Diagnostic uncertainty in patients, parents, and physicians: a compensatory control theory perspective.

Medical diagnoses offer a structure by which psychological uncertainty can be attenuated, allowing patients to diminish psychological threats and focus on health prognosis. Yet when no diagnosis can be made, patients may experience diagnostic uncertainty - perceiving the medical field as unable to provide an accurate explanation of the cause of their health problems. This review examines the psychological threat that diagnostic uncertainty imposes on individuals' need for control and understanding, and the resulting consequences experienced by patients, parents of pediatric patients, and physicians. Using compensatory control theory as a framework, we propose a taxonomy of behaviors that people may adopt in order to regain control in the face of diagnostic uncertainty and to reaffirm that the world is not random and chaotic. To manage diagnostic uncertainty, people may bolster their personal agency, affiliate with external systems they see as acting in their interest, affirm clear connections between behaviors and outcomes, and affirm nonspecific epistemic structure. Diagnostic uncertainty is approached from the perspectives of patients, parents of pediatric patients, and physicians, demonstrating how each group responds in order to maintain a sense that the world has structure and is not random. Discussion centers on moderators, limitations, and implications for clinical practice.

Individual costs and community benefits: Collectivism and individuals' compliance with public health interventions.

Differences in national responses to COVID-19 have been associated with the cultural value of collectivism. The present research builds on these findings by examining the relationship between collectivism at the individual level and adherence to public health recommendations to combat COVID-19 during the pre-vaccination stage of the pandemic, and examines different characteristics of collectivism (i.e., concern for community, trust in institutions, perceived social norms) as potential psychological mechanisms that could explain greater compliance. A study with a cross-section of American participants (N = 530) examined the relationship between collectivism and opting-in to digital contact tracing (DCT) and wearing face coverings in the general population. More collectivistic individuals were more likely to comply with public health interventions than less collectivistic individuals. While collectivism was positively associated with the three potential psychological mechanisms, only perceived social norms about the proportion of people performing the public health interventions explained the relationship between collectivism and compliance with both public health interventions. This research identifies specific pathways by which collectivism can lead to compliance with community-benefiting public health behaviors to combat contagious diseases and highlights the role of cultural orientation in shaping individuals' decisions that involve a tension between individual cost and community benefit.

Social norms explain prioritization of climate policy.

Most people in the United States recognize the reality of climate change and are concerned about its consequences, yet climate change is a low priority relative to other policy issues. Recognizing that belief in climate change does not necessarily translate to prioritizing climate policy, we examine psychological factors that may boost or inhibit prioritization. We hypothesized that perceived social norms from people's own political party influence their climate policy prioritization beyond their personal belief in climate change. In Study 1, a large, diverse sample of Democratic and Republican participants (N = 887) reported their prioritization of climate policy relative to other issues. Participants' perceptions of their political ingroup's social norms about climate policy prioritization were the strongest predictor of personal climate policy prioritization-stronger even than participants' belief in climate change, political orientation, environmental identity, and environmental values. Perceptions of political outgroup norms did not predict prioritization. In Study 2 (N = 217), we experimentally manipulated Democratic and Republican descriptive norms of climate policy prioritization. Participants' prioritization of climate policy was highest when both the political ingroup and the outgroup prioritized climate policy. Ingroup norms had a strong influence on personal policy prioritization whereas outgroup norms did not. These findings demonstrate that, beyond personal beliefs and other individual differences, ingroup social norms shape the public's prioritization of climate change as a policy issue. Supplementary Information: The online version contains supplementary material available at 10.1007/s10584-022-03396-x.

Politicians polarize and experts depolarize public support for COVID-19 management policies across countries.

Political polarization impeded public support for policies to reduce the spread of COVID-19, much as polarization hinders responses to other contemporary challenges. Unlike previous theory and research that focused on the United States, the present research examined the effects of political elite cues and affective polarization on support for policies to manage the COVID-19 pandemic in seven countries (n = 12,955): Brazil, Israel, Italy, South Korea, Sweden, the United Kingdom, and the United States. Across countries, cues from political elites polarized public attitudes toward COVID-19 policies. Liberal and conservative respondents supported policies proposed by ingroup politicians and parties more than the same policies from outgroup politicians and parties. Respondents disliked, distrusted, and felt cold toward outgroup political elites, whereas they liked, trusted, and felt warm toward both ingroup political elites and nonpartisan experts. This affective polarization was correlated with policy support. These findings imply that policies from bipartisan coalitions and nonpartisan experts would be less polarizing, enjoying broader public support. Indeed, across countries, policies from bipartisan coalitions and experts were more widely supported. A follow-up experiment replicated these findings among US respondents considering international vaccine distribution policies. The polarizing effects of partisan elites and affective polarization emerged across nations that vary in cultures, ideologies, and political systems. Contrary to some propositions, the United States was not exceptionally polarized. Rather, these results suggest that polarizing processes emerged simply from categorizing people into political ingroups and outgroups. Political elites drive polarization globally, but nonpartisan experts can help resolve the conflicts that arise from it.

