Indiana University-Purdue University Indianapolis (IUPUI) / Compared to White and high socioeconomic (SES) patients, Black and low SES patients are less likely to receive adequate pain care, including receiving fewer analgesic medications. Providers may, inadvertently or not, contribute to these disparities in pain care via biased decision-making. Prior work suggests there is a complex relationship in which race and SES uniquely and interactively affect providers’ clinical decisions, but few studies have examined the influence of patient race and SES simultaneously on providers’ pain-related decisions. Furthermore, previous studies suggest that providers’ attitudes about race and SES influence their clinical decisions. The present study examined the influence of patient race and SES and providers’ implicit and explicit attitudes about race and SES on providers' pain-related decisions. Four hundred and seven medical residents and fellows made pain assessment (interference and distress) and treatment (opioids, opioid contracts, and workplace accommodations) decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Subjects completed Implicit Association Tests to assess implicit attitudes and feeling thermometers to assess explicit attitudes about race and SES. Repeated measures ANOVAs indicated that patient race and/or SES had main effects on all pain-related decisions and had interaction effects on providers’ ratings for interference, distress, and workplace accommodations. Providers’ implicit attitudes about race and explicit attitudes about race and SES predicted their pain-related decisions, but these effects were not consistent across all decisions. The current study highlights the need to examine the effects of patient race and SES together, along with providers’ implicit and explicit attitudes, in the context of pain care. Results inform future work that can lead to the development of evidence-based interventions to reduce disparities in pain care.

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Race and social class are inherently confounded in the American society/culture—people stereotypically assume poor Black and rich White when only race is specified. However, much of the social psychological literature focuses on either race or social class during stereotype and attitude assessment. This focus is problematic given that different patterns of responses arise when both categories are specified (e.g., rich Black) rather than when only one of the two categories is reported (e.g., Black). Here I report on two pilot studies and two independent studies to examine the unique and combined effects of race and social class on stereotypes, implicit attitudes, explicit attitudes, and decision-making when stimulus race and/or social class are/is manipulated. In Pilot Study 1, I examined general race only and social class only implicit preferences and found overall pro-White/anti-Black and pro-rich/anti-poor preferences. In Pilot Study 2, I examined implicit associations between race and social class. Results confirmed that participants hold implicit rich-White and/or poor-Black associations. In Study 1a and 1b, I directly examined implicit attitudes, explicit stereotypes, and explicit affective responses when both race and social class are specified. Across all measures, participants had more positive attitudes and stereotypes about rich Blacks than rich Whites, rich Whites than poor Whites, and rich Blacks than poor Blacks. Attitudes and stereotypes about poor Whites compared to poor Blacks were more nuanced and were measure dependent. In Study 2, I investigated how race and social class information influences decision-making in a situation resembling a real world scenario (i.e., academic honor society selection processes). The results of this study suggest that the intersection of race and social class might be nuanced for this type of decision-making task, as only marginally significant effects for race appeared. Participants demonstrated lower criterion for Black than White applicants, suggesting that they are more likely to accept Black than White applicants into the honor society. This effect did not vary by target social class. These findings provide important insight into associations between race and social class, how the intersection of race and social class information affects stereotyping and attitudes, and fluctuations in decision-making when both race and social class of an academic honor society applicant are known. Overall, these results suggest that the intersection of race and social class need to be examined together. / Psychology

As college students are preparing to enter the workforce as professionals, it is important that we examine their explicit and implicit attitudes toward older workers to investigate what organizations can do on behalf of older workers. For instance, organizations may have policies that are giving preferential treatment toward older workers and reinforcing younger workers’ negative attitudes. For the present study, I used a scenario based-procedure in which participants read about an older worker who has been promoted based on an employment policy that favors older workers or the most competent workers. I examined students’ pre- and post explicit and implicit attitudes toward older individuals for each condition. Students in the preferential treatment condition did not have significantly different explicit attitudes from students in the merit condition, thus Hypothesis 1 was supported. Aside from treatment, students’ post implicit attitudes significantly decreased (i.e., were less negative) from students’ pre-implicit attitudes. Therefore, Hypothesis 2 was partially supported. In addition, students in the preferential treatment condition exhibited only negative emotions toward the older worker and not harmful behaviors. Therefore, Hypothesis 3 was partially supported. Finally, there was no impact of preferential treatment toward older workers on students’ aging anxiety. Implications of these findings with regard to both implicit and explicit attitudes toward older workers are discussed.

