Keywords

The manifestation of unrealistic optimism during the particular period of a pandemic is unquestionably a cognitively interesting phenomenon in its own right. Equally (or perhaps even more) interesting is how cognitive biases are related to the manifestation of specific, e.g., health-promoting, behaviors. After all, you have likely been thinking to yourself for some time: “well, I know what cognitive biases are; I can see that they occur during the COVID-19 pandemic as well. I also remember that they are functional: they enable us to reduce stress, fear, and anxiety. Perhaps, then, this falsehood should not be taken away from us? After all, what’s wrong with deluding ourselves about the present and the future?”

These questions are absolutely crucial because the reduction of prolonged stress should have a positive effect on long-term health. Egotistical illusions can therefore be treated as a health-promoting factor.

3.1 Unrealistic Pessimism

Recall at this point that the very idea of our carrying out an extensive program of research on comparative illusions during a pandemic originated in our observation that this distinctive state of vagueness and a sense of widespread danger is very much like the situation in which a radioactive cloud loomed over people’s heads in the aftermath of the Chernobyl nuclear power plant accident. At that time, one of the authors of this book and his colleagues (Dolinski et al., 1987) observed the occurrence of unrealistic pessimism. Most of the people in their research felt more vulnerable to radiation exposure than the average person. Of course, in the rather large population studied by these psychologists at the time, there were also those who demonstrated unrealistic optimism. They believed that it would be others, rather than them, who would become ill in the future with diseases that were a consequence of significantly elevated radiation.

The aforementioned study also specified the relationship between comparative optimism and pessimism, on the one hand, and the declared intensity of manifestation of various preventive behaviors that could (at least potentially) reduce the effects of radiation, on the other hand. Such behaviors were, for example, drinking Lugol’s iodine or refraining from drinking milk (the milkman system was popular in Poland at the time, and fresh unpasteurized milk which came from cows feeding on irradiated grass was delivered to the doors of homes in the morning). Another health-promoting behavior was to refrain from eating fresh vegetables that grew on contaminated soil and to limit time spent outdoors or even keeping windows closed in the home.

It turned out that people exhibiting unrealistic pessimism are far more likely to engage in such behavior than those demonstrating unrealistic optimism. The link between unrealistic optimism and ignoring health recommendations seems quite obvious here: since I think that the disease will affect others rather than me, there is no reason for me to manifest any health-promoting behavior that requires me to make smaller or larger sacrifices. And conversely, the pessimist believes that they are especially vulnerable and declares proactive health-oriented actions. To summarize, optimism seems wildly dangerous for one who falsifies their perception of reality in this way! This then gives rise to the assumption that some social biases are dysfunctional. We should take a closer look at this issue, as it may turn out that in the current (and future!) pandemic, social communication efforts should be aimed not only at encouraging health protection measures (wearing masks, refraining from participating in social gatherings at a time of rising rates of the disease, hand washing, and – above all – vaccination) but also at demolishing people’s illusions.

3.2 Unrealistic Optimism: Pre-pandemic Research

The negative association of unrealistic optimism with the manifestation of health-promoting behaviors has also been noted in numerous psychological studies conducted under “normal” conditions, i.e., those in which there was no state of emergency or widespread danger. Moreover, other studies do not rely on the declaration noted in our study in the aftermath of the Chernobyl explosion (pessimistic respondents claimed to actively protect their health, but of course we did not know if they actually did so), so it is possible to see exactly how social biases affect real behavior (health-promoting or health-destroying). For example, it was shown that tobacco smokers who showed unrealistic optimism about getting lung cancer were less likely to quit smoking than those who exhibited no such optimistic bias (Dillard et al., 2006). This means that unrealistic optimists have actively damaged their health by increasing the risk of serious, fatal diseases like lung cancer.

