The use of traditional, complementary, and alternative medicine (TCAM) practices is growing worldwide. To understand the reasons behind this trend, we explored basic psychological variables such as personality traits and thinking dispositions as predictors of TCAM use. A sample representative of the Serbian adult population (N = 1003; 57.6% female; age range: 18-75) completed: 1) TCAM-22, a comprehensive checklist for
indicating lifelong use of 22 TCAM practices such as acupuncture, use of herbal products, meditation/mindfulness, and prayer for own health, 2) HEXACO personality inventory, 3) DELTA inventory assessing the additional personality trait of Disintegration – a tendency towards psychotic-like experiences, 4) REI-8 assessing rational and experiential thinking styles, and 5) the Cognitive Reflection Test (CRT). An average participant used eight TCAM practices during their lifetime (M = 7.92), but there was also a considerable level of variability in TCAM use (SD = 3.30). Personality traits and thinking dispositions were significant predictors of TCAM use, F(10, 992) = 10.70, p < .001, explaining 9.7% of its variance. More use of TCAM was best predicted by high experientiality (β = .16) and high Openness (β = .14), followed by high Emotionality (β = .12) and Disintegration
(β = .11), with low Honesty-Humility (β = -.09) and low cognitive reflection (β = -.06) also contributing to the prediction. Our results suggest that thinking styles and personality traits may play a significant role in the choice of medical treatment and should thus be taken into consideration when planning healthcare strategies.

Rather than following official medical advice, people often succumb to different questionable health practices to improve their health or recover from illness. For example, they may intentionally not adhere to official medical advice by making decisions about their therapy or self-medicating, or use complementary, traditional, and alternative medicine (TCAM). Research from other countries suggests that these two types of behavior are widespread, however, their prevalence in Serbia is unknown. To address this, we asked a nationally representative sample of Serbian citizens (N = 1003) about their lifetime experiences with non-adherence to official recommendations (12 items) and the use of TCAM practices for health reasons (22 items). On average, respondents reported not adhering to 4.01 (SD = 2.94) out of 12 proposed medical recommendations, while 88.9% reported at least one non-adherence. The most prevalent non-adhering behaviors were not going to the doctor when feeling ill (77.6%), taking antibiotics without a prescription (46.7%), and refusing to change unhealthy lifestyle habits (40.4%). The least frequent non-adhering behaviors were not reporting or minimizing symptoms when talking to a doctor (23.6%), self-determining the dosage of the prescribed medicine (16.2%), and avoiding a medical check-up (16.2%). For TCAM practices, respondents reported using, on average, 7.51 (SD = 3.27) out of 22 practices at some point in their life. At the same time, 99.3% had used at least one of the proposed TCAM practices. The most frequent TCAM practices were consuming herbal products (88.8%), using herbal balms, pledgets, creams, or ointments (85.2%), and eating herbs (garlic, houseleek, etc.) for improving health (87.7%). The least prevalent practices were quantum medicine (6.7%), crystal therapy (6.1%), and spiritual healing (4.6%). Even though behaviors covered by the checklists were quite diverse, both instruments proved to be fairly internally consistent – Cronbach’s alpha for non-adherence was ɑ = .79 and for TCAM ɑ = .77, suggesting common latent tendencies. The correlation between lifetime non-adherence to medical recommendations and use of TCAM was r = .29. Based on observed prevalences, clinicians should be advised not to assume a fully compliant patient, since it seems that non-adherence and trying alternatives is more a norm than an exception.

Ključne reči: prevalence, complementary and alternative medicine, health behaviors, traditional medicine

