Confronting Confirmation Bias

I had a couple of interesting conversations today that made me think about confirmation bias. Someone raised the question: 

How can you be certain you are not operating out of confirmation bias?

This is an excellent question and one that we should never stop asking ourselves. 

Confirmation bias is the tendency for us to see what we want to see and ignore what we don't want to see. As professional massage therapists who want to serve our clients well, it's important for us to be aware of confirmation bias and take steps to minimize it. The very first step is to recognize that it exists. 

By their very nature, we tend not to be aware of the assumptions we make until we encounter someone who does not share those assumptions. It can be quite jarring at first when someone who doe not share our assumptions asks, "How do you know this? Where did you get that information? What evidence do you have to support that statement?" Sometimes our reaction is, "Well, everyone knows this!" or even to take offense. Obviously the person who asked did not share that assumption and this is an opportunity to ask ourselves, "Exactly how do I know this? Where did this information come from? My teacher? Where did they get this?" We are presented with an opportunity to learn whether our assumptions are valid or not.

I particularly enjoy talking with physical therapists and other related health care professionals about some of the things that I encounter in my practice precisely because they do not necessarily share my assumptions and may present a different perspective. Discussing issues with other massage therapists is great and can give valuable insight, but because we often share common assumptions it can be limiting. We may reinforce each other's confirmation biases without realizing it. By speaking with educated professionals outside of my field, I gain a broader perspective and can compare what is assumed within my profession to what is known in different fields of science. Do my assumptions about physiology coincide with what my medical student friend is being taught in med school? What does current pain research have to say about the the ideas that are popular among my colleagues? How much is actually known versus how much is hypothesized? 

Richard Feynman, in his famous "Cargo Cult" speech, challenges us to confront our confirmation biases.

"The first principle is not to fool yourself, and you are the easiest person to fool."

Feynman lays out a model of how not to fool ourselves. First, be careful in your observations, be as objective and accurate as possible. Develop a hypothesis to explain your observations, then think of all the reasons why you could be wrong and account for them. After you have done that, design an experiment that would fairly test your hypothesis and record exactly what you did, how you did it, and what were your results. Submit this to your peers so they can examine it and look for flaws or mistakes in your methodology or your thinking. If your hypothesis can pass all these tests, then perhaps you are on to something. Feynman sets a high standard for scientific integrity but he is right to do that. If one is sending an unmanned vehicle to Mars or trying to find a cure for cancer, a lot is at stake and it's important to get it right!

We may not be conducting important scientific experiments, but we can aspire to the level of integrity that Feynman describes. When our clients come to us and trust their bodies and their psyches to our hands, we want to be worthy of that trust by committing to having an understanding of what we are doing and by giving them clear and accurate information. 

We can never be certain we are operating free of confirmation bias, but we can take steps to minimize it. We can commit to making careful observations and avoid jumping to conclusions. We can share our observations with others who are knowledgeable and listen to their questions and comments. We can familiarize ourselves with the scientific literature that pertains to us and look at what is known in science. Do our ideas agree with what is known in biomedical research or in pain science or physiology or physics? We can learn about hierarchies of evidence and quality of evidence and think carefully about how solid or weak is the evidence to support our thinking.

Cultivating science literacy, research literacy, and critical thinking skills can help us minimize confirmation bias by giving us tools to examine our ideas and the ideas of others and evaluate them fairly. 

There is a saying that in science we can never be completely right, but over time we can hope to become less wrong. We can never completely eliminate confirmation bias, but by cultivating awareness and committing to adapting our thinking to the evidence rather than ignoring evidence that contradicts our existing beliefs, we can reduce confirmation bias. 

I believe that massage therapy has a lot to offer and that by devoting ourselves to understanding how the body actually works, rather than clinging to our fantasies about how it works, we can become even more effective and better serve our clients and our profession.