This is not an isolated result: women demonstrating unrealistic optimism about the possibility of developing breast cancer were less likely to undergo mammography screening (McCaul et al., 1996), which directly leads to lower detection of this dangerous type of cancer, reducing the chance of early (and therefore more effective) medical intervention. Another study (Dillard et al., 2009), on the other hand, found that students demonstrating unrealistic optimism about the likelihood of experiencing various problems associated with excessive alcohol consumption actually experienced them more frequently and intensely in the future (this was investigated more than 2 years later). It is worth mentioning in passing that the association of unrealistic optimism with a risky drinking style also occurred in a study conducted by Kim and Niederdeppe (2016). Davidson and Prkachin (1997), in turn, showed that people who were advised to exercise did so less often if they displayed unrealistic optimism about their health status and the potential for it to deteriorate in the future. These researchers also gauged the level of unrealistic optimism in people at risk for coronary heart disease and then invited them to attend a special lecture on preventive health behaviors recommended for such individuals. It turned out that people characterized by unrealistic optimism benefited the least from this lecture (i.e., remembered the least relevant information). Most likely, they decided that there was no point in listening carefully or taking notes because such a threat simply did not apply to them. Summarizing the results of Davidson and Prkachin (1997), we thus see a troubling nexus of detrimental reactions triggered by unrealistic optimism: not only do I actively withdraw from behaviors that are recommended for me, but I fail to acquire new information about my condition, which sets in motion further negative consequences. I will not engage in health-promoting activities because I simply know less about them (than a person unaffected by the tendency to falsify reality). This, in turn, shows how deeply social bias penetrates us: once we are affected by negative changes in our bodies, then, despite reducing anxiety or worry, in the long term, we are bound not only to exacerbate our health problems. And with their onset or aggravation, our rates of psychological discomfort will also increase.

Kim and Niederdeppe (2013), on the other hand, measured participants’ levels of unrealistic optimism about infection with the H1N1 virus and asked them about their intention to pay particular attention to hand hygiene (as a proven behavior that protects against infection). It turned out that the relationship between the two phenomena was negative: the more someone exhibited unrealistic optimism, the less they intended to follow medical recommendations.

Treloar and Hopwood (2008), on the other hand, show that unrealistic optimism can lead to either abandoning or delaying help-seeking in conditions where, objectively speaking, the patient needs it (immediately!). Hepatitis C patients believed that the negative side effects of therapy tended to affect other people rather than themselves. When such negative side effects appeared, unrealistically optimistic patients first ignored them for a long time and then reacted with shock and strongly negative affect when confronted with reality. Let us emphasize: hepatitis C is insanely dangerous, and postponing or downplaying treatment directly damages the patient’s health! Thus, an exceedingly serious conclusion emerges: unrealistic optimism is a useful short-term psychological mechanism for reducing fear and anxiety but in the long-term a serious detriment when it relates to issues of health. Concluding this review, let us note that a raft of other data on the relationship of unrealistic optimism to the possibility of experiencing various medical conditions and ignoring medical advice is also presented by Perloff (1983), whose work we recommend to the reader interested in the details.

3.3 Unrealistic Optimism in the Midst of the COVID-19 Pandemic

Now we move on to the substance of this work (which is not to say that the previous chapters were superfluous; they constitute a conceptual framework, contextualize our later research, and ultimately produce practical recommendations), that is, to see if and how unrealistic optimism can modify behaviors aimed at protecting one’s health. In light of the findings presented so far, it seemed not only to us but also to other researchers very likely that studies of human functioning under conditions of the COVID-19 pandemic would also reveal a negative association of unrealistic optimism with the manifestation (or lack) of health-promoting behavior. This is precisely the very clear negative association between levels of unrealistic optimism and behaviors aimed at protecting one’s health that was noted in a large-scale study conducted in four countries (Italy, France, Switzerland, and the United Kingdom) involving more than 12,000 people (McColl et al., 2022). The study took place during the first wave of COVID-19 cases in February and March 2020. They found that levels of unrealistic optimism were negatively correlated with the reported frequency of behaviors such as wearing a mask, avoiding touching one’s mouth and nose, using hand sanitizer gel, and avoiding contact with people who look sick. This means that in the case of COVID-19 as well, those who falsify reality are harming themselves! It is also worth mentioning that for other recommended behaviors, such as frequent hand washing, using disposable tissues when sneezing or coughing, and avoiding the use of public transportation, while the association with the level of unrealistic optimism did not reach the conventional level of statistical significance (0.05), it too was negative.