Although it lacks a solid evidence base, people use traditional, complementary, and alternative medicine (TCAM), and they do so in three distinct ways: 1) for preventive purposes, 2) complementarily to prescribed therapy, and 3) as an alternative to it. While preventive use of TCAM is of least concern, these treatments can sometimes have detrimental interactions with conventional when used as complementary, and especially as an alternative to treatment. Using TCAM instead of conventional treatments can delay efficient cure and decrease the chance of recovery. Previous studies have indicated that the use of TCAM is rooted in the “irrational mindset” (IM) – a composite of irrational beliefs and cognitive biases. However, different ways of using TCAM may not be equally irrational. Here, we explored whether the IM predicts the three ways of TCAM use. Participants from a nationally representative Serbian sample (N = 1003) filled in a set of the IM measures: Medical conspiracy theories (ɑ = .83), Superstition (ɑ = .70), Magical beliefs about health (ɑ = .77), Extrasensory beliefs (ɑ = .77), and Naturalness bias (single item). They also indicated how they typically used different domains of TCAM practices (preventively, complementarily, alternatively, or none). We coded their answers “1” if they indicated that they used a domain in a particular way and with “0” otherwise. We tested the explanatory power of IM variables for the ways of TCAM use within three binary logistic regression models, one for each way of use. The irrational mindset was the most predictive for the alternative use of TCAM (χ2(5) = 40.56, p < .001; Nagelkerke R2 = .07). Those endorsing medical conspiracy theories (OR = 1.48, p = .001) and extrasensory perception beliefs (OR = 1.41, p = .009) were more likely to turn to TCAM alternative to the prescribed therapy. On the other hand, the predictive power of IM was quite weak for preventive (χ2(5) = 14.39, p = .013; Nagelkerke R2 = .02) and complementary use (χ2(5) =18.06, p = .003; Nagelkerke R2 = .02) suggesting these behaviors not to be irrational. Whilst abandoning treatment and turning to TCAM is the rarest scenario (17%), it is the most dangerous one, particularly in case of life-threatening illnesses. This is why health communication interventions must cut deeper and also address its underlying irrational beliefs: endorsing unfounded extrasensory abilities and dismissing official medicine due to so-called “Big pharma conspiracies”.

Ključne reči: Irrational beliefs, Complementary and alternative medicine, Traditional medicine, Health behaviors

Medical practices outside of conventional medicine can be classified into the broad category of traditional, alternative, and complementary medicine (TCAM). To appeal to people’s biases and play into their irrational beliefs, TCAM practices are often presented so as to appear scientific, for example, through the use of pseudoscientific jargon (e.g. biofeedback or chelation therapy). Their names are strategically crafted to signal that fact – the name should serve as a heuristic of a kind. Drawing from pseudoscientific jargon, we invented five fake medical practices and embedded them in a list of 71 existing TCAM practices. A total of 500 Serbian respondents (73% women, mean age M = 38.59) assessed how familiar they were with all of them. Next, we explored if those who claimed they were familiar with non-existent practices were also (1) more likely to have a positive attitude towards TCAM and use TCAM practices in general and (2) more likely to have the so-called “irrational mindset” (a set of beliefs such as conspiracy mentality, superstition, and biases such as illusory correlation, omission, and naturalness biases). On average, around 22% of people reported having heard of at least one practice that does not exist. Also, the more fake practices participants recognized, the more likely (albeit to a small degree) they were to have a positive attitude towards TCAM (r = .13, p = .003) and to use existing TCAM practices (r = .09, p = .035). Most importantly, the more fake practices they recognized, the more likely they were to hold magical beliefs about health (r = .21, p < .001), and conspiratorial beliefs (r = .14, p = .002), to be susceptible to illusory correlation (r = .11, p = .016), and omission bias (r = .11, p = .010). Once all of these predictors are entered into a regression model, the model significantly predicts familiarity with non-existent practices (F(6, 493) = 4.343, p < .001, R2 = .039), with only magical health beliefs contributing significantly (β = 0.187, p = .004). Our findings suggest that people more prone to non-normative reasoning, with a conspiratorial worldview, and especially those endorsing false beliefs about health tend to rely more on pseudoscientific proxies when navigating the offer of TCAM practices. The fact that they claim having heard about fake practices they have no prior information on, could potentially make them candidates to try different non-evidence-based treatments, thus endangering their health.