Beliefs and Social Norms as Precursors of Environmental Support: The Joint Influence of Collectivism and Socioeconomic Status.

The present research investigates how the cultural value of collectivism interacts with socioeconomic status (SES) to influence the basis of action. Using a U.S. national sample (N = 2,538), the research examines how these sociocultural factors jointly moderate the strength of two precursors of environmental support: beliefs about climate change and perceived descriptive norms. SES and collectivism interacted with climate change beliefs such that beliefs predicted environmental support (i.e., proenvironmental behaviors and policy support) more strongly for those who were high in SES and low in collectivism than for all other groups. This interaction was explained, in part, by sense of control. For descriptive norms, SES and collectivism did not interact but rather norms predicted action most strongly for those high in collectivism and high in SES. These findings demonstrate the theoretical and applied importance of examining multiple sociocultural characteristics together to understand the factors that drive action.

Psychology and the Threat of Contagion: Feeling Vulnerable to a Disease Moderates the Link Between Xenophobic Thoughts and Support for Ingroup-Protective Actions.

The widespread threat of contagious disease disrupts not only everyday life but also psychological experience. Building on findings regarding xenophobic responses to contagious diseases, this research investigates how perceived vulnerability to a disease moderates the psychological link between people's xenophobic thoughts and support for ingroup-protective actions. Three datasets collected during the time of Ebola (N = 867) and COVID-19 (Ns = 992 and 926) measured perceived disease risk, group-serving biases (i.e., xenophobic thoughts), and support for restrictive travel policies (i.e., ingroup-protective actions). Using correlational and quasi-experimental analyses, results indicated that for people who perceive greater disease risk, the association between group-serving bias and restrictive policy support is weakened. This weakened association occurred because people who felt more vulnerable to these diseases increased support for ingroup-protective actions more strongly than xenophobic thoughts. This research underscores the importance of understanding the impact of threats on psychological processes beyond the impact on psychological outcomes.

Structured reflection increases intentions to reduce other people's health risks during COVID-19.

People believe they should consider how their behavior might negatively impact other people, Yet their behavior often increases others' health risks. This creates challenges for managing public health crises like the COVID-19 pandemic. We examined a procedure wherein people reflect on their personal criteria regarding how their behavior impacts others' health risks. We expected structured reflection to increase people's intentions and decisions to reduce others' health risks. Structured reflection increases attention to others' health risks and the correspondence between people's personal criteria and behavioral intentions. In four experiments during COVID-19, people (N  = 12,995) reported their personal criteria about how much specific attributes, including the impact on others' health risks, should influence their behavior. Compared with control conditions, people who engaged in structured reflection reported greater intentions to reduce business capacity (experiment 1) and avoid large social gatherings (experiments 2 and 3). They also donated more to provide vaccines to refugees (experiment 4). These effects emerged across seven countries that varied in collectivism and COVID-19 case rates (experiments 1 and 2). Structured reflection was distinct from instructions to carefully deliberate (experiment 3). Structured reflection increased the correlation between personal criteria and behavioral intentions (experiments 1 and 3). And structured reflection increased donations more among people who scored lower in cognitive reflection compared with those who scored higher in cognitive reflection (experiment 4). These findings suggest that structured reflection can effectively increase behaviors to reduce public health risks.

When election expectations fail: Polarized perceptions of election legitimacy increase with accumulating evidence of election outcomes and with polarized media.

