William M. P. Klein

Resistance of personal risk perceptions to debiasing interventions.

The tendency to believe that ones own risk is less than that of others may reduce interest in health-protective behaviors. This article describes 4 attempts to reduce such optimistic biases. In Study 1, New Jersey residents (N = 222) were provided with lists of risk factors for several health problems. This manipulation was strengthened in Study 2 by presenting risk factors in such a way that participants (164 undergraduates) might see their own standing as inferior to that of others. In Study 3, risk factors were presented one at a time, and participants (190 undergraduates) incorporated them into a mental image of a high-risk individual. Finally, 374 undergraduates in Study 4 generated lists of personal attributes that they believed increased their risk. Optimistic biases were found in each study, but none of the manipulations reduced these biases consistently. In contrast, conditions using opposite manipulations often exacerbated the biases.

Experimental manipulations of self-affirmation: A systematic review

The objective of this systematic review of studies using self-affirmation manipulations was to identify research gaps and provide information to guide future research. We describe study characteristics, categories of manipulations, and report effects on various dependent variables. Our search strategies yielded 47 eligible articles (69 studies). Manipulations varied by affirmation domain (values or personal characteristics), attainment (participant- or investigator-identified), and procedure (scale, essay, feedback, etc.). Most dependent variables were cognitive. Strong effects of self-affirmation were found for attitudes and persuasion/bias, but future work is needed for variables with mixed results including risk cognitions, intentions, and behavior. Suggestions and considerations for future research involving self-affirmation manipulations are discussed.

Objective standards are not enough : Affective, self-evaluative, and behavioral responses to social comparison information

Three studies examined affective, self-evaluative, and behavioral responses to objective and social comparison information. In the first study, 437 male and female college undergraduates imagined they had a 30% or 60% risk of experiencing a negative event and that the average persons risk was higher or lower. All types of responses were sensitive to relative but not absolute risk. In the second study, 60 male and female college undergraduates learned that they scored 40% or 60% on a task and that this score was above or below average. Subsequent behaviors whose outcomes depended largely on objective ability still reflected attention to relative standing. This effect of comparative feedback was shown to be mediated by changes in self-evaluation. A third, follow-up study demonstrated that attention to comparative feedback (in the context of objective information) hinges on its desirability. Implications for social comparison theory are discussed.

Varieties of uncertainty in health care: a conceptual taxonomy.

Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given the growing emphasis on evidence-based medicine, shared decision making, and patient-centered care. However, our understanding of this problem is limited, in part because of the absence of a unified, coherent concept of uncertainty. There are multiple meanings and varieties of uncertainty in health care that are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action. The literature on uncertainty in health care is thus fragmented, and existing insights have been incompletely translated to clinical practice. This article addresses this problem by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology and developing a new integrative conceptual taxonomy of uncertainty. A 3-dimensional taxonomy is proposed that characterizes uncertainty in health care according to its fundamental sources, issues, and locus. It is shown how this new taxonomy facilitates an organized approach to the problem of uncertainty in health care by clarifying its nature and prognosis and suggesting appropriate strategies for its analysis and management.

Dispositional, Unrealistic, and Comparative Optimism: Differential Relations with the Knowledge and Processing of Risk Information and Beliefs about Personal Risk

This study examined the relationship of dispositional, unrealistic, and comparative optimism to each other and to personal risk beliefs, actual risk, and the knowledge and processing of risk information. The study included 146 middle-age adults who reported heart attack-related knowledge, beliefs, and behaviors and read an essay about heart attack risk factors. Dispositional optimism was correlated with comparative optimism (perception of low risk relative to peers) but not with a variable assessing accuracy of participants’ comparative risk estimates (unrealistic optimism). Individuals high in dispositional optimism and comparative optimism possessed an adaptive risk and belief profile and knew more about heart attacks, whereas unrealistically optimistic individuals exhibited the opposite pattern and also learned relatively less of the essay material. Evidently, perceptions of low comparative risk are relatively accurate, dispositional optimism is associated in an adaptive way with information processing, and unrealistic optimism may be associated with processing deficits and defensiveness, as well as higher risk.

Handbook of Imagination and Mental Simulation

Over the past thirty years, and particularly within the last ten years, researchers in the areas of social psychology, cognitive psychology, clinical psychology, and neuroscience have been examining fascinating questions regarding the nature of imagination and mental simulation - the imagination and generation of alternative realities. Some of these researchers have focused on the specific processes that occur in the brain when an individual is mentally simulating an action or forming a mental image, whereas others have focused on the consequences of mental simulation processes for affect, cognition, motivation, and behavior.This handbook provides a novel and stimulating integration of work on imagination and mental simulation from a variety of perspectives. It is the first broad-based volume to integrate specific sub-areas such as mental imagery, imagination, thought flow, narrative transportation, fantasizing, and counterfactual thinking, which have, until now, been treated by researchers as disparate and orthogonal lines of inquiry. As such, the volume enlightens psychologists to the notion that a wide-range of mental simulation phenomena may actually share a commonality of underlying processes.

