Announcer:
0:00
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts Hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Dr. Michael Koren:
0:11
Hello, I'm Dr. Michael Koren. I am the executive editor of MedEvidence and we have a fascinating podcast. Today, I'm fortunate to be joined by Dr. Chris Steilberg, who's an industrial psychologist, and he's going to teach me and help me understand why people think the way they do oh, , sort of yeah, well, we'll get into it. But why people fall into these impressions?
Dr. Chris Steilberg:
0:36
Some think in very uh unique ways.
Dr. Michael Koren:
0:40
Okay, fair enough.
Dr. Michael Koren:
0:42
and this is important because in mid we have this platform that talks about medical issues. We have usually two physicians talking to each other In this case, it's an industrial psychologist and a physician and what we like to do is help people understand what's true, what we know for sure, what we don't know, and how we learn about the stuff that we don't know. Okay, that's our general theme and our mantra. So you're going to help us understand why the brain works in certain ways and how people can use that knowledge of the way the brain works to make better decisions. So go ahead, introduce yourself to the audience and then we'll get into a conversation.
Dr. Chris Steilberg:
1:17
Okay, as you mentioned, my name is Chris Steillberg and I've been practicing as an IO psychology expert for well over 25 years. I'll leave it at that,
Dr. Michael Koren:
1:28
and IO stands for
Dr. Chris Steilberg:
1:29
Industrial Organizational.
Dr. Chris Steilberg:
1:30
We haven't figured out a better way to actually label that. So it's psychology at work, .
Dr. Michael Koren:
1:37
Okay.
Dr. Chris Steilberg:
1:38
So, with the topic of looking at data and not being able to analyze it rationally and see the same facts that others do, the issue with this has something to do with the way that people think about anything. So if we start with the reality that the human brain is not a computer and it doesn't store information in bits and bytes on a disk, we store it in chunks called schema Okay, a schema for horse and we unpack that when we begin to get asked more detailed questions, mm-hmm. So when the schemas get some emotional charge, that's when they become attitudes, and attitudes can vary in strength to the point where they can get to a belief that is very central to an individual's identity, and that's when things get really difficult to change anybody's point of view on things, no matter what the data. Interesting.
Dr. Michael Koren:
2:45
Okay.
Dr. Chris Steilberg:
2:45
Yeah.
Dr. Michael Koren:
2:52
So we're going to definitely delve into this more, but of course, we're interested particularly in terms of healthcare attitudes, and certainly healthcare attitudes are very, very important in terms of our ability as physicians to put together a plan for a patient, to impart some of our wisdom on patients, but also to do it in a way that is not judgmental, is not disrespectful for what their preexisting notions may be, and ultimately helping them understand things, based on, again, what we know for sure, what we don't know and how we learn about the stuff we don't know. Right.
Dr. Chris Steilberg:
3:28
Well, there is a model that I'm sure you're familiar with called motivational interviewing. It's client-centric, it's going and collaborating with the other individual. I'm seeing this personally, actually, as I relate to my physicians. They involve me more and more in my own self-care.
Dr. Michael Koren:
3:53
These are your physicians for your own personal health, outside of your business issues. It's just.
Dr. Chris Steilberg:
3:57
I've begun to see this actually happening with me. In a case where you are able to form a relationship like that, the chances of getting to attitude change are much better. You want to build the trust, you want to refine the message. The context is mutually acceptable to both and the individual is generally not already closed. They haven't gotten to a point where they've put up their firewall, and I'm not going to listen most of the time, but there are examples that belie that that people do put up a firewall.
Dr. Chris Steilberg:
4:42
One public example comes from Dick Cheney. Here's an individual who began smoking as a teenager. A couple of packs, three packs a day, and he had a progression of heart attacks in total about five.
Dr. Michael Koren:
5:00
Yeah, first heart attack in his thirties, as I recall.
Dr. Chris Steilberg:
5:03
Yeah 37.