Ključne reči: irrational beliefs, complementary and alternative medicine, health behaviors, traditional medicine

Epistemically unfounded beliefs and biases that are not compliant with normative
rationality and are typically resistant to counter-evidence can be labeled jointly under
the term Irrational Mindset. These different aspects of irrational thinking and reasoning
are usually measured separately, in specific domains – for example, research focuses
either on cognitive biases (e.g., belief bias, base rate bias), or on epistemically unfounded beliefs (e.g., superstition, conspiracy mentality). However, research
suggests these beliefs and biases are interrelated, indicating that they might have a
shared root. This shared core of the irrational mindset can, in turn, be traced back to a
common approach to information processing – one that is characterized by more
intuitive and less analytical thinking. In the present study, we explored (1) whether various aspects of the Irrational Mindset converge toward one latent factor and if so, (2) could this Irrational mindset factor further be tracked to a disposition for less reflective and more intuitive thinking. A sample of 224 panelists (54% females, Mean age = 41.5, SD = 12.64) completed an online set of questionnaires and were remunerated for their participation. We collected data on ten irrational mindset variables, including epistemically unfounded beliefs (superstition, conspiracy mentality, medical conspiracy beliefs, magical beliefs about health, doublethink) and cognitive biases (commitment bias, naturalness bias, belief bias, illusory correlation, and probability reasoning biases). We also assessed thinking dispositions: (1) rational and experiential thinking styles, using Rational-Experiental Inventory (REI), and (2) cognitive reflection using Cognitive Reflection Task (CRT). A principal component analysis on the Irrational Mindset variables clearly indicated a single-factor solution, explaining 31.2% of total variance. All Irrational Mindset variables loaded onto this factor, although cognitive biases had somewhat lower loadings (.31 < w< .44) compared to unfounded beliefs (.59 < w < .83). A multiple regression analysis indicated that 20.8% of the Irrational Mindset’s variance could be explained by thinking dispositions (F(3, 223) = 20.50, p < .001). As expected, Irrational Mindset was predicted by lower cognitive reflection (β = -.34, p < .001) and higher experiential thinking style (β = .29, p < .001), while rational thinking style was not a significant predictor (β = .07, p = .31). Despite the fact that these diverse aspects of the irrational mindset differ both in their content and way of measurement, the obtained pattern of results strongly supports the idea of a shared core for different manifestations of irrationality. We discuss the implications of this “irrational core” as well as its importance for various detrimental outcomes, such as, for example, the use of questionable health practices.

Ključne reči: irrational beliefs, cognitive biases, thinking styles, irrational mindset, irrationality

To preserve their health, people are increasingly resorting to traditional, complementary and alternative medicine (TCAM). While its appeal grows, it is still lacking a strong evidence base and can lead to adverse effects. In a previous study in Serbia, we developed a new instrument to measure the lifetime use of diverse TCAM practices (e.g., acupuncture, art therapy, herbal balms, prayer etc.) and explored its psychological antecedents. The results showed that the pattern of use of TCAM practices can be classified into four domains: Alternative medical systems, Natural product-based practices, New-age medicine, and Rituals/Customs. Moreover, an irrational mindset (IM; consisting of irrational beliefs and cognitive biases) contributed to the prediction of TCAM use, over and above socio-demographics, ideological beliefs and self-reported health status. To conceptually replicate the results, we validated the measure in a novel setting (Bosnia and Herzegovina). Participants first reported their lifetime TCAM use (N = 580). Using CFA, we replicated a four-factor structure of TCAM domains (CFI = 0.94; TLI = 0.93; RMSEA = .03 (95% CI .03-.04). Next, for the participants who filled out all measures (N = 470, 65% women; Mage = 44.9, SDage = 10.2), we explored whether IM variables (magical health beliefs, conspiracist thinking, superstition and the naturalness bias) contributed to the prediction of TCAM use. As expected, after controlling for socio-demographics, ideological beliefs, and self-reported health status, IM significantly contributed to the prediction (Fchange(4,457) = 20.33, p < .001, ΔR2 = .127), with magical health beliefs, superstition and naturalness bias contributing over and above other predictors. Magical health beliefs were the strongest predictor, alongside gender. We find that our results largely replicate in a novel setting, offering further evidence of the importance of including IM when considering the susceptibility to TCAM use.

