Are women the more empathetic gender? The effects of gender role expectations

Are women the more empathetic gender? The effects of gender role expectations. Charlotte S. Löffler & Tobias Greitemeyer. Current Psychology, Feb 2 2021. https://link.springer.com/article/10.1007/s12144-020-01260-8

Abstract: The present research aimed to extend the state of knowledge regarding the relationship between self-perceived empathy and traditional gender roles and placed particular focus on the contextual conditions under which gender differences in empathy are present, can be created, or eliminated. Across two studies, women rated themselves higher in empathy than men in all experimental conditions, whereas an objective female superiority in emotion recognition was only evident in one condition. In Study 1 (n = 736), using the term ‘social-analytic capacity’ instead of ‘empathic capacity’ increased gender differences in self-reported empathy and resulted in women performing better in the Eyes-test than men. In a neutral task (verbal intelligence), gender differences (in this case, a male superiority), were only found when participants believed that this task had an association with empathy. In Study 2 (n = 701), gender differences in self-reported empathic capacity, but not in performance in emotion recognition, increased when motivation for empathy was raised. Further, gender-role orientation mediated the association between gender and self-reported empathic capacity, whereas it did not account for the association between gender and emotion recognition. Overall, the present studies provide strong support for the idea that empathy is influenced by contextual factors and can be systematically biased by gender roles and stereotypical beliefs.

General Discussion

The present studies advance our knowledge regarding the relationship between the concept of empathy and traditional gender roles and demonstrates how a slight linguistic variation in one term (Study 1) or a motivational reframing of empathy (Study 2) can effectively create more pronounced gender differences. As previous research has shown, gender differences are most evident when empathy is assessed on self-report scales or when gender role expectations are made salient, but these differences become smaller or completely undetectable when more objective measurements are used (Eisenberg and Lennon 1983; Ickes et al. 2000). In line with these results, women rated themselves as significantly more empathic than men in all four conditions, while a female superiority in emotion recognition was only evident in the condition where empathy was referred to as ‘social-analytic capacity’. On this basis, the present studies lend strong support for the idea that there is a female tendency to report a stronger empathic response rather than an actual difference in male and female ability, as a number of authors have already suggested (e.g., Berman 1980; Eisenberg and Lennon 1983; Hodges et al. 2011; Ickes et al. 2000; Thomas and Maio 2008).

However, the assumption that gender differences in self-reported empathic capacity and performance in emotion recognition would be smaller when participants were not aware of the true nature of the tasks (Hypothesis 1a, Hypothesis 2a) could not be verified, as our experimental setup could not conceal the fact that empathy was measured by using the term ‘social-analytic capacity’. It is conceivable that, in the present case, the term ‘social-analytic’ appeared too sophisticated or even artificial and, as a consequence, had a deterrent effect on some participants, whereas, in the female sample, it apparently raised motivation for empathy. On the other hand, it is also conceivable that the term ‘social’ has a higher emotional connotation than the term ‘analytic’—so it might have overshadowed it. As a result, gender differences in both self-reported empathic capacity and objective emotion recognition were more pronounced when we used the term ‘social-analytic capacity’ compared to the term ‘empathic capacity’. Against this background, it seems reasonable to suppose that the term ‘social-analytic’, which was originally meant to be more neutral and less influenced by stereotypical beliefs than the term ‘empathy’, had the opposite effect and created gender differences in the performance in emotion recognition that were not observable when using the term ‘empathy’.

Regarding our hypothesis that gender differences on a neutral task (verbal intelligence) are more pronounced when participants believe that it is related to empathy (Hypothesis 1c), unexpectedly, we detected a male superiority in verbal intelligence when we evoked the association with empathy. Hence, it seems possible that even a presumed association with empathy might induce differences in the performance of men and women. But remarkably, in this case, men might have had a higher motivation and outperformed women when they were led to believe that a concept, with which they were familiar with, was related with empathy. The fact that verbal intelligence was weakly associated with masculine gender role orientation across the full sample cannot provide an explanation for this effect, because gender differences were only evident in the condition that had received the manipulation.

While in Study 1 we were able to manipulate emotion recognition by using an alternative term for empathy, emotion recognition was not significantly influenced in Study 2 by using external motivators (Hypothesis 2b). This result is contrary to some previous research in the field of empathic accuracy (Klein and Hodges 2001; Thomas and Maio 2008) that demonstrated that appropriate motivators could indeed increase the performance in emotion recognition. However, regarding self-reported empathic capacity, we did demonstrate more pronounced gender-differences in the condition that had received the motivation (Hypothesis 2a). This result suggests that external motivations can indeed manipulate self-reports and lends support for the notion that the context can play a key role in self-perception. But at this point, we have to concede that the stimuli we used to raise motivation for empathy turned out to be weak, as suggested not only by the failed manipulation check, but also the fact that we could only demonstrate a small motivational effect in females.

Apart from this, our research managed to demonstrate that the association between gender and self-reported empathy was fully mediated by gender role orientation (Hypothesis 3a), whereas gender role orientation did not account for the relationship between gender and emotion recognition (Hypothesis 3b). Together with the finding that a female superiority in emotion recognition was detected in only one case when the context had been manipulated successfully, these results provide strong evidence that a female superiority in empathy and related constructs does not reflect the differential ability of men and women and may indeed be a stereotype—a stereotype that causes women to present themselves as empathic, because being caring and interpersonally oriented are part of the traditional feminine role. On the other hand, men may tend to underestimate their full empathic potential in the absence of appropriate external motivators. It is also important to point out that in both studies there was only a moderate correlation between the self-reported empathy measure and the performance in the emotion recognition task. Taken together, the belief to be empathic may not be reflected in actual empathy.

As noted above, an important limitation of the present research is the failed manipulation check in Study 2. Hence, no strong conclusions are warranted how the motivation to appear empathic has an impact on gender differences in empathy. Furthermore, most of the present findings were small in terms of their effect sizes. In fact, analyses of variance did not reveal significant interaction effects (with one exception), but only the more statistically powerful planned comparisons yielded significant effects.

