating the importance of each one, eliminating items from the pros and cons lists of roughly equal importance (or groups of items that can cancel each other out) until one column (pro or con) is dominant. Experts on decision support systems for practical reasoning have warned that the Ben Franklin method is only appropriate for very informal decision making: "A weakness in applying this rough-and-ready approach is a poverty of imagination and lack of background knowledge required to generate a full enough range and detail of competing considerations." Social psychologist Timothy D. Wilson has warned that the Ben Franklin method can be used in ways that fool people into falsely believing rationalisations that do not accurately reflect their true motivations or predict their future behaviour.
In papers from 1959 onwards, Irving Janis and Leon Mann coined the phrase decisional balance sheet and used the concept as a way of looking at decision-making.James O. Prochaska and colleagues then incorporated Janis and Mann's concept into the transtheoretical model of change, an integrative theory of therapy that is widely used for facilitating behaviour change. Research studies on the transtheoretical model suggest that, in general, for people to succeed at behaviour change, the pros of change should outweigh the cons before they move from the contemplation stage to the action stage of change. Thus, the balance sheet is both an informal measure of readiness for change and an aid for decision-making.
One research paper reported that combining the decisional balance sheet technique with the implementation intentions technique was "more effective in increasing exercise behaviour than a control or either strategy alone." Another research paper said that a decisional balance intervention may strengthen a person's commitment to change when that person has already made a commitment to change, but could decrease commitment to change if that person is ambivalent; the authors suggested that evocation of change talk (a technique from motivational interviewing) is more appropriate than a decisional balance sheet when a clinician intends to help ambivalent clients resolve their ambivalence in the direction of change.William R. Miller and Stephen Rollnick's textbook on motivational interviewing discusses decisional balance in a chapter titled "Counseling with Neutrality", and describes "decisional balance as a way of proceeding when you wish to counsel with neutrality rather than move toward a particular change goal".
Variations
There are several variations of the decisional balance sheet. In Janis and Mann's original description there are eight or more cells depending on how many choices there are. For each new choice there are pairs of cells (one for advantages, one for disadvantages) for these four different aspects:
- anticipated utilitarian effects for self
- anticipated utilitarian effects for significant others
- anticipated effect on how one is regarded by significant others
- anticipated effects on how one views oneself
John C. Norcross is among the psychologists who have simplified the balance sheet to four cells: the pros and cons of changing, for self and for others. Similarly, a number of psychologists have simplified the balance sheet to a four-cell format consisting of the pros and cons of the current behaviour and of a changed behaviour. Some authors separate out short- and long-term benefits and risks of a behaviour. The example below allows for three options: carrying on as before, reducing a harmful behaviour to a level where it might be less harmful, or stopping it altogether; it therefore has six cells consisting of a pro and con pair for each of the three options.
| Plusses | Minuses | |
|---|---|---|
| Continue drinking as I am | It's what my friends do It makes me less anxious It's fun being drunk I like the taste |
I get into fights Health problems Divorce threat Debts I can't remember things the next day |
| Cut down | I can still meet my friends It will help my health |
Will my partner believe me? Can I stick to it? |
| Stop drinking | I won't get into fights any more It will please my partner It will save money Good for my health |
I might have to avoid my friends How will I cope with anxiety? What will I do for fun? |
Any evaluation is subject to change and often the cells are inter-connected. For example, looking at the table above, if something were to happen in the individual's marital life (an argument or the partner leaves or becomes pregnant or has an accident), the event can either increase or decrease how much weight the person gives to the elements in the balance sheet that refer to the relationship.
Another refinement of the balance sheet is to use a scoring system to give numerical weights to different elements of the balance sheet; in such cases, the balance sheet becomes what is often called a decision matrix.
Similarly, Fabio Losa and Valerie Belton combined drama theory and multiple-criteria decision analysis, two decision-making techniques from the field of operations research, and applied them to an example of interpersonal conflict over substance abuse, which they described as follows:
A couple, Jo and Chris, have lived together for a number of years. However, Chris cannot stand any longer that Jo is always drunk and threatens to leave. The scene setting establishes the initial frame, the situation seen by a particular actor (Chris) at a specific point. The actors are Jo and Chris and each has a single yes/no policy option—for Chris this is to stay or leave and for Jo it is to stop drinking or not. These options define four possible scenarios or futures...
Dialectical behavior therapy includes a form of decisional balance sheet called a pros and cons grid.
Kickstarter co-founder Yancey Strickler created a four-cell matrix similar in appearance to a decisional balance sheet that he compared to a bento box, with cells for self and others, present and future.
ABC model
Psychology professor Finn Tschudi's ABC model of psychotherapy uses a structure similar to a decisional balance sheet: A is a row that defines the problem; B is a row that lists schemas (tacit assumptions) about the advantages and disadvantages of resolving the problem; and C is a row that lists schemas about the advantages and disadvantages of maintaining the problem. Tschudi was partly inspired by Harold Greenwald's book Decision Therapy, which posited that much of psychotherapy involves helping people make decisions. In the ABC model, people are said to be blocked or stuck in resolving a problem when their C schemas define strong advantages to maintaining the problem and/or strong disadvantages to resolving the problem, and often their C schemas are at a low level of awareness. In such cases, resolving the problem usually requires raising awareness and restructuring the C schemas, although several other general strategies for resolving the problem are available as alternatives or adjuncts.
