Risk probabilities in everyday life

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Iwillheal

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Just had a convo with an old friend about most difficult clinical situations we've been in, and he recalled doing CBT with an older mathematician with a severe case of OCD who would always want to know the exact likelihood that something would happen. A lot of this was interpreted as resistance of course but my friend had little luck getting this person back to work and functioning again, but it did get me thinking how neat it would be if there was a book on this kind of thing. Like the possibility of car accident (or them resulting in death) getting HIV or STDs (despite protection), getting/surviving particular disease (cancer, heart disease, etc), getting food poisoning...and the list goes on and on. There have been some good scientific articles on lifetime prevalence of certain illnesses of course and likelihood of certain outcome, given a particular disease (though conclusions or numbers do not necessarily always agree). Same thing about medical procedures and chances of success. And of course, a lot has been written on medical screening and what the test results actually mean. I think people, including some very educated ones, continue to ignore base rate fallacy.

This is not the first time this idea has occurred to me. I once read a paper about how the irrational fear of flying (this was a couple of years after 9/11) now resulted in many more road fatalities, and in fact I remember thinking how awesome it would be if we had similar data on everything, likelihood of dying from getting trapped in an elevator, from getting infected from an illness merely from shaking the hand of an ill person, whatever. So if somebody was not willing to handle "dirty" money because she'd fear serious illness, well, you could say that the chance of that happening is 1/9334549947435841 and that you're more likely to die from a mosquito bite than that. Lol, I hope that would not simply result in the person replacing one phobia with another. But it would be helpful in appealing to a rational person who was not satisfied with "it's quite unlikely" or "there is a low chance of that happening."
 
This reminds me of a time when I had a kid client with extreme anxiety about bad weather. I did an internet search to find some info to encourage her to more critically evaluate the situation and essentially reassure her. Glad I did the search myself instead of having her do it. Turns out the risks are much higher than I would have anticipated and all of the websites out there attempt to increase rather than decrease concern on this matter!

Dr. E
 
All you fellow hikers will be glad to hear that you're more likely to become president of the US than be killed by a mountain lion:
http://imgur.com/mKESf
 
Seems like this guy could have benefited from an easy career change into infectious disease epidemiology. Not sure if I'm kidding or not.

I agree with Dr. E, seems hard to challenge "irrational" phobias, when they might not be statistically so irrational!
 
Darn, the cancer risk is pretty high. For men, 1/2 developing, 1/4 dying from. For women, 1/3 developing, 1/5 dying from:

http://www.cancer.org/Cancer/CancerBasics/lifetime-probability-of-developing-or-dying-from-cancer

I suppose George Costanza was not particularly neurotic when worried about the "white discoloration" on his lips. All this risk stuff also reminds me of "Along Came Polly" and Ben Stiller's character, the risk assessment expert, who, having fallen in love with Aniston, who is his opposite in many ways, changes his ways. Ah, the logic of romantic comedies, love fixing all quirks and mental health issues. Only if it were that simple.
 
Yes, and the horribly embarrassing stereotype of the CBT psychologist scoffing at people who insist on washing their hands after using the restroom 🙄. What a bunch of neurotic freaks they all are for wanting anything to be clean!!
 
I don't have a source for this, but there is such a chart! An old supervisor of mine had one posted on the wall, and it listed maybe 50+ types of fatalities, represented as dots on a vertical list. There was a large circle at the very top that represented more "typical" causes of death, like cancer, heart disease, etc., and then moved on to slightly smaller circles for stuff like car accidents. The bulk of the chart was dedicated to the circles that quickly got much smaller towards the bottom, for stuff like lightning strikes, tornadoes, bees, etc. It was more artsy than scientific (it cited some source at the bottom), but was clearly designed for therapy. I wish I could remember more about it!
 
I'm not sure presenting a stat sheet to an OCD client is going to help them. In my experience, all the OCD clients have been well aware that their behavior is irrational. Telling them it's irrational would be a moot point. Without the DSM in front of me, I'm pretty sure a component of OCD is being aware that the behavior is abnormal (except with kids).
 
I'm not sure presenting a stat sheet to an OCD client is going to help them. In my experience, all the OCD clients have been well aware that their behavior is irrational. Telling them it's irrational would be a moot point. Without the DSM in front of me, I'm pretty sure a component of OCD is being aware that the behavior is abnormal (except with kids).

I agree. Also, isn't the anxiety even more prominent WHEN the feared event isn't terribly common?! If it were really likely to happen, where's the fear in that (especially from an exposure point of view)?
 
I'm not sure presenting a stat sheet to an OCD client is going to help them. In my experience, all the OCD clients have been well aware that their behavior is irrational. Telling them it's irrational would be a moot point. Without the DSM in front of me, I'm pretty sure a component of OCD is being aware that the behavior is abnormal (except with kids).

That's a really good point. I think this sort of technique is best used with mild to moderately anxious folks who are not dx'd with full blown OCD. Also, I think it is more of a jumping off point than the complete intervention. For example, "your fear of X is really significant, but we know the actual likelihood of X is ... " From there (depending on the case) you could do some sort of discussion about motivation for the anxiety (Love to use Burn's magic button example here) or explore hx further for clues about why this particular fear, etc.

Dr. E
 
I agree. Also, isn't the anxiety even more prominent WHEN the feared event isn't terribly common?! If it were really likely to happen, where's the fear in that (especially from an exposure point of view)?

I don't know about the particular gradations being discussed here, but this is actually central to the definition of each. Fear is about relatively certain and pending outcomes. Anxiety is about vague and uncertain outcomes. The two are not as closely related as one might think. John Curtin has a lot of great work on the topic using shock paradigms to assess the effects of alcohol on fear vs. anxiety, systematically varying the relevant components.
 
I don't know about the particular gradations being discussed here, but this is actually central to the definition of each. Fear is about relatively certain and pending outcomes. Anxiety is about vague and uncertain outcomes. The two are not as closely related as one might think. John Curtin has a lot of great work on the topic using shock paradigms to assess the effects of alcohol on fear vs. anxiety, systematically varying the relevant components.

Ah, good point. I was almost starting to think along those lines. Is it a timing issue? For example, a certainty of something happening now creates fear vs. an imagined future event creates anxiety? In that sense, there probably is no such thing as an irrational fear--if it is certain to happen, it's rational! So, an "irrational fear of flying" probably depends on what the person fears--heights or a closed space would be a certain outcome (depending on what fear is associated with that main fear--therefore rational fear?) whereas your run-of-the-mill airplane crashing fear is not likely (therefore irrational). I guess I should read Curtin. 😉
 
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