In conclusion, the present studies provide evidence that self-reported empathy and even objective performance in emotion recognition can both be influenced by the contextual setting, and that even a presumed association with the concept of empathy might induce gender differences. In addition, it was demonstrated that there is indeed a female tendency to report stronger empathic responses, while our results did not suggest a major female superiority in emotion recognition. We find it remarkable that at the present time that is characterized by reshaping traditional gender roles and societal structures empathy still appears to be perceived as a typical feminine trait. Therefore, it is questionable to use self-reports of empathy as a measure for actual empathic capacity in research. This is not only suggested by the fact that the association between gender and self-reported empathy was fully mediated by gender role orientation, but also by the weak correlation between self-reported empathy and performance in emotion recognition and that self-reported empathy was shown to be highly dependent on the experimental context. Against this background, some scientific results in this field might have been systematically biased by implicit gender stereotypes and that differences between males and females had been overestimated.

Regarding the present research, a female superiority in emotion recognition was only found in one of our experimental conditions. But even if there is indeed such a small female advantage, as Kirkland et al. (2013) and Warrier et al. (2018) suggested in their meta-analyses, it is important to keep in mind that the concept of gender differences is too narrow to map and explain the huge variety of inter-individual differences that are observable in psychological research and that a female advantage in empathy and related constructs could rather reflect a combination of biological factors, differing experience, socialization, and cultural expectations, which in turn appear to be mediated by some form of motivation (Hodges et al. 2011). The specific interactions between these factors remain to be determined by future studies. Another important question concerns the implementation of alternative instruments for measuring objective empathic responses, such as physiological or unobtrusive observations. Further, it would be of interest to address whether other constructs, that are likewise afflicted by gender stereotypes (e.g., emotionality, dominance, or intuitive processing), are also context-dependent and are influenced by gender role orientation in a similar way. Until then, it is important not to overemphasize these potential differences because, as Hyde (2013) has pointed out, gender similarities are as interesting and as important as gender differences.

Grandiose narcissistic traits are associated with self-enhancement biases; they perceive lower susceptibility to SARS-CoV-2 infection

Perceived susceptibility to COVID-19 infection and narcissistic traits. Tina A.G. Venema, Stefan Pfattheicher. Personality and Individual Differences, Volume 175, June 2021, 110696. https://doi.org/10.1016/j.paid.2021.110696

Highlights

• Prevention policies benefit from knowing who feels invulnerable to infection.

• Self-enhancing biases prevent accurate susceptibility perceptions.

• Grandiose narcissistic traits are associated with self-enhancement biases.

• High scores on the NPI-16 predict low perceived susceptibility.

• High scores on the NARQ Admiration subscale predict high perceived susceptibility.

Abstract: People's perceived susceptibility to illnesses plays a key role in determining whether or not to take protective measures. However, self-enhancing biases hinder accurate susceptibility perceptions, leaving some individuals to feel invulnerable in the face of acute health risks. Since such biases are prominent characteristics of individuals with narcissistic personality traits, this article empirically examined whether low perceived susceptibility of infection with COVID-19 is related to subclinical narcissism, as measured with the Narcissistic Personality Inventory (NPI-16) and the Narcissism Admiration and Rivalry Questionnaire (NARQ). We report the findings from a worldwide sample (N = 244), a UK sample before governmental pandemic restrictions (N = 261), a UK sample after restrictions (N = 261) and a pooled data analysis (N = 766). Overall, grandiose narcissism as measured with the NPI-16 predicted lower perceived susceptibility of infection, also after controlling for age and gender, whereas the NARQ Admiration subscale predicted higher perceived susceptibility. The findings are discussed in the light of theoretical and policy implications.

Keywords: Perceived susceptibilityRiskGrandiose narcissismNPI-16NARQCOVID-19

6. General discussion

The aim of the present work was to investigate whether low perceived susceptibility to infection with the coronavirus COVID-19 is related to narcissistic personality traits because the same cognitive biases known to influence perceived susceptibility are commonly found as self-enhancement strategies in narcissistic individuals. Across all studies, we found that higher scores of grandiose narcissism, as measured with the NPI-16, predicted lower perceived susceptibility or risk of infection with COVID-19. One unanticipated finding was that people with higher scores on Admiration (NARC, Back et al., 2013) perceived themselves as more susceptible to infection. Moreover, these studies demonstrate that narcissistic traits are related to perceived susceptibility to infection also after controlling for the effects of age and gender.

In general, people are more likely to display an optimism bias for problems that they believe they can control (Klein & Helweg-Larsen, 2002). The results of the current studies connect this finding to narcissism, as narcissistic individuals are characterized by overconfidence in their skills and knowledge, and therefore have a high sense of control over their surroundings and outcomes (Macenczak, Campbell, Henley, & Campbell, 2016; Mathieu & St-Jean, 2013). The idea that more personal control lessens a threat is not per se illogical (e.g., De Neys, 2012); knowing how to navigate in risky situations will lower the chances of a bad outcome. The problem for narcissistic individuals is that their perception of control is not objectively supported by their skills (i.e., they only think they are good; Farwell & Wohlwend-Lloyd, 1998). A systematic overview of the relation between health and narcissism suggested that narcissistic individuals consistently inflate their self-reported health and fitness levels, even though their engagement in behaviours that contribute to good health are equal, or even lower, compared to non-narcissistic individuals (Konrath & Bonadonna, 2014). To illustrate, narcissism predicted both strong self-reported oral health and a low frequency of tooth brushing (once per day or less) in medical students (Dumitrescu, Zetu, Zetu, & Păcurar, 2013). Prevention policy makers are advised to take this invulnerability fallacy into account when designing campaigns to target groups with high prevalence of narcissistic traits — men and young adults.

Surveying a worldwide sample, Dryhurst et al. (2020) found that men consistently reported a lower perceived risk of infection than women, despite the fact that their objective risk of dying of COVID-19 is almost two and a half times higher (Jin et al., 2020). The present work corresponds with this finding, and contributes by showing that the effect of gender on perceived susceptibility disappeared when accounting for grandiose narcissism. This suggests that the factors that cause men to report lower perceived susceptibility are covered by grandiose narcissism measures. A meta-analysis has shown robust evidence that men show stronger narcissistic traits than women (Grijalva et al., 2015), especially the facets exploitation and leadership are more prominent among men than women. Even though the grandiose narcissism measures in the current studies (NPI-16 and the NARQ) do not account for these facets, a gender difference was found across all samples. Age remained a significant predictor of perceived susceptibility when including the narcissism measures, signalling that there are other factors besides overconfidence and self-absorption (Ames et al., 2006) that contribute to lower perceived susceptibility of young adults.

