International Journal of Psychology, 2015 Vol. 50, No. 2, 121–127, DOI: 10.1002/ijop.12079
Dispositional optimism, self-framing and medical decision-making Xu Zhao1 , Chunlei Huang1 , Xuesong Li1 , Xin Zhao1 , and Jiaxi Peng2 1 School 2
of Marxism, Liaoning Shihua University, Fushun, China Department of Psychology, Fourth Military Medical University, Xi’an, China
S
elf-framing is an important but underinvestigated area in risk communication and behavioural decision-making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self-frame and decision-making. Participants (N = 500) responded to the Life Orientation Test-Revised and self-framing test of medical decision-making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self-frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5-year survival rate. Based on the current findings, it can be concluded that self-framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision-making. Keywords: Dispositional optimism; Self-framing; Medical decision-making.
Framing effect refers to significant changes in decision-making regarding the same problem when the problem is presented differently (Tversky & Kahneman, 1981). A classic example of the framing effect is the Asian disease problem, where participants imagine that a government is preparing for an outbreak of an Asian disease that will result in 600 deaths. Two sets of rescue plans are proposed. Plan A could save 200 people (400 deaths), and Plan B has a one-in-three chance of saving all 600 people (no deaths) and a two-in-three chance of failure to save anyone (all dead). About 72% choose Option A when the question is framed in terms of “lives saved.” About 78% choose Option B when the same problem is framed in terms of “deaths” (Tversky & Kahneman, 1981). Previous studies have documented the universality and robustness of the framing effect (Huang & Wang, 2010; Levin, Gaeth, Schreiber, & Lauriola, 2002). The scope and depth of these studies have continuously expanded with the development of studies on risky decisionmaking. Medical practice involves risks because clinical decisions are made under uncertain conditions (Peng, He, et al., 2013). For this reason, several studies have
examined the framing effect in medical situations. One example is the study of Armstrong, Schwartz, Fitzgerald, Putt, and Ubel (2002), in which they randomly divided participants into three groups and oriented each group about two treatment programmes. In their experiment, the mortality curves were presented to the first group, the survival curves were shown to the second group, and both the survival and mortality curves were shown to the third group. The participants in the first group had less preference for preventative surgery compared with those in the other two groups. Bigman, Cappella, and Hornik (2010) reported that describing the effects of the human papilloma virus (HPV) to two different groups of participants as 70% effective and 30% ineffective, respectively, produced inconsistent results. Moreover, despite the similarity of the information presented in the two frames, the participants who received the positive frame believed that the prophylactic was more effective, thus increasing their willingness to receive the vaccine. Meanwhile, Peng, He, et al. (2013) found that social distance could moderate the framing effect in medical decision-making.
Correspondence should be addressed to Jiaxi Peng, Department of Psychology, Fourth Military Medical University, Xi’an, Shaanxi 710032, China. (E-mail: [email protected]).
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Tversky and Kahneman (1981) divided the decision-making process into coding and evaluation. In their scheme, a frame can be a product of decision-makers who actively encode and process information on decision-making or information that is passively accepted by others (Peng, Xiao, Yang, Wu, & Miao, 2014). Real-life choices are often described vaguely and clear frames are rarely observed. At the same time, people are often compelled to encode and process decision-making information intuitively before making a decision (Wang, 2004). The “self-frame” is formed through internal representation. Wang (2004) performed a preliminary exploration of self-frames by representing information through a pie chart. By asking the participants to edit the decision-making information through a cloze task, he found that they used different vocabularies to describe the programme prospects. Self-frames and traditional frames produce a similar effect on decision-making. Peng et al. (2014) and McElroy, Seta, and Waring (2007) cited these findings in their own studies, arguing that individual differences resulted in variations on how people understand decision-making information. In turn, such variations lead to the formation of different self-frames. For example, individuals with low self-esteem or high trait anxiety use more negative vocabularies in their respective self-frames. Personality trait is another important factor that affects decision-making (Levin et al., 2002). Dispositional optimism, a personality trait exhibited by individuals who consistently develop positive expectations amid different times and situations (Wenglert & Rosen, 2000), is a key topic in the field of positive psychology and health studies. Dispositional optimism is found to be positively correlated with positive emotions (Kapikiran, 2012) and life satisfaction (Wong & Lim, 2009), but is negatively correlated with negative emotions (You, Fung, & Isaacowitz, 2009), anxiety (Boman & Yates, 2001) and depression (Wong & Lim, 2009). Previous studies have also investigated the link between dispositional optimism and risk perception. For example, Steginga and Occhipinti (2006) reported that dispositional optimism is inversely associated with threatening feelings resulting from decision-making. Luo and Isaacowitz (2007) found that individuals with low dispositional optimism paid more attention when they are at a high objective risk of developing skin cancer, whereas those with high dispositional optimism tend to exhibit adaptive, health-promoting behaviours. Katapodi, Lee, Facione, and Dodd (2004) argued that optimism could negatively predict cancer worry, and that such relationship could be mediated by the perceived risk of cancer. Studies from other fields have also investigated the relationship between optimism and risk perception. Gibson and Sanbonmatsu (2004) examined the relationship between dispositional optimism and gambling, and found that optimists displayed
