Why Options Matter for Mental Health

The psychologist Barry Schwartz, in his book The Paradox of Choice, defended a hypothesis that spoke powerfully to many people feeling overwhelmed by the modern world. The abundant choices we face – over twenty flavors of Triscuit crackers, for example – make us anxious and indecisive, always mindful of the many options we are turning down when we make a choice.

This is a phenomenon that psychologists call choice overload. Schwartz argued that choice overload makes us anxious and unhappy, and we would be wise to adjust our decision-making to modulate our anxieties.

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However, it turns out that choice overload may not be as robust a phenomenon as is sometimes supposed.

In 2010, an article by Benjamin Scheibehenne and co-authors noted several powerful theoretical arguments against choice overload, for example, that consumer behavior indicates that people seem to prefer having more options.

Scheibehenne and co-authors, therefore, conducted a large 2010 meta-analysis of studies that try to quantify choice overload and found the following: "the overall mean effect size [of choice overload] was virtually zero." As Derek Thompson argued inThe Atlantic, the empirical literature on choice overload suggests an alternative moral: "Less isn't always more. More is more."

So the evidence that choice overload, or an excess of options, may not be as much of a concern as some have supposed. Maybe we feel better when we have lots of options or believe we do. But an opposite hypothesis may be somewhat more compelling, that a lack of options – or a belief that one lacks options – is associated with mental health challenges.

Indeed, there is evidence that it is, especially when we turn our attention from anxiety to depression. For example, there is evidence that depression is associated with excessive "pruning" of one's decision tree or a narrowing of the options that one is considering. The depressive person often experiences the vividly colored space of options that most of us confront as a much more monochrome and limited array.

If this is right, then one aim of therapy may be to reframe this poverty of options, which we might call choice underload. This is a process that will feel intuitively familiar to many clinicians. It is the process of making someone who feels trapped in a dead-end career of the many professional options that might be open to her. Or the process of making someone who insists they are alone of the varieties of human connection that might be open to them. Or it may simply be making someone who is always angry aware of the other ways of feeling that are possible.

Increasingly, this sort of intuitive practice has been built into more systematic and testable approaches to therapeutic intervention. Consider the choice point model sometimes used within acceptance and commitment therapy. The choice point model attempts to build awareness of moments in life when individuals face a choice between an option that is consistent with their values (say, making a donation to their church) or inconsistent with their values (say, buying a lottery ticket).

The model encourages individuals to reflect on the factors that influenced their choice, how they made their choice, and what choice they ended up making. Crucially, the choice point model does not involve recommending one choice or the other. It is simply aimed at fostering greater awareness of the choice.

In a recent pilot study, a version of the choice point model for substance use disorders, CHOPS (Choice Point for Substances), was tested in a residential treatment facility for substance use disorders. It showed to build precisely the skills that are useful for managing substance use disorders and preventing relapse, namely an increase in psychological flexibility, an increase in values-based action, and an increase in self-compassion.

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It is interesting to contrast these results with some widespread theories about addiction. Some hold that substance use disorders are the product of an inexorable compulsion to use substances and that the addicted person, in the throes of her addiction, has no choice in the matter.

One lesson drawn from CHOPS is that emphasizing a diametrically opposed picture of addiction, on which substance use is a product of deliberate choice, has salutary effects on the mindsets of people with addictions.

The choice point model is an intervention that stresses that agents are not compelled by their circumstances or desires. Instead, we face choices that we may make more or less mindfully and more or less in line with our values. Indeed, the choice point model is simply one way of making this fact about ourselves salient. The CHOPS study is one indication that highlighting this about ourselves may be useful in the management of one condition, namely substance use disorders. But, in principle, underscoring this aspect of the agentive condition may have wider ramifications.

To be a person in a modern industrialized country is to face abundant options. From an economic point of view, this is a good thing. The choice overload hypothesis suggests that it is not quite as good as it appears and may indeed be at the root of anxiety. But, as we have seen, there are reasons to be skeptical of the choice overload hypothesis.

But there may well be another hypothesis in the offing. Such a hypothesis may indicate that people often perceive that they lack options – typically, at least for people in modern industrialized countries, a false perception – and that this perception can ground depression, substance use disorders, and other mental health conditions. If that is right, then one aim of cognitive therapy may be to help correct choice underload and clarify all the options we have.