Dr. Chris Steilberg:
5:05
And you know all the medical community is saying you've got to lead a more healthy lifestyle, you can't continue to smoke, You've got to lose some weight, et cetera. No behavior change, I mean. The interesting thing is I was reminded of this anecdote from a book written by a guy I've worked with, Alan Deutschman. The title of the book is called Change or Die. Okay, All right, and the sort of punchline with Dick Cheney is after four heart attacks he continued to make the choice that lines up with die. And it really was in his 50s that he began to lead a more healthy lifestyle. But the denial of Freudian ego defense mechanism just wasn't going to change his behavior.
Dr. Michael Koren:
5:58
So, just for people who may not be familiar with politics from 20, 30 years ago, dick Cheney was a congressman from Wyoming and the vice president of the United States for eight years.
Dr. Chris Steilberg:
6:09
Yes.
Dr. Chris Steilberg:
6:10
Yeah, very stressful job, you know.
Dr. Chris Steilberg:
6:13
But he moderated his behavior and you know it's an example of, you know, an addiction a habit and an identity that he had in himself. This is a tough guy that was very resistant to that kind of change.
Dr. Michael Koren:
6:31
So did he change? How did that happen?
Dr. Chris Steilberg:
6:34
He did.
Dr. Chris Steilberg:
6:35
He did change and his staff began to carry his elliptical trainer onto Air Force Two. He was exercising, he lost weight, he quit smoking.
Dr. Michael Koren:
6:48
Did he start working out with Bernie Sanders? I'm joking.
Dr. Chris Steilberg:
6:52
I don't know, I doubt it, maybe not that extreme no not that extreme, but he did see the light and came around. But the point is he's not alone. A lot of people follow the same exact path.
Dr. Chris Steilberg:
7:04
And in my coaching practice I deal with a lot of people who are ensconced in a particular attitude that might be resistant to change, and I work with them to get them to a point usually where we examine why they're talking to me Okay. And I asked them a question, and that's this If you had the choice, would you rather be right or influential? Mm-hmm.
Dr. Chris Steilberg:
7:36
Because you're about to write yourself on out of this organization. Okay, this is a pattern that I see very frequently. Individuals are rewarded for an ascendant career up to a point and then when they start beating people up with their own data, trouble happens. They need to begin to play nicely in the sandbox and you know those are turnaround kind of coaching engagements
Dr. Michael Koren:
8:07
interesting, so I'm going to bring this into medicine, and particularly, let's talk about covid vaccines something non-controversial tongue-in-cheek, of course.
Dr. Michael Koren:
8:21
So I'm going to tell you a little anecdote. I want to get your reaction to it and then also help you help me figure out how to approach people that come from the view of COVID vaccines from one extreme or the other. So I was in my gym in 2021. And we were still at a point where people were being asked to wear masks in different places, including the gym, Although in my gym there were some sessions where masks were mandatory and others where they were not. So my schedule was such that I had to go to a mask mandatory session in my gym and I put my mask on.
Dr. Michael Koren:
9:03
But I had brought several masks with me, because the way my mind works as a researcher is, I wanted to see if a paper mask was different than an N95 mask and did that affect my ability to work out. So I put my mask on and then I took it off and I put another mask, and I took it off and I put on another mask and one of the monitors of the gym was saying, oh, Dr. Koren, you have to keep your mask on at all times. And I said, okay, I'm fine. I'm on my stationary bicycle. I'm socially distant. I'm more than 10 feet from everybody else and I respect the rules of this session. But I'm just doing this little experiment and I was explaining that. You may not know this, but I actually have done COVID research and this is my own little research project to see if the things I've heard from my patients that it's hard to do certain things with a mask on is accurate in my personal opinion.
