How is physicians' implicit prejudice against the obese and mentally ill moderated by specialty and experience?

BACKGROUND: Implicit prejudice can lead to disparities in treatment. The effects of specialty and experience on implicit obesity and mental illness prejudice had not been explored. The main objective was to examine how specializing in psychiatry/general medicine and years of experience moderated implicit obesity and mental illness prejudice among Swiss physicians. Secondary outcomes included examining the malleability of implicit bias via two video interventions and a condition of cognitive load, correlations of implicit bias with responses to a clinical vignette, and correlations with explicit prejudice. METHODS: In stage 1, participants completed an online questionnaire including a clinical vignette. In stage 2, implicit prejudice pre- and post- intervention was tested using a 4 × 4 between-subject design including a control group. In stage 3, explicit prejudice was tested with feeling thermometers and participants were debriefed. Participants were 133 psychiatrists and internists working in Geneva, hospital-based and private practice. Implicit prejudice was assessed using a Weight IAT (Implicit Association Test) and a Mental Illness IAT. Explicit feelings towards the obese and the mentally ill were measured using Feeling Thermometers. A clinical vignette assessed the level of concern felt for a fictional patient under four conditions: control, obese, depression, obese and depression. Linear regression was conducted to test for association of gender, experience, and specialty with responses to vignettes, pre-intervention IATs and explicit attitudes, and to test for association of interventions (or control) with post-intervention IATs and explicit attitudes. Reported effect sizes were computed using Cohen's d. Two-tailed p < 0.05 was selected as the significance threshold. RESULTS: Compared to internists, psychiatrists showed significantly less implicit bias against mentally vs. physically ill people than internists and warmer explicit feelings towards the mentally ill. More experienced physicians displayed warmer explicit feelings towards the mentally ill and a greater level of concern for the fictional patients in the vignette than the less experienced, except when the patient was described as obese. CONCLUSIONS: Specialty moderates both implicit and explicit mental illness prejudice. Experience moderates explicit mental illness bias and concern for patients. The effect of specialty on implicit prejudice seems to be based principally on self-selection.

Automatic integration of social information in emotion recognition.

This study investigated the automaticity of the influence of social inference on emotion recognition. Participants were asked to recognize dynamic facial expressions of emotion (fear or anger in Experiment 1 and blends of fear and surprise or of anger and disgust in Experiment 2) in a target face presented at the center of a screen while a subliminal contextual face appearing in the periphery expressed an emotion (fear or anger) or not (neutral) and either looked at the target face or not. Results of Experiment 1 revealed that recognition of the target emotion of fear was improved when a subliminal angry contextual face gazed toward-rather than away from-the fearful face. We replicated this effect in Experiment 2, in which facial expression blends of fear and surprise were more often and more rapidly categorized as expressing fear when the subliminal contextual face expressed anger and gazed toward-rather than away from-the target face. With the contextual face appearing for 30 ms in total, including only 10 ms of emotion expression, and being immediately masked, our data provide the first evidence that social influence on emotion recognition can occur automatically.

Social appraisal influences recognition of emotions.

The notion of social appraisal emphasizes the importance of a social dimension in appraisal theories of emotion by proposing that the way an individual appraises an event is influenced by the way other individuals appraise and feel about the same event. This study directly tested this proposal by asking participants to recognize dynamic facial expressions of emotion (fear, happiness, or anger in Experiment 1; fear, happiness, anger, or neutral in Experiment 2) in a target face presented at the center of a screen while a contextual face, which appeared simultaneously in the periphery of the screen, expressed an emotion (fear, happiness, anger) or not (neutral) and either looked at the target face or not. We manipulated gaze direction to be able to distinguish between a mere contextual effect (gaze away from both the target face and the participant) and a specific social appraisal effect (gaze toward the target face). Results of both experiments provided evidence for a social appraisal effect in emotion recognition, which differed from the mere effect of contextual information: Whereas facial expressions were identical in both conditions, the direction of the gaze of the contextual face influenced emotion recognition. Social appraisal facilitated the recognition of anger, happiness, and fear when the contextual face expressed the same emotion. This facilitation was stronger than the mere contextual effect. Social appraisal also allowed better recognition of fear when the contextual face expressed anger and better recognition of anger when the contextual face expressed fear.

Psychophysics of emotion: the QUEST for emotional attention.

To investigate the mechanisms involved in automatic processing of facial expressions, we used the QUEST procedure to measure the display durations needed to make a gender decision on emotional faces portraying fearful, happy, or neutral facial expressions. In line with predictions of appraisal theories of emotion, our results showed greater processing priority of emotional stimuli regardless of their valence. Whereas all experimental conditions led to an averaged threshold of about 50 ms, fearful and happy facial expressions led to significantly less variability in the responses than neutral faces. Results suggest that attention may have been automatically drawn by the emotion portrayed by face targets, yielding more informative perceptions and less variable responses. The temporal resolution of the perceptual system (expressed by the thresholds) and the processing priority of the stimuli (expressed by the variability in the responses) may influence subjective and objective measures of awareness, respectively.