In an approach to psychotherapy called coherence therapy, A is called the symptom, B is called the anti-symptom position and C is called the pro-symptom position, although coherence therapy also differentiates between "functional" symptoms that are directly caused by C and "functionless" symptoms that are not directly caused by C. In terms of behaviour modification, the problematic half of A describes one or more costly operants, and C describes the reinforcement that the operant provides.
The following table summarizes the structure of the ABC model.
| A = problem | a1 = problem position (PP) | a2 = desired position (DP) |
| B = elaboration of A | b1 = disadvantages of PP | b2 = advantages of DP |
| C = defines dilemma | c2 = advantages of PP | c1 = disadvantages of DP |
Four square tool
In an approach to psychotherapy called focused acceptance and commitment therapy (FACT) the four square tool is a tabular method similar in appearance to a decisional balance sheet. The four square tool shows four sets of behaviors: positive behaviors (called "workable" behaviors) and negative behaviors (called "unworkable" behaviors) that a person does publicly and privately. In the four square tool, the advantages and disadvantages of the behaviors are implied, rather than listed in separate cells as in a decisional balance sheet. The following table is a blank four square tool.
| Not working (do less) |
More workable (do more) |
|
|---|---|---|
| Public behavior |
||
| Private behavior |
See also
- Analysis paralysis – Overthinking causes
- Cost–benefit analysis – Systematic approach to estimating the strengths and weaknesses of alternatives
- Decision cycle – Sequence of steps for decision-making
- Decision tree – Decision support tool
- Formula for change
- Immunity to change
- Issue mapping – Diagram in which pros and cons are types of nodes
- Motivational salience – Cognitive process
- Opportunity cost – Benefit lost by a choice between options
- Practical reason – Use of reason to decide how to act
- Psychological dependence – Form of behavioral dependence involving emotional symptoms
- Reflective equilibrium – State of balance among a set of beliefs, arrived at by considering general principles
- SWOT analysis – Business planning and analysis technique
- Trade-off – Situational decision
- Unintended consequences – Unforeseen outcomes of an action
- DiClemente, Carlo C. (2003). Addiction and change: how addictions develop and addicted people recover. New York: Guilford Press. ISBN 978-1572300576. OCLC 50684146.
- Dixon, David N.; Glover, John A. (1984). Counseling: a problem-solving approach. New York: John Wiley & Sons. ISBN 978-0471888772. OCLC 10046418.
- Ecker, Bruce; Ticic, Robin; Hulley, Laurel (2012). Unlocking the emotional brain: eliminating symptoms at their roots using memory reconsolidation. New York: Routledge. ISBN 9780415897167. OCLC 772112300.
- Franklin, Benjamin (1975) [1772]. "To Joseph Priestley". In Willcox, William Bradford (ed.). The papers of Benjamin Franklin: January 1 through December 31, 1772. Vol. 19. New Haven: Yale University Press. pp. 299–300. ISBN 978-0300018653. OCLC 310601.
- Freimuth, Marilyn (2008). "Unmasking addiction and preparing for change". Addicted?: recognizing destructive behavior before it's too late. Lanham, MD: Rowman & Littlefield. pp. 211–239. ISBN 9780742560253. OCLC 183258453.
- Girle, Rod; Hitchcock, David; McBurney, Peter; Verheij, Bart (2004). "Decision support for practical reasoning". In Reed, Chris; Norman, Timothy J. (eds.). Argumentation machines: new frontiers in argument and computation. Argumentation library. Vol. 9. Boston: Kluwer Academic Publishers. pp. 55–83. doi:10.1007/978-94-017-0431-1_3. ISBN 978-1402018114. OCLC 53814623.
- Greenberg, Leslie S.; Webster, Michael C. (September 1982). "Resolving decisional conflict by Gestalt two-chair dialogue: relating process to outcome" (PDF). Journal of Counseling Psychology. 29 (5): 468–477. CiteSeerX 10.1.1.471.5776. doi:10.1037/0022-0167.29.5.468. Archived from the original (PDF) on 2015-07-14.
- Greenwald, Harold (1973). Decision therapy. New York: P.H. Wyden. OCLC 707490.
- Horan, John J. (1979). Counseling for effective decision making: a cognitive-behavioral perspective. North Scituate, MA: Duxbury Press. ISBN 978-0878721955. OCLC 4114485. Alternative HTML version: "Counseling for effective decision making". horan.asu.edu. Archived from the original on 2016-03-04. Retrieved 2015-07-13.
- Janis, Irving L. (March 1959). "Decisional conflicts: a theoretical analysis". Journal of Conflict Resolution. 3 (1): 6–27. doi:10.1177/002200275900300102. JSTOR 172865. S2CID 143316864.