The present study, conducted immediately after the 2020 presidential election in the United States, examined whether Democrats' and Republicans' polarized assessments of election legitimacy increased over time. In a naturalistic survey experiment, people (N = 1,236) were randomly surveyed either during the week following Election Day, with votes cast but the outcome unknown, or during the following week, after President Joseph Biden was widely declared the winner. The design unconfounded the election outcome announcement from the vote itself, allowing more precise testing of predictions derived from cognitive dissonance theory. As predicted, perceived election legitimacy increased among Democrats, from the first to the second week following Election Day, as their expected Biden win was confirmed, whereas perceived election legitimacy decreased among Republicans as their expected President Trump win was disconfirmed. From the first to the second week following Election Day, Republicans reported stronger negative emotions and weaker positive emotions while Democrats reported stronger positive emotions and weaker negative emotions. The polarized perceptions of election legitimacy were correlated with the tendencies to trust and consume polarized media. Consumption of Fox News was associated with lowered perceptions of election legitimacy over time whereas consumption of other outlets was associated with higher perceptions of election legitimacy over time. Discussion centers on the role of the media in the experience of cognitive dissonance and the implications of polarized perceptions of election legitimacy for psychology, political science, and the future of democratic society.

The Challenges of Military Veterans in Their Transition to the Workplace: A Call for Integrating Basic and Applied Psychological Science.

Long-standing structural features of the military have created a culture and society that is dramatically different and disconnected from civilian society. Thus, veterans transitioning to civilian society face a number of challenges related to fulfilling basic psychological needs (e.g., need for structure and order, belonging) and civilians' reliance on stereotypes to understand military veterans. In an attempt to enrich the understanding of these challenges, we integrate social psychological theories and insights with research from sociology, clinical psychology, military psychology, and organizational behavior. Theories of compensatory control, stereotype threat, and stereotyping are drawn on to help explain the psychological challenges that veterans may encounter during their transition to civilian society. We present recent research that leverages these theories to understand issues veterans face. This theoretical integration illustrates the opportunity and potential for psychological researchers to conduct basic and applied research in the context of veterans and for clinicians and managers to draw on basic theory to inform programs and interventions.

The Changing Landscape of Doctoral Education in Science, Technology, Engineering, and Mathematics: PhD Students, Faculty Advisors, and Preferences for Varied Career Options.

The landscape of graduate science education is changing as efforts to diversify the professoriate have increased because academic faculty jobs at universities have grown scarce and more competitive. With this context as a backdrop, the present research examines the perceptions and career goals of advisors and advisees through surveys of PhD students (Study 1, N = 195) and faculty mentors (Study 2, N = 272) in science, technology, engineering, and math disciplines. Study 1 examined actual preferences and career goals of PhD students among three options: research careers, teaching careers, and non-academic careers in industry, and compared the actual preferences of students with what they perceived as being the normative preferences of faculty. Overall, students had mixed preferences but perceived that their advisors had a strong normative preference for research careers for them. Moreover, students who ranked research positions as most desirable felt the most belonging in their academic departments. Further analyses revealed no differences in career preferences as a function of underrepresented minority (URM) student status or first-generation (FG) status, but URM and FG students felt less belonging in their academic departments. Study 2 examined faculty preferences for different careers for their advisees, both in general and for current students in particular. While faculty advisors preferred students to go into research in general, when focusing on specific students, they saw their preferences as being closely aligned with the career preference of each PhD student. Faculty advisors did not perceive any difference in belonging between their students as a function of their URM status. Discrepancies between student and faculty perceptions may occur, in part, because faculty and students do not engage in sufficient discussions about the wider range of career options beyond academic research. Supporting this possibility, PhD students and faculty advisors reported feeling more comfortable discussing research careers with each other than either non-academic industry positions or teaching positions. Discussion centers on the implications of these findings for interpersonal and institutional efforts to foster diversity in the professoriate and to create open communication about career development.

Bolstering trust and reducing discipline incidents at a diverse middle school: How self-affirmation affects behavioral conduct during the transition to adolescence.

A three-year field experiment at an ethnically diverse middle school (N = 163) tested the hypothesis that periodic self-affirmation exercises delivered by classroom teachers bolsters students' school trust and improves their behavioral conduct. Students were randomly assigned to either a self-affirmation condition, where they wrote a series of in-class essays about personally important values, or a control condition, where they wrote essays about personally unimportant values. There were no behavioral effects of affirmation at the end of 6th grade, after students had completed four writing exercises. However, after four additional exercises in 7th grade, affirmed students had a significantly lower rate of discipline incidents than students in the control condition. The effect continued to grow and did not differ across ethnic groups, such that during 8th grade students in the affirmation condition on average received discipline at a 69% lower rate than students in the control condition. Analyses of student climate surveys revealed that affirmation was associated with higher school trust over time, a tendency that held across ethnic groups and partially mediated the affirmation effect on discipline. Repeated self-affirmation can bolster students' school trust and reduce the incidence of discipline in middle school, findings with both theoretical and practical implications.

