Date of Award
Summer 2026
Language
English
Embargo Period
4-19-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College/School/Department
Department of Educational and Counseling Psychology
Program
Counseling Psychology
First Advisor
M. Dolores Cimini, PhD
Committee Members
M. Dolores Cimini, Jessica L. Martin, Laura L. Longo, Bruce S. Liese
Keywords
psychotherapy, substance use, addictive disorders, affect heuristic, cognitive science, countertransference
Subject Categories
Clinical Psychology
Abstract
Therapists are at risk for engaging in the affect heuristic, which occurs when automatic emotional reactions influence clinical decision-making more than objective data about clients. Emotional reactions are common when treating clients using substances (CUS), but the influence of the affect heuristic on therapists’ clinical decision-making with CUS has yet to be quantified. This study investigated (1) the extent to which therapist trainees engage in the affect heuristic with CUS and (2) whether it can be reduced through brief cognitive science training. Graduate-level therapists (n = 130) were randomized to one of two conditions: brief online training involving psychoeducation (heuristics, System 1 and 2 thinking), case examples of emotionally-influenced clinical errors, and practice recommendations, or no training. Following randomization, participants responded to two clinically identical vignettes of CUS statistically demonstrated to elicit positive or negative affect. Trainees completed a clinical decision-making scale (CDMS) for both vignettes. Most clinical judgments and decisions (12 of 16) differed significantly between vignettes, providing evidence for the occurrence of the affect heuristic. Results of an ANCOVA controlling for knowledge of addictive disorders and their treatment indicated that participants receiving training evidenced significantly lower CDMS difference scores than control participants, demonstrating that training reduced engagement in the affect heuristic. Findings demonstrate that graduate-level therapists’ emotional reactions have the potential to influence their judgments and decisions with CUS and that engagement in this affect heuristic can be reduced via brief cognitive science training. Future studies can explore whether more intensive training formats (e.g., in-person workshops) exert stronger protective effects and whether training effects improve treatment outcomes with actual CUS.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Monley, Corey M., "Improving Clinical Decision-Making: Reducing the Affect Heuristic in Substance Use Treatment" (2026). Electronic Theses & Dissertations (2024 - present). 383.
https://scholarsarchive.library.albany.edu/etd/383