Dr. Michael Koren:
9:50
So I went through that whole business. So there was two people that overheard this conversation and the first person that came up to them and came up to me and said I'm glad that you gave them a hard time about wearing masks. This whole thing with COVID is just a big hoax. And then I said well, no, no, the COVID is a real thing. I'm doing the research on it. It's important that we take these precautions, but I was just trying to see whether or not it affected your ability to do exercise and she was okay with that. And then, literally about two minutes later, another guy comes up with me and he says you know why we had such a bad pandemic? Because people like you who wouldn't wear their masks. So I got hit from both sides on this and it just shows you how people had their opinions that were probably firewalled using your approach, but didn't even hear the whole circumstance, because all they think about is whether or not I would comply with wearing the mask or not.
Dr. Chris Steilberg:
10:42
Yes, what happens is with regard to attitudes. We talk about latitude of acceptance, latitude of non-commitment and latitude of rejection, and with the extreme opinions and beliefs there's a very wide latitude of rejection. It's very difficult for anything to penetrate that firewall, and people will actually. It threatens their personal and their social identity when they hear or become aware of contra-positional information.
Dr. Michael Koren:
11:17
Ideas that are different than pre-existing notions. Exactly so how do you do it? You're a coach. How do you help people when it's destructive?
Dr. Michael Koren:
11:35
when these pre-existing notions and this firewall is just destructive.
Dr. Chris Steilberg:
11:40
Well the best that I use is called cognitive behavioral therapy. I'm not Not a therapist, but the technique can be used for my purposes. It involves working with them to build trust, not to throw facts and fear and force in front of their face, like I described earlier in terms of change or die.
Dr. Chris Steilberg:
11:59
But if you build the trust and you get to a point where we can agree that there's a common shared interest we may have different points of view but we all want the best outcome Then the automatic kind of firewall related outcome thinking it changes into a more deliberative mode where they will think about data. So, in the context of medical evidence, the goal is to break down those automatic rejection triggers, and there are ways to do that.
Dr. Michael Koren:
12:59
Give me an example
Dr. Chris Steilberg:
13:00
one of them is called paradoxical thinking okay and in paradoxical thinking uh is is is catching on um in the research but what it involves is not coming at the individual with a counterargument but instead going to them with one that is uh consistent with their attitude but is absurd with one that is consistent with their attitude but is absurd. Okay, it's extreme Gotcha. The intent is to generate surprise, because surprise will break down that automatic thinking Interesting, and you know, an example of that would be something that I can talk about, an event that I had with a friend, a very close friend. We were talking a little bit about. Well, the climate and the storms are getting more violent and temperatures are rising and all that. And my friend said, ah, global warming is just a hoax. And that was my surprise. You mean the human-created, accelerated portion of this, right? Sure? No, I was told that. The airport, uh, the temperatures are always taken at the airport and the airport's always three degrees warmer than any other anywhere else. So I said so, if we turn the entire world into an airport, right, what would happen? That's a good one, yeah, and it didn't change my friend's mind. I didn't think so, but it broke him into a smile. Right.
Dr. Chris Steilberg:
14:12
Right, and that is an example of taking something to an absurd extreme In a more plausible model. With regard to the smoking example that I gave you, you know, someone might say smoking isn't dangerous. The paradoxical thinking retort to that would be absolutely Lung cancer has nothing to do with smoking. Well you know you put them in a bind because you're agreeing with them, but you go to it.
Dr. Michael Koren:
14:44
Right, something that's extreme, yeah, interesting. In a bind because you're agreeing with them, but you go to it, right, something that's extreme, yeah, interesting. That reminds me there was a psychiatrist who was famous back in the 1970s and 1980s named Albert Ellis. Are you familiar with his work?
Dr. Chris Steilberg:
14:57
I'm a few more bars
Dr. Michael Koren:
14:58
yeah, so he was, um, a fellow that became famous by doing something similar to what you're describing. So when people were dealing with depressed patients, most people would try to talk them off the ledge and he would take the opposite approach. He would say, yeah, your life sucks, there's the window, you should jump out right now. And that took him by surprise and seemed to work. Now I haven't heard much from him recently, so maybe it worked in 99% of the cases. In that one case they actually took you up on the offer. But to your point, sometimes you have to do something to kind of break through this firewall, and something extreme might be able to accomplish that.