Ključne reči: alternative medicine, irrational beliefs, cognitive biases, magical health beliefs

Traditional, complementary, and alternative medicine (TCAM) refers to healthcare practices that are not a part of conventional health systems. Their use can be subsumed into four domains: Alternative medical systems (e.g., homeopathy), New age practices (e.g., art therapy), Natural product-based practices (e.g., herbal balms), and Rituals/Customs (e.g., prayers for health). These practices can be used in three distinct ways: for preventive purposes, together with official medical practices, or as an alternative to them, with the latter being the most problematic. Psychological roots of the tendency to resort to these practices is repeatedly proved to be an “irrational mindset” (IM), a composite of irrational beliefs and cognitive biases. Here we explored whether IM (Superstition, Magical health beliefs, Conspiracy mentality, and Naturalness bias) can differentiate between different types of TCAM use. To this end, for each of the four domains participants indicated the way they typically use it. We recruited 470 participants from Bosnia and Herzegovina (Mage = 44.9, SDage = 10.2; 65% women). Using Linear discriminant analysis (LDA), we explored the relation between ways of TCAM use and IM.

Since only Natural product-based medicine had frequency of alternative use > 4%, we ran LDA to explore how IM predicts the way of use for this TCAM domain. Discriminant function indicated that IM has a role in predicting the way people use natural product-based medicine (Wilk’s Λ = .96, χ2 (12) = 21.06, R = .20, p = .050), with Superstition and Naturalness bias as the crucial predictors. The obtained function best differentiates the individuals who used natural product-based medicine as an alternative to the conventional treatments from the others. Our results show that people who tend to abandon official medical practices for TCAM are those prone to superstition and searching for naturalness. The official health communication could be tailored to specifically target these beliefs.

Ključne reči: irrational beliefs, preventive TCAM use, alternative TCAM use, health behaviors

Background: When the media does not adhere to reporting guidelines regarding traditional, complementary, and alternative medicine (TM/CAM), this may deceive or mislead consumers about the safety and efficacy of these practices. We analyzed whether Serbian online media adheres to reporting guidelines and described dominant psychological appeals used to promote TM/CAM. Methods: We conducted a content analysis of 182 articles from six news and six magazine websites, published July–December 2021.
Findings: Biologically based treatments – predominantly herbal products – were the most common (205/289 practices). TM/CAM
practices were claimed to improve general health (71/386 claims), as well as to alleviate respiratory problems, boost the immunity, and detox the body. The tone was overwhelmingly positive, with most of the positive articles (145/176) neglecting to disclose the potential harms of TM/CAM. Few articles provided a recommendation to speak with a healthcare provider (24/176). Articles tended to appeal to TM/CAM’s long tradition of use (115/176), naturalness (80/176), and convenience (72/176). They used vague pseudoscientific jargon (105/176) and failed to cite sources for the claims that TM/CAM use is supported by science (39/176).
Discussion: Given that TM/CAM use may lead to harmful outcomes (such as adverse events, avoidance of official treatment or interaction with it), Serbian online media reports on TM/CAM are inadequate to assist consumers’ decision-making. Our findings highlight issues that need to be addressed towards ensuring more critical health reporting, and, ultimately, better informed TM/CAM consumption choices.

While some health practices are supported by science and recommended by authorities, for others scientific evidence-base might be lacking or is yet to be established. Both non-adhering to recommendations and resorting to non evidence-based practices (typically in the domain of traditional, complementary and alternative medicine (TCAM)) can be detrimental for health. We investigated psychological roots of two types of health practices, focusing on  their relationship with an “irrational mindset”, an umbrella term comprising certain cognitive biases, belief in conspiracy theories, superstition and magical health beliefs. In a preregistered study (N = 583) we contrasted how an irrational mindset contributes to the prediction of both types of health practices, above other  relevant factors, such as sociodemographics, ideological beliefs,  health status or relation to the healthcare system. Although the two types of health practices were positively related, they could be traced to different predictors: non-adherence was primarily explained by negative experiences with the health system, whilst irrational mindset did not additionally contribute. In contrast, irrational mindset consistently added to the prediction of different types of TCAM use, with magical health beliefs being the strongest predictor. We highlight the importance of tailoring interventions to the type of health practices so they also target underlying irrational beliefs, on top of providing correct information.

