Virtue Discounting: Observability Reduces Moral Actors' Perceived Virtue.

Performing prosociality in public presents a paradox: only by doing so can people demonstrate their virtue and also influence others through their example, yet observers may derogate actors' behavior as mere "virtue signaling." Here we investigate the role of observability of actors' behavior as one reason that people engage in such "virtue discounting." Further, we investigate observers' motivational inferences as a mechanism of this effect, using the comparison of generosity and fairness as a case study among virtues. Across 14 studies (7 preregistered, total N = 9,360), we show that public actors are perceived as less virtuous than private actors, and that this effect is stronger for generosity compared to fairness (i.e., differential virtue discounting). Exploratory factor analysis suggests that three types of motives-principled, reputation-signaling, and norm-signaling-affect virtue discounting. Using structural equation modeling, we show that observability's effect on actors' trait virtue ratings is largely explained by inferences that actors have less principled motivations. Further, we leverage experimental evidence to provide stronger causal evidence of these effects. We discuss theoretical and practical implications of our findings, as well as future directions for research on the social perception of virtue.

Scaling Up Change: A Critical Review and Practical Guide to Harnessing Social Norms for Climate Action.

Anthropogenic carbon emissions have the potential to trigger changes in climate and ecosystems that would be catastrophic for the well-being of humans and other species. Widespread shifts in production and consumption patterns are urgently needed to address climate change. Although transnational agreements and national policy are necessary for a transition to a fully decarbonized global economy, fluctuating political priorities and lobbying by vested interests have slowed these efforts. Against this backdrop, bottom-up pressure from social movements and shifting social norms may offer a complementary path to a more sustainable economy. Furthermore, norm change may be an important component of decarbonization policies by accelerating or strengthening the impacts of other demand-side measures. Individual actions and policy support are social processes-they are intimately linked to expectations about the actions and beliefs of others. Although prevailing social norms often reinforce the status quo and unsustainable development pathways, social dynamics can also create widespread and rapid shifts in cultural values and practices, including increasing pressure on politicians to enact ambitious policy. We synthesize literature on social-norm influence, measurement, and change from the perspectives of psychology, anthropology, sociology, and economics. We discuss the opportunities and challenges for the use of social-norm and social-tipping interventions to promote climate action. Social-norm interventions aimed at addressing climate change or other social dilemmas are promising but no panacea. They require in-depth contextual knowledge, ethical consideration, and situation-specific tailoring and testing to understand whether they can be effectively implemented at scale. Our review aims to provide practitioners with insights and tools to reflect on the promises and pitfalls of such interventions in diverse contexts.

Psychological Science in the Wake of COVID-19: Social, Methodological, and Metascientific Considerations.

The COVID-19 pandemic has extensively changed the state of psychological science from what research questions psychologists can ask to which methodologies psychologists can use to investigate them. In this article, we offer a perspective on how to optimize new research in the pandemic's wake. Because this pandemic is inherently a social phenomenon-an event that hinges on human-to-human contact-we focus on socially relevant subfields of psychology. We highlight specific psychological phenomena that have likely shifted as a result of the pandemic and discuss theoretical, methodological, and practical considerations of conducting research on these phenomena. After this discussion, we evaluate metascientific issues that have been amplified by the pandemic. We aim to demonstrate how theoretically grounded views on the COVID-19 pandemic can help make psychological science stronger-not weaker-in its wake.

Global Behaviors, Perceptions, and the Emergence of Social Norms at the Onset of the COVID-19 Pandemic.

We conducted a large-scale survey covering 58 countries and over 100,000 respondents between late March and early April 2020 to study beliefs and attitudes towards citizens' and governments' responses at the onset of the COVID-19 pandemic. Most respondents reported holding normative beliefs in support of COVID-19 containment measures, as well as high rates of adherence to these measures. They also believed that their government and their country's citizens were not doing enough and underestimated the degree to which others in their country supported strong behavioral and policy responses to the pandemic. Normative beliefs were strongly associated with adherence, as well as beliefs about others' and the government's response. Lockdowns were associated with greater optimism about others' and the government's response, and improvements in measures of perceived mental well-being; these effects tended to be larger for those with stronger normative beliefs. Our findings highlight how social norms can arise quickly and effectively to support cooperation at a global scale.