Dr. Chris Steilberg:
15:41
Well, exactly, and in any form of behavior change or attitude change, there are four critical factors there's the messenger, there's the message, there's the context and then there's the audience or the target. Any one of these poses different threats to whether a message is going to be received or not, and so, in your example, there isn't really a cookie cutter model that can be applied to everyone, but there are general themes that we've learned. I mean, some of them are very obvious. Regarding the messenger, you don't want to put somebody up who is associated with a particular point of view or ideology.
Dr. Chris Steilberg:
16:30
In terms of the message. We've talked about that in terms of paradoxical thinking and not trying to throw facts in the face of somebody and really threaten their identity. The context we live in a pretty contextually polarized world and it makes these factual arguments more difficult. And then the individual just one factor about the individual is need for closure. Some people have a high need for closure. Executives tend to. They want to close it down quickly and be done.
Dr. Chris Steilberg:
17:13
And if you go in with I want to talk about the data they want to buy the book with the title Don't Make Me Think Not because they're going to read it. They're going to just put it down on their conference you know conference table, so everybody else can see it right, interesting, interesting.
Dr. Michael Koren:
17:31
So, um, two areas I want to jump into before we conclude our conversation. So I'm a physician, cardiologist, and we use drugs, and you're talking about the way the brain is processing information and and the fact that we work in schema and that it's hard to change those ways of organizing our thoughts once they're solidified, and, um, and, of course, when we're dealing with other brain issues, we talk about drugs. So are you familiar with any information and I not, so I'm just throwing it out there in just a very general sense of medicines that can help people transform psychologically, or, you know, obviously the common example is alcohol, which we use to try to influence people one way or another. But are there other things that are proven, that are evidence-based, to show that we can actually help people make progress in this realm?
Dr. Chris Steilberg:
18:24
I wish I could talk about a scientific study in this case, but I can speculate that some anti-anxiety type medicines could dampen a little bit of the reactionary mode of an automatic rejection, leave somebody open to some conversation, not unlike alcohol and kind of that social lubricant, if you will. Sure you know, but in terms of an injection I haven't read it.
Dr. Michael Koren:
18:58
OK, well, there's. There's research in our world that I'm not terribly familiar with, but it's on psychedelics, mostly psilocybin-based products, with the concept that psychedelics can help change the way you think. A little bit Obviously, back in the 60s people were using LSD to try to help them see the world differently Lucy in the sky with diamonds
Dr. Chris Steilberg:
19:19
Fascinating
Dr. Michael Koren:
19:19
and there is some research going on now looking at these kind of chemicals.
Dr. Michael Koren:
19:27
and I was wondering if you had any insight or thoughts about whether that could work, given your understanding of the way the brain works.
Dr. Chris Steilberg:
19:42
I believe that it could really shift the framework of the mental models and the worldview. The walls come down and the person becomes more contemplative, more deliberative, more open to things. I don't know that they become more rational, more effective in their reasoning, necessarily, but they are less defensive and there's a broader. It sort of shrinks the latitude of rejection and opens up at least the latitude of no commitment, and it also makes people feel good and so with that they tend to be more favorable to relating to each other Interesting, and they will probably entertain something factually inconsistent with their beliefs.
Dr. Michael Koren:
20:36
Interesting, interesting.
Dr. Chris Steilberg:
20:49
And there really is hope for this right. psychology has been looking at this for a long time and uh you know in an individual context or even in groups when you bring people together they find out that their schema might be more divergent than they actually are and they can begin to relate In bigger groups. It gets more complicated, obviously, and we have to think about it. Like you know, I say sometimes reeling in a 50-pound fish on a two-pound test. You've got to be able to, you know, have to give and go with the audience, the individual, the context, but you know change can happen, it does. Individual, the context, um, but you know change can happen, it does, uh, and people can be, you know, encouraged to take a more deliberate. You know, look at the data. Scientists do this, uh, we, you know that scientists do create their own kind of points of view sure, but when the data say otherwise, people will change their kind of understanding based on knowledge.
