Neurobiology of Implicit and Explicit Bias: Implications for Clinicians

Abstract

FIGURE 1. Cultural stereotypes are used to infer information about an individual based on how they are categorized. Prejudices and biases derived from the applied stereotype may result in predictable changes in behavior (i.e., discrimination). The stereotype content model systematizes stereotypes along the social judgment dimensions of warmth and competence. 1-5 The dimension of warmth rates intentions (benevolent, malevolent) and provides a basis for inferring whether someone will be a friend or enemy. The dimension of competence rates the ability to enact intentions (capable, ineffectual) and correlates very highly with status across cultures. The two dimensions separate groups into four clusters, each associated with a particular combination of expectations and emotional biases. These, in turn, can influence behaviors, including delivery of clinical care. 4 Groups stereotyped as high on warmth but low on competence, such as individuals with intellectual disabilities, may be institutionalized unnecessarily. Groups stereotyped as low on both dimensions, such as homeless individuals, are more likely to receive a lower level of care in general. A study assessing where groups with mental illnesses fell within this framework reported that when evaluated as a category, people with mental illnesses were rated very much like poor people, somewhat low on both warmth and competence. 5 When specific mental illnesses were rated, the categories of anxiety or eating disorders were rated as relatively more competent and warm than the serious mental illnesses such as schizophrenia or sociopathy. 5

Leveraging Neuroscience to Fight Stigma Around Mental Health

“…This is sometimes compounded by the paradoxical implicit and explicit stigmatizing attitudes held by professional caregivers (nurses, doctors, social workers; Lauber et al, 2006 ; Gaebel et al, 2011 ; Stuart et al, 2012 ; Henderson et al, 2014 ; Lebowitz and Ahn, 2014 ; Oliveira et al, 2020 ) towards the very people they are supposed to help and treat (Gaebel et al, 2015 ). Stigma held by professionals is usually reflected in physician-patient communication, optimism regarding treatment options, and prediction of the chance of recovery (see Peris et al, 2008 ; Wahl, 2012 ; Reihl et al, 2015 ; Haque et al, 2021 ). Interestingly, Loch et al ( 2013 ) concluded that psychiatrists become increasingly stigmatized towards their patients as they become more familiar with the clinical features of the illness they are treating (also see Weiner et al, 1988 ).…”

“…Consistent with this view, Loughman and Haslam ( 2018 ) suggested that a crucial element in the fight against mental health-related stigma is public communication that “emphasizes complexity over reduction, and plasticity over fixity”. A key lesson gained from research in social neuroscience is that categorization (or labeling), based on fundamental cues such as sex, race, and age, as well as other outwardly signs, or stereotypes (e.g., facial aesthetics and expression, or tattoos and dress style), may be activated in an automatic manner, enabling appraisal and evaluation of the subject, and shaping of the behavior by the perceiver (Macrae and Bodenhausen, 2000 ; Reihl et al, 2015 ; Comte et al, 2016 ). Therefore, examination of whether and how perceptions are subject to modulation (manipulation) would seem to be a worthwhile undertaking in the future.…”

“… 5 Krendl and colleagues’ work has of course been preceded by investigations by other authors but has also been confirmed or extended in other studies—for a comprehensive review, see Amodio and Cikara ( 2021 ). Readers interested in further details on the functional neuroanatomy of implicit and explicit bias may also refer to Reihl et al ( 2015 ). …”

Biais dans la consultation : quels outils pour le·la clinicien·ne ?

“…Stratégies pour améliorer la reconnaissance et la gestion des biais[11][12][13][14] les étudiant•e•s à comprendre l'existence des biais et leur impact, basée sur des connaissances en psychologie cognitive, et une mise en pratique par des exercices tels que les tests d'association implicite et des ateliers de mise en situation, pour intégrer la reconnaissance et la gestion des biais 14. …”

Borderline Personality Disorder: Neurobiological Contributions to Remission and Recovery

“…Negative perceptions of individuals with BPD among mental health care providers have potential to impact both access to care and quality of treatment provided. [29][30][31][32][33] For example, erroneous common beliefs (e.g., treatment resistance, need for resource intensive treatment plans) may create significant barriers to care. 33 Research indicates that more severe symptoms at baseline do not impair treatment response, and may actually promote better outcomes.…”