high tendency to maintain positive expectations and continue gambling even after experiencing negative gaming outcomes. Xie (2001) found that highly optimistic people showed a higher risk propensity in different situations compared with people with low optimism. Based on the abovementioned information, “selfframe” can be defined as the active adjustment of decision-making information that can be affected by personality traits. Dispositional optimism is a stable personality trait that greatly affects the cognition, emotion, attitudes and behaviours of an individual, and highly optimistic individuals develop a positive attitude and can perceive the positive side of situations. Therefore, we propose three hypotheses, which are stated as follows: 1 Individuals with high and low dispositional optimism exhibit significant differences in terms of their formation of self-frames, with the former group having a higher tendency to generate positive self-frames compared with the latter group. 2 Individuals exhibit significant differences in their decision-making when the medical problem is described in positive or negative self-frames. They may be far-sighted and perceive more opportunities instead of threats, and more tend to take immediate risks when the medical problem is described in positive self-frames and vice versa. 3 Dispositional optimism is correlated with risk preference of decision-makers, and the decision-makers with a high dispositional optimism more tend to take immediate risks. METHOD Participants and procedure A total of 500 undergraduates enrolled at a general university in Xi’an (mean age = 19.14 years; SD = 1.47) volunteered to participate in the study for extra course credits. These participants majored in Law, Political Science, Physics and Optics. They all completed the questionnaire in the auditorium. When risk is involved, there are significant differences in decision-making between males and females (Huang & Wang, 2010; Peng, Miao, & Xiao, 2013) and in the effects of optimism on their decision-making (Felton, Gibson, & Sanbonmatsu, 2003). Therefore, we only selected male participants for this study. All participants provided their written informed consent before completing the measures. Measures Life Orientation Test-Revised The Life Orientation Test-Revised (LOT-R) of Scheier, Carver, and Bridges (1994) is a 6-item measure © 2014 International Union of Psychological Science
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Figure 1. Self-framing study material.
(with four additional filler items) of individual differences in dispositional optimism and pessimism. The items are rated from 1 (strongly disagree) to 5 (strongly agree). Sample items include “I usually expect the best outcome during uncertain times” and “Something will go wrong if it is meant to go wrong.” The scale scores are computed by adding the items and reverse coding the relevant items. Higher scores reflect a greater tendency for an individual to expect positive outcomes. The Cronbach’s alpha coefficient for the LOT-R was .71 in this study. Following McElroy et al. (2007), we divided the participants into two groups based on their LOT-R scores. The participants whose scores were higher than the middle value were considered highly optimistic, and the remaining ones were considered low optimistic. Self-framing test We created a self-framing questionnaire for medical decision-making based on the self-framing questionnaire (Wang, 2004; revised by Peng et al., 2014) and on the classic medical decision-making problem from the Adult Decision-Making Competence Inventory (Bruine de Bruin, Parker, & Fischhoff, 2007). The participants were presented with a cover story about a decision-maker who was compelled to decide between undergoing surgery or radiation therapy. We then asked the participants to describe the expected outcomes through their own words before making a decision. The cover story is presented in Figure 1. Self-frame rating The medical problem may be described using different words, such as “Surgery: Of 100 people who undergo surgery, 50 people die after surgery, and 40 people remain alive at the end of five years; Radiation therapy: Of 100 people who undergo radiation therapy, all people live, and 80 people die at the end of five years” or “Surgery: Of 100 people who have surgery, 50 people still live after surgery, and 40 people remain alive at the end of five years; Radiation therapy: Of 100 people who undergo © 2014 International Union of Psychological Science
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radiation therapy, no people die, and 20 people live at the end of five years.” Following Wang (2004), we collated all the verbs and verb phrases used by the participants in their self-frames, after which we randomised the verbs. A total of 20 male undergraduates who did not participate in the self-frame test rated the hedonic tone of each verb based on their own understanding. They were asked to judge their feelings after seeing each word. The ratings were made on a 7-point emotional scale that ranged from 1 (very unpleasant) to 7 (very pleasant) (Appendix A). We coded the mean value for each verb as the score. For example, the verb “die” was scored as 1.9 based on its mean value of the hedonic tone. All the verbs used by the participants in the questionnaire and their respective scores are shown in Appendix B. We considered the total score of all verbs used in the surgery programme as the score for the entire programme. For example, given that die and remain alive in “Surgery: Of 100 people who undergo surgery, 50 people die after surgery, and 40 people remain alive at the end of five years” were coded as 1.9 and 5.9, respectively, we coded the entire surgery programme as 7.8. A similar score was constructed for the radiotherapy programme. After adding the scores of the surgery and radiotherapy programmes, we considered the sum as the total score for that self-frame. Wang (2004) argued that self-frames with scores that are higher than the middle value are positive, whereas those with scores lower than the middle value are negative. The self-framing effect requires people to make significantly different decisions under different self-frames. The pictures were misinterpreted in 43 of the 500 distributed questionnaires (i.e. the participants mistook the dotted portion of the pie chart, which indicated disappearance or death, as the number of rehabilitation/survival). We excluded the data for these 43 questionnaires from the analysis. RESULTS The relation between dispositional optimism and self-frame The optimism scores were positively correlated with self-frame hedonic tones based on the Pearson correlation analysis (r = .215, p < .001). Table 1 shows the differences in the optimism scores and the self-frame hedonic tones between the high and low dispositional optimism groups. The dispositional optimism score of the high dispositional optimism group was significantly different from that of the low dispositional optimism group, t(498) = 27.52, p < .001. Significant differences were also observed between the high and low dispositional optimism groups in terms of their hedonic tone