Anorexia nervosa (AN) is a serious disorder with long-term consequences for those afflicted. No evidence-based care is available for adults with full or subthreshold AN. The thesis research investigated aspects of emotion and cognition relevant to the maintenance of AN that might inform psychological treatment. In addition, the effectiveness of a recent psychotherapy model of AN was investigated. Study I investigated alexithymia and emotional awareness and their associations with depression, anxiety, and perfectionism among patients with AN compared with a control group. The AN group exhibited the same level of emotional awareness as did the control group and the same level of alexithymia when controlling for depression and anxiety. Alexithymia and emotional awareness were not associated, despite representing an overlapping construct. The results of the present study indicate that those with AN can trust their emotional awareness. Study II explored implicit pro-thin and anti-fat attitudes (towards the self and others), striving for thinness (loosely corresponding to positive reinforcement), and avoidance of fatness (loosely corresponding to negative reinforcement). The AN and the control groups were found to have equally strong implicit pro-thin and striving for thinness attitudes. The AN group exhibited stronger implicit anti-fat and avoidance of fatness attitudes (loosely corresponding to negative reinforcement) than did the control group. There was no association between implicit and explicit measures. The results are in line with the over-evaluation of weight and shape as a core feature of eating disorders. Study III compared the effectiveness of Acceptance and Commitment Therapy (ACT) and treatment as usual (TAU) for adults with AN after day-care. Follow-up measures indicated no difference in improvement or deterioration between the two groups. The level of perfectionism was reduced in the ACT group relative to the TAU group. The study was compromised by a lower inflow of patients than anticipated and by a high drop-out rate, and thus fails to provide evidence of a difference between the two groups. The present thesis demonstrates that emotional awareness is intact in those with AN and that implicit attitudes concerning weight and shape reflect the explicit attitudes, although without association. The treatment study indicates that, when designing treatment, it is important to consider the ambivalence to treatment among those suffering from AN, which is reflected in the high drop-out rate in the present study.

Cette thèse porte sur l’influence du parrainage dans le sport et de la consommation d’alcool dans les films sur les attitudes implicites vis-à-vis de l’alcool. Peu de recherches portent sur les mécanismes psychologiques permettant d’expliquer l’influence de l’exposition à de la publicité pour de l’alcool sur les comportements de consommation à long terme. L’hypothèse générale soutenue dans cette thèse est qu’un processus de conditionnement évaluatif par fausse attribution affective médiatise l’effet de l’exposition à des stimuli en lien avec l’alcool sur les attitudes implicites vis-à-vis de l’alcool. L’effet de deux autres processus automatiques (i.e. effet de simple exposition, association avec le soi) sont également étudiés. Deux études (1 et 2) ont d’abord été menées afin de mettre en place une induction permettant (i) d’inhiber les processus contrôlés et (ii) de maximiser la fausse attribution affective par inhibition du contrôle attentionnel dans un paradigme de conditionnement évaluatif. Trois études sur le parrainage ont ensuite été menées dans lesquels nous observé un effet de l’exposition au parrainage sur les attitudes implicites (études 3 et 5). L’effet de l’exposition au parrainage peut être expliqué par un effet de simple exposition aux marques (étude 5), cependant, nos données ne nous permettent pas de conclure à un effet de conditionnement évaluatif (étude 4). Deux études sur la représentation de la consommation d’alcool dans les films et les séries télévisées ont permis de mettre en évidence un effet de conditionnement évaluatif indépendant de l’association avec le soi (étude 6), et que cet effet de conditionnement dépendait de processus contrôlés (étude 7). Dans l’ensemble, l’influence du parrainage sur les attitudes implicites semble s’exercer par un effet de simple exposition, tandis que l’influence de la représentation de l’alcool dans les films et séries télévisées semble davantage s’exercer par conditionnement évaluatif et association du concept d’alcool avec le soi. / This thesis focuses on the influence of alcohol sport sponsorship and alcohol consumption in movies on implicit attitudes towards alcohol. Few researches have focused on the mediating psychological mechanisms between exposure to alcohol promotion in media and long-term consumption. Our hypothesis is that evaluative conditioning through affect misattribution mediatizes the effect of exposure to alcohol stimuli on implicit attitudes toward alcohol. The effect of two other automatic processes (i.e. mere exposure effect, association with the self) are also studied. Two studies (1 and 2) were led to test an induction that (i) impairs controlled processes and (ii) maximizes affect misattribution by inhibiting attentional control in an evaluative condition paradigm. Three studies on alcohol sponsorship were then led in which we found a main effect of on implicit attitudes (studies 3 and 5). A mere exposure effect was observed in the study 5, but we found no convincing evidence for evaluative conditioning (study 4). However, we found an evaluative conditioning effect in two studies on alcohol consumption in movies and TV shows which was shown to be independent from association with the self (study 6), as well as relying on controlled processes (study 7). Overall, sponsorship effects on implicit attitudes seems to occur via a mere exposure effect, while alcohol portrayals in movies seems to impact implicit attitudes toward alcohol through evaluative conditioning and association of alcohol with the self.