The State of Research on Racial/Ethnic Discrimination in The Receipt of Health Care

OBJECTIVES We conducted a review to examine current literature on the effects of interpersonal and institutional racism and discrimination occurring within health care settings on the health care received by racial/ethnic minority patients. METHODS We searched the PsychNet, PubMed, and Scopus databases for articles on US populations published between January 1, 2008 and November 1, 2011. We used various combinations of the following search terms: discrimination, perceived discrimination, race, ethnicity, racism, institutional racism, stereotype, prejudice or bias, and health or health care. Fifty-eight articles were reviewed. RESULTS Patient perception of discriminatory treatment and implicit provider biases were the most frequently examined topics in health care settings. Few studies examined the overall prevalence of racial/ethnic discrimination and none examined temporal trends. In general, measures used were insufficient for examining the impact of interpersonal discrimination or institutional racism within health care settings on racial/ethnic disparities in health care. CONCLUSIONS Better instrumentation, innovative methodology, and strategies are needed for identifying and tracking racial/ethnic discrimination in health care settings.

Unrealistic Optimism in Smokers: Implications for Smoking Myth Endorsement and Self-Protective Motivation

Although some optimists may be accurate in their positive beliefs about the future, others may be unrealistic—their optimism is misplaced. Research shows that some smokers exhibit unrealistic optimism by underestimating their relative chances of experiencing disease. An important question is whether such unrealistic optimism is associated with risk-related attitudes and behavior.We addressed this question by investigating if ones perceived risk of developing lung cancer, over and above ones objective risk, predicted acceptance of myths and other beliefs about smoking. Hierarchical regressions showed that those individuals who were unrealistically optimistic (i.e., whose perceived risk was less than their objective risk) were more likely to endorse beliefs that there is no risk of lung cancer if one only smokes for a few years and that getting lung cancer depends on ones genes. Unrealistic optimists were also more likely to believe that a greater number of lung cancer patients are cured, but they were less likely to identify smoking cessation/avoidance as a way to reduce cancer risk. Most importantly, unrealistic optimists were less likely to plan on quitting smoking. Taken together, these data suggest that in the smoking arena, unrealistic optimism is a potentially costly cognitive strategy.

Perceived Ambiguity About Cancer Prevention Recommendations: Relationship to Perceptions of Cancer Preventability, Risk, and Worry

In this study, we apply the concept of “ambiguity,” as developed in the decision theory literature, to an analysis of potential psychological consequences of uncertainty about cancer prevention recommendations. We used Health Information National Trends Survey (HINTS) 2003 data to examine how perceived ambiguity about cancer prevention recommendations relates to three other cognitive variables known to influence cancer-protective behavior: perceived cancer preventability, perceived cancer risk, and cancer-related worry. Using logistic regression analyses, we tested several predictions derived from a review of literature on the effects of ambiguity perceptions on decision making, cognitions, and emotions. We found perceived ambiguity to have a strong negative relationship with perceived cancer preventability, consistent with “ambiguity aversion”—a pessimistic bias in the interpretation of ambiguity. Cancer worry moderated this relationship; ambiguity aversion increased with higher levels of worry. At the same time, perceived ambiguity was positively related to both perceived cancer risk and cancer worry. Furthermore, perceived risk partially mediated the relationship between perceived ambiguity and worry. These findings suggest that perceived ambiguity about cancer prevention recommendations may have broad and important effects on other health cognitions. We discuss ethical implications of these findings for health communication efforts, and propose a tentative causal model to guide future research.

Risk involvement and risk perception among adolescents and young adults

Adolescents as a group know about the connections between many risky behaviors and negative outcomes. However, it is unclear whether adolescents who engage in risky behavior differ in risk perceptions from those who do not. We proposed that risk differences between risk-involved and risk-uninvolved adolescents depend on how risk questions are framed. High school and college students estimated their risk of smoking and unprotected sex by replying to four different questions. The results revealed that, for both high school and college students, smokers saw their outcome risk (risk of negative outcomes) as higher than that of nonsmokers. A similar finding was obtained for sexual behavior, though only for high school students. No significant differences between risk groups were obtained when risk was measured by asking about behavior risk (general riskiness of the behavior). Overall, the data suggest that adolescents engaged in risky behavior do not have a complete appreciation of their exposure to harm. Programs intended to prevent or reduce risky behavior need to take a multifaceted approach to persuasion about risk.