In an effort to preserve their health, people may rely on official medical recommendations, or turn to non-evidence based, pseudoscientific practices (from unproven traditional herbal remedies to alternative medical systems like homeopathy). These pseudoscientific practices (PSP) may be particularly appealing to people with a “high entropy” mindset, i.e. more prone to endorsing irrational beliefs, such as conspiracy theories, superstition or mutually contradictory beliefs (i.e. doublethink). These irrational beliefs may further stem from the lack of trust in the official epistemic authorities, with science being the most prominent one. Drawing from a student sample (N=270), we tested path models in which distrust in science (both general and in specific domains) predicts the use of PSP through the endorsement of irrational beliefs. General distrust in science indirectly affected the use of PSP, through all three types of irrational beliefs. Lack of trust in science of genetically modified foods predicted the use of PSP both directly, and indirectly through all three types of irrational beliefs. Lack of trust in climate science, biotechnology and nuclear energy, on the other hand, did not contribute to the prediction, indicating cultural differences in the scientific content being disputed in the media. Interventions aiming to foster better health decisions should therefore aim to build general trust in science and to challenge specific irrational beliefs.

To understand the reasons behind the trend of growing use of traditional, complementary and alternative (TCAM) practices we should first reflect on how people use them – to prevent disease/promote health, to treat medical conditions by complementing official medical
treatments, or as an alternative to them. A total of N = 583 (M_age = 39.01 years, SD_age = 12.10; 74.4% females) participants from Serbia completed an online survey including a list of 24 TCAM practices, grouped into four domains: Alternative Medical Systems (e.g., acupuncture, homeopathy), Natural product-based practices (e.g., herbal extracts/supplements), New Age medicine (e.g., yoga, mindfulness) and Rituals/Customs (e.g., visiting monasteries for health). Participants who indicated using a certain practice in the past year were asked to consider their most recent experience with that practice and choose only one option for how they used it: for
preventive purposes/advancing health, at the same time with official medicine therapy, instead of official medicine therapy. Participants also provided information on whether a TCAM practitioner was involved in their last use of any of the TCAM practices and how often, in general, they consult TCAM practitioners. Overall, 63%, 95%CI [60, 65] of participants used TCAM practices for preventive purposes, 31% [29, 34] in parallel with, and 6% [5, 8] as an alternative to official treatments. Of the four domains of TCAM use, New Age medicine and
Rituals/Customs were most frequently used for prevention, with 78% [74, 83] and 77% [72, 82], respectively, while Natural product-based practices were used for prevention in 57% [54, 60] and Alternative Medical Systems in 41% [33, 49] of the cases. Alternative use of TCAM
practices was the most common in the case of Alternative Medical Systems (21% [14, 28]), while it amounted to no more than 7% of participants for any of the other domains. For 24% of participants, a TCAM practitioner was present during their last TCAM use, 10% reported a practitioner previously prescribing the practice, while 66% of participants reported no practitioner involvement. The results suggest the importance of treating different domains of TCAM practices separately, as they may have different impacts on people’s health behavior. We especially point to the importance of monitoring adherence to alternative medical systems, as they may potentially distract patients from official therapies and thus further compromise their health.

Ključne reči: alternative medicine, traditional medicine, preventive TCAM use, alternative TCAM use, health behaviors

Despite unknown efficiency, known risks, and associated adverse effects of certain traditional, complementary, and alternative medicine (TCAM) practices, the number of people using them appears to be on the rise. Existing taxonomies of TCAM practices mostly relied on either conceptual reasons, or they relied on attitudes toward TCAM, rather than its actual use. In this study, we sought to group TCAM practices based on their patterns of use. A sample of N = 583 (Mage = 39.01 years, SDage = 12.10; 74.4% females) participants residing in Serbia completed an online survey including a list of 71 TCAM practices. For each practice, they indicated if and when they used it to promote their own or their children’s health (options: never heard about it/never used it/more than a year ago/in the past year/during the past two weeks). To evaluate the lifetime use of TCAM, we binarized all TCAM items to reflect whether participants have ever used a given practice (never using a practice was coded as 0, using it at least once as 1). After excluding items with frequencies below 5%, we performed an exploratory factor analysis on the tetrachoric correlation matrix for the remaining 49 items. Using a minimum residual method of extraction and oblimin rotation, we identified four meaningful factors explaining 42% of total variance: 1) Natural product–based practices (NP) comprising the use of products such as extracts and supplements of herbal and non–herbal origin; 2) Rituals/Customs (RC) which reflected the use of traditional medicine and religious practices, such as visiting monasteries; 3) New age medicine (NA) incorporating mind–body therapies and energy medicine practices; and 4) Alternative medical systems (AMS) such as acupuncture, homeopathy, quantum medicine, and osteopathy/chiropractic. Factor correlations ranged from r = .18, p <.001 for RC and AMS to r = .30, p < .001 for NA and AMS. The latent structure we obtained based on the pattern of TCAM use corresponds closely to existing conceptual typologies, as well as to those based on attitudes toward TCAM. This suggests that consumers are sensitive to common characteristics of certain TCAM treatments and are more likely to resort to similar types of TCAM practices to promote their health. The existence of relatively independent factors of TCAM use opens the possibility of differential patterns of their psychological predictors and health-related outcomes.

