Decisional Balance Sheet
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A decisional balance sheet or decision balance sheet is a
tabular Table may refer to: * Table (furniture), a piece of furniture with a flat surface and one or more legs * Table (landform), a flat area of land * Table (information), a data arrangement with rows and columns * Table (database), how the table data ...
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 Ambivalence is a state of having simultaneous conflicting reactions, beliefs, or feelings towards some object. Stated another way, ambivalence is the experience of having an attitude towards someone or something that contains both positively and neg ...
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 The transtheoretical model of behavior change is an integrative theory of therapy that assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual. The model is ...
of change,; ; and in certain circumstances in
motivational interviewing Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to e ...
.


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 Psychological resistance, also known as psychological resistance to change, is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically ...
. An early use of a decisional balance sheet was by
Benjamin Franklin Benjamin Franklin ( April 17, 1790) was an American polymath who was active as a writer, scientist, inventor, statesman, diplomat, printer, publisher, and political philosopher. Encyclopædia Britannica, Wood, 2021 Among the leading inte ...
. In a 1772 letter to
Joseph Priestley Joseph Priestley (; 24 March 1733 – 6 February 1804) was an English chemist, natural philosopher, separatist theologian, grammarian, multi-subject educator, and liberal political theorist. He published over 150 works, and conducted exp ...
, 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 system A decision support system (DSS) is an information system that supports business or organizational decision-making activities. DSSs serve the management, operations and planning levels of an organization (usually mid and higher management) and h ...
s 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 Timothy DeCamp Wilson is an American social psychologist and writer. He is the Sherrell J. Aston Professor of Psychology at the University of Virginia and teaches public policy at the Frank Batten School of Leadership and Public Policy. He is ...
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
motivation Motivation is the reason for which humans and other animals initiate, continue, or terminate a behavior at a given time. Motivational states are commonly understood as forces acting within the agent that create a disposition to engage in goal-dire ...
s or predict their future behaviour. In papers from 1959 onwards,
Irving Janis Irving Lester Janis (May 26, 1918 – November 15, 1990) was an American research psychologist at Yale University and a professor emeritus at the University of California, Berkeley most famous for his theory of "groupthink" which described the ...
and Leon Mann coined the phrase ''decisional balance sheet'' and used the concept as a way of looking at
decision-making In psychology, decision-making (also spelled decision making and decisionmaking) is regarded as the Cognition, cognitive process resulting in the selection of a belief or a course of action among several possible alternative options. It could be ...
. James O. Prochaska and colleagues then incorporated Janis and Mann's concept into the
transtheoretical model The transtheoretical model of behavior change is an integrative theory of therapy that assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual. The model is ...
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 intention An implementation intention is a self-regulatory strategy in the form of an " if-then plan" that can lead to better goal attainment, as well as help in habit and behavior modification. It is subordinate to goal intentions as it specifies the ''whe ...
s technique was "more effective in increasing exercise behaviour than a
control Control may refer to: Basic meanings Economics and business * Control (management), an element of management * Control, an element of management accounting * Comptroller (or controller), a senior financial officer in an organization * Controllin ...
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 Stephen Rollnick is Honorary Distinguished Professor in the School of Medicine, Cardiff University, Wales, UK. Alongside William R Miller, he developed many of the founding principles of motivational interviewing. Biography Professor Stephen ...
'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:
  1. anticipated utilitarian effects for self
  2. anticipated utilitarian effects for significant others
  3. anticipated effect on how one is regarded by significant others
  4. 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. 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 A decision matrix is a list of values in rows and columns that allows an analyst to systematically identify, analyze, and rate the performance of relationships between sets of values and information. Elements of a decision matrix show decisions bas ...
. Similarly, Fabio Losa and
Valerie Belton Valerie Belton, commonly known as Val Belton, is a retired professor of management science at University of Strathclyde. She is a researcher who has worked on the design and application of multi-criteria decision making (MCDM) approaches for over ...
combined
drama theory {{Use dmy dates, date=July 2021 Drama theory is one of the problem structuring methods in operations research. It is based on game theory and adapts the use of games to complex organisational situations, accounting for emotional responses that ca ...
and
multiple-criteria decision analysis Multiple-criteria decision-making (MCDM) or multiple-criteria decision analysis (MCDA) is a sub-discipline of operations research that explicitly evaluates multiple conflicting criteria in decision making (both in daily life and in settings ...
, two decision-making techniques from the field of
operations research Operations research ( en-GB, operational research) (U.S. Air Force Specialty Code: Operations Analysis), often shortened to the initialism OR, is a discipline that deals with the development and application of analytical methods to improve deci ...
, 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 Kickstarter is an American public benefit corporation based in Brooklyn, New York, that maintains a global crowdfunding platform focused on creativity. The company's stated mission is to "help bring creative projects to life". As of July 2021, ...
co-founder
Yancey Strickler Yancey Strickler (born November 4, 1978) is an American author, entrepreneur, and former music critic. He co-founded Kickstarter, the funding platform for creative projects and wrote ''This Could Be Our Future'', a 2019 Penguin Random House book ...
created a four-cell matrix similar in appearance to a decisional balance sheet that he compared to a
bento box A is the Japanese iteration of a single-portion take-out or home-packed meal, often for lunch. Outside Japan, it is common in other East and Southeast Asian culinary styles, especially within Chinese, Korean, Singaporean cuisines and more, as r ...
, with cells for self and others, present and future.


