Cognition associated with use of and belief in complementary and alternative medicine (CAM)

The use of and belief in the effectiveness of complementary and alternative medicine (CAM) is associated with two cognitive biases: over-reliance on intuitive thinking and ontological mistakes. This thesis reports seven studies which explore the nature of these biases.Aims. The aim of study 1 was to develop and test a valid and reliable measure of belief in the effectiveness of CAM and use of CAM (the Attitudes to Complementary and Alternative Medicine scale; ACAM). Studies 2-3 explored whether the previously reported relationship between CAM beliefs and intuitive thinking could be found when using performance measures (rather than just self-report measures) of thinking. Studies 4-7 tested the proposal that being able to spot ontological mistakes is a system 2, analytical process and that overlooking ontological mistakes is more likely when one relies on intuitive, automatic processing. Methods. Studies 1-3 employed a mixture of self-report questionnaires and performance measures of thinking (the cognitive reflection test and base rate problems) in a survey methodology. Studies 4-7 employed experimental methods, and specifically a variation of the syllogistic belief bias paradigm. Results. In study 1, a principal components analysis yielded four factors for the ACAM, each reflecting beliefs in the effectiveness of different categories of CAM (alternative whole medical systems, energy medicines, herbalism and natural products, mind and body approaches). The ACAM had good internal consistency and convergent validity. In study 2, psychology students’ self-reported analytical thinking was negatively related to belief in CAM effectiveness. In study 3, self-reported intuitive thinking was positively related to CAM beliefs in a mixed sample of students and the general population. Performance measures of thinking style largely did not relate with CAM beliefs. In studies 4-7, it was found that ontological correctness biased responding when simultaneous processing demands were low, but when ontological statements were embedded in difficult reasoning problems, particularly those in which belief and logic conflicted, ontological correctness was less likely to bias responding.Conclusions. These findings suggest that faith in CAM effectiveness depends not so much on the people’s actual thinking style but rather on people’s perception of their own thinking style. Furthermore, noticing ontological mistakes appears to be a system 2, analytical process which is more difficult to carry out when simultaneous reasoning competes for processing capacity. However, the ability to spot ontological mistakes is made easier following simple psychoeducational instructions. These findings improve our understanding of the cognitive factors which might underpin beliefs in the effectiveness of CAM and have implications for the design of health psychology interventions to improve people’s health decision-making