Dana R. Carney

Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients

ContextStudies documenting racial/ethnic disparities in health care frequently implicate physicians’ unconscious biases. No study to date has measured physicians’ unconscious racial bias to test whether this predicts physicians’ clinical decisions.ObjectiveTo test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes.Design, Setting, and ParticipantsAn internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient.Main Outcome MeasuresIAT scores (normal continuous variable) measuring physicians’ implicit race preference and perceptions of cooperativeness. Physicians’ attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians’ explicit racial biases by questionnaire.ResultsPhysicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians’ prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009).ConclusionsThis study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.

Power Posing Brief Nonverbal Displays Affect Neuroendocrine Levels and Risk Tolerance

Humans and other animals express power through open, expansive postures, and they express powerlessness through closed, contractive postures. But can these postures actually cause power? The results of this study confirmed our prediction that posing in high-power nonverbal displays (as opposed to low-power nonverbal displays) would cause neuroendocrine and behavioral changes for both male and female participants: High-power posers experienced elevations in testosterone, decreases in cortisol, and increased feelings of power and tolerance for risk; low-power posers exhibited the opposite pattern. In short, posing in displays of power caused advantaged and adaptive psychological, physiological, and behavioral changes, and these findings suggest that embodiment extends beyond mere thinking and feeling, to physiology and subsequent behavioral choices. That a person can, by assuming two simple 1-min poses, embody power and instantly become more powerful has real-world, actionable implications.

Combining Explicit and Implicit Measures of Racial Discrimination in Health Research

OBJECTIVES To improve measurement of discrimination for health research, we sought to address the concern that explicit self-reports of racial discrimination may not capture unconscious cognition. METHODS We used 2 assessment tools in our Web-based study: a new application of the Implicit Association Test, a computer-based reaction-time test that measures the strength of association between an individuals self or group and being a victim or perpetrator of racial discrimination, and a validated explicit self-report measure of racial discrimination. RESULTS Among the 442 US-born non-Hispanic Black participants, the explicit and implicit measures, as hypothesized, were weakly correlated and tended to be independently associated with risk of hypertension among persons with less than a college degree. Adjustments for both measures eliminated the significantly greater risk for Blacks than for Whites (odds ratio = 1.4), reducing it to 1.1 (95% confidence interval = 0.7, 1.7). CONCLUSIONS Our results suggest that the scientific rigor of research on racism and health will be improved by investigating how both unconscious and conscious mental awareness of having experienced discrimination matter for somatic and mental health.

The Ergonomics of Dishonesty The Effect of Incidental Posture on Stealing, Cheating, and Traffic Violations

Research in environmental sciences has found that the ergonomic design of human-made environments influences thought, feeling, and action. In the research reported here, we examined the impact of physical environments on dishonest behavior. In four studies, we tested whether certain bodily configurations—or postures—incidentally imposed by the environment led to increases in dishonest behavior. The first three experiments showed that individuals who assumed expansive postures (either consciously or inadvertently) were more likely to steal money, cheat on a test, and commit traffic violations in a driving simulation. Results suggested that participants’ self-reported sense of power mediated the link between postural expansiveness and dishonesty. Study 4 revealed that automobiles with more expansive driver’s seats were more likely to be illegally parked on New York City streets. Taken together, the results suggest that, first, environments that expand the body can inadvertently lead people to feel more powerful, and second, these feelings of power can cause dishonest behavior.

Review and Summary of Research on the Embodied Effects of Expansive (vs. Contractive) Nonverbal Displays

In 2010, we published an article in which two experiments demonstrated that expansive (vs. contractive) nonverbal displays produced subjective feelings of power and increased risk tolerance (Carney, Cuddy, & Yap, 2010). One of these experiments demonstrated that such displays increased subjective feelings of power, risk tolerance, and testosterone, and decreased cortisol. Our two experiments were the eighth and ninth to be reported in the literature on the embodied effects of nonverbal expansiveness—seven experiments on this topic were published prior to 2010. Since our article in 2010, 24 additional experiments on the effects of expansive postures have been published (see Table 1). Embodiment and the long-standing discussion of mind-body connection has its experimental roots in William James’s (1890/1950) theories of emotion and ideomotor action. Since then, many studies have demonstrated the bidirectional link between nonverbal behavior and human thought and feeling (see Laird & Lacasse, 2014). One such study was conducted by Ranehill et al. (2015), who reported a conceptual replication of one of our experiments: They found an effect of expansive posture on subjective feelings of power, but no effect of posture on risk tolerance, testosterone, or cortisol. We offer four comments that we hope elucidate the similarities and differences among the 33 published experiments (harvested from the literature through extensive keyword searches and cross-referencing of published articles) and the newly published research of Ranehill et al. We also highlight the specific differences between our experiment and that of Ranehill et al. Unpublished findings were excluded in Table 1. Ranehill et al.’s commentary, with the review presented here, serves as an excellent springboard for identifying potential moderators of the psychological effects of nonverbally expansive (vs. contractive) posture. Thirty-Three Published Results on Expansive Posture