The unexpected finding that high scores on the NARQ Admiration subscale coincide with higher perceived susceptibility corresponds with a recent study with a Polish sample (Nowak et al., 2020). Using a different narcissism measure (the Dark Triad Dirty Dozen scale), the authors found that the Dark Triad traits (that includes narcissism, as well as, psychopathy and Machiavellianism) were related to higher perceived susceptibility to infection with COVID-19 (Nowak et al., 2020). It is possible that becoming infected with COVID-19 has a certain dramatic appeal to individuals with strong needs for admiration; infection would result in a special status in society, and receiving a lot of attention (e.g., Albarracin, 2015). Rivalry traits (but not Admiration) have been shown to be a predictor of ignoring governmental restrictions in relation to the coronavirus (Zajenkowski, Jonason, Leniarska, & Kozakiewicz, 2020). The authors suggested that individuals with strong rivalry scores might view the situation as less risky; however, in the current studies we found no evidence that Rivalry was related to lower perceived susceptibility. Lockdown restrictions possibility threaten the individuals' autonomy, invoking antagonistic tendencies (captured by the NARQ Rivalry subscale), whereas the threat of a non-human virus might not elicit this tendency.

It should be noted that the findings in this article are inconclusive and further research needs to be done to test the relation between perceived susceptibility and grandiose narcissism traits. Next, we want to point to potential suppression effects in the regression analyses (e.g., Lynam, Hoyle, & Newman, 2006). While the NPI-16 and the NARQ Admiration subscale share considerable statistical and conceptual overlap, the current studies contribute to the literature that suggests that it is their distinction after controlling for their overlap that holds unique predictive properties for behaviour and attitudes (Hart, Richardson, Tortoriello, & Breeden, 2019; Sedikides, 2020).

In discussing the findings, we also want to acknowledge the limitations of the present research and point to future directions. First, there is no standardized way to measure perceived susceptibility to illnesses in general (Ranby, Aiken, Gerend, & Erchull, 2010), let alone specifically to infection with the coronavirus COVID-19 (e.g., Dryhurst et al., 2020). We took caution to compose our perceived susceptibility measure of an absolute risk estimation and direct comparisons to others close in social distance (i.e., peers of the same age and neighbours) in all studies. In uncertain situations people tend to incorporate information about other people's choices and (health) risks in order derive a better sense of their own perceived risk (Buunk & Gibbons, 2007), which in turn helps them decide whether preventive action is necessary (Klein & Weinstein, 1997). Usually information about others in close social distance is therefore more informative and influential than information about distant others (e.g., Guo, Song, Liu, Xu, & Shen, 2019). Future research should investigate whether the social proximity of “the other” makes a difference for narcissistic individuals in updating their perceived susceptibility or estimated risk. Moreover, perceived susceptibility also seems to impact general risk updates, as new information is less likely to be deemed relevant (e.g., Ahn et al., 2014; Jaccard et al., 2005), which might exacerbate the problem. Longitudinal studies could be conducted to investigate the interplay of perceived susceptibility and updated beliefs after exposure to disease related information in individuals with strong narcissistic traits.

We furthermore want to acknowledge that the participants in the current studies were primarily from Western countries, and that the samples were not representative of the entire population in these countries. Moreover, we did not set out to study observable behavioral consequences of narcissists' altered risk perception.4 As such, it might be useful to replicate the findings of the present studies using representative samples, to conduct the studies in other (non-)Western countries, and to include objectively observable behavioral outcomes in the analysis (such as hand disinfection upon entering a building). Furthermore, the observed effect sizes are small. However, in the context of the pandemic also small effect sizes matter, since an individuals' perceived susceptibility does not only bear consequences for this specific individual, but also for the people around them (e.g., Funder & Ozer, 2019). Lastly, we would like to emphasize that perceived susceptibility is not only influenced by biases (e.g., Van Der Pligt, 1998), but also by other factors, such as, awareness of local prevalence rates, and knowledge about effective protection measures, which were not accounted for in the current studies.

The insight from the present work that perceived susceptibility seems to be related to narcissistic personality traits, might help policy makers in effectively targeting individuals who perceive themselves at low risk of infection to COVID-19. While campaigns that invoke empathy for other people have good potential to increase wearing face masks and keeping distance for the population at large (e.g., Pfattheicher, Nockur, Böhm, Sassenrath, & Petersen, 2020), they might be less effective for narcissistic individuals(e.g., Hepper, Hart, & Sedikides, 2014). Instead, policy makers could appeal to aspects that are important to narcissists (e.g., Hill, 2017). Narcissistic individuals have been shown to knowingly take risks because potential rewards or benefits have a stronger appeal to them compared to individuals with lower narcissistic traits (Buelow & Brunell, 2014; Foster, Shenesey, & Goff, 2009). Because individuals with grandiose narcissistic traits are known to prefer settings in which there is a higher chance of receiving praise and attention (Grapsas et al., 2020), it might be especially appealing to ignore rules and recommendations about limiting contact with other people. This insight could be translated into adequate policies in this current corona setting, and suggests that initiatives that downplay the potential appealing benefits, such as closing down bars at 10 PM, might be more effective in reaching this target group.

We judge own accidental harms more wrong than harms caused by others, hold ourselves more responsible for accidental harms than they hold others, & recruit ‘empathy for pain’ regions more when causing harm, vs observing

When my wrongs are worse than yours: Behavioral and neural asymmetries in first-person and third-person perspectives of accidental harms. Joshua Hirschfeld-Kroen et al. Journal of Experimental Social Psychology, Volume 94, May 2021, 104102. https://doi.org/10.1016/j.jesp.2021.104102

Highlights

• People judge own accidental harms more wrong than harms caused by others.

• People hold themselves more responsible for accidental harms than they hold others.