ABC model

Psychology professor Finn Tschudi's ABC model of
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
uses a structure similar to a decisional balance sheet: A is a row that defines the problem; B is a row that lists
schema The word schema comes from the Greek word ('), which means ''shape'', or more generally, ''plan''. The plural is ('). In English, both ''schemas'' and ''schemata'' are used as plural forms. Schema may refer to: Science and technology * SCHEMA ...
s (
tacit assumption A tacit assumption or implicit assumption is an assumption that underlies a logical argument, course of action, decision, or judgment that is not explicitly voiced nor necessarily understood by the decision maker or judge. These assumptions may be ...
s) 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 Harold Greenwald (July 28, 1910 – March 26, 1999) was a noted psychotherapist who pioneered a variation on rational emotive behavior therapy, "direct decision therapy." He was an expert on the psychology of prostitution, and authored a disser ...
'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 Coherence therapy is a system of psychotherapy based in the theory that symptoms of mood, thought and behavior are produced coherently according to the person's current mental models of reality, most of which are implicit and unconscious. It was ...
, A is called the ''
symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...
'', 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 Behavior modification is an early approach that used respondent and operant conditioning to change behavior. Based on methodological behaviorism, overt behavior was modified with consequences, including positive and negative reinforcement continge ...
, the problematic half of A describes one or more costly
operant Operant conditioning, also called instrumental conditioning, is a learning process where behaviors are modified through the association of stimuli with reinforcement or punishment. In it, operants—behaviors that affect one's environment—are c ...
s, and C describes the
reinforcement In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher freq ...
that the operant provides. The following table summarizes the structure of the ABC model.


Four square tool

In an approach to psychotherapy called focused
acceptance and commitment therapy Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfu ...
(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.


See also

* * * * * *
Immunity to change Robert Kegan (born August 24, 1946) is an American developmental psychologist. He is a licensed psychologist and practicing therapist, lectures to professional and lay audiences, and consults in the area of professional development and organiza ...
*
Issue mapping The issue-based information system (IBIS) is an argumentation-based approach to clarifying wicked problems—complex, ill-defined problems that involve multiple stakeholders. Diagrammatic visualization using IBIS notation is often called issue ...
Diagram in which pros and cons are types of nodes * * * * * * * *


Notes


References

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * {{Refend Decision analysis Motivation Psychotherapy