Emergency Physicians and Personal Narratives Improve the Perceived Effectiveness of COVID-19 Public Health Recommendations on Social Media: A Randomized Experiment.

BACKGROUND: Containment of the coronavirus disease 2019 (COVID-19) pandemic requires the public to change behavior under social distancing mandates. Social media are important information dissemination platforms that can augment traditional channels communicating public health recommendations. The objective of the study was to assess the effectiveness of COVID-19 public health messaging on Twitter when delivered by emergency physicians and containing personal narratives. METHODS: On April 30, 2020, we randomly assigned 2,007 U.S. adults to an online survey using a 2 × 2 factorial design. Participants rated one of four simulated Twitter posts varied by messenger type (emergency physician vs. federal official) and content (personal narrative vs. impersonal guidance). The main outcomes were perceived message effectiveness (35-point scale), perceived attitude effectiveness (PAE; 15-point scale), likelihood of sharing Tweets (7-point scale), and writing a letter to their governor to continue COVID-19 restrictions (write letter or none). RESULTS: The physician/personal (PP) message had the strongest effect and significantly improved all main messaging outcomes except for letter writing. Unadjusted mean differences between PP and federal/impersonal (FI) were as follows: perceived messaging effectiveness (3.2 [95% CI = 2.4 to 4.0]), PAE (1.3 [95% CI = 0.8 to 1.7]), and likelihood of sharing (0.4 [95% CI = 0.15 to 0.7]). For letter writing, PP made no significant impact compared to FI (odds ratio = 1.14 [95% CI = 0.89 to 1.46]). CONCLUSIONS: Emergency physicians sharing personal narratives on Twitter are perceived to be more effective at communicating COVID-19 health recommendations compared to federal officials sharing impersonal guidance.

Effect of Physician Gender and Race on Simulated Patients' Ratings and Confidence in Their Physicians: A Randomized Trial.

Importance: Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. Objective: To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged. Design, Setting, and Participants: This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures. Interventions: A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis. Main Outcomes and Measures: A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician's diagnosis, and (5) likelihood to request additional tests. Results: Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants' race, gender, racial prejudice, or sexism. Conclusions and Relevance: No significant differences were observed for simulated patients' evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction. Trial Registration: ClinicalTrials.gov Identifier: NCT04190901.

Rare and Costly Prosocial Behaviors Are Perceived as Heroic.

Heroism has only recently become a topic of empirical investigation. Existing research suggests a connection between heroism and four well-documented dimensions of human social behavior: (1) the cost incurred by the actor; (2) the benefit provided to the recipient; (3) the perceived frequency (i.e., descriptive normativity); and (4) the perceived expectation to perform it (i.e., injunctive normativity). In a series of exploratory studies (total N = 408), we aim to shed light on how each of these constructs influence lay intuitions about the nature of heroism (i.e., what determines which acts people perceive to be heroic). In Study 1, subjects generated a list of acts they deemed to be heroic. In Study 2, subjects rated the heroicness of the acts from Study 1, revealing considerable variation in the level of heroism. Finally, subjects in Study 3 rated the cost to the actor, the benefit to the recipient(s), the descriptive normativity (i.e., frequency), and the injunctive normativity (i.e., obligatoriness) of ten acts, five of which received particularly high heroism scores in Study 2 ("exemplary" acts of heroism) and five of which received particularly low heroism scores in Study 2 ("ambiguous" acts of heroism). We find that more heroic acts are seen as rarer and more costly to actors-but, interestingly, not more beneficial to recipients or less obligatory. These findings help to illuminate what it means to be seen as a hero, and suggest clear future directions for both empirical and theoretical work.

Credibility-enhancing displays promote the provision of non-normative public goods.