• People recruit ‘empathy for pain’ regions more when causing harm, versus observing.

• People recruit ‘theory of mind’ regions less when causing harm, versus observing.

Abstract: Research on third-party moral judgments highlights two mechanisms as central to moral judgments of accidental harms: the inference of intent and the perception of harm. However, little is known about how these mechanisms are recruited when people evaluate themselves for harm that they have accidentally caused. Here we explore how a person's perspective — as either actor or observer — influences their moral judgments of accidental harm. We use fMRI to investigate how brain regions involved in the inference of intent and the perception of harm differentially respond when participants either cause (first-person) or observe (third-person) accidental harm. First, we find that people judge their own accidental harms more harshly than they judge others' accidents, and hold themselves more responsible for the unintended harmful outcomes of their choices. Second, we find that regions responding to the first-hand experience of pain are also more sensitive to first-person harms relative to third-person harms, and brain-behavior relationships in a subset of these regions suggest that the tendency to judge oneself more harshly may be supported by a greater sensitivity to the victim's experience of harm. Third, though we find that first-person harms recruit regions for mental state inference to a lesser extent than third-person harms, this difference does not appear to account for the behavioral differences in moral judgment between first-person and third-person harms. The results of this experiment suggest that accidental harms are an important context for broadening our understanding of the relationship between agency, empathy, and moral judgments about the self.

Keywords: MoralityAccidentAgencyHarmTheory of mindfMRI

Happiness doesn't reduce polarization or conspiracy endorsement, and doesn't make easier to realize that a deep fake is fake

Yu, Xudong, Magdalena Wojcieszak, Seungsu Lee, Andreu Casas, Rachid Azrout, and Tomasz Gackowski. 2021. “The (null) Effects of Happiness on Affective Polarization, Conspiracy Endorsement, and Deep Fake Recognition: Evidence from Five Survey Experiments in Three Countries.” OSF Preprints. February 5. doi:10.31219/osf.io/txzqf

Rolf Degen's take: Happiness did not bring the slightest benefit in mitigating the animosity toward the political opponents

Abstract: Affective polarization is a key concern in America and other democracies. Although past evidence suggests some ways to minimize it, there are no easily applicable interventions that have been found to work in the increasingly polarized climate. This project examines whether irrelevant factors, or incidental happiness more specifically, have the power to reduce affective polarization (i.e., misattribution of affect or “carryover effect”). On the flip side, happiness can minimize systematic processing, thus enhancing beliefs in conspiracy theories and impeding individual ability to recognize deep fakes. Three preregistered survey experiments in the US, Poland, and the Netherlands (total N = 3,611) induced happiness in three distinct ways. Happiness had no effects on affective polarization toward political outgroups and hostility toward various divisive social groups, and also on endorsement of conspiracy theories and beliefs that a deep fake was real. Two additional studies in the US and Poland (total N = 2,220), also induced anger and anxiety, confirming that all these incidental emotions had null effects. These findings, which emerged uniformly in three different countries, among different partisan and ideological groups, and for those for whom the inductions were differently effective, underscore the stability of outgroup attitudes in contemporary America and other countries.

Emerging evidence suggests that episodes of drinking with one’s intimate partner can have positive immediate consequences for relationship functioning, whereas drinking episodes without partner do not

Testa, M., Wang, W., & Derrick, J. L. (2021). Effects of couple drinking events on short-term relationship harmony and discord: An ecological momentary assessment study. Psychology of Addictive Behaviors. Advance online publication. https://doi.org/10.1037/adb0000703

Abstract

Objective: Couples with concordant drinking patterns have higher relationship satisfaction and greater relationship stability over time. Emerging evidence suggests that episodes of drinking with one’s intimate partner can have positive immediate consequences for relationship functioning, whereas drinking episodes without partner do not. The present ecological momentary assessment (EMA) study examined the impact of drinking with partner (DWP) and drinking without partner (DWOP) events on immediate and next-day self-reported relationship harmony and discord. 

Method: Heterosexual, cohabiting community couples with congruent drinking patterns, ages 21–35 (N = 191), made three random reports each day for 30 days. Multilevel modeling was used to examine the impact of DWP and DWOP events on momentary relationship functioning, controlling for quantity of alcohol consumed and for functioning at the previous report.

Results: As hypothesized, harmony increased immediately after DWP (but not after DWOP) compared with no drinking for men and women. There were no immediate effects of drinking on discord. There were also positive effects of DWP on next morning harmony, but these were specific to women’s drinking reports. Women’s DWP and DWOP predicted reduced next morning discord for men; however, men’s and women’s discord increased as women consumed more drinks the previous evening.

Conclusions: Findings suggest that concordant drinking couples may achieve immediate benefits for couple harmony from drinking together. Women’s drinking seems to be more impactful than men’s on next-day harmony and discord, with greater harmony following women’s evening DWP but increased discord associated with heavier evening drinking by women.

Young and restless, old and focused: Age-differences in mind-wandering frequency and phenomenology

Moran, C. N., McGovern, D. P., Warren, G., Grálaigh, R. Ó, Kenney, J. P. M., Smeaton, A., & Dockree, P. M. (2021). Young and restless, old and focused: Age-differences in mind-wandering frequency and phenomenology. Psychology and Aging, Feb 2021. https://doi.org/10.1037/pag0000526

Abstract: The consistently observed age-accompanied diminution in mind-wandering stands seemingly opposed to accounts that present mind-wandering as a failure of executive control. This study examined the impact of aging on the frequency and phenomenology of mind-wandering and investigated distinct variables mediating age-related differences in unintentional and intentional mind-wandering. Thirty-four younger and 34 healthy older adults completed a neuropsychological test battery and contrast change detection task embedded with experience sampling probes asking participants to discriminate the nature of their thoughts. Results revealed age-related decreases in unintentional and intentional mind-wandering, but equivalent task accuracy. Parallel mediations demonstrated that older adults reduced their unintentional mind-wandering through having less anxiety and greater task engagement than younger adults. Despite the evidence of age-related decline on cognitive function tests, neither executive function nor task demand variables further contributed to the model. Our results adjudicate between competing theories, highlighting the roles of affective and motivational factors in unintentional mind-wandering. Intentional mind-wandering showed no significant associations with the neuropsychological measures; however, intentional mind-wandering was associated with more false alarms, which was mediated by greater reaction time variability (RTV). In the context of the exploitation/exploration framework, we suggest that younger adults were more inclined to intentionally mind-wander, indexed by increased RTV, while preserving comparable performance accuracy to older adults. Conversely, older adults exploited greater task focus, marked by reduced RTV, with less bias toward, or resources for, exploration of the mind-wandering space. Therefore, dispositional and strategic factors should be considered in future investigations of mind-wandering across the lifespan.