It depends: Partisan evaluation of conditional probability importance.

Policies to suppress rare events such as terrorism often restrict co-occurring categories such as Muslim immigration. Evaluating restrictive policies requires clear thinking about conditional probabilities. For example, terrorism is extremely rare. So even if most terrorist immigrants are Muslim-a high "hit rate"-the inverse conditional probability of Muslim immigrants being terrorists is extremely low. Yet the inverse conditional probability is more relevant to evaluating restrictive policies such as the threat of terrorism if Muslim immigration were restricted. We suggest that people engage in partisan evaluation of conditional probabilities, judging hit rates as more important when they support politically prescribed restrictive policies. In two studies, supporters of expelling asylum seekers from Tel Aviv, Israel, of banning Muslim immigration and travel to the United States, and of banning assault weapons judged "hit rate" probabilities (e.g., that terrorists are Muslims) as more important than did policy opponents, who judged the inverse conditional probabilities (e.g., that Muslims are terrorists) as more important. These partisan differences spanned restrictive policies favored by Rightists and Republicans (expelling asylum seekers and banning Muslim travel) and by Democrats (banning assault weapons). Inviting partisans to adopt an unbiased expert's perspective partially reduced these partisan differences. In Study 2 (but not Study 1), partisan differences were larger among more numerate partisans, suggesting that numeracy supported motivated reasoning. These findings have implications for polarization, political judgment, and policy evaluation. Even when partisans agree about what the statistical facts are, they markedly disagree about the relevance of those statistical facts.

Integrating Self-Affirmation and Implementation Intentions: Effects on College Student Drinking.

Background: High levels of alcohol consumption are an enduring health risk among college students. Integrating multiple, complementary behavior change theories may offer a promising approach to promote reductions in alcohol consumption. Purpose: The current study tested if integrating self-affirmation and implementation intentions would be more effective than a self-affirmation only, implementation intentions only, or control condition at reducing alcohol consumption in college students over a 2-week period. Method: Two hundred and ninety-three college students who reported drinking in the past month were randomly assigned to a condition in a 2 (self-affirmation: values vs. control writing task) × 2 (implementation intentions: formed vs. not formed) between-subjects factorial design. Participants first completed a self-affirmation or control writing task, then read an article describing the risks of drinking. Next, all participants reported their common drinking behaviors and contexts, and then selected two harm-reduction strategies forming (or not forming) implementation intentions to use the strategies. Alcohol consumption was measured 1 and 2 weeks after the experiment. Results: Participants in the integrated self-affirmation and implementation intention condition were most likely to abstain from drinking 1 week later. Affirmed participants continued to be more likely to abstain from drinking 2 weeks later. Conclusions: The findings support the efficacy of integrating self-affirmation and implementation intentions to reduce college student drinking (ClinicalTrials.gov number NCT02926794).

Psychological Barriers to Bipartisan Public Support for Climate Policy.

Psychological scientists have the expertise-and arguably an obligation-to help understand the political polarization that impedes enactment of climate policy. Many explanations emphasize Republican skepticism about climate change. Yet results from national panel studies in 2014 and 2016 indicate that most Republicans believe in climate change, if not as strongly as Democrats. Political polarization over climate policy does not simply reflect that Democrats and Republicans disagree about climate change but that Democrats and Republicans disagree with each other. The results of a national panel experiment and of in-depth interviews with four former members of Congress suggest that Democrats and Republicans-both ordinary citizens and policymakers-support policies from their own party and reactively devalue policies from the opposing party. These partisan evaluations occur both for policies historically associated with liberal principles and politicians (cap-and-trade) and for policies associated with conservative principles and politicians (revenue-neutral carbon tax). People also exaggerate how much other Democrats and Republicans are swayed by partisanship. This foments false norms of partisan opposition that, in turn, influence people's personal policy support. Correcting misperceived norms of opposition and decoupling policy evaluation from identity concerns would help overcome these seemingly insurmountable barriers to bipartisan support for climate policy.

Toward Surmounting the Psychological Barriers to Climate Policy-Appreciating Contexts and Acknowledging Challenges: A Reply to Weber (2018).

The authors acknowledge and respond to three concerns raised by Weber (2018) about oversimplifying psychological barriers to climate policy. First, skepticism about climate change remains a major barrier to climate policy, along with political partisanship. Second, recognizing multifaceted barriers to climate policy calls for multiple targeted interventions to be implemented at critical junctures. Finally, translating pro-environmental attitudes into action requires an appreciation of proximate sociopolitical contexts and cultures. Rather than a one-size-fits-all approach, psychological scientists are well equipped to understand and address the complex barriers to climate policy within the natural flow of everyday social life.

