Bio-terrorism and the role of perceived control in minimizing automated fears

Len Lecci, Ph.D. & Dale Cohen, Ph.D.

University of North Carolina – Wilmington

The ThreatAnthrax

– Will result in death

– Everyone at risk• Delivered by Postal Service

– But, low probability• 1 in 14 million (vs. 1 in 5 million risk of being struck by

lightning)

Facilitating Factor: Ambiguity

Forer Effect (1949)

(a.k.a.Barnum Effect)

People accept vague and general descriptions as uniquely applicable to themselves without realizing that the same description could be applied to just about anyone.

HoroscopeYou have a need for other people to like and admire you, and yet you tend to be critical of yourself. While you have some personality weaknesses you are generally able to compensate for them. You have considerable unused capacity that you have not turned to your advantage.

Facilitating Factor: Ambiguity

Anthrax (CDC)

Initial symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is usually fatal.

Common Cold (NIAID)

Nasal discharge, obstruction of nasal breathing, swelling of the sinus membranes, sneezing, sore throat, cough, and headache

• Extensive Media Coverage

– Influences Perception of Risk

– High media Coverage = Increased Perception of Risk

Facilitating Factor: Media

Lichtenstein, et al., 1978

High Salience = High Perceived Health Threat

Low Salience = Low Perceived Health Threat

High Actual Health Threat

Low Actual Health Threat

Small Pox Vaccine

Heart Disease

Food Poisoning

Diabetes

CNN

MSNBC

Anthrax

• High Perceived Risk– Extensive media coverage makes threat salient

• Ambiguous symptoms – Similar to common cold, yet need for early detection

• Low Actual RiskNote: Reducing anxiety by providing statistical

information has little influence because people don’t understand very small numbers (Cohen, et al., In Press)

Personality and Health Fears

High Perceived Health Threat

Low Perceived Health Threat

High Actual Health Threat

Low Actual Health Threat

Perceived Vulnerability

Perceived Invulnerability

Optimal

Optimal

Clinical Hypochondriasis

• Individuals make extensive use of medical care services

• Epidemiological data: 4-5% of the general population exhibits such symptoms

• Upwards of 50% of adult ambulatory health care costs

Dangerous Interaction

High Salience = High Perceived Health Threat

Low Salience = Low Perceived Health Threat

High Actual Health Threat

Low Actual Health Threat

Perceived Vulnerability

&Anthrax

Health behavior and salient health threats

• This can easily overburden the medical system by – limiting the availability of resources through increased

demand (e.g., Cipro by healthy individuals)

– making interventions less effective (e.g., individual immune to interventions because they are used inappropriately)

– making the health delivery system less efficient (higher rate of false positives)

How can we minimize hypochondriacal responses to health threats?

Perceived Control

– Predicts well-being, health, and mortality

– Has been linked to individual differences in the use of medical resources

– Easier to manipulate than real control

Exploratory research (NSF grant #0204846)

Method

Participants – randomly assigned to one of two conditions• High Control condition (152 participants) - “List 3 things

that are within your control that could result in reducing the likelihood that you will contract anthrax.”

• Low Control condition (150 participants) - “List 3 things that are outside of your control that could result in increasing the probability that you will contract anthrax.”

Method - continued

• Participants were provided with an anthrax fact sheet and photos depicting cutaneous anthrax exposure (arms & hands)

– Importance of re-establishing salience (Lecci & Cohen 2002), especially given the decrease in media coverage as the data was being collected (February to April, 2002)

– Provides all participants with similar level of knowledge and exposure to anthrax information

• Assessed hypochondriacal tendencies using the SAMPI

Measured controlled and automatic responses to health threats

Controlled Behavior

Intentional thoughts and actions

Examples

Goal: “I will regularly visit a doctor”

Behavior: Seeking out medical attention

Automatic Behaviors Habitual, Involuntary, thoughts and actions

• Physiological responses

– Increased Heart Rate– Shallow Breathing

• Psychological Responses

– Recall associated memories– Attention fixates on threat

stimuli

Three questions:

• Can perceptions of control minimize the types of automated behaviors we just described?

• Will this occur even though health fears have been activated?

• Will this occur even if the individual exhibits tendencies to be hypochondriacal (i.e., they perceive themselves to be unusually vulnerable to health threats)?

Preliminary Results

Manipulation of control beliefs eliminated automatic health relevant behaviors – Even after activating anthrax fears

– Even for those evidencing hypochondriacal tendencies.

Low control condition - those with high hypochondriacal tendencies were more likely to involuntarily devote attention to Anthrax related stimuli

High control condition - No Effect

General Implications • When threatened with biological warfare, more

individuals will exhibit hypochondriacal tendencies

• This increase in individuals exhibiting health vulnerability beliefs will likely strain the health care system

• A simple manipulation of control beliefs may affect the manner or extent to which individuals process health threats.

Data to be analyzed

• How does our manipulation affect controlled behaviors?

– Can perceived control change people’s health goals?

– Can perceived control minimize the overuse of the health system?

* Over 600 participants are being tracked for their long term use of the university health care system

Open Questions

• Do these findings generalize to all health threats?

• Can unambiguous descriptions of symptoms mitigate automated and controlled health related behaviors?