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ZHAO ET AL. TABLE 1 Differences in self-framing between the low and high dispositional optimism groups
Low High
Optimism scores
Hedonic tone of surgery
Hedonic tone of radiotherapy
Positive frame N (% total)
Negative frame N (% total)
18.77 ± 2.21 23.99 ± 2.03
8.90 ± 2.11 9.81 ± 1.61
8.62 ± 2.17 9.76 ± 1.83
37 (44.0) 61 (66.3)
47 (56.0) 31 (33.7)
Note: Cells in columns 2–4 represent M ± SD. TABLE 3 The decision-making difference between low and high optimism groups
TABLE 2 Self-framing effect in medical situation Medical decision-making
Self-frame Negative Positive
Surgery N (% total)
Medical decision-making
Radiotherapy N (% total)
77 (33.6) 116 (50.9)
152 (66.4) 112 (49.1)
for surgery plans t(425.61) = 5.09, p < .001, radiotherapy plans t(449.17) = 4.01, p < .001 and self-frames t(436.83) = 4.96, p < .001, indicating that individuals with high optimism tend to use more positive words when describing the surgery and radiotherapy results and when narrating the whole story. Further analysis revealed that 66.3% and 44% of individuals in the high and low dispositional optimism groups, respectively, produced positive self-frames, indicating a statistically significant difference (χ2 = 12.97, p < .001). Therefore, Hypothesis 1 was confirmed. Test of the self-framing effect We further tested the self-framing effect in a medical situation, and found no significant difference between the number of people who chose surgery over radiotherapy and those who chose radiotherapy over surgery (χ2 = 0.07, p = .79) in a positive self-frame. However, more people chose radiotherapy over surgery in a negative frame (χ2 = 24.56, p < .001). There was also a significant difference between the participants who chose radiotherapy or surgery in a positive or negative frame (χ2 = 13.94, p < .001). Thus, Hypothesis 2 was confirmed (Table 2). The relationship between dispositional optimism and decision-making Next, we tested the effect of dispositional optimism on medical decision-making. Results showed that 47.4% and 37.1% of the participants in the high and low dispositional optimism groups, respectively, chose surgery over radiotherapy, indicating a significant difference (χ2 = 8.38, p = .003). Therefore, Hypothesis 3 was confirmed (Table 3).
Dispositional optimism
Surgery N (% total)
Radiotherapy N (% total)
Low High
78 (34.1) 108 (47.4)
151 (65.9) 120 (52.6)
TABLE 4 Self-framing effect in low and high dispositional optimism groups Decision Dispositional optimism Low High
Self-frame
Surgery N (% total)
Radiotherapy N (% total)
Positive Negative Positive Negative
42 (44.2) 37 (27.6) 74 (55.6) 40 (42.1)
53 (55.8) 97 (72.4) 59 (44.4) 55 (57.9)
We further calculated the differences between the high and low dispositional optimism groups in terms of their decision-making in positive and negative frames. Participants from both groups chose surgery over radiotherapy in positive frames more often than in negative frames (χ2 high = 12.31, p < .001; χ2 low = 8.76, p = .003) (Table 4). In addition, in both positive and negative frames, the participants in the high dispositional optimism group who chose surgery in both positive and negative frames also outnumbered those in the low dispositional optimism group (χ2 positive = 3.00, p = .08; χ2 negative = 5.23, p = .022). DISCUSSION Many studies have investigated the framing effect since the emergence of this concept, many of which have proven the robustness of the framing effect. Researchers over the last three decades have attempted to explain the causes of the framing effect from various perspectives by applying different theories. This topic continues to attract many prospective researchers (Levin et al., 2002). However, other issues, such as the frames formed © 2014 International Union of Psychological Science
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by decision-makers in practical situations, the difference between self-framing effect and traditional framing effect, the effects of individual differences on fuzzy decision information-processing and the consistency of the self-framing effect across different situations, have all attracted limited research attention. Wang (2004) was the first to investigate the self-framing effect, and McElroy et al. (2007) and Peng et al. (2014) investigated the effect of self-esteem and trait anxiety on self-frame. The findings of the current study verify the occurrence of the self-framing effect in medical situations. Moreover, the differences in dispositional optimism have created various criteria for decision-making problems and have produced significant effects on decisions. The participants with high and low dispositional optimism tend to use positive and negative vocabularies, respectively, to interpret ambiguous graphical information. This finding may be attributed to the effect of dispositional optimism on attention bias. Trait congruency effects demonstrate that participants who obtain a high score in traits related to positive emotions pay more attention to positive stimuli, whereas those who obtain a high score in traits related to negative emotions pay more attention to negative stimuli (Hainaut, Monfort, & Bolmont, 2006). For example, highly anxious participants easily notice a threatening stimulus rather than a neutral stimulus; they also tend to perceive an ambiguous stimulus as a threatening stimulus (Rusting, 1999). Canli, Sivers, Whitfield, Gotlib, and Gabrieli (2002) reported that the amygdala of people with high extraversion is intensely activated as they process cheerful expressions. Tafarodi and Milne (2002) provided evidence for the consistent effect of traits, in which people with low self-esteem often process failure- or inability-related information. Dispositional optimism is a stable trait variable that refers to the expectation of an individual for a consistently positive or negative outcome across different times and conditions (Wenglert & Rosen, 2000). In addition, self-frame is the basis for decision-making information (Wang, 2004). Individuals with a low dispositional optimism are highly sensitive to threatening stimuli, thus developing a negative expectation. Therefore, these individuals easily notice the blank area in the graph, which represent death, and tend to use negative vocabularies in their interpretation of graphical data. In this study, we also observed a significant self-framing effect, which showed its consistency in different situations (McElroy et al., 2007; Peng et al., 2014; Wang, 2004). Instead of adopting the classical Asia disease problem, we adopted surgery and radiotherapy as its frame issues. However, these two programmes are both uncertain, and the treatment and 5-year survival rates of these procedures differ from each other. Moreover, this problem reflects the adventurism and conservatism of people and demonstrates how they choose between long© 2014 International Union of Psychological Science
