85: Poor decision making, anxiety and stress due to cognitive dissonance

Being an eye care specialist is difficult. Every day I make hundreds of decisions. What could cause this symptom? What could cause this sign? Is the patient being accurate with their responses during subjective refraction? Does the patient understand my instructions and/or my advice? Should I recommend new glasses? Is there an eye disease present? Do I need to refer the patient to another specialist? How soon does this patient need to be seen by another eye specialist?

Usually, I make the right decision. Sometimes I make the wrong decision. When I make the wrong decision it’s important for me to accept that I have made the wrong decision because without acceptance I cannot learn from my mistake. This acceptance is often called ‘having insight’. A person who accepts they made a bad decision has insight and having insight can lead to learning. Learning means a bad decision is less likely to be made in the future.

There is a thought process called cognitive dissonance. This creates tension between a person’s beliefs and the evidence. Some people unconsciously block out awareness of their mistakes by denying they ever happened. When this strategy is adopted, learning is impossible. The key is to develop a system and a culture that allow mistakes to happen without blame, so people can learn from them. Without this kind of system in place, the same mistakes can happen again and again.

The term cognitive dissonance is used to describe the mental discomfort that results from holding two conflicting beliefs, values, or attitudes. People tend to seek consistency in their attitudes and perceptions, so this conflict causes feelings of unease or discomfort.

This inconsistency between what people believe and how they behave motivates people to engage in actions that will help minimize feelings of discomfort. People attempt to relieve this tension in different ways, such as by rejecting, explaining away, or avoiding new information.

Everyone experiences cognitive dissonance to some degree, but that doesn’t mean that it is always easy to recognise. Some signs that what you are feeling might be related to dissonance include:

  • Feeling uncomfortable before doing something or making a decision
  • Trying to justify or rationalize a decision that you’ve made or an action you have taken
  • Feeling embarrassed or ashamed about something you’ve done and trying to hide your actions from other people
  • Experiencing guilt or regret about something you’ve done in the past
  • Doing things because of social pressure, even if it wasn’t something you wanted to do

There are a number of different situations that can create conflicts that lead to cognitive dissonance.

Forced Compliance 

Sometimes you might find yourself engaging in behaviours that are opposed to your own beliefs due to external expectations, often for work, school, or a social situation. This might involve going along with something due to peer pressure or doing something at work to avoid getting fired.

New Information 

Sometimes learning new information can lead to feelings of cognitive dissonance. For example, if you engage in a behaviour that you later learn is harmful, it can lead to feelings of discomfort. People sometimes deal with this by finding ways to justify their behaviours or findings ways to discredit or ignore new information.


People make decisions on a daily basis. When faced with two similar choices, people often are left with feelings of dissonance because both options are equally appealing. Once a choice has been made, however, people need to find a way to reduce these feelings of discomfort. People accomplish this by justifying why their choice was the best option so that they can believe that they made the right decision.

Cognitive dissonance can often have a powerful influence on our behaviours and actions. It doesn’t just influence how you feel—it also motivates you to take action to reduce feelings of discomfort.

Impact of cognitive dissonance

Cognitive dissonance can make people feel uneasy and uncomfortable, particularly if the disparity between their beliefs and behaviours involves something that is central to their sense of self. For example, behaving in ways that are not aligned with your personal values may result in intense feelings of discomfort. Your behaviour contradicts not just the beliefs you have about the world, but also the beliefs that you have about yourself.

This discomfort can manifest itself in a variety of ways. People may feel:

  • Anxiety
  • Embarrassment
  • Regret
  • Sadness
  • Shame
  • Stress

Cognitive dissonance can even influence how people feel about and view themselves, leading to negative feelings of low self-esteem and self-worth.

Because people want to avoid this discomfort, cognitive dissonance can have a wide range of effects. Dissonance can play a role in how people act, think, and make decisions. They may engage in behaviours or adopt attitudes to help relieve the discomfort caused by the conflict.

Some things that a person might do to cope with these feelings include:

  • Adopting beliefs or ideas to help justify or explain away the conflict between their beliefs or behaviours. This can sometimes involve blaming other people or outside factors.
  • Hiding their beliefs or behaviours from other people. People may feel ashamed of their conflicting beliefs and behaviours, so hiding the disparity from others can help minimize feelings of shame and guilt.
  • Only seeking out information that confirms their existing beliefs. This phenomenon, known as confirmation bias, affects the ability to think critically about a situation but helps minimize feelings of dissonance.

When there are conflicts between cognitions (thoughts, beliefs, opinions), people will take steps to reduce the dissonance and feelings of discomfort. They can go about doing this in a few different ways, such as:

Adding more supportive beliefs that outweigh dissonant beliefs

In order to reduce the dissonance, a person may seek out new information that overrides the belief that greenhouse gasses contribute to global warming.

 Reducing the importance of the conflicting belief

A practitioner who cares about his health might be disturbed to learn that sitting for long periods of time during the day is linked to a shortened lifespan. Since he has to work all day in a consulting room and spends a great deal of time sitting, it is difficult to change his behaviour. To deal with the feelings of discomfort, he might instead find some way of rationalising the conflicting cognition. He might justify his sedentary behaviour by saying that his other healthy behaviours—like eating sensibly and occasionally exercising—make up for his largely sedentary lifestyle.

Changing the belief

Changing the conflicting cognition is one of the most effective ways of dealing with dissonance, but it is also one of the most difficult, particularly in the case of deeply held values and beliefs, such as religious or political leanings.2

In eye care practice I can see two ways that cognitive dissonance could occur. A mistake is made (for example, a disease missed or a wrong prescription issued) and the practitioner’s strong beliefs in their abilities prevent them from accepting responsibility. The practitioner blames the patient or someone else in the practice. As I mentioned above this prevents learning and means the mistake can be made again.

A practice culture where mistakes are accepted as part of the learning process and no one is blamed for mistakes is the best way to prevent this form of cognitive dissonance.

An eye care specialist could be put under pressure to prescribe glasses or new glasses even when a patient does not need them or will not have any benefit from them over their current glasses. The eye specialist is forced to recommend glasses and this goes against their beliefs and values. This can lead to anxiety and stress. The cognitive dissonance can be relieved if the eye specialist finds ways to justify the new prescriptions such as the patient will look better in the new glasses. The old glasses had scratched lenses. The practice needs the money to be sustainable.

Sometimes, the ways that people resolve cognitive dissonance can contribute to unhealthy behaviours or poor decisions.