A similar pattern of results was noted by Wise et al. (2020), who conducted their studies in the United States between March 11 and 16, 2020 on a sample of about 1500 people. Their analysis yielded a group of 135 people from this sample who were particularly unlikely to engage in preventive behaviors with respect to the risk of contracting COVID-19 (mainly involving thorough hand washing and limiting the number of direct contacts with other people). It turned out that the effect of unrealistic optimism was particularly strong in this particular group. Juxtaposed with the previous result, therefore, a clear picture is emerging of how in the COVID-19 pandemic unrealistic optimism does harm in the same way as in earlier studies (and discussed in the previous section) on the relationship between social bias and health-oriented behaviors.

Park et al. (2021), in turn, showed that the individuals displaying the strongest unrealistic optimism about the likelihood of contracting COVID-19 also report the least interest in obtaining information from medical and other sources about the disease and how to minimize the likelihood of contracting it. This should not come as a surprise. Since, in their view, it is not they but rather other people who are particularly susceptible to contracting the virus, it is these others, not they, who should seek such information. We note here the consistency with the research cited above on unrealistic optimism and hepatitis C. The results are convergent: not only do we harm ourselves by abandoning health-promoting behaviors when we exhibit cognitive bias in the form of unrealistic optimism, but we also forego access to knowledge that could help us stay healthy!

Oljača et al. (2020), on the other hand, examined people’s general tendency to manifest unrealistic optimism (i.e., the belief that various negative events will more likely affect others than oneself) and declared adherence to medical recommendations during a pandemic. It turned out that both measures correlated negatively.

In our research (Izydorczak et al., 2023: https://royalsocietypublishing.org/doi/10.1098/rsos.220775), we decided to go a step further and tested the level of comparative optimism with the declaration of intent to take a vaccine. Note that in the case of COVID-19, vaccination is the cheapest, easiest, and most effective preventive protection to date against death resulting from infection with COVID-19. Thus, examining the relationship between unrealistic optimism and the coronavirus pandemic was also particularly important in that it may facilitate some predictions for human behavior during future pandemics, which would be tackled with newly introduced vaccines.

It is worth stipulating that our study was conducted on data collected from June to August 2020, when COVID-19 vaccines were not yet available (and there was no cause to believe they would soon be ready), so, unable to study the actual act of vaccination, we relied on declarations of willingness to vaccinate. A noteworthy strength of our study was the mini-meta-analysis we conducted (i.e., analyzing the data collected in our various studies and comparing the distribution of results for consistency indicating a stable, strong effect, or inconsistency making it difficult to report a stable phenomenon). We took into account the results of our six studies (N = 2409 conducted around the world – Germany, Poland, Italy, etc.). Our participants estimated the risk of contracting COVID-19, so we were able to distinguish three groups of people, which we conventionally called pessimists (who thought they were more at risk than others), realists (the largest group, these people estimated as equal the probability that they themselves would get sick and that another person would get sick), and optimists (those who thought they were less at risk than others).

Figure 3.1 shows the results of our research.

Fig. 3.1
2 forest plots. A and B exhibit 6 study values for 6 different countries. The R E model value and the scale of effect size from minus 0.6 to plus 0.4 and minus 0.8 to 0.2 is presented.

Forest plot (a) difference in vaccine intention between comparative realists and comparative optimists, (b) difference in vaccine intention between comparative realists and comparative pessimists. (Source: Royal Society Open Science, Copyright: The Royal Society Publishing)

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As we can see, the results were surprising. Both pessimists and optimists were more likely than realists to say they would vaccinate whenever possible. The inclination of pessimists to vaccinate is fully understandable and in line with our research conducted after the Chernobyl nuclear power plant explosion: pessimists declared high proactivity toward protecting their health by avoiding exposure to radioactive contamination (avoiding leaving the house, closing windows, not eating contaminated products, and drinking Lugol’s iodine). In our research, we may assume that since unrealistic pessimists feel particularly threatened, they are obviously motivated to take measures that reduce this threat, and inoculation is undoubtedly one of them. What is puzzling, however, is the inclination of optimists to be vaccinated and the lack of such propensity among realists. We will begin with the latter issue.

Our third study, conducted in August 2021, a time when vaccines were already available (Izydorczak et al., 2022), sheds some light on explaining why realists declared the weakest willingness to vaccinate. It turned out that realists, in contrast to optimists and pessimists, were less afraid of getting infected with COVID-19 but also more afraid of the vaccine per se. Realists often expressed concern that the vaccines were introduced too hastily, without proper and comprehensive studies.