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and short-term interests under different situations (Armstrong et al., 2002). Wang (2004) argued that self-frame involves the emotional response of the decision-maker and serves as a motivational buffer for anticipated outcomes. In turn, these outcomes allow decision-makers to adjust the hedonic tone of self-framing and reduce the psychological effect of their negative expectations. For example, when faced with death, the participants described the situation as a cure, recovery and recuperation rather than death. Therefore, the conclusion presented by Wang has been supported in this study. In addition, when faced with a medical problem involving a matter of life and death, 80% of the participants used positive vocabularies in their descriptions of events. Dispositional optimism significantly affects decisions. In particular, we found that the highly optimistic participants were more willing to choose surgery with a low treatment survival rate and a high 5-year survival rate rather than radiotherapy. However, the relationship between optimism and decision is yet to be fully analysed. The results of this study can be explained from several angles. First, individuals with high optimism develop highly positive expectations (Scheier, Weintraub, & Carver, 1986; Wenglert & Rosen, 2000). Therefore, they demonstrate strong desires for their expected outcomes, pay more attention to long-term results, and have a stronger bearing capacity for misfortune. Second, dispositional optimism can reduce the threatening feelings resulting from the decision-making process (Steginga & Occhipinti, 2006). Many studies have shown that decision-makers tend to take risks when they perceive opportunities rather than threats, and vice versa (Highhouse & Yüce, 1996; Thomas, Clark, & Gioia, 1993). Therefore, our participants with high optimism tended to take immediate risks, such as selecting the surgery programme with a low treatment survival rate but with a high 5-year survival rate, in order to achieve long-term benefits. This study expands the literature on the application of self-frames in medical situations and analyses the effect of dispositional optimism on decision. We find that compared with low dispositional optimism individuals, highly dispositional optimism individual more tend to generate positive self-frames, and are more willing to take immediate risks. Although several meaningful conclusions can be obtained from this study, a number of limitations must be addressed. First, our experimental study did not involve random assignment to conditions. Some important confounding factors, such as other personality traits, were not controlled in this study, preventing us from concluding the existence of causality among dispositional optimism, self-frame and medical decision-making. Future studies must, therefore, implement a more rigid experimental design to explore such causality. Second, we adopted convenient sampling in this study—all participants were college students, and the gender factor was
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controlled in the sampling, thus limiting the applicability of the research findings. Future studies are encouraged to address the effect of gender on self-framing as well as the potential interactions between dispositional optimism and self-frame. Third, we adopted a design in which a participant who accomplished the self-framing was separated from a participant who evaluated the words. A particular verb may indicate various emotional implications among different individuals. Therefore, the integral method of self-framing must be further discussed in future studies. Fourth, the decision-making outcome represents a simple two-way choice in our study. We dichotomised the optimism and self-framing scores to facilitate the data analysis. However, such dichotomisation may produce misleading estimates. Thus, in order to reflect the decision-making behaviour of a participant, future studies are suggested to compute a continuous variable, such as responses in a scale ranging from 1 (strong tendency to choose surgery) to 6 (strong tendency to choose radiotherapy). This method allows additional statistical methods to be used in the analysis. Manuscript received December 2013 Revised manuscript accepted April 2014 First published online May 2014
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APPENDIX A Verbs rating scale 1. When you see the verb phrase “(Illness) has been well in hand,” how would you feel? 1 2 3 4 5 6 7 Very unpleasant Very pleasant 2. When you see the verb “recover,” how would you feel? 1 2 3 4 5 6 7 Very unpleasant Very pleasant …… 12. When you see the verb phrase “live healthy,” how would you feel? 1 2 3 4 5 6 7 Very unpleasant Very pleasant
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APPENDIX B Table B1. Mean hedonic ratings for all the verbs used in the self-frames Verbs and verb phrases (Illness) has been well in hand Recover Modify (symptoms) Remain alive Successfully treat Failed treat Live Die Recurrence (of cancer) Cure Pass crisis Live healthy
Mean hedonic tone
SD
4.8 6.1 5.2 5.9 6.1 2.4 5.1 1.95 1.85 6.2 5.5 6.1
1.06 1.02 1.01 0.97 0.85 1.88 1.17 1.16 0.67 0.77 1.05 1.1
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Dispositional optimism, self-framing and medical decision-making Xu Zhao1 , Chunlei Huang1 , Xuesong Li1 , Xin Zhao1 , and Jiaxi Peng2 1 School 2
of Marxism, Liaoning Shihua University, Fushun, China Department of Psychology, Fourth Military Medical University, Xi’an, China
S
elf-framing is an important but underinvestigated area in risk communication and behavioural decision-making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self-frame and decision-making. Participants (N = 500) responded to the Life Orientation Test-Revised and self-framing test of medical decision-making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self-frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5-year survival rate. Based on the current findings, it can be concluded that self-framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision-making. Keywords: Dispositional optimism; Self-framing; Medical decision-making.