Dr. Chris Steilberg:
21:49
It's when the beliefs get so central to who I am that things get more difficult, and then we're probably talking about generational change
Dr. Michael Koren:
21:58
Right, and the challenge of clinical trials, of course, is to take something like psychedelics and decide how to dose them, decide what patient population, type people you're trying to help, and then create a structured experiment where you can match a psychedelic against either a placebo or another type of agent and see whether or not you can move something that is quantifiable in one direction or another. And so that's just starting to happen for things like psychedelics to some degree with cannabinoid type products.
Dr. Chris Steilberg:
22:35
Yeah, Well, I am aware that there has been a lot of research with psychedelics with regard to depression and some other psychological conditions. I think that is what you're describing as an innovative opportunity.
Dr. Michael Koren:
22:50
Yeah, I'll share one little anecdote from college.
Dr. Michael Koren:
22:58
Two of my college suite mates were celebrating we won't mention any names. They were celebrating the graduation week and one of them we knew had a longstanding issue about what he would do with his life and he basically did not want to do what his dad was doing. He wanted to declare his independence, not want to do what his dad was doing. He wanted to declare his independence, so he consumes some mushrooms, and then became obsessed with digging a hole behind our little apartment and burying a chair in that hole and it was so bizarre that I couldn't understand it. And then, really, this revelation came on me just relatively recently and I realized that this was psychological, because his father was a dentist and he was trying to bury a dental chair to free himself from his father's profession.
Dr. Chris Steilberg:
23:55
Yeah, yeah. Well, you know that's a great example of how the schema change and you know it basically was an expression that was facilitated by the mushrooms, that he otherwise might not have been able to make the point quite as succinctly as to why.
Dr. Michael Koren:
24:18
Right.
Dr. Chris Steilberg:
24:32
But these things get deep, interesting, you know,and this is really where uh you know a lot of people like to think that Freud really was all you know just Theory and no substance but the ego defense mechanisms of denial repression uh you know projection, all of these things, those are very real and that's what's at the heart of a lot of the difficulties of changing people's attitudes. They want to protect their identity, they want to protect their social identity okay, so two, two quick things.
Dr. Michael Koren:
24:54
Uh, give me an example of a recent success of yours as an industrial psychologist, and so the listeners and the viewers can get a better sense for what you do day to day and how it makes a difference in people's lives
Dr. Chris Steilberg:
25:07
All right.
Dr. Chris Steilberg:
25:08
Very recently, I've been working with an individual but I've been doing so over a longer period of time who, although I'm not a clinical psychologist it may be that this individual is on the spectrum and has some difficulty-
Dr. Michael Koren:
25:27
You're not talking about me now, just about there.
Dr. Chris Steilberg:
25:32
No, this is somebody that I've been working with.
Dr. Chris Steilberg:
25:35
But the individual has a hard time going from what I call the spotlight to the floodlight. How do you go from getting detailed to generalizing? Okay, you know his kind of rigid fixation on the details and the data and you know being right has gotten in the way of him making a difference. And it actually led to what sounded like it was going to be a near you know nearly being fired from the organization he works in.
Dr. Chris Steilberg:
26:21
He's commissioned me to work with him. Uh, he didn't. And uh, recently he shared with me an example where he got into a little bit of a disagreement with somebody at work. Uh, it hit his trigger. He was able to push the pause button. Okay, and you know, take him out of the situation. Let the emotions die die settle down, get back in more rational, not a threat, and have a different kind of conversation with the individual Cool.
Dr. Michael Koren:
26:50
Yeah, that's very powerful.
Dr. Michael Koren:
26:52
Thanks for sharing that.