- Janis, Irving L.; Mann, Leon (1977). Decision making: a psychological analysis of conflict, choice, and commitment. New York: Free Press. ISBN 978-0029161609. OCLC 2542340.
- Linehan, Marsha M. (2015) [1993]. DBT skills training manual (2nd ed.). New York: Guilford Press. ISBN 9781462516995. OCLC 883366057.
- Lock, Robert D. (2005) [1992]. Taking charge of your career direction. Career planning guide. Vol. 1 (5th ed.). Belmont, CA: Thomson Brooks/Cole. ISBN 978-0534574260. OCLC 56967151.
- Losa, Fabio Beniamino; Belton, Valerie (May 2006). "Combining MCDA and conflict analysis: an exploratory application of an integrated approach". Journal of the Operational Research Society. 57 (5): 510–525. doi:10.1057/palgrave.jors.2602034. JSTOR 4102448. S2CID 5605202.
- Miller, William R.; Rollnick, Stephen (March 2009). "Ten things that motivational interviewing is not" (PDF). Behavioural and Cognitive Psychotherapy. 37 (2): 129–140. doi:10.1017/S1352465809005128. PMID 19364414. S2CID 35320869.
- Miller, William R.; Rollnick, Stephen (2013) [1991]. Motivational interviewing: helping people change. Applications of motivational interviewing (3rd ed.). New York: Guilford Press. ISBN 9781609182274. OCLC 788281018.
- Miller, William R.; Rose, Gary S. (March 2015). "Motivational interviewing and decisional balance: contrasting responses to client ambivalence". Behavioural and Cognitive Psychotherapy. 43 (2): 129–141. doi:10.1017/S1352465813000878. PMID 24229732.
- Norcross, John C.; Loberg, Kristin; Norcross, Jonathon (2012). Changeology: 5 steps to realizing your goals and resolutions. New York: Simon & Schuster. ISBN 9781451657616. OCLC 779265892.
- Prestwich, Andrew; Lawton, Rebecca; Conner, Mark (December 2003). "The use of implementation intentions and the decision balance sheet in promoting exercise behaviour" (PDF). Psychology & Health. 18 (6): 707–721. doi:10.1080/08870440310001594493. S2CID 143757202.
- Prochaska, James O.; Velicer, Wayne F.; Rossi, Joseph S.; Goldstein, Michael G.; Marcus, Bess H.; Rakowski, William; Fiore, Christine; Harlow, Lisa L.; Redding, Colleen A.; Rosenbloom, Dena (January 1994). "Stages of change and decisional balance for 12 problem behaviors". Health Psychology. 13 (1): 39–46. doi:10.1037/0278-6133.13.1.39. PMID 8168470.
- Roes, Nicholas A. (2002). Solutions for the "treatment-resistant" addicted client: therapeutic techniques for engaging difficult clients. New York: Haworth Press. ISBN 978-0789011213. OCLC 45715882.
- Strickler, Yancey (5 November 2019). "How the bento box can change how we think about the world". Time. Retrieved 2019-11-05.
- Strosahl, Kirk; Gustavsson, Thomas; Robinson, Patricia A. (2012). Brief interventions for radical change: principles and practice of focused acceptance and commitment therapy. Oakland, CA: New Harbinger Publications. ISBN 9781608823451. OCLC 774496029.
- Suhr, Jim (1999). The choosing by advantages decisionmaking system. Westport, CT: Quorum. ISBN 978-1567202175. OCLC 38862607.
- Tschudi, Finn (1977). "Loaded and honest questions: a construct theory view of symptoms and therapy" (PDF). In Bannister, Donald (ed.). New perspectives in personal construct theory. London; New York: Academic Press. pp. 321–350. ISBN 978-0120779406. OCLC 10274182.
- Tschudi, Finn; Winter, David A. (2011). "The ABC model revisited" (PDF). In Caputi, Peter; Viney, Linda L.; Walker, Beverly M.; Crittenden, Nadia (eds.). Personal construct methodology. Malden, MA: John Wiley & Sons. pp. 89–108. doi:10.1002/9781119953616.ch4. ISBN 9780470770870. OCLC 730906380.
- Ullman, David G. (2006). Making robust decisions: decision management for technical, business, and service teams. Victoria, BC: Trafford. ISBN 9781425109561. OCLC 81600845.
- Velicer, Wayne F.; DiClemente, Carlo C.; Prochaska, James O.; Brandenburg, Nancy (May 1985). "Decisional balance measure for assessing and predicting smoking status". Journal of Personality and Social Psychology. 48 (5): 1279–1289. doi:10.1037/0022-3514.48.5.1279. PMID 3998990.
- Walters, Scott T.; Rotgers, Frederick, eds. (2012) [1996]. Treating substance abuse: theory and technique (3rd ed.). New York: Guilford Press. ISBN 9781462502578. OCLC 730404390.
- Wilson, Timothy D. (2002). "Introspection and self-narratives". Strangers to ourselves: discovering the adaptive unconscious. Cambridge, MA: Belknap Press of Harvard University Press. pp. 159–182. ISBN 978-0674009363. OCLC 49355958.