Exposing Racial Discrimination: Implicit & Explicit Measures–The My Body, My Story Study of 1005 US-Born Black & White Community Health Center Members

Background To date, research on racial discrimination and health typically has employed explicit self-report measures, despite their potentially being affected by what people are able and willing to say. We accordingly employed an Implicit Association Test (IAT) for racial discrimination, first developed and used in two recent published studies, and measured associations of the explicit and implicit discrimination measures with each other, socioeconomic and psychosocial variables, and smoking. Methodology/Principal Findings Among the 504 black and 501 white US-born participants, age 35–64, randomly recruited in 2008–2010 from 4 community health centers in Boston, MA, black participants were over 1.5 times more likely (p<0.05) to be worse off economically (e.g., for poverty and low education) and have higher social desirability scores (43.8 vs. 28.2); their explicit discrimination exposure was also 2.5 to 3.7 times higher (p<0.05) depending on the measure used, with over 60% reporting exposure in 3 or more domains and within the last year. Higher IAT scores for target vs. perpetrator of discrimination occurred for the black versus white participants: for “black person vs. white person”: 0.26 vs. 0.13; and for “me vs. them”: 0.24 vs. 0.19. In both groups, only low non-significant correlations existed between the implicit and explicit discrimination measures; social desirability was significantly associated with the explicit but not implicit measures. Although neither the explicit nor implicit discrimination measures were associated with odds of being a current smoker, the excess risk for black participants (controlling for age and gender) rose in models that also controlled for the racial discrimination and psychosocial variables; additional control for socioeconomic position sharply reduced and rendered the association null. Conclusions Implicit and explicit measures of racial discrimination are not equivalent and both warrant use in research on racial discrimination and health, along with data on socioeconomic position and social desirability.

Some Evidence for Unconscious Lie Detection

To maximize survival and reproductive success, primates evolved the tendency to tell lies and the ability to accurately detect them. Despite the obvious advantage of detecting lies accurately, conscious judgments of veracity are only slightly more accurate than chance. However, findings in forensic psychology, neuroscience, and primatology suggest that lies can be accurately detected when less-conscious mental processes (as opposed to more-conscious mental processes) are used. We predicted that observing someone tell a lie would automatically activate cognitive concepts associated with deception, and observing someone tell the truth would activate concepts associated with truth. In two experiments, we demonstrated that indirect measures of deception detection are significantly more accurate than direct measures. These findings provide a new lens through which to reconsider old questions and approach new investigations of human lie detection.

Testosterone’s negative relationship with empathic accuracy and perceived leadership ability.

Two studies examine the relationship between naturally occurring levels of circulating testosterone and empathic accuracy. In Study 1, the authors find that higher endogenous levels of testosterone are negatively related to the accuracy with which people infer the thoughts and feelings of others. In Study 2, the authors use 360 data collected in the field to show that individuals with higher levels of endogenous testosterone are evaluated by their real-world professional colleagues as functioning with lower levels of empathic accuracy. Furthermore, the authors report evidence that this negative relationship between testosterone and perceived empathic accuracy has downstream consequences for perceptions of one’s leadership skills and abilities.

First Is Best

We experience the world serially rather than simultaneously. A century of research on human and nonhuman animals has suggested that the first experience in a series of two or more is cognitively privileged. We report three experiments designed to test the effect of first position on implicit preference and choice using targets that range from individual humans and social groups to consumer goods. Experiment 1 demonstrated an implicit preference to buy goods from the first salesperson encountered and to join teams encountered first, even when the difference in encounter is mere seconds. In Experiment 2 the first of two consumer items presented in quick succession was more likely to be chosen. In Experiment 3 an alternative hypothesis that first position merely accentuates the valence of options was ruled out by demonstrating that first position enhances preference for the first even when it is evaluatively negative in meaning (a criminal). Together, these experiments demonstrate a “first is best” effect and we offer possible interpretations based on evolutionary mechanisms of this “bound” on rational behavior and suggest that automaticity of judgment may be a helpful principle in clarifying previous inconsistencies in the empirical record on the effects of order on preference and choice.

Even in Modern Media, the Picture is Still the Same: A Content Analysis of Clipart Images

Both psychological theory and empirical research have consistently indicated that human beings use media images to form cognitive schemas, and that these schemas can then have an effect on perceptions of ability and performance. Gender and ethnic biases are well documented in common media, such as television and picture books. This study examined images of human beings in two popular computer clipart packages, Microsoft Office 97 and Print Shop Ensemble III, to investigate whether this new medium would embody modern, egalitarian goals for gender and racial equality or would depict more traditional and differentiated views. As hypothesized, computer clipart was similar to other media, depicting Caucasian males more frequently and in more active/nonnurturant and desirable roles than any other group. Findings suggest that individuals using these programs to make business and educational materials more interesting and engaging may inadvertently activate maladaptive cognitive schemas.