Ključne reči: alternative medicine, traditional medicine, TCAM taxonomy, TCAM use, health behaviors

Non-adherence to medical recommendations (NAR) leads to increasing mortality/disease rates and raises the costs of treatments, thus it is a burden on the healthcare system. Typically viewed as harmless, the use of traditional/complementary/alternative medicine (TM/CAM) can lead to adverse health events, but also to avoidance of official treatment or undesirable interaction with it. Thus, there is an increasing call in the medical community to promote evidence-based use of TM/CAM and adherence to official advice; understanding why consumers opt for questionable health practices can contribute to this call. We put forward a comprehensive program to study the psychological roots of these two broad categories of questionable health practices. The program offers a framework for concepts from cognitive, personality, social, and health psychology. We propose that an irrational mindset (a system of irrational thinking and beliefs), rooted in basic psychological dispositions (personality, thinking styles) makes certain consumers susceptible to NAR and TM/CAM practices. We plan to: a. explore the media environment the consumers are exposed to (e.g. predatory practices in advertising TM/CAM), b. identify the large spectrum of NAR and TM/CAM typical for the local cultural context, c. test whether irrational beliefs of very different content really form a mindset (how they are interrelated), d. measure the prevalence of NAR and TM/CAM and relate them to irrational mindset and further to personality traits, and e. test whether the TM/CAM proneness can be affected by manipulating irrational beliefs. The results will be useful to stakeholders in different ways: information on the prevalence of TM/CAM and NAR in Serbia is useful by itself, but identifying their underlying psychological mechanisms will help in understanding the most vulnerable portions of the population. In addition, we will provide useful input for designing interventions that will support consumers in making rational health decisions.

Ključne reči: Health behaviors, Evidence-based health decisions, Adherence to medical recommendations, Traditional/Complementary medicine, Irrational mindset, Individual differences in personality/thinking styles

The main project methodology is planned in five stages that inform one another and cross-validate data from multiple methods. These include:

(1) A study documenting online media coverage of TM/CAM practices in Serbia. This study will use a qualitative methodology and conduct a content analysis of news stories from the five most popular news websites in Serbia, focusing on identifying the types of reported
practices and content of the advice (e.g., whether risks are addressed)

(2) Development of instruments for assessing familiarity and frequency of two types of health behaviors: engagement with different TM/CAM practices, as well as the frequency of NAR. Instrument development will be based on the results of the qualitative study, literature review, and input from medical and CAM practitioners. The instrument will be piloted on a convenience sample

(3) A study tracking the prevalence and the pattern of TM/CAM usage and NAR during 3 weeks on a community sample. This study will consist of a development of a mobile app and battery for experience sampling of TM/CAM and NAR behaviors over 21 days and their relations with personality and cognitive styles in a community sample

(4) Examining the relations between these two types of health behaviors on a general population. This study will explore the relations between TM/CAM, NAR, personality, and cognitive styles in a representative sample in Serbia.

(5) Developing interventions aimed at reducing TM/CAM use and NAR through changing the irrational mindset. This study will be experimental and will examine how inducing or reducing irrational beliefs affects health behaviors, and if certain personality traits and/or thinking styles moderate the outcome of these interventions.

Ključne reči: General population prevalence, Experimental interventions, Content analysis, Experience sampling