In this light, however, the positive relationship between unrealistic optimism and declared willingness to vaccinate may seem surprising. However, we believe that this relationship is only superficially illogical. It may surprise us when we treat unrealistic optimism as the independent variable and the tendency to vaccinate as the dependent variable. The belief that I am less likely than the average person to contract a disease should result in a refusal to be vaccinated, rather than a willingness to be vaccinated. However, we should note that the results we obtained only prejudge the correlation relationship, not the direction of a possible (because even this is not certain) causal relationship. So let’s try to invert our understanding. Treat the decision to get vaccinated in the near future as the independent variable and the level of unrealistic optimism as the dependent variable. One who has made the decision to get vaccinated against COVID-19 in the near future (“whenever possible”) now has a full rational basis for perceiving themself as less vulnerable than the “average other.” After all, they know that there are many people in the population who are skeptical of vaccination against COVID-19, so many people will not be vaccinated. With this interpretation, the results regarding optimists cease to be surprising and assume a reasonable logic.

The results of experiments conducted in Brazil (Vieites et al., 2021) seem consistent with such an assumption. The researchers hypothesized that if they focus an individual on the fact that they are demonstrating preventive behaviors, they will consequently reveal higher levels of unrealistic optimism than somebody who is simply asked to estimate the risk of disease for themselves and others. This, we note, is because such an awareness-raising influence increases self-conscientiousness by elevating it, and – as we discussed above – this is heavily associated with social cognition biases. In keeping with this line of reasoning, the researchers have rightly assumed that one of the sources of unrealistic optimism is cognitive egocentrism – the mechanism we outlined in Sect. 1.4, i.e., that one’s own behavior is more cognitively accessible to us than other people’s behavior. (We simply know perfectly well how we behave and cannot have such equally precise and expansive knowledge of others if only for the reason that we do not see/experience other people’s behavior as much as our own.) Through simple interventions, however, it is possible to further increase an individual’s cognitive accessibility to information about their appropriate and desirable reactions. In their first experiment, the researchers simply asked people first how often they wore a mask and then estimated their level of unrealistic optimism. In the second study, prior to measuring their degree of unrealistic optimism, participants were asked to determine whether they agreed with the following statement:

The authorities have recommended mask wearing as a measure to contain the dissemination of the coronavirus. According to experts, wearing a mask when going out significantly reduces the risk of contamination. Do you agree with this statement? ___ Yes ___ No. (Vieites et al., 2021, p. 626)

It turned out that both of these simple interventions led to increased levels of unrealistic optimism. When looking at them, it is essential to consider that the measure of unrealistic optimism was constructed by the researchers in such a way that the lower the bars on the graphs, the higher the level of unrealistic optimism (this refers to the way the authors coded the results; we have already said that there are different methods of measuring and analyzing unrealistic optimism).

3.4 Better than Average

There is also the question of whether the stated intention to vaccinate against COVID-19 will be positively correlated with another positive comparative bias we write about in this book, i.e., the better-than-average effect. In one of our studies (Kulesza et al., 2022b), we decided to test this. The respondents first estimated the extent to which they themselves engage in various behaviors recommended during the pandemic by medical authorities (keeping social distance, wearing masks, frequent hand washing, etc.) and the extent to which the average person of their sex and age does so. This allowed us to calculate a better-than-average effect factor for each participant. We then asked each participant to indicate on an 11-point scale (from “definitely not” to “definitely yes”) their intention to take a COVID-19 vaccine as soon as it became available. (We conducted the survey in August 2020, when no such vaccine was available, but it was already rumored to be coming relatively soon.) Regression analysis showed a moderate relationship between the two variables.

Thus, we see that the magnitude of the better-than-average effect is a predictor of intention to vaccinate; but, on the other hand, the relative weakness of this relationship indicates that the tendency to vaccinate is based largely on other mechanisms than the propensity to manifest other health-promoting behaviors. There is no doubt that, from a medical perspective, the most effective way to prevent a pandemic is mass vaccination of the population. From a psychological perspective, however, the situation is quite complex. Indeed, as we have shown in previous sections of this book, cognitive biases may not foster various health-promoting behaviors. The studies we present now, on the other hand, show that they can induce people to get vaccinated.