Demonstrate values: Behavioral displays of moral outrage as a cue to long-term mate potential

Brown, M., Keefer, L. A., Sacco, D. F., & Brown, F. L. (2021). Demonstrate values: Behavioral displays of moral outrage as a cue to long-term mate potential. Emotion, Feb 2021. https://doi.org/10.1037/emo0000955

Rolf Degen's take: The expression of outrage can serve as an instrument of courtship, ideally suited for men to pitch themselves to women as long-term partners.

Abstract: Recent findings suggest that moral outrage signals trustworthiness to others, and such perceptions play a uniquely important role in identifying social opportunities. We conducted four studies (N = 870) investigating how displays of moral outrage are perceived in the specific context of mating. Results indicated participants, particularly women, found prospective mates describing outrage-signaling activism to be more desirable for long-term mating (Study 1), and this perception of desirability was similarly inferred among same-sex raters (Study 2). We further replicated findings in Study 1, while additionally considering the basis of women’s attraction toward outraged behavior through candidate mediators (Studies 3). Although we found consistent evidence for the desirability of an ostensibly outraged target, Study 4 finally identified a boundary condition on the desirability of outrage, wherein mere expression of outrage (without activism) was insufficient to bolster attraction. We frame results from complementary perspectives of trust signaling and sexual strategies theory.

Gender Differences in the Intention to Start a Business: Greater differences in higher egalitarian countries

Gender Differences in the Intention to Start a Business: An Updated and Extended Meta-Analysis. Holger Steinmetz, Rodrigo Isidor, and Corinna Bauer. Zeitschrift für Psychologie (2021), 229, pp. 70-84. February 4, 2021. https://doi.org/10.1027/2151-2604/a000435

Abstract. The present study updates and extends the meta-analysis by Haus et al. (2013) who applied the theory of planned behavior (TPB) to analyze gender differences in the motivation to start a business. We extend this meta-analysis by investigating the moderating role of the societal context in which the motivation to start a business emerges and proceeds. The results, based on 119 studies analyzing 129 samples with 266,958 individuals from 36 countries, show smaller gender differences than the original study and reveal little differences across cultural regions in the effects of the tested model. A meta-regression analyzing the role of specific cultural dimensions and economic factors on gender-related correlations reveals significant effects only of gender egalitarianism and in the opposite direction as expected. In summary, the study contributes to the discussion on gender differences, the importance of study replications and updates of meta-analyses, and the generalizability of theories across cultural contexts.

Keywords: gender differences, entrepreneurship, theory of planned behavior, meta-analysis, starting a business

There is little evidence that spicy food in hot countries is an adaptation to reducing infection risk

There is little evidence that spicy food in hot countries is an adaptation to reducing infection risk. Lindell Bromham, Alexander Skeels, Hilde Schneemann, Russell Dinnage & Xia Hua. Nature Human Behaviour, Feb 4 2021. https://www.nature.com/articles/s41562-020-01039-8

Popular version: https://socialsciences.nature.com/posts/why-do-hot-countries-have-spicy-food

Rolf Degen's take: Use of spices in dishes did not evolve as an adaptation to ward off infection risk in hot areas, laying to rest the “Darwinian gastronomy” hypothesis.

Abstract: Spicier food in hot countries has been explained in terms of natural selection on human cultures, with spices with antimicrobial effects considered to be an adaptation to increased risk of foodborne infection. However, correlations between culture and environment are difficult to interpret, because many cultural traits are inherited together from shared ancestors, neighbouring cultures are exposed to similar conditions, and many cultural and environmental variables show strong covariation. Here, using a global dataset of 33,750 recipes from 70 cuisines containing 93 different spices, we demonstrate that variation in spice use is not explained by temperature and that spice use cannot be accounted for by diversity of cultures, plants, crops or naturally occurring spices. Patterns of spice use are not consistent with an infection-mitigation mechanism, but are part of a broader association between spice, health, and poverty. This study highlights the challenges inherent in interpreting patterns of human cultural variation in terms of evolutionary pressures.

Sex Differences in Mate Preferences Across 45 Countries - A Large-Scale Replication in 45 Countries

Sex Differences in Mate Preferences Across 45 Countries: A Large-Scale Replication. Kathryn V. Walter et al. Psychological Science, March 20, 2020. https://doi.org/10.1177/0956797620904154

h/t David Schmitt Mate Preferences Across 45 Countries: A Large-Scale Replication...Support for universal sex differences in preferences remains robust...Beyond age of partner, neither pathogens nor gender equality robustly predicted sex differences across countries

Abstract: Considerable research has examined human mate preferences across cultures, finding universal sex differences in preferences for attractiveness and resources as well as sources of systematic cultural variation. Two competing perspectives—an evolutionary psychological perspective and a biosocial role perspective—offer alternative explanations for these findings. However, the original data on which each perspective relies are decades old, and the literature is fraught with conflicting methods, analyses, results, and conclusions. Using a new 45-country sample (N = 14,399), we attempted to replicate classic studies and test both the evolutionary and biosocial role perspectives. Support for universal sex differences in preferences remains robust: Men, more than women, prefer attractive, young mates, and women, more than men, prefer older mates with financial prospects. Cross-culturally, both sexes have mates closer to their own ages as gender equality increases. Beyond age of partner, neither pathogen prevalence nor gender equality robustly predicted sex differences or preferences across countries.