abstract: While acceptance towards same-sex marriage is gradually increasing, same-sex marriage is banned in many states within the United States. Laws that prohibit same-sex couples from marrying have been shown to increase feelings of depression, exclusion, and stigma for same-sex attracted individuals. The intention of this study was to explore the effect both pro- and anti-same-sex marriage advertisements have on heterosexual individuals' implicit attitudes towards same-sex couples. It was predicted that exposure to anti-same-sex advertisements would lead to viewing same-sex couples as more unpleasant and heterosexual couples as being more pleasant. However, heterosexual participants who viewed anti-same-sex marriage ads were more likely to rate heterosexual couples as being unpleasant and same-sex couples as pleasant. It is theorized that viewing anti-same-sex marriage advertisements led heterosexual individuals to report heterosexual stimuli as being more unpleasant compared to same-sex stimuli as a form of defensive processing. / Dissertation/Thesis / M.S. Psychology 2013

Are implicit biases something we can rightly be held responsible for, and if so, how? A variety of social and cognitive psychological studies have documented the existence of wide-ranging implicit biases for over 30 years. These implicit biases can best be described as negative mental attitudes that operate immediately and unconsciously in response to specific stimuli. The first chapter of this thesis surveys the psychological literature, as well as presents findings of real-world experiments into racial biases. I then present the dominant model of implicit attitudes as mere associations, followed by evidence that at least some implicit attitudes take on a propositional form and involve making inferences based on evidence. I then reject adopting either of these two rigid models in favor of a dispositional approach that treats implicit biases as on the same spectrum of, but adjacent to, beliefs. I then evaluate the moral wrongdoing associated with holding explicitly prejudicial beliefs, appealing first to Kantian notions of respecting individuals as agents, then appealing to Strawson’s argument that we are responsible for expressions of our will. Our status as human agents involves participating in complex and sustained interactions with others, which necessarily implies that we take part in the social practice of holding each other responsible for the quality of their will. The reactive attitudes we display in our everyday interactions indicate which features and circumstances are most important when investigating this practice. After applying this approach to implicit attitudes, I then pose the objection that their unconscious and unendorsed nature disqualifies implicit attitudes as proper expressions of our will. I develop this objection using Scanlon’s account of moral responsibility, which requires the capacity to self-govern in light of principles that are generally agreed upon as good reasons for guiding interactions with one another. Finally, I critique Real Self theories that seek to arbitrarily privilege one part of ourselves in favor of the Whole Self, which privileges those features that are most integrated into our overall character.