Promoting the adoption of public goods that are not yet widely accepted is particularly challenging. This is because most tools for increasing cooperation-such as reputation concerns1 and information about social norms2-are typically effective only for behaviours that are commonly practiced, or at least generally agreed upon as being desirable. Here we examine how advocates can successfully promote non-normative (that is, rare or unpopular) public goods. We do so by applying the cultural evolutionary theory of credibility-enhancing displays3, which argues that beliefs are spread more effectively by actions than by words alone-because actions provide information about the actor's true beliefs. Based on this logic, people who themselves engage in a given behaviour will be more effective advocates for that behaviour than people who merely extol its virtues-specifically because engaging in a behaviour credibly signals a belief in its value. As predicted, a field study of a programme that promotes residential solar panel installation in 58 towns in the United States-comprising 1.4 million residents in total-found that community organizers who themselves installed through the programme recruited 62.8% more residents to install solar panels than community organizers who did not. This effect was replicated in three pre-registered randomized survey experiments (total n = 1,805). These experiments also support the theoretical prediction that this effect is specifically driven by subjects' beliefs about what the community organizer believes about solar panels (that is, second-order beliefs), and demonstrate generalizability to four other highly non-normative behaviours. Our findings shed light on how to spread non-normative prosocial behaviours, offer an empirical demonstration of credibility-enhancing displays and have substantial implications for practitioners and policy-makers.

Turking Overtime: How Participant Characteristics and Behavior Vary Over Time and Day on Amazon Mechanical Turk.

Online experiments allow researchers to collect datasets at times not typical of laboratory studies. We recruit 2,336 participants from Amazon Mechanical Turk to examine if participant characteristics and behaviors differ depending on whether the experiment is conducted during the day versus night, and on weekdays versus weekends. Participants make incentivized decisions involving prosociality, punishment, and discounting, and complete a demographic and personality survey. We find no time or day differences in behavior, but do find that participants at nights and on weekends are less experienced with online studies; on weekends are less reflective; and at night are less conscientious and more neurotic. These results are largely robust to finer grained measures of time and day. We also find that those who participated earlier in the course of the study are more experienced, reflective, and agreeable, but less charitable than later participants.

Empathic nonverbal behavior increases ratings of both warmth and competence in a medical context.

In medicine, it is critical that clinicians demonstrate both empathy (perceived as warmth) and competence. Perceptions of these qualities are often intuitive and are based on nonverbal behavior. Emphasizing both warmth and competence may prove problematic, however, because there is evidence that they are inversely related in other settings. We hypothesize that perceptions of physician competence will instead be positively correlated with perceptions of physician warmth and empathy, potentially due to changing conceptions of the physician's role. We test this hypothesis in an analog medical context using a large online sample, manipulating physician nonverbal behaviors suggested to communicate empathy (e.g. eye contact) and competence (the physician's white coat). Participants rated physicians displaying empathic nonverbal behavior as more empathic, warm, and more competent than physicians displaying unempathic nonverbal behavior, adjusting for mood. We found no warmth/competence tradeoff and, additionally, no significant effects of the white coat. Further, compared with male participants, female participants perceived physicians displaying unempathic nonverbal behavior as less empathic. Given the significant consequences of clinician empathy, it is important for clinicians to learn how nonverbal behavior contributes to perceptions of warmth, and use it as another tool to improve their patients' emotional and physical health.

The collective benefits of feeling good and letting go: positive emotion and (dis)inhibition interact to predict cooperative behavior.

Cooperation is central to human existence, forming the bedrock of everyday social relationships and larger societal structures. Thus, understanding the psychological underpinnings of cooperation is of both scientific and practical importance. Recent work using a dual-process framework suggests that intuitive processing can promote cooperation while deliberative processing can undermine it. Here we add to this line of research by more specifically identifying deliberative and intuitive processes that affect cooperation. To do so, we applied automated text analysis using the Linguistic Inquiry and Word Count (LIWC) software to investigate the association between behavior in one-shot anonymous economic cooperation games and the presence inhibition (a deliberative process) and positive emotion (an intuitive process) in free-response narratives written after (Study 1, N = 4,218) or during (Study 2, N = 236) the decision-making process. Consistent with previous results, across both studies inhibition predicted reduced cooperation while positive emotion predicted increased cooperation (even when controlling for negative emotion). Importantly, there was a significant interaction between positive emotion and inhibition, such that the most cooperative individuals had high positive emotion and low inhibition. This suggests that inhibition (i.e., reflective or deliberative processing) may undermine cooperative behavior by suppressing the prosocial effects of positive emotion.

Reflection does not undermine self-interested prosociality.