Keywords: mate preferences, sex differences, cross-cultural studies, evolutionary psychology, biosocial role theory, open data, preregistered

Check also How Sexually Dimorphic Are Human Mate Preferences? Daniel Conroy-Beam. Personality and Social Psychology Bulletin, June 11, 2015. https://doi.org/10.1177/0146167215590987

Abstract: Previous studies on sex-differentiated mate preferences have focused on univariate analyses. However, because mate selection is inherently multidimensional, a multivariate analysis more appropriately measures sex differences in mate preferences. We used the Mahalanobis distance (D) and logistic regression to investigate sex differences in mate preferences with data secured from participants residing in 37 cultures (n = 10,153). Sex differences are large in multivariate terms, yielding an overall D = 2.41, corresponding to overlap between the sexes of just 22.8%. Moreover, knowledge of mate preferences alone affords correct classification of sex with 92.2% accuracy. Finally, pattern-wise sex differences are negatively correlated with gender equality across cultures but are nonetheless cross-culturally robust. Discussion focuses on implications in evaluating the importance and magnitude of sex differences in mate preferences.

Keywords: mate selection, sex differences, multivariate analysis, cross-cultural analysis

And Conroy-Beam, D., & Buss, D. M. (2019). Why is age so important in human mating? Evolved age preferences and their influences on multiple mating behaviors. Evolutionary Behavioral Sciences, 13(2), 127-157. https://www.bipartisanalliance.com/2019/04/why-is-age-so-important-in-human-mating.html

We find that cell phone vibrations of intermediate length (400ms) evoke a reward response, particularly among younger & more impulsive consumers, which in turn boosts purchasing in online shopping

Hampton, William H., and Christian Hildebrand. 2021. “Pavlov’s Buzz? Mobile Vibrations as Conditioned Rewards.” PsyArXiv. February 4. psyarxiv.com/92ksn

Abstract: People spend a large portion of their day interacting with vibrating mobile devices, yet how we respond to the vibrotactile sensations emitted by these devices, and their effect on consumer decision-making is largely unknown. Integrating recent work on haptic sensory processing and classical conditioning, the current research examines: (1) the relationship between vibration duration and reward response, (2) to what extent rewarding vibrations modify consumer decision-making, and (3) the underlying mechanism of this effect. We find that mobile vibrations of intermediate length (400ms) evoke a reward response, particularly among younger and more impulsive consumers, which in turn boosts purchasing in ecological online shopping environments. We examine mobile vibration in a variety of experimental settings, drawing on a diverse participant pool, leveraging both controlled experiments and a large, country-wide field experiment to assess theoretically- and practically-important boundary conditions. We further examine the mechanism of this effect, providing direct evidence that vibrations influence consumers due to classical conditioning, such that vibrations become rewarding due to their learned association with positive mobile events. Our findings have important implications for the effective design of haptic interfaces in marketing and the role of mobile vibration stimuli as a novel form of reward.

‘You can’t bullshit a bullshitter’ (or can you?): Bullshitting frequency predicts receptivity to various types of misleading information

‘You can’t bullshit a bullshitter’ (or can you?): Bullshitting frequency predicts receptivity to various types of misleading information. Shane Littrell  Evan F. Risko  Jonathan A. Fugelsang. British Journal of Social Psychology, February 4 2021. https://doi.org/10.1111/bjso.12447

Rolf Degen's take: Notorious bullshitters are particularly bad at seeing through the bullshit of others. https://t.co/oiLV02cRfL https://t.co/np4SXk5ISt

Abstract: Research into both receptivity to falling for bullshit and the propensity to produce it have recently emerged as active, independent areas of inquiry into the spread of misleading information. However, it remains unclear whether those who frequently produce bullshit are inoculated from its influence. For example, both bullshit receptivity and bullshitting frequency are negatively related to cognitive ability and aspects of analytic thinking style, suggesting that those who frequently engage in bullshitting may be more likely to fall for bullshit. However, separate research suggests that individuals who frequently engage in deception are better at detecting it, thus leading to the possibility that frequent bullshitters may be less likely to fall for bullshit. Here, we present three studies (N = 826) attempting to distinguish between these competing hypotheses, finding that frequency of persuasive bullshitting (i.e., bullshitting intended to impress or persuade others) positively predicts susceptibility to various types of misleading information and that this association is robust to individual differences in cognitive ability and analytic cognitive style.

Men and women are equally interested in being the recipient of sexual behaviours while they sleep; this particular interest (proposed term "dormaphilia") opens up new and interesting research questions

Somnophilia: Examining Its Various Forms and Associated Constructs. Elizabeth T. Deehan, Ross M. Bartels. Sexual Abuse, November 15, 2019. https://doi.org/10.1177/1079063219889060

Abstract: Somnophilia refers to the interest in having sex with a sleeping person. Using an online sample of 437 participants, the present study provides the first empirical examination of somnophilia, its various forms, and theorized correlates. Participants completed the newly developed Somnophilia Interest and Proclivity Scale, which comprises three subscales (active consensual, passive consensual, and active nonconsensual somnophilia). To test hypotheses about the convergent and divergent validity of different paraphilic interests, participants also completed scales measuring necrophilic, rape-related, and sadistic/masochistic sexual fantasies, rape proclivity, and the need for sexual dominance/submission. Male participants scored higher than females on all scales except the passive subscale. For both males and females, each subscale was associated most strongly with conceptually congruent variables. These results support existing theoretical assumptions about somnophilia, as well as offering newer insights, such as distinguishing between active and passive somnophilia. Limitations and implications for further research are discussed.

Keywords: somnophilia, necrophilia, paraphilia, biastophilia, sexual fantasy, dormaphilia

The findings of this study support the notion that self-perceived facial attractiveness is not only motivated by psychological traits, but objectively measured phenotypic traits also contribute significantly

Kanavakis G, Halazonetis D, Katsaros C, Gkantidis N (2021) Facial shape affects self-perceived facial attractiveness. PLoS ONE 16(2): e0245557. https://doi.org/10.1371/journal.pone.0245557

Abstract: Facial appearance expresses numerous cues about physical qualities as well as psychosocial and personality traits. Attractive faces are recognized clearly when seen and are often viewed advantageously in professional, social and romantic relationships. On the other hand, self-perceived attractiveness is not well understood and has been mainly attributed to psychological and cognitive factors. Here we use 3-dimensional facial surface data of a large young adult population (n = 601) to thoroughly assess the effect of facial shape on self-perceived facial attractiveness. Our results show that facial shape had a measurable effect on self-perception of facial attractiveness in both sexes. In females, self-perceived facial attractiveness was linked to decreased facial width, fuller anterior part of the lower facial third and more pronounced middle forehead and root of the nose. Males favored a well-defined chin, flatter cheeks and zygomas, and more pronounced eyebrow ridges, nose and middle forehead. The findings of this study support the notion that self-perceived facial attractiveness is not only motivated by psychological traits, but objectively measured phenotypic traits also contribute significantly. The role of social stereotypes for facial attractiveness in modern society is also inferred and discussed.