Framing effect refers to significant changes in decision-making regarding the same problem when the problem is presented differently (Tversky & Kahneman, 1981). A classic example of the framing effect is the Asian disease problem, where participants imagine that a government is preparing for an outbreak of an Asian disease that will result in 600 deaths. Two sets of rescue plans are proposed. Plan A could save 200 people (400 deaths), and Plan B has a one-in-three chance of saving all 600 people (no deaths) and a two-in-three chance of failure to save anyone (all dead). About 72% choose Option A when the question is framed in terms of “lives saved.” About 78% choose Option B when the same problem is framed in terms of “deaths” (Tversky & Kahneman, 1981). Previous studies have documented the universality and robustness of the framing effect (Huang & Wang, 2010; Levin, Gaeth, Schreiber, & Lauriola, 2002). The scope and depth of these studies have continuously expanded with the development of studies on risky decisionmaking. Medical practice involves risks because clinical decisions are made under uncertain conditions (Peng, He, et al., 2013). For this reason, several studies have
examined the framing effect in medical situations. One example is the study of Armstrong, Schwartz, Fitzgerald, Putt, and Ubel (2002), in which they randomly divided participants into three groups and oriented each group about two treatment programmes. In their experiment, the mortality curves were presented to the first group, the survival curves were shown to the second group, and both the survival and mortality curves were shown to the third group. The participants in the first group had less preference for preventative surgery compared with those in the other two groups. Bigman, Cappella, and Hornik (2010) reported that describing the effects of the human papilloma virus (HPV) to two different groups of participants as 70% effective and 30% ineffective, respectively, produced inconsistent results. Moreover, despite the similarity of the information presented in the two frames, the participants who received the positive frame believed that the prophylactic was more effective, thus increasing their willingness to receive the vaccine. Meanwhile, Peng, He, et al. (2013) found that social distance could moderate the framing effect in medical decision-making.
Correspondence should be addressed to Jiaxi Peng, Department of Psychology, Fourth Military Medical University, Xi’an, Shaanxi 710032, China. (E-mail: [email protected]).
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Tversky and Kahneman (1981) divided the decision-making process into coding and evaluation. In their scheme, a frame can be a product of decision-makers who actively encode and process information on decision-making or information that is passively accepted by others (Peng, Xiao, Yang, Wu, & Miao, 2014). Real-life choices are often described vaguely and clear frames are rarely observed. At the same time, people are often compelled to encode and process decision-making information intuitively before making a decision (Wang, 2004). The “self-frame” is formed through internal representation. Wang (2004) performed a preliminary exploration of self-frames by representing information through a pie chart. By asking the participants to edit the decision-making information through a cloze task, he found that they used different vocabularies to describe the programme prospects. Self-frames and traditional frames produce a similar effect on decision-making. Peng et al. (2014) and McElroy, Seta, and Waring (2007) cited these findings in their own studies, arguing that individual differences resulted in variations on how people understand decision-making information. In turn, such variations lead to the formation of different self-frames. For example, individuals with low self-esteem or high trait anxiety use more negative vocabularies in their respective self-frames. Personality trait is another important factor that affects decision-making (Levin et al., 2002). Dispositional optimism, a personality trait exhibited by individuals who consistently develop positive expectations amid different times and situations (Wenglert & Rosen, 2000), is a key topic in the field of positive psychology and health studies. Dispositional optimism is found to be positively correlated with positive emotions (Kapikiran, 2012) and life satisfaction (Wong & Lim, 2009), but is negatively correlated with negative emotions (You, Fung, & Isaacowitz, 2009), anxiety (Boman & Yates, 2001) and depression (Wong & Lim, 2009). Previous studies have also investigated the link between dispositional optimism and risk perception. For example, Steginga and Occhipinti (2006) reported that dispositional optimism is inversely associated with threatening feelings resulting from decision-making. Luo and Isaacowitz (2007) found that individuals with low dispositional optimism paid more attention when they are at a high objective risk of developing skin cancer, whereas those with high dispositional optimism tend to exhibit adaptive, health-promoting behaviours. Katapodi, Lee, Facione, and Dodd (2004) argued that optimism could negatively predict cancer worry, and that such relationship could be mediated by the perceived risk of cancer. Studies from other fields have also investigated the relationship between optimism and risk perception. Gibson and Sanbonmatsu (2004) examined the relationship between dispositional optimism and gambling, and found that optimists displayed
