1. 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

2. The Threat Anthrax –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)

3. 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. Horoscope You 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.

4. 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

5. Extensive Media Coverage –Influences Perception of Risk –High media Coverage = Increased Perception of Risk Facilitating Factor: Media

6. 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

7. CNN

8. MSNBC

9. Anthrax High Perceived Risk –Extensive media coverage makes threat salient Ambiguous symptoms –Similar to common cold, yet need for early detection Low Actual Risk Note: Reducing anxiety by providing statistical information has little influence because people don’t understand very small numbers (Cohen, et al., In Press)

10. 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

11. 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

12. 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

13. 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)

14. 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

15. 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.”

16. 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

17. 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

18. Automatic Behaviors Habitual, Involuntary, thoughts and actions Physiological responses –Increased Heart Rate –Shallow Breathing Psychological Responses –Recall associated memories –Attention fixates on threat stimuli

19. 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)?

20. 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

21. 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.

22. 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

23. Open Questions Do these findings generalize to all health threats? Can unambiguous descriptions of symptoms mitigate automated and controlled health related behaviors?