Discussion

This study assesses the effect of facial shape variation on self-perceived facial attractiveness using three-dimensional data of a large young adult population. Current evidence suggests that facial attractiveness, as perceived by others, is related to averageness, symmetry, masculinity/femininity, and also to secondary characteristics, namely skin texture and tone, hair quality and style as well as eye color [9, 11, 12, 25, 26]. Intuitively, it might be expected that objective facial characteristics are only important when judging the esthetic appearance of an unfamiliar face, and not when performing a self-assessment of facial attractiveness. So far, self-perceived facial attractiveness is more commonly linked to internal processes related to individual self-concept and self-esteem [13, 14]. Here, we put this preconception under scrutiny and show that self-perceived facial attractiveness is also affected by objective factors, namely facial shape.

Comparisons of facial shape space (as described by Procrustes coordinates) between males and females in our sample, demonstrated significant sexual dimorphism. Males, on average, presented a wider face with more prominent eyebrow ridges, a pronounced chin and more protruded nose. On the other hand, the average female face was narrower, with more protruded lips and cheeks, as well as more dominant eyes. These facial differences between males and females represent well known phenotypic expressions of sexual hormones during growth and development of the human face [27, 28]. Biologically, they might be related to inherent differences in lung capacity, body mass and distribution of adipose tissue, which to some degree influence facial anatomy [29].

Due to the distinct sexual differences, shape variation was also explored separately in males and females within the present sample. A more careful examination of the principal components explaining more than 50% of the variation within each sex [PC1-PC4] revealed that PC1 and PC2 described changes in the nose, lower facial height and midfacial width (Figs 3–6). Thus, the areas with the largest variation within the male and female population are similar to the areas presenting the largest differences between sexes (Fig 2); potentially signifying the different effect of sexual hormones not only between, but also within same sex populations. A genetic and environmental interpretation of the observed variation might also be plausible. Mapping of the genetic effect on human facial shape has identified a strong genetic control of the lower third of the face (primarily the chin) and the nose [30–32], in all large continental populations. In addition, anatomic investigations of human skulls from populations that lived in diverse climates show marked dissimilarities in the piriform and zygomatic areas between specimens from tropical and temperate areas [33]. These are attributed to evolutionary adaptations to climate conditions and manifest the presence of an additional environmental effect on facial morphology. From a biological view, our results fall within the above spectrum. PC3 and PC4 in our female and male populations, mostly describe changes in the perioral region, the lips and the eyes. The genetic effect on these structures has also been demonstrated, with the distances between the eyes as well as between the eyes and the mouth presenting a high heritability effect [34].

The face is the most influencing factor in human interactions, it contributes to effective communication and affects social and personal relationships [4, 9]. Facial dimorphism related to inherent sexual characteristics plays an important role in romantic relationships by shaping perceived impressions about mating quality, health and reproductive potential [34]. Females, for example, exhibit an increased sexual preference for males with more masculine features during their ovulation period [9, 35]. During this time, females are also judged as more attractive by observers of the same or opposite sex [36].

Features of masculinity and femininity provide cues for physical and social traits, such as attractiveness, personality, trustworthiness, dominance and aggression [5, 8, 9, 12, 34, 37]. Typically, masculine male faces and feminine female faces are considered more attractive by both sexes, although this is only true for small deviations from the average face [11, 12, 37, 38]. Despite the extensive data supporting the above, the notion of universal attractiveness cues has been challenged, and there seem to be significant differences between populations [39]. It is suggested that attractiveness cues are learned within a social environment [37, 39] and, thus, many of our beliefs might be representative of western societies only. In the present study all participants were born and raised in the United States, therefore the ethnic variability within our sample did probably not influence self-assessments considerably.

Our results showed that facial shape had a significant effect on self-perceived facial attractiveness and predicted 4% and 5% of the variation in VAS scores in females and males, respectively. Furthermore, females with more feminine features and males with more masculine features seemed to consider themselves more attractive, confirming the findings of numerous previous studies that have assessed attractiveness with external ratings. Given the multidimensionality of factors interfering with the process of self-assessment, our findings reveal the importance of facial shape, an objective factor, in partially steering peoples’ opinions about themselves. It has been suggested that self-perceived attractiveness is an acquired feature that evolves throughout the course of our lifetime according to our social interactions [40]. Furthermore, it strongly affects romantic relationships; individuals with high self-ratings of attractiveness set higher upper limits in their dating expectations regardless of their objective facial appearance [41]. The effect of facial shape becomes more noteworthy when taking into account that humans evaluate faces that resemble them as 22% more attractive [42]. This fairly narcissistic phenomenon implies that people are less likely to consider their objective appearance when making dating decisions and tend to adjust their attractiveness estimates of their potential dates according to their own appearance. The present study counters this idea, since young adults in our sample appeared to be influenced by the morphology of their faces when making their self-assessment. This is a sign that the intuitive process of making romantic or mating decisions may also be subconsciously influenced by more objective factors, such as an individual’s facial shape.