The cognitive basis of prosocial behavior has received considerable recent attention. Previous work using economic games has found that in social dilemmas, intuitive decisions are more prosocial on average. The Social Heuristics Hypothesis (SHH) explains this result by contending that strategies which are successful in daily life become automatized as intuitions. Deliberation then causes participants to adjust to the self-interested strategy in the specific setting at hand. Here we provide further evidence for the SHH by confirming several predictions regarding when and for whom time pressure/delay will and will not alter contributions in a Public Goods Game (PGG). First, we replicate and extend previous results showing that (as predicted by the SHH) trust of daily-life interaction partners and previous experience with economic games moderate the effect of time pressure/delay in social dilemmas. We then confirm a novel prediction of the SHH: that deliberation should not undermine the decision to benefit others when doing so is also individually payoff-maximizing. Our results lend further support to the SHH, and shed light on the role that deliberation plays in social dilemmas.

E.M.P.A.T.H.Y.: a tool to enhance nonverbal communication between clinicians and their patients.

There is a gap in the medical education literature on teaching nonverbal detection and expression of empathy. Many articles do not address nonverbal interactions, instead focusing on "what to say" rather than "how to be." This focus on verbal communication overlooks the essential role nonverbal signals play in the communication of emotions, which has significant effects on patient satisfaction, health outcomes, and malpractice claims. This gap is addressed with a novel teaching tool for assessing nonverbal behavior using the acronym E.M.P.A.T.H.Y.-E: eye contact; M: muscles of facial expression; P: posture; A: affect; T: tone of voice; H: hearing the whole patient; Y: your response. This acronym was the cornerstone of a randomized controlled trial of empathy training at Massachusetts General Hospital, 2010-2012. Used as an easy-to-remember checklist, the acronym orients medical professionals to key aspects of perceiving and responding to nonverbal emotional cues. An urgent need exists to teach nonverbal aspects of communication as medical practices must be reoriented to the increasing cultural diversity represented by patients presenting for care. Where language proficiency may be limited, nonverbal communication becomes more crucial for understanding patients' communications. Furthermore, even in the absence of cultural differences, many patients are reluctant to disagree with their clinicians, and subtle nonverbal cues may be the critical entry point for discussions leading to shared medical decisions. A detailed description of the E.M.P.A.T.H.Y. acronym and a brief summary of the literature that supports each component of the teaching tool are provided.

The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To determine whether the patient-clinician relationship has a beneficial effect on either objective or validated subjective healthcare outcomes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Electronic databases EMBASE and MEDLINE and the reference sections of previous reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included studies were randomized controlled trials (RCTs) in adult patients in which the patient-clinician relationship was systematically manipulated and healthcare outcomes were either objective (e.g., blood pressure) or validated subjective measures (e.g., pain scores). Studies were excluded if the encounter was a routine physical, or a mental health or substance abuse visit; if the outcome was an intermediate outcome such as patient satisfaction or adherence to treatment; if the patient-clinician relationship was manipulated solely by intervening with patients; or if the duration of the clinical encounter was unequal across conditions. RESULTS: Thirteen RCTs met eligibility criteria. Observed effect sizes for the individual studies ranged from d = -.23 to .66. Using a random-effects model, the estimate of the overall effect size was small (d = .11), but statistically significant (p = .02). CONCLUSIONS: This systematic review and meta-analysis of RCTs suggests that the patient-clinician relationship has a small, but statistically significant effect on healthcare outcomes. Given that relatively few RCTs met our eligibility criteria, and that the majority of these trials were not specifically designed to test the effect of the patient-clinician relationship on healthcare outcomes, we conclude with a call for more research on this important topic.

Social heuristics shape intuitive cooperation.

Cooperation is central to human societies. Yet relatively little is known about the cognitive underpinnings of cooperative decision making. Does cooperation require deliberate self-restraint? Or is spontaneous prosociality reined in by calculating self-interest? Here we present a theory of why (and for whom) intuition favors cooperation: cooperation is typically advantageous in everyday life, leading to the formation of generalized cooperative intuitions. Deliberation, by contrast, adjusts behaviour towards the optimum for a given situation. Thus, in one-shot anonymous interactions where selfishness is optimal, intuitive responses tend to be more cooperative than deliberative responses. We test this 'social heuristics hypothesis' by aggregating across every cooperation experiment using time pressure that we conducted over a 2-year period (15 studies and 6,910 decisions), as well as performing a novel time pressure experiment. Doing so demonstrates a positive average effect of time pressure on cooperation. We also find substantial variation in this effect, and show that this variation is partly explained by previous experience with one-shot lab experiments.