It is this distinctiveness of vaccination from other forms of protection against infection that may psychologically partly explain why the studies recorded a negative association of the level of unrealistic optimism with the frequency of such medical/health-related behaviors as washing one’s hands or limiting real, direct contact with other people but unrealistic optimism was positively associated with the intention to be vaccinated. Perhaps unrealistic optimism is associated differently with behaviors that have already been manifested (or are currently being manifested) and still differently with hypothetical, future behaviors that the individual is only just considering. Whether this is indeed the case could only be conclusively determined by empirical research, which we strongly encourage.

However, it should be emphasized here that the positive relationship declared in our study conducted in Poland (a country with an average vaccination rate) between unrealistic optimism and COVID-19 vaccination did not occur in the study conducted in Romania – a country with a record low level of COVID-19 vaccination and also the highest mortality rate from the disease in Europe (Maftei & Petroi, 2022). Four groups of people were engaged in the study – those declaring they would definitely not vaccinate, those who were hesitant, those declaring they would definitely vaccinate, and those who had already been vaccinated. Unrealistic optimism was examined in relation to both the probability of contracting COVID-19 and the severity of the disease. The respondents were asked to determine the probabilities of both states of affairs for themselves and the average Romanian of their age and sex. It turned out that those declaring that they would definitely not vaccinate exhibited the highest level of unrealistic optimism, the hesitant slightly lower, and those determined to vaccinate the lowest. We should add for the sake of argument that those who had already been vaccinated also reported high optimism (the same as those who definitely did not want to be vaccinated), but in their case, it is difficult to speak of unrealistic optimism. After all, they were comparing themselves with the average person, and the vast majority of the Romanian population was not vaccinated.

As we proceed toward recommendations, summaries, and therefore the conclusions of this book, let us consider the studies presented above in a broader perspective. The McColl et al. (2022) study conducted in four Western European countries and the Maftei and Petroi (2022) study just discussed by us in Romania, as well as the Wise et al. (2020) and Park et al. (2021) studies we mentioned earlier in this book, show clearly that, in certain cases, unrealistic optimism can lead to inappropriate behavior, increasing not only the likelihood of a particular person contracting the disease but consequently the spread of infections and the growth of a pandemic. To put it bluntly, unrealistic optimism thus has destructive consequences both at the individual level (avoidance of health-promoting behaviors) and at the community level (when the mass of people avoids washing their hands thoroughly or wearing masks, a pandemic will develop!). If we additionally consider the fact that, in the realm of health, unrealistic optimism can also prove dangerous for many other diseases and disorders (e.g., Dillard et al., 2006, 2009; McCaul et al., 1996) and the fact that the aforementioned illusion can also be dangerous in areas of human functioning other than health (e.g., Sweeny & Shepperd, 2010; Yang et al., 2007), the question of ways to reduce unrealistic optimism clearly must arise. Moreover, it may turn out that unrealistic optimism in general negatively affects all health-promoting behaviors, significantly degrading the health of the person falsifying reality in this way. In other words, we would like to say that, so far, what has been analyzed is the association of unrealistic optimism with single health-promoting behaviors targeting particular diseases. Probably nobody has yet analyzed the role of unrealistic optimism in downplaying all types of health risks. If it turned to be the case that unrealistic optimism globally influences a particular person’s disengagement from a vast number of health-promoting behaviors (e.g., forgoing mammograms, screening and follow-up examinations, excessive alcohol consumption, avoidance of dietary recommendations, etc.), we could speak of a sort of psychological sepsis! Even if this is not the case, the potential (i.e., concerning specific individual risks) harm of unrealistic optimism is beyond question. The vital issue of methods to reduce unrealistic optimism is therefore the focus of the next section of this book.

We also note in passing that in the preceding section we have paid almost no attention to the relationship between the better-than-average illusion and health-promoting behavior. This is because we did not find many works reporting such results. More research is therefore needed, both on the COVID-19 pandemic and the broader aspect of global health. This seems crucial to developing a better understanding (and therefore preparation) for upcoming pandemics (and perhaps other sudden, unpredictable, and massive disasters; we will write more about this in the conclusion of this book).