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Cognitive Therapy and Human Error
Q: As a Cognitive psychologist, how could you help reduce human error either at work, on the roads, or at home?
Word Count: 1819
Human error is evident is all areas of human involvement, and may differ vastly in terms of the seriousness of the outcome. A typing error, for example, is easily corrected with no harm to anyone; however, an error in a medical procedure may have more damaging consequences for both the patient and the medical practitioner. Reason (2000) identifies two main approaches to human error namely the system approach and the person approaches. The system approach maintains that human error is inevitable, but reviews it as a consequence of larger, systemic problems. The person approach, which is largely the more popular, views error as, ‘arising primarily from aberrant mental processes such as forgetfulness, inattention, poor motivation, carelessness, negligence, and recklessness’ (Reason, 2000: 768). In his essay, Reason (2000) suggests that there be a movement toward a system approach to human error, arguing that the human condition is not changeable, yet the conditions under which they work are.
The following essay will consider the role of cognitive therapy in reducing human error. Focusing on two main areas of research: cognition and behaviour. This will be followed by a conclusion of findings.
2. Cognitive Therapy and Human Error
Aaron Beck is the founder of Cognitive Therapy (CT) and in this approach he proposes that our feelings, thoughts and behaviours are all interlinked, and that thought and behaviour changes, will result in feelings being transformed (Sanders & Wills, 2006). Therefore, Cognitive Therapists make use of behavioural experiments and target cognitions in order to bring about cognitive, emotional and behavioural strategies.
This understanding of CT and the methods used by Cognitive Therapists becomes increasingly relevant to the theory of human error when considered in the backdrop of ‘The Emerging Model of Cognitions’ presented by Panko (1997).
The Emerging Model of Cognitions (Panko, 1997) highlights the interplay between three subsystems, namely: the automatic subsystem, the attentional subsystem and the environment, and each of these systems impact on the cultivation and execution of a plan. The automatic subsystem includes schemata (sets of information and response patterns) that are below the level of consciousness. These schemata are triggered by a specific stimulus, which elicits a patterned response. Panko (1997) gives the example of speech, which involves a number of complex processes, or schemata, which we are not conscious of, but results in the patterned response of speech. Error will sometimes occur when a situation arises for which there is no existing patterned response (schemata). In such a situation, a schema that has been activated in a similar situation is then activated, resulting in occasional error. The second subsystem described by Panko (1997) is the attentional subsystem. This subsystem involves logical and attentional thought, which, like the automatic subsystem, is also built on schematic organisation. According to Panko (1997) error rooted in the attentional subsystem can be largely attributed to ‘lay theories’. This researcher explains that, ‘Even after people receive training in specific areas, such as physics, they often revert to lay theories afterward…lay theories are schemata that we have developed over many years. They are very likely to produce errors when we model situations’ (Planko, 1997:¶16). Finally, the environment is the third subsystem indicated by Planko (1997). According to this researcher, the planning and execution of an action is in constant play with the environment. Plans are fed back to the environment, and are then adjusted accordingly. When the environment is a buzz of information and stimulus, thus confusing the schema, unexpected results can occur.
From this model, the following ’causes’ of human error can be identified. Firstly, disruption to the automatic subsystem, as a result of the ill matching of schema to an unknown situation. Secondly, disruption to the attentional subsystem, by reverting to ‘lay theories’, and finally, the environmental impact, where it is understood as influencing the formation of schema.
This model brings to the forefront the idea that, to a large degree, human error can be understood as being rooted in cognitive and behavioral mishaps. Cognitive therapy may be employed to help reduce these errors by tackling the automatic and attentional subsystems presented in the model.
2.1 Automatic Subsystem
Cognitive Therapy explains the working of schema, defining it as ‘a relatively enduring, deep cognitive structure that organizes the principles of giving appraisal and meaning to experiences, especially in relation to rules of living, with regards to self, others and the world’ (Sanders & Wills, 2006: 147). An event schema, or cognitive script, involves processes and practices of approach tasks and problems. These ways of processing are behaviorally oriented and triggered by certain stimulus (Scholl, 2002). Such schema are constructed either directly, through repeated a process a number of times, or indirectly through movies, role models and stories (Scholl, 2002).
Scholl (2002: ¶4) identifies two distinct methods of data processing.
Data-driven or stimulus-driven processing occurs when no schema exist form which to process information. The individual examines all information and proceeds through a careful decision making process.
Schema-driven processing occurs when an individual responds to a stimulus (decision making or problem solving situation) by evoking a programmed response or behavior script (schema). This is done without extensive data collection or analysis.
