Decisional balance sheet

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A decisional balance sheet or decision balance sheet is a tabular method for representing the pros and cons of different choices and for helping someone decide what to do in a certain circumstance. They are often used in working with ambivalence 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 Motivational Interviewing and those based on the Transtheoretical Model of change.[1][2]

History and use[edit]

In papers from 1959 onwards, Irving Janis and Leon Mann used the concept as a way of looking at decision-making.[3][4] The balance sheet recognises that both gains and losses can be consequences of a single decision. It can be used both for individual and organisational decisions.[5]

The balance sheet records the advantages and disadvantages of different options facing an individual. 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 maybe 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 can increase psychological resistance and denial.[6]

There are several variations of the decisional balance sheet. In Janis and Mann's original description there are 8 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: a) utilitarian effects for self, b) utilitarian effects for significant others, c) effect on how one is regarded by significant others and d) effects on how one views oneself.[7][8]

Velicer and colleagues (1985) simplified this to a four-cell format consisting of the pros and cons of the current behaviour and of a changed behaviour.[9] The example below, however, 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.

Some authors separate out short- and long-term benefits and risks of a behaviour.[10] Another refinement of the process is to use a scoring system to give weights to different elements of the balance sheet.[11] Any evaluation is subject to change and often the cells are inter-connected.[12] For example, looking at the table below, if something were to happen in the individual's marital life, (an argument or the partner leaves or becomes pregnant or has an accident,) this can either increase or decrease how much weight the person gives to the elements in the balance sheet that refer to the relationship.

Example of decisional balance sheet for someone experiencing alcohol problems
Plusses Minuses
Continue drinking as I am It's what my friends do
It makes me less anxious
It's fun being drunk
I like the taste
I get into fights
Health problems
Divorce threat
Debts
I can't remember things the next day
Cut down I can still meet my friends
It will help my health
Will my partner believe me?
Can I stick to it?
Stop drinking I won't get into fights any more
It will please my partner
It will save money
Good for my health
I might have to avoid my friends
How will I cope with anxiety?
What will I do for fun?

References[edit]

  • Janis, Irving L. & Mann, Leon (1977) Decision making: A psychological analysis of conflict, choice, and commitment, New York, Free Press
  • Lock, Robert D. (2004) Taking charge of your career direction
  • Miller, William R. & Rollnick, Stephen (2002) Motivational Interviewing: Preparing People for Change, New York, The Guilford Press
  • James O. Prochaska, Wayne F. Velicer, Joseph S. Rossi, Michael G. Goldstein, Bess H. Marcus, William Rakowski, Christine Fiore, Lisa L. Harlow,Colleen A. Redding, Dena Rosenbloom, and Susan R. Rossi "Stages of Change and Decisional Balance for 12 Problem Behaviors", Health Psychology 1994, Vol. 13, No. 1
  • Roes, Nicholas A. (2002) Solutions for the "treatment-resistant" addicted client: therapeutic techniques for engaging difficult clients, London, Routledge
  • Velicer, Wayne F., DiClemente, Carlo C., Prochaska, James O., Brandenburg, Nancy, "Decisional Balance Measure for Assessing and Predicting Smoking Status", Journal of Personality and Social Psychology (1985) Vol. 8, No. 5
  • Walters, Scott T. Rotgers, Frederick (2002) Treating Substance Abuse, Third Edition: Theory and Technique New York, Guilford Press

Notes[edit]

  1. ^ Miller & Rollnick (2002), pp.15–16, 369
  2. ^ Prochaska, Velicer, et al (1994), pp 39–46
  3. ^ Velicer, DiClemente, et al (1985), pp.1279-89
  4. ^ Janis & Mann, p.135ff
  5. ^ Velicer, DiClemente et al. (1985)
  6. ^ Roes (2002), p.83
  7. ^ Prochaska et al (1994) p.40
  8. ^ An example of an 8-cell balance sheet using Janis and Mann's original categories can be seen at http://www.careerkey.org/asp/your_decision/decisions_balance_sheet.html
  9. ^ Walters, Rotgers, Frederick (2002), p.16.
  10. ^ See e.g. Roes (2002) p.84.
  11. ^ Such a weighted version is used to help readers choose between colleges in Lock, Robert D. (2004), pp.320ff.
  12. ^ Miller & Rollnick (2002) p.16