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Implicit Cognition in Health Psychology Why Common Sense Goes out the Window

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Implicit Cognition in Health Psychology Why Common Sense Goes out the Window From Handbook of Implicit Social Cognition: Measurement, Theory, and Applications. Edited by Bertram Gawronski and B. Keith Payne Copyright 2010 by The Guilford Press. All rights reserved. CHAPTER 25 Implicit Cognition in Health Psychology Why Common Sense Goes Out the Window Reinout W. Wiers, Katrijn Houben, Anne Roefs, Peter de Jong, Wilhelm Hofmann, and Alan W. Stacy n the 1990s Tara MacDonald and colleagues she also does not have condoms but is taking birth I performed a beautiful series of experiments that control pills. They discuss whether it is possible to nicely illustrate a number of the central concepts obtain a condom, decide that this is not feasible, in this chapter. The goal of these studies was to and discuss their sexual history. Mike states that investigate systematically why seemingly sensible he is “clean” and Rebecca states that she does not people (students, admittedly only males)1 often “sleep around.” At the end of the video, Mike asks reported to have unprotected sex after drinking Rebecca, “What do you want to do?” Rebecca re- alcohol while knowing the dangers in the era of sponds, “I don’t know. What do you want to do?” HIV and other sexually transmitted diseases. In- The video then ends with a freeze frame, and par- terestingly, many of the same students, when asked ticipants complete the dependent measures while in a survey, indicated that it would be very foolish viewing the freeze frame. Across seven studies, it to have sex without a condom. This discrepancy il- was found that male participants were more will- lustrates a central issue in health psychology: why ing to engage in unsafe sex when they were in many people in specific situations act against their the alcohol condition and sexually aroused by the own health- related interests or, as MacDonald and video (MacDonald, Fong, Zanna, & Martineau, colleagues put it, “why common sense goes out of 2000; MacDonald, MacDonald, Zanna, & Fong, the window” (MacDonald, Zanna, & Fong, 1996). 2000; MacDonald et al., 1996).3 In this chapter, we argue that dual- process models This example illustrates some of the central may provide interesting answers to this important concepts available to help explain a wide range question. of perplexing findings in health psychology. First, Let us consider the experiments first. MacDon- there is an internal conflict between the “cold,” ald and colleagues selected students who did not or rational, attitudes and beliefs about the health have a steady relationship and who regularly used behavior (it is foolish not to use condoms) on the condoms. Participants received alcohol or not2 one hand and the actual intentions and behavior- and were shown a video. In this video, two stu- al inclinations in a tempting, or “hot,” situation on dents, Mike and the attractive Rebecca, go out on the other. We argue that similar internal conflicts a date and then go back to her apartment. There are central in many areas of health psychology, they begin to kiss on the couch and continue to often (but not always) with associative, “implicit” make out until Mike awkwardly discloses that he processes triggering approach reactions, while “re- did not bring any condoms. Rebecca states that flective” processes “know better” and suggest re- 463 464 V. APPLIED PERSPECTIVES frain from approach. Importantly, participants can their subjective arousal and intention to have un- differ regarding both their impulsive or associative protected sex in this situation on a questionnaire. processes and the contents and strength of their Hence, the example should not be read as indi- reflective or controlled processes, and both can be cating that implicit measures always assess “hot” assessed (Hofmann, Friese, & Wiers, 2008). processes and explicit measures “cold” processes. Another key feature illustrated by this research Rather, implicit measures aim to elicit the same is that “cold” measures (e.g., a survey of attitudes processes as are operating in the actual “hot” situa- and intentions regarding unsafe sex) may be sub- tion, but, of course, that claim should be validated optimal to predict actual health behavior in “hot” (De Houwer, 2006; De Houwer, Teige- Mocigemba, situations. People (especially the “usual subjects”: Spruyt, & Moors, 2009). In other words, the whole undergraduate students) often know rather well MacDonald experiment can be taken as an anal- what is good or bad for their health; the problem is ogy of what implicit measures try to do, irrespec- that they still engage in a number of unhealthy and tive of the fact that a simple attitude scale is used risky behaviors, such as binge drinking, smoking, to assess the “hot” cognitions. Note further that binge eating, unhealthy eating, unsafe sex, and so it is incorrect to equate implicit measures to reac- on. Recent research has confirmed the relevance of tion time measures, as witnessed by memory asso- this discrepancy for health psychology: In a “cold” ciation and affect misattribution measures (Payne, state, people underestimate the influence of “hot Cheng, Govorun, & Stewart, 2005; Payne, Go- cognitions” under influence of visceral states, such vorun, & Arbuckle, 2007; Payne, McClernon, & as hunger, thirst, sexual arousal, and craving, a Dobbins, 2007; Stacy, Leigh, & Weingardt, 1997; phenomenon called the “cold-to-hot empathy gap” Stacy, Newcomb, & Ames, 2000). Finally, this (Nordgren, van der Pligt, & van Harreveld, 2007, condom-use example illustrates a common theme 2008; Sayette, Loewenstein, Griffin, & Black, in health psychology: Many unhealthy behaviors 2008). The underestimation of “hot” inclinations occur in combination; for example, unsafe sex oc- is likely to play a role in the underestimation of curs frequently after alcohol use. the risk of becoming addicted and of risky situa- tions in quitters (Sayette et al., 2008) as well as in judgments of impulsive (“irrational”) behaviors of A SHORT REVIEW OF HEALTH oneself and of others. This is likely to contribute to PSYCHOLOGY APPROACHES the negative stigma of impulsive problem behav- TO PREDICT HEALTH BEHAVIOR iors such as addiction and obesity. In a “cold” state, it appears far more difficult to feel empathy with In our view, the idea to explicitly incorporate the impulsive drives compared with a judgment made notion of impulsive processes in health behavior in a “hot” state (Nordgren et al., 2007). is a relatively new one. Initially, the field of health Note that we are not arguing that it is useless to psychology has received much stimulation and is assess “cold” attitudes or intentions but rather that still somewhat dominated by the application of they are insufficient alone to predict health be- reasoned action approaches (Ajzen, 1991; Fish- haviors in “hot” situations. We need indices of the bein & Ajzen, 1975) to health- related decisions associative processes that are triggered in a “hot” and behaviors such as with protection motivation situation. One way to conceive the large number theory (Rogers, 1983) or the health belief model of recently developed implicit or indirect measures (Janz & Becker, 1984). One common element is as mini- experiments aimed at triggering and as- of these models, in a nutshell, is the assumption sessing spontaneous associative processes in reac- that health behavior is the result of cognitive ap- tion to relevant stimuli, similar to the video used praisal processes of the (1) expectancy and value by MacDonald and colleagues (De Houwer, 2006). of potential health threats and (2) possible cop- The difference is that indirect measures usually ing responses. From these appraisal processes, a provide simpler stimuli (pictures or words present- behavioral intention to avoid a health threat and ed one at the time rather than a tempting video) to engage in healthy behavior may be formed. Im- to which participants have to react fast, by pro- portantly, these appraisal processes and the result- viding either a first association without reflection ing goal- directed behavior are typically seen as or a speeded response (see Sekaquaptewa, Var- reasoned, conscious, and intentional acts that re- gas, & von Hippel, Chapter 8, Teige- Mocigemba, quire a person’s willpower in order to be effective. Klauer, & Sherman, Chapter 7, and Wentura & Therefore, these models largely speak to reflective Degner, Chapter 6, this volume). In the studies of processes by which health behavior is regulated. MacDonald and colleagues, participants indicate They typically do not, however, integrate the no- 25. Implicit Cognition in Health Psychology 465 tion of impulsive influences on behavior (in other been suggested to incorporate the notion of habit words treating impulsive influences on behavior (i.e., routine past behaviors) in order to account as error variance). This neglect may be one rea- for additional variance not accounted for by mark- son why the predictive validity of reasoned action ers of intentional goal pursuit (Aarts, Verplanken, models is typically far from perfect (Conner & & van Knippenberg, 1998; Verplanken, Aarts, Sparks, 2002; Stacy, Bentler, & Flay, 1994). van Knippenberg, & Moonen, 1998). Note that all A second general approach has been to get to these approaches tend to rely on self- report meth- know better the situational and dispositional risk odology. Hence, incremental predictive validity factors that play a role in determining health- may be limited by the known problems of intro- related behavior outcomes. On the one hand, social spective access or by self- presentational concerns psychology-
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