high tendency to maintain positive expectations and continue gambling even after experiencing negative gaming outcomes. Xie (2001) found that highly optimistic people showed a higher risk propensity in different situations compared with people with low optimism. Based on the abovementioned information, “selfframe” can be defined as the active adjustment of decision-making information that can be affected by personality traits. Dispositional optimism is a stable personality trait that greatly affects the cognition, emotion, attitudes and behaviours of an individual, and highly optimistic individuals develop a positive attitude and can perceive the positive side of situations. Therefore, we propose three hypotheses, which are stated as follows: 1 Individuals with high and low dispositional optimism exhibit significant differences in terms of their formation of self-frames, with the former group having a higher tendency to generate positive self-frames compared with the latter group. 2 Individuals exhibit significant differences in their decision-making when the medical problem is described in positive or negative self-frames. They may be far-sighted and perceive more opportunities instead of threats, and more tend to take immediate risks when the medical problem is described in positive self-frames and vice versa. 3 Dispositional optimism is correlated with risk preference of decision-makers, and the decision-makers with a high dispositional optimism more tend to take immediate risks. METHOD Participants and procedure A total of 500 undergraduates enrolled at a general university in Xi’an (mean age = 19.14 years; SD = 1.47) volunteered to participate in the study for extra course credits. These participants majored in Law, Political Science, Physics and Optics. They all completed the questionnaire in the auditorium. When risk is involved, there are significant differences in decision-making between males and females (Huang & Wang, 2010; Peng, Miao, & Xiao, 2013) and in the effects of optimism on their decision-making (Felton, Gibson, & Sanbonmatsu, 2003). Therefore, we only selected male participants for this study. All participants provided their written informed consent before completing the measures. Measures Life Orientation Test-Revised The Life Orientation Test-Revised (LOT-R) of Scheier, Carver, and Bridges (1994) is a 6-item measure © 2014 International Union of Psychological Science
OPTIMISM, SELF-FRAME AND DECISION-MAKING
Figure 1. Self-framing study material.
(with four additional filler items) of individual differences in dispositional optimism and pessimism. The items are rated from 1 (strongly disagree) to 5 (strongly agree). Sample items include “I usually expect the best outcome during uncertain times” and “Something will go wrong if it is meant to go wrong.” The scale scores are computed by adding the items and reverse coding the relevant items. Higher scores reflect a greater tendency for an individual to expect positive outcomes. The Cronbach’s alpha coefficient for the LOT-R was .71 in this study. Following McElroy et al. (2007), we divided the participants into two groups based on their LOT-R scores. The participants whose scores were higher than the middle value were considered highly optimistic, and the remaining ones were considered low optimistic. Self-framing test We created a self-framing questionnaire for medical decision-making based on the self-framing questionnaire (Wang, 2004; revised by Peng et al., 2014) and on the classic medical decision-making problem from the Adult Decision-Making Competence Inventory (Bruine de Bruin, Parker, & Fischhoff, 2007). The participants were presented with a cover story about a decision-maker who was compelled to decide between undergoing surgery or radiation therapy. We then asked the participants to describe the expected outcomes through their own words before making a decision. The cover story is presented in Figure 1. Self-frame rating The medical problem may be described using different words, such as “Surgery: Of 100 people who undergo surgery, 50 people die after surgery, and 40 people remain alive at the end of five years; Radiation therapy: Of 100 people who undergo radiation therapy, all people live, and 80 people die at the end of five years” or “Surgery: Of 100 people who have surgery, 50 people still live after surgery, and 40 people remain alive at the end of five years; Radiation therapy: Of 100 people who undergo © 2014 International Union of Psychological Science
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radiation therapy, no people die, and 20 people live at the end of five years.” Following Wang (2004), we collated all the verbs and verb phrases used by the participants in their self-frames, after which we randomised the verbs. A total of 20 male undergraduates who did not participate in the self-frame test rated the hedonic tone of each verb based on their own understanding. They were asked to judge their feelings after seeing each word. The ratings were made on a 7-point emotional scale that ranged from 1 (very unpleasant) to 7 (very pleasant) (Appendix A). We coded the mean value for each verb as the score. For example, the verb “die” was scored as 1.9 based on its mean value of the hedonic tone. All the verbs used by the participants in the questionnaire and their respective scores are shown in Appendix B. We considered the total score of all verbs used in the surgery programme as the score for the entire programme. For example, given that die and remain alive in “Surgery: Of 100 people who undergo surgery, 50 people die after surgery, and 40 people remain alive at the end of five years” were coded as 1.9 and 5.9, respectively, we coded the entire surgery programme as 7.8. A similar score was constructed for the radiotherapy programme. After adding the scores of the surgery and radiotherapy programmes, we considered the sum as the total score for that self-frame. Wang (2004) argued that self-frames with scores that are higher than the middle value are positive, whereas those with scores lower than the middle value are negative. The self-framing effect requires people to make significantly different decisions under different self-frames. The pictures were misinterpreted in 43 of the 500 distributed questionnaires (i.e. the participants mistook the dotted portion of the pie chart, which indicated disappearance or death, as the number of rehabilitation/survival). We excluded the data for these 43 questionnaires from the analysis. RESULTS The relation between dispositional optimism and self-frame The optimism scores were positively correlated with self-frame hedonic tones based on the Pearson correlation analysis (r = .215, p < .001). Table 1 shows the differences in the optimism scores and the self-frame hedonic tones between the high and low dispositional optimism groups. The dispositional optimism score of the high dispositional optimism group was significantly different from that of the low dispositional optimism group, t(498) = 27.52, p < .001. Significant differences were also observed between the high and low dispositional optimism groups in terms of their hedonic tone
