1. Project Implicit Mental Health: An online platform to discover mental health associations outside conscious control Bethany Teachman Alexandra Werntz University of Virginia May, 2014 PACT Lab: Program for Anxiety Cognition & Treatment

2. Outline Role of implicit associations in psychopathology Measurement of implicit associations Limits of lab-based studies Project Implicit Mental Health web site Implicit/explicit relationships Individual difference predictors of implicit associations

3. Clinical Mysteries…

4. Heart racing = Heart attack Appearance = Shameful Me = Drinker

5. Implicit Associations Automatic associations in memory: Activated rapidly Without intention Difficult to consciously control Central to many theories of psychopathology (e.g., schema, dual process models)

6. Implicit Association Measures Implicit Association Test (IAT; Greenwald et al., 1998)  Reaction time task that measures relative strength of associations between constructs  Outside conscious control & perhaps awareness Example: Evaluation of the self (vs. others )as calm vs. panicked

7. Panicked + Not Me Calm + Me Relaxed Left key Right key

8. Panicked + Not Me Calm + Me Self Left key Right key

9. Panicked + Not Me Calm + Me Afraid Left key Right key

10. Panicked + Me Calm + Not Me Self Left key Right key Order of the category pairing conditions is counterbalanced

11. Implicit Calm (vs Panicked) Associations (Teachman, Smith-Janik, & Saporito, 2007)

12. Implicit Associations & Psychopathology Self + Panicked (Teachman, Smith-Janik, & Saporito, 2007) Heights + afraid (Teachman, Stefanucci, Clerkin, Cody, & Proffitt, 2008) Spider + danger (Teachman, Woody, & Gregg, 2001) Blood-injury-injection + disgust (Teachman & Saporito, 2009) Appearance + Shameful (Clerkin, Teachman, Smith, & Buhlmann, 2014) Self + Drinker (Lindgren et al., 2012)

13. Implicit Associations Change Pre- to Post-Treatment Implicit Spider Fear Associations (Teachman & Woody, 2003, Journal of Abnormal Psychology ) Just 3 hours of Cognitive Behavior Therapy!

14. What Have We Learned in the Lab? Biased implicit associations: Tied to numerous forms of psychopathology Change over treatment (and change predicts degree of later symptom reduction, & activation of associations changes, not just ability to override) Predicts disorder-linked behaviors, sometimes even after controlling for explicit predictors

15. Limitations of Lab Research on Implicit Associations in Psychopathology Small, homogenous samples… Implicit/explicit relationships are not reliable across studies No normative estimates of implicit association levels Little chance to look at individual differences as predictors of implicit association levels Missing outreach opportunity… …Project Implicit Mental Health: Education + Research mission

16. Project Implicit Mental Health (>130,000 tasks begun) Site Directors: Bethany Teachman, Matt Nock, Brian Nosek, Mahzarin Banaji, Tony Greenwald

17. Try it out! www.ImplicitMentalHealth.com

18. Anxiety IAT Me (vs. Others) + Anxious vs. Calm N (consented): 21,304 Depression IAT Me (vs. Others) + Sad vs. Happy N (consented): 24,126 Alcohol IAT Me (vs. Others) + Drinker vs. Abstaining N (consented): 12,387 Eating IAT High-fat Food (vs. Low-Fat Food) + Shameful vs. Acceptable N (consented): 10,115 Volunteers: Sept., 2011 – May, 2014 *Plus symptom & explicit association (semantic differential) measures

19. Implicit/Explicit Relations StudyImplicit/ Explicit Associations Implicit/ Symptoms Alcohol.24**.29** Anxiety.25**.28** Depression.32**.36** Eating.15**.10** ** p<.001

20. Implicit/Explicit Relations StudyImplicit/ Explicit Associations Implicit/ Symptoms Explicit Associations/ Symptoms Alcohol.24**.29**.46** Anxiety.25**.28**.42** Depression.32**.36**.56** Eating.15**.10**.41** ** p<.001

21. Individual Differences & Implicit Associations Examples: StudyAge/ Implicit (Pearson) Education/ Implicit (Spearman) Gender (t-tests) Alcohol-.08**-.02 ns6.42** (men > women) Anxiety-.17**-.12**-6.58** (women > men) Depression-.14**-.10**-.40 ns Eating.13**-.03*-2.49 ✚✚ (women > men) ** p<.001, * p<.01, ✚✚ p=.01

22. Step 1: Assessment, Step 2: Cognitive Bias Modification www.ImplicitMentalHealth.com …what’s next? www.ImplicitMentalHealth.com …what’s next?

23. Healthy implicit associations Heart racing = Alright Appearance = Acceptable Me = NonDrinker

24. Thank you Funding:  NIA R01 AG033033  PIMH Site Co-Directors: Matt Nock, Brian Nosek, Mahzarin Banaji, Tony Greenwald Current team: Jessica Beadel Cruz, Christina Emeh, Karl Fua, Jeff Glenn, Gena Gorlin, Jen Green, Erin Maresh, Daniel Martin, Nauder Namaky, Sam Portnow, Meg Reuland, Shari Steinman, Alex Werntz. Programmer: Dan Funk Lab alum: Elise Clerkin, Meghan Cody, Tynessa Gordon, Jean Hu, Ann Lambert, Joshua Magee, Craig Marker, Jena Saporito, Shannan Smith-Janik, Fred Smyth