By April Boykin, LCSW

Consider how you rate your driving ability compared to everybody else you know. Compared to all those fellow travelers along I-40? What about your intelligence? Humor? Professional skills? Cooking? Memory? Honesty? Personality? Are you better than average in one, most, or all of these areas?

Social comparison is a necessary process involving people coming to know themselves by evaluating their skills, abilities, attitudes, and traits compared to others. In most cases, we compare ourselves to those in our peer groups, such as family, friends, work colleagues, or others we consider similar. The better-than-average effect (BTAE) is a social comparison construct in which people compare their characteristics or behaviors against the average standing of their peers. However, BTAE refers to the tendency for people to perceive their abilities, attributes, and personality traits as superior to their peers. Research on the better-than-average effect suggests that most people rate themselves above average across a wide range of skills, intelligence, and personality characteristics. Zell, Strickhouser, Sedikides, & Alicke (2020) found that 65% of people rate their intelligence as better than average. However, it is statistically impossible for most people to have above-average intelligence.

Research has explained the BTAE phenomenon in terms of a self-enhancement bias, which suggests people are prone to view themselves more favorably than warranted by objective reality. The theory suggests that most of us tend to interpret the world in a way that makes us feel better about ourselves, even if there is no evidence or proof, even if the comparison is inaccurate. It is fair to believe we even have a bias that assumes we are less biased than the average person! The optimistic bias also contributes to the BTAE construct. The optimistic bias involves comparisons about life events, pointing to the tendency to overestimate one's chances of good fortune and to underestimate one's risk for misfortune.

As healthcare providers, our patients are influenced by the better-than-average effect every day. The following are signs a patient is acting from a position of better-than-average.

Medical Advice Avoiders-BTAE patients are often less receptive to medical recommendations and treatment. They manage their medical care by deciding when to or not to follow medical guidance (i.e., medication, therapy, DME, etc.). No information goes unchallenged or researched.

Distortions-BTAE patients often have a distorted sense of themselves doing better than they are. Patients also think their condition is not as bad as other people's, and they don't need the same treatment. For example, patients may think they don't need to take all the antibiotics because they heal faster than others.

At-Risk Behaviors -BTAE patients do not internalize the risks to which their behaviors expose them. They believe they will be the fortunate ones who will not get cancer from cigarettes or skin damage from the sun.

Doctor Shopping-BTAE contributes to seeking opinion after opinion because of distortions about wellness, control over one's health, and disbelief about needing care.

Techniques to Address Better-Than-Average-Effect

For the most part it is impossible to convince or persuade people to change their beliefs or decisions. However we know that people do better with their own information and process so the following skills help access our patients internal process for change.

Rapport- One of the best ways to overcome the better-than-average effect is to build a strong rapport, especially with new patients. People are wired to respond to faces, so face-to-face interactions often have a more significant impact. The quickest way to build rapport is to make good eye contact and then engage in mirroring and matching. Mirroring and matching is a process where you position your physical self at the same level as the patient and reflect your patient's energy, engagement, and even posture. This connection will create instant rapport and allow for a more open discussion.

Name the objection: We tend to find trends in people's objections about experiences that become obstacles for them. For example, many people touring ALFs may say things like "I don't want to live with all these old people" even though they are the same age or older. One way to overcome this obstacle is to name the objection ahead of time. For example, try saying, "Sometimes, when people begin to tour ALFs, they only see the people using walkers and wheelchairs and overlook people who are actively going about their day. Let's look for the more active community members as we tour."

Get Curious- It is easy to become disengaged when we have given our best recommendation, and our patients believe they know better. Getting curious is a great way to overcome the patient's limitations without becoming adversarial. Try saying, "It seems you came to me having decided what you would and would not accept as a diagnosis. I am curious what you have done in other situations where you get conflicting information.

Or I am curious how you will handle a second or third opinion if it gives you the same information.

Or I am curious what you would need to happen to be open to new and different information.

Rhetorical Questions-Rhetorical questions are a great way to get someone to do their own thinking through a subject. You can use them to start a discussion when it is too difficult to answer simply. "Wouldn't it be nice" instead of "Do you think"? Wouldn't it be nice if healthcare decisions were easy to make? Instead of Don't you think everyone is afraid of a cancer diagnosis? The rhetorical question can extend the conversation and allow the patient to explore their own reasoning.

Scales: An excellent way to help people overcome BTAE is to use a scale to help them explore their thinking. "On a scale of 1 to 10, where are you on this [decision]?" Then explore the reasons behind the score, why it is not higher or lower, and what would cause it to change. The scale allows patients to work through their process for decision-making.

It is important to note that we can all be influenced by the better-than-average effect. It can be a defense mechanism or a way to make ourselves feel better. It does not necessarily mean we are self-absorbed or narcissistic, as long as we are open to feedback. If patients struggle to work in their best interest because they lack judgment or the ability to accept feedback, they may need a referral for counseling to help solve the problem.

April Boykin is a Licensed Clinical Social Worker and cofounder of Counseling Resource Services (CRS). Established in 2013, CRS is a community-based in-home integrated behavioral health agency serving the aged and disabled population in Central Florida. As a mental health counselor, she has provided individual, family and caregiver counseling to children, teens and adults.   She can be reached at april@counselingresourceservices.com