Self-affirmation facilitates minority middle schoolers' progress along college trajectories.

Small but timely experiences can have long-term benefits when their psychological effects interact with institutional processes. In a follow-up of two randomized field experiments, a brief values affirmation intervention designed to buffer minority middle schoolers against the threat of negative stereotypes had long-term benefits on college-relevant outcomes. In study 1, conducted in the Mountain West, the intervention increased Latino Americans' probability of entering a college readiness track rather than a remedial one near the transition to high school 2 y later. In study 2, conducted in the Northeast, the intervention increased African Americans' probability of college enrollment 7-9 y later. Among those who enrolled in college, affirmed African Americans attended relatively more selective colleges. Lifting a psychological barrier at a key transition can facilitate students' access to positive institutional channels, giving rise to accumulative benefits.

Cultural Variability in the Link Between Environmental Concern and Support for Environmental Action.

Research on sustainability behaviors has been based on the assumption that increasing personal concerns about the environment will increase proenvironmental action. We tested whether this assumption is more applicable to individualistic cultures than to collectivistic cultures. In Study 1, we compared 47 countries ( N = 57,268) and found that they varied considerably in the degree to which environmental concern predicted support for proenvironmental action. National-level individualism explained the between-nation variability above and beyond the effects of other cultural values and independently of person-level individualism. In Study 2, we compared individualistic and collectivistic nations (United States vs. Japan; N = 251) and found culture-specific predictors of proenvironmental behavior. Environmental concern predicted environmentally friendly consumer choice among European Americans but not Japanese. For Japanese participants, perceived norms about environmental behavior predicted proenvironmental decision making. Facilitating sustainability across nations requires an understanding of how culture determines which psychological factors drive human action.

Fear of Ebola: The Influence of Collectivism on Xenophobic Threat Responses.

In response to the Ebola scare in 2014, many people evinced strong fear and xenophobia. The present study, informed by the pathogen-prevalence hypothesis, tested the influence of individualism and collectivism on xenophobic response to the threat of Ebola. A nationally representative sample of 1,000 Americans completed a survey, indicating their perceptions of their vulnerability to Ebola, ability to protect themselves from Ebola (protection efficacy), and xenophobic tendencies. Overall, the more vulnerable people felt, the more they exhibited xenophobic responses, but this relationship was moderated by individualism and collectivism. The increase in xenophobia associated with increased vulnerability was especially pronounced among people with high individualism scores and those with low collectivism scores. These relationships were mediated by protection efficacy. State-level collectivism had the same moderating effect on the association between perceived vulnerability and xenophobia that individual-level value orientation did. Collectivism-and the set of practices and rituals associated with collectivistic cultures-may serve as psychological protection against the threat of disease.

Impact of Cultural Exposure and Message Framing on Oral Health Behavior: Exploring the Role of Message Memory.

BACKGROUND: Health messages are more effective when framed to be congruent with recipient characteristics, and health practitioners can strategically choose message features to promote adherence to recommended behaviors. We present exposure to US culture as a moderator of the impact of gain-frame versus loss-frame messages. Since US culture emphasizes individualism and approach orientation, greater cultural exposure was expected to predict improved patient choices and memory for gain-framed messages, whereas individuals with less exposure to US culture would show these advantages for loss-framed messages. METHODS: 223 participants viewed a written oral health message in 1 of 3 randomized conditions-gain-frame, loss-frame, or no-message control-and were given 10 flosses. Cultural exposure was measured with the proportions of life spent and parents born in the US. At baseline and 1 week later, participants completed recall tests and reported recent flossing behavior. RESULTS: Message frame and cultural exposure interacted to predict improved patient decisions (increased flossing) and memory maintenance for the health message over 1 week; for example, those with low cultural exposure who saw a loss-frame message flossed more. Incongruent messages led to the same flossing rates as no message. Memory retention did not explain the effect of message congruency on flossing. LIMITATIONS: Flossing behavior was self-reported. Cultural exposure may only have practical application in either highly individualistic or collectivistic countries. CONCLUSIONS: In health care settings where patients are urged to follow a behavior, asking basic demographic questions could allow medical practitioners to intentionally communicate in terms of gains or losses to improve patient decision making and treatment adherence.