Dr. Chris Steilberg:
26:55
You're welcome
Dr. Michael Koren:
26:56
My final question is a little bit of a selfish one, which is how can we take the insights that you share with your clients on a day-to-day basis, in which you've studied, and how do we make MedE vidence better, this program, this platform of communicating with a large patient population and other healthcare providers, any advice for me, any insights as we go on the MedE vidence journey together? Right?
Dr. Chris Steilberg:
27:21
Well, you know, I think that in scale, it would largely be a lot of the same things that I've described, with the base that you're trying to influence through constant messaging the validity of the data, the impartiality, the openness to disagreement. I'm not trying to change your belief, I'm just trying to change your understanding kind of framework. You know, most people will get to a point where they will take another look at the information and it's just a question of you know at what point does a person's sort of firewall begin to? You know, fizzle a little bit or change a little bit, but as long as the messaging is constant, it goes across contexts. Uh, you know it is impartial.
Dr. Chris Steilberg:
28:29
Uh, you know, sometimes call out the uh, um, equivocations that they may have. You know, yeah, maybe you do think that all pharmaceuticals are just out to make a buck,
Dr. Michael Koren:
28:45
extract money from your wallet.
Dr. Chris Steilberg:
28:48
You know I can understand how you would feel that way, but that's why they come to us and we take the ball and the pharmaceuticals are not involved. Take the ball and the pharmaceuticals are not involved. Uh, but I, but I, I really believe that this is about, um, you know, communicating and relating to the people who are in the. You know the various trials that you do. Um, some will want to be more collaborative, they want to deliberate a little bit more. Some are the need for closure. You simply say you know this is a test and it's not safe.
Dr. Chris Steilberg:
29:26
And you know, we're trying to help advance science and so forth. But you know, over time you will begin to get the people that you can get and there will be a small minority that probably just can't or it takes just too much time.
Dr. Michael Koren:
29:45
Yeah, so as a professional industrial psychologist and as I understand, you've had a little bit of personal experience in looking at clinical research.
Dr. Chris Steilberg:
29:59
Yeah, yeah, yeah.
Dr. Michael Koren:
30:00
So can you describe how this very different way of approaching the healthcare system can maybe open things up Maybe not quite as powerfully as psychedelics, but it definitely will open your perspectives. So maybe you can comment on that as a final comment.
Dr. Chris Steilberg:
30:17
Yeah, well, something that has happened, you know, with modern technology and information sharing and the like, is that your physician, the medical doctor, is not the one and only source of all the information available to people and they don't enjoy a position of do as I say and move on to the next patient. It's going to require more incorporation of some of the psychological principles that we're talking about the motivational interviewing to keep the patient involved,
Dr. Michael Koren:
30:58
and also the collectiveness of a whole team working together to try to answer a question
Dr. Chris Steilberg:
31:11
People have a need to socialize and to improve society so that you know message really does carry some weight. When you get to individuals and soliciting participation in these trials, do it for the benefits of others, share the findings Absolutely and make, I suppose and interpret them for people, because they can get pretty deep and technical. Interpret them for people, I would say, but also maybe give them an index.
Dr. Chris Steilberg:
31:47
That's what I tell my coaching clients in businesses. You want to go in with a five-page presentation. You can have the 75-page index behind you, or appendix rather. But don't start with that. You don't start with that.
Dr. Chris Steilberg:
32:02
You need to tell a story, you need to be consistent If you really believe it, it helps and you become a more trusted partner and individuals are engaged in their own interests, in their own health, you know, vis-a-vis these studies, so I see the shift the world is, you know, moving away from do as I say to let's talk about this.
Dr. Michael Koren:
32:32
Right and share the results. Share the results Beautiful. Yeah, Chris, thank you so much for your insights. It's been a pleasure. I've learned a tremendous amount from our conversation and hopefully people who got the chance to view this will glean some insights as well.
Announcer:
32:48
I hope so as well. Thank you very much. Thanks for joining the MedEvidence podcast. To learn more, head over to MedEvidencecom or subscribe to our podcast on your favorite podcast platform.