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ZHAO ET AL. TABLE 1 Differences in self-framing between the low and high dispositional optimism groups
Low High
Optimism scores
Hedonic tone of surgery
Hedonic tone of radiotherapy
Positive frame N (% total)
Negative frame N (% total)
18.77 ± 2.21 23.99 ± 2.03
8.90 ± 2.11 9.81 ± 1.61
8.62 ± 2.17 9.76 ± 1.83
37 (44.0) 61 (66.3)
47 (56.0) 31 (33.7)
Note: Cells in columns 2–4 represent M ± SD. TABLE 3 The decision-making difference between low and high optimism groups
TABLE 2 Self-framing effect in medical situation Medical decision-making
Self-frame Negative Positive
Surgery N (% total)
Medical decision-making
Radiotherapy N (% total)
77 (33.6) 116 (50.9)
152 (66.4) 112 (49.1)
for surgery plans t(425.61) = 5.09, p < .001, radiotherapy plans t(449.17) = 4.01, p < .001 and self-frames t(436.83) = 4.96, p < .001, indicating that individuals with high optimism tend to use more positive words when describing the surgery and radiotherapy results and when narrating the whole story. Further analysis revealed that 66.3% and 44% of individuals in the high and low dispositional optimism groups, respectively, produced positive self-frames, indicating a statistically significant difference (χ2 = 12.97, p < .001). Therefore, Hypothesis 1 was confirmed. Test of the self-framing effect We further tested the self-framing effect in a medical situation, and found no significant difference between the number of people who chose surgery over radiotherapy and those who chose radiotherapy over surgery (χ2 = 0.07, p = .79) in a positive self-frame. However, more people chose radiotherapy over surgery in a negative frame (χ2 = 24.56, p < .001). There was also a significant difference between the participants who chose radiotherapy or surgery in a positive or negative frame (χ2 = 13.94, p < .001). Thus, Hypothesis 2 was confirmed (Table 2). The relationship between dispositional optimism and decision-making Next, we tested the effect of dispositional optimism on medical decision-making. Results showed that 47.4% and 37.1% of the participants in the high and low dispositional optimism groups, respectively, chose surgery over radiotherapy, indicating a significant difference (χ2 = 8.38, p = .003). Therefore, Hypothesis 3 was confirmed (Table 3).
Dispositional optimism
Surgery N (% total)
Radiotherapy N (% total)
Low High
78 (34.1) 108 (47.4)
151 (65.9) 120 (52.6)
TABLE 4 Self-framing effect in low and high dispositional optimism groups Decision Dispositional optimism Low High
Self-frame
Surgery N (% total)
Radiotherapy N (% total)
Positive Negative Positive Negative
42 (44.2) 37 (27.6) 74 (55.6) 40 (42.1)
53 (55.8) 97 (72.4) 59 (44.4) 55 (57.9)
We further calculated the differences between the high and low dispositional optimism groups in terms of their decision-making in positive and negative frames. Participants from both groups chose surgery over radiotherapy in positive frames more often than in negative frames (χ2 high = 12.31, p < .001; χ2 low = 8.76, p = .003) (Table 4). In addition, in both positive and negative frames, the participants in the high dispositional optimism group who chose surgery in both positive and negative frames also outnumbered those in the low dispositional optimism group (χ2 positive = 3.00, p = .08; χ2 negative = 5.23, p = .022). DISCUSSION Many studies have investigated the framing effect since the emergence of this concept, many of which have proven the robustness of the framing effect. Researchers over the last three decades have attempted to explain the causes of the framing effect from various perspectives by applying different theories. This topic continues to attract many prospective researchers (Levin et al., 2002). However, other issues, such as the frames formed © 2014 International Union of Psychological Science
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by decision-makers in practical situations, the difference between self-framing effect and traditional framing effect, the effects of individual differences on fuzzy decision information-processing and the consistency of the self-framing effect across different situations, have all attracted limited research attention. Wang (2004) was the first to investigate the self-framing effect, and McElroy et al. (2007) and Peng et al. (2014) investigated the effect of self-esteem and trait anxiety on self-frame. The findings of the current study verify the occurrence of the self-framing effect in medical situations. Moreover, the differences in dispositional optimism have created various criteria for decision-making problems and have produced significant effects on decisions. The participants with high and low dispositional optimism tend to use positive and negative vocabularies, respectively, to interpret ambiguous graphical information. This finding may be attributed to the effect of dispositional optimism on attention bias. Trait congruency effects demonstrate that participants who obtain a high score in traits related to positive emotions pay more attention to positive stimuli, whereas those who obtain a high score in traits related to negative emotions pay more attention to negative stimuli (Hainaut, Monfort, & Bolmont, 2006). For example, highly anxious participants easily notice a threatening stimulus rather than a neutral stimulus; they also tend to perceive an ambiguous stimulus as a threatening stimulus (Rusting, 1999). Canli, Sivers, Whitfield, Gotlib, and Gabrieli (2002) reported that the amygdala of people with high extraversion is intensely activated as they process cheerful expressions. Tafarodi and Milne (2002) provided evidence for the consistent effect of traits, in which people with low self-esteem often process failure- or inability-related information. Dispositional optimism is a stable trait variable that refers to the expectation of an individual for a consistently positive or negative outcome across different times and conditions (Wenglert & Rosen, 2000). In addition, self-frame is the basis for