According to Scholl (2002) error is more likely to occur when an individual has a rigid schema. In this instance, an individual, despite the in information provided, uses the same schema to respond to similar situations and no longer makes a distinction between them. The results in inaccurate decision making and errors occur. Such error can be seen to occur, for example, on the road. An individual with a rigid schema may have his or her problem solving diminished when confronted by a faulty traffic light. Instead of considering the unique information, he or she responds as if it where a normal functioning light, resulting in an accident. Cognitive therapy, by means of schema therapy and challenging core beliefs attempts to loosen and change some of the enduring schema.
2.2 Attentional Subsystem
As previously described, disruption to the attentional subsystem occurs when a person reverts their attention to a particular thought. From this it can be understood that, despite having a variety of options available, thinking because inflexible and rigid. A person may even be said to have become fixated. One such ‘lay theory’ may be seen in the form of excessive worry. Worry is a type of negative intrusive thought, which tends to distract the worrier from the task at hand. For example, a person new to their job, having undergone and successfully completed the necessary training, may become anxious on starting their job. This would be further compounded by such worrisome thoughts of, ‘I am not good enough’, ‘I know that I will make a mistake’, ‘when I make a mistake I will be fired’. This talk is the ‘lay theory’ they have about themselves and their competence. This negative self-talk interferes with the brain processes necessary for completing the task, and error occurs. Shearer and Gordon (2006) give reference to a number of cognitive behavioral strategies that can be employed for the reduction of worry, including repeatedly challenging the worry process, experiments of behavioral exposure and mindfulness based meditation.
Another approach offered by cognitive therapy for confronting such patterns of thought is that of Attentional Training. Wells and Papageorgiou are the founders of Attentional Training and describe it as a way of decreasing the fixed focus (which is typically self-focus) and allow for more flexibility in thought (Sanders and Wills, 2006). Harvey, Watkins, Mansell, and Shafran (2004: 67) describe the process involved in Attentional Training:
The therapy is divided into several stages:
The therapist first provides a clear rationale for why reducing or interrupting self-focused processing may aid recovery.
The patient is asked to fixate on a visual stimulus (e.g. a mark on the wall) and then to focus attention for several moments on each of a series of different sounds (therapist’s voice, tapping, clock). The patient is instructed to exclusively focus on each sound alone.
The patient shifts their attention rapidly between the sets of sounds.
The patient attends simultaneously to all of the sounds, trying to be aware of as many sounds as possible.
Through this process a person preoccupied by worrisome thoughts, learns to attend to more than one stimulus, and is thus able to shift there attention when these thoughts arise.
This essay explored and discussed the phenomenon of human error, the processes involved in human error and the possible negative outcomes when human error occurs. This included a range of problem outcomes, from relatively harmless to far more damaging ones. Two prominent theories of human error where identified, namely the system and person approaches. Working from the person approach, The Emerging Model of Cognition provided a framework from which to consider the role of cognitions in human error. This model highlighted the role of cognitive therapy in helping to reduce human error. Schema Therapy was identified as an effective method for helping to make rigid schema more flexible, thereby freeing the individual to be able to consider a larger variety of options before acting. Attentional Training was identified as a method for approaching unconscious schema in the attentional subsystem. This approach in cognitive therapy trains the individual to attend to more than one stimulus. This allows the individual to be less distracted by intrusive thoughts, such as worry, and attend to the task at hand.
Cognitive therapy is an increasingly popular option for psychological therapy. Interventions using this approach have shown long lasting effects, and reduce the possibility of relapse. Cognitive therapy has been developed for a large range of problems from panic and anxiety disorders to eating problems and hallucinations. It is also applied in a range of settings from mental health to life coaching (Sanders & Wills, 2006). This essay has pointed to two ways in which cognitive therapy can be useful in helping reduce the occurrence of human error.
Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive Behavioural Processes Across Psychological Disorders: A transdiagnostic approach to research and treatment. Oxford University Press.
Panko, R.R. (1997). Theories of Human Error. Retrieved on March 1st, 2007, from http://panko.cba.hawaii.edu/HumanErr/Theory.htm.
Reason, J. (2000). Human error: Models and management. British Medical Journal, 320, 768-770.
Sanders, D., & Wills, F. (2006). Cognitive Therapy: An introduction. London: Sage.
Scholl, R.W. (2002). Social Cognition and Cognitive Schema. Retrieved on May 3, 2007, from http://www.uri.edu/research/lrc/scholl/Notes/Cognitive_Schema.htm.
Shearer, S, & Gordon, L. (2006). The patient with excessive worry. American Family Physician, 73, 1045-1056.