decision-making information (Wang, 2004). Individuals with a low dispositional optimism are highly sensitive to threatening stimuli, thus developing a negative expectation. Therefore, these individuals easily notice the blank area in the graph, which represent death, and tend to use negative vocabularies in their interpretation of graphical data. In this study, we also observed a significant self-framing effect, which showed its consistency in different situations (McElroy et al., 2007; Peng et al., 2014; Wang, 2004). Instead of adopting the classical Asia disease problem, we adopted surgery and radiotherapy as its frame issues. However, these two programmes are both uncertain, and the treatment and 5-year survival rates of these procedures differ from each other. Moreover, this problem reflects the adventurism and conservatism of people and demonstrates how they choose between long© 2014 International Union of Psychological Science
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and short-term interests under different situations (Armstrong et al., 2002). Wang (2004) argued that self-frame involves the emotional response of the decision-maker and serves as a motivational buffer for anticipated outcomes. In turn, these outcomes allow decision-makers to adjust the hedonic tone of self-framing and reduce the psychological effect of their negative expectations. For example, when faced with death, the participants described the situation as a cure, recovery and recuperation rather than death. Therefore, the conclusion presented by Wang has been supported in this study. In addition, when faced with a medical problem involving a matter of life and death, 80% of the participants used positive vocabularies in their descriptions of events. Dispositional optimism significantly affects decisions. In particular, we found that the highly optimistic participants were more willing to choose surgery with a low treatment survival rate and a high 5-year survival rate rather than radiotherapy. However, the relationship between optimism and decision is yet to be fully analysed. The results of this study can be explained from several angles. First, individuals with high optimism develop highly positive expectations (Scheier, Weintraub, & Carver, 1986; Wenglert & Rosen, 2000). Therefore, they demonstrate strong desires for their expected outcomes, pay more attention to long-term results, and have a stronger bearing capacity for misfortune. Second, dispositional optimism can reduce the threatening feelings resulting from the decision-making process (Steginga & Occhipinti, 2006). Many studies have shown that decision-makers tend to take risks when they perceive opportunities rather than threats, and vice versa (Highhouse & Yüce, 1996; Thomas, Clark, & Gioia, 1993). Therefore, our participants with high optimism tended to take immediate risks, such as selecting the surgery programme with a low treatment survival rate but with a high 5-year survival rate, in order to achieve long-term benefits. This study expands the literature on the application of self-frames in medical situations and analyses the effect of dispositional optimism on decision. We find that compared with low dispositional optimism individuals, highly dispositional optimism individual more tend to generate positive self-frames, and are more willing to take immediate risks. Although several meaningful conclusions can be obtained from this study, a number of limitations must be addressed. First, our experimental study did not involve random assignment to conditions. Some important confounding factors, such as other personality traits, were not controlled in this study, preventing us from concluding the existence of causality among dispositional optimism, self-frame and medical decision-making. Future studies must, therefore, implement a more rigid experimental design to explore such causality. Second, we adopted convenient sampling in this study—all participants were college students, and the gender factor was
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controlled in the sampling, thus limiting the applicability of the research findings. Future studies are encouraged to address the effect of gender on self-framing as well as the potential interactions between dispositional optimism and self-frame. Third, we adopted a design in which a participant who accomplished the self-framing was separated from a participant who evaluated the words. A particular verb may indicate various emotional implications among different individuals. Therefore, the integral method of self-framing must be further discussed in future studies. Fourth, the decision-making outcome represents a simple two-way choice in our study. We dichotomised the optimism and self-framing scores to facilitate the data analysis. However, such dichotomisation may produce misleading estimates. Thus, in order to reflect the decision-making behaviour of a participant, future studies are suggested to compute a continuous variable, such as responses in a scale ranging from 1 (strong tendency to choose surgery) to 6 (strong tendency to choose radiotherapy). This method allows additional statistical methods to be used in the analysis. Manuscript received December 2013 Revised manuscript accepted April 2014 First published online May 2014
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APPENDIX A Verbs rating scale 1. When you see the verb phrase “(Illness) has been well in hand,” how would you feel? 1 2 3 4 5 6 7 Very unpleasant Very pleasant 2. When you see the verb “recover,” how would you feel? 1 2 3 4 5 6 7 Very unpleasant Very pleasant …… 12. When you see the verb phrase “live healthy,” how would you feel? 1 2 3 4 5 6 7 Very unpleasant Very pleasant
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APPENDIX B Table B1. Mean hedonic ratings for all the verbs used in the self-frames Verbs and verb phrases (Illness) has been well in hand Recover Modify (symptoms) Remain alive Successfully treat Failed treat Live Die Recurrence (of cancer) Cure Pass crisis Live healthy
Mean hedonic tone
SD
4.8 6.1 5.2 5.9 6.1 2.4 5.1 1.95 1.85 6.2 5.5 6.1
1.06 1.02 1.01 0.97 0.85 1.88 1.17 1.16 0.67 0.77 1.05 1.1
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