A more in-depth exploration of our sample, in sub-groups, revealed that in white individuals the previously described effect of facial shape was not evident in males and was stronger in females, as compared to the entire female sample. Furthermore, no effect was evident in the subgroup of non-white females. Both of the above observations have significant social implications. Most beauty standards have been historically developed based on white facial features [43], and although beauty standards have evolved with western societies becoming more multi-racial, our finding entertains the thought that young white females might experience more pressure in meeting certain social standards of facial appearance. On the other hand, maybe the effect of facial shape on self-perceived facial attractiveness is mediated by the limited effect of other factors, such as skin texture. Coetzee et al. [44] studied a group of white and black individuals within a western society and observed that whites based their assessments of attractiveness primarily on facial shape, in contrast to blacks who were more influenced by skin tone. They connected their finding to the large variety of darker skin tones, to which whites are visually oblivious compared to blacks. Our results support this conclusion, since self-perceptions of non-white females were not affected by their facial shape. Another reason for this could be that the increased facial shape variation in the non-white females group compared to the white females’ group might have added noise to the outcomes failing to detect a significant effect. However, the absence of statistical significance on this test was definitive, based on the measured p-value, thus, not supporting this notion.

As mentioned before, the same observation was made here in white males; which may be subject to multifold interpretations. Males tend to have a higher self-esteem than females [45] and are more satisfied with their overall appearance [46]. This difference is unlikely to have a genetic or biological origin and seems to dissipate with age, since it is not seen in mature adults [45]. This universally seen phenomenon is rather a result of environmental factors that influence the development of self-esteem over a lifetime [47]. Western societies likely enable males to develop higher self-esteem than females, which in result affects more acquired social features. If so, it can be speculated that the effect of self-esteem on self-perceived attractiveness in young males overshadows any other, more objective feature. This is also supported by the comparison of VAS scores between males and females in our population, which showed that males gave significantly higher attractiveness ratings to themselves (P<0.001). The above considerations together with the reduced sample size of the white male sample might have made the detection of a significant effect in the specific sample impossible.

Methodological considerations

The results of this study must be interpreted within the realm of the studied population and cannot be extrapolated to the general population. We have investigated a large group of young adults that were all highly educated, were born and had lived most of their lives in the United States. Despite their ethnic diversity, it may thus be assumed that their standards for facial attractiveness did not vary significantly. It must be noted that if the same study was repeated in an older population, the results might have been different due to changes in perception of attractiveness with age [48]. Here we did not report on the effect of age on the results, as an initial exploratory analysis revealed that it was not statistically significant.

In addition, participants were not able to look at their pictures prior to evaluating their facial attractiveness, which might have triggered a different response, had it been allowed. However, it was preferred to obtain more “genuine” answers that were not affected by the instant stimulus produced from prior exposure to their facial image.

Furthermore, the reliability testing did not include the image acquisition error related to the camera system since this has been found to be minimal (approximately 0.2mm) [49, 50]. Therefore, it was not considered to have a significant impact on the results.

Significance and implications

This study provides novel and important information regarding the effect of facial morphology on self-perceived facial attractiveness. Self-assessments of body image and attractiveness are largely performed under the scope of psychosocial evaluations. Thus, the effect of objective features is often understated. Here we show that objective facial appearance is important when humans make decisions about their own facial attractiveness. In addition, we provide support to the notion that even in multicultural, modern societies, beauty stereotypes have changed little and continue to have a strong impact. Our findings are particularly insightful for plastic surgeons, maxillofacial surgeons, orthodontists and other specialists who are involved in treatments affecting patients’ facial appearance and particularly facial shape. Facial shape was identified as a factor related to facial appearance, and thus, as an important element to consider when aiming to improve facial appearance. The latter is shown to be a reason for patients to seek treatment and a factor that affects patient satisfaction from a given intervention. In addition, the results of this study provide helpful information to clinical psychologists interested in aspects of human perception, and are of interest for the general public as facial appearance is an important feature of everyday human interactions.

“Important Conversations” Are Needed to Explain the Nocebo Effect

“Important Conversations” Are Needed to Explain the Nocebo Effect. Anita Slomski. JAMA, February 3, 2021. doi:10.1001/jama.2020.25840

Roger needed no convincing that taking a statin could prevent his early death. At age 52 years, he had mixed lipidemia, severe peripheral vascular disease, obesity, fatty liver disease, and a previous femoral artery occlusion. But as he explained to the investigators of the SAMSON (Self-Assessment Method of Statin Side Effects or Nocebo) trial, he’d already tried 3 different statins and discontinued each one due to the dreadful muscle pain he felt while taking them.

“He was totally gobsmacked when we unblinded the results of SAMSON and showed him that his worst months—including muscle pain so bad he couldn’t get out of bed—were from placebo,” said cardiologist James P. Howard, MB BChir, clinical research fellow at Imperial College London and co–first author of the SAMSON report published in the New England Journal of Medicine. After discovering that he reported feeling fine during the months of the trial that he received a statin, Roger resumed statin therapy with no symptoms for the 4 years since receiving his personal results.

The novel n-of-1 trial validated what physicians have long observed: patients’ negative expectations for statin therapy rather than the drug’s pharmacological action are often responsible for intolerable adverse effects. SAMSON, in fact, found that 90% of adverse effects from statins were explained by this nocebo effect. “The nocebo effect is a massive burden; in our 60 patients, side effects were so bad that they had to come off the tablets on 71 occasions,” Howard said in an interview.

The 60 study participants, all who had previously discontinued statin therapy because of intolerable adverse effects, received 4 bottles each of 20-mg atorvastatin and placebo, and 4 empty bottles. Each month for a year, participants took pills or nothing in a random sequence and recorded their daily symptom intensity on their smartphones.

“To work out the nocebo effect, it’s imperative that you have a nontreatment arm where the patient takes nothing so you can subtract the background symptoms that are ever-present, such as the aches and pains of getting older or of arthritis, for example,” Howard said. “As far as we know, this is the first time anyone has done such a trial.”

At the end of the trial, patients saw how they rated their symptoms during the 3 treatment sequences, which was compelling enough to convince half of them to resume statin therapy. “Only 18 of the original 60—less than one-third—told us that they weren’t restarting statins because they still believed they caused side effects,” Howard said.

Although trials in other journals including JAMA and The Lancet have reported nocebo effects in statin therapy, SAMSON stood out because the study design demonstrated to patients themselves that the nocebo effect is real.

The study’s participants had first-hand evidence that “just the simple act of taking a pill, where they might have been expecting side effects, explained much of the symptoms,” Donald Lloyd-Jones, MD, ScM, president-elect of the American Heart Association (AHA), told JAMA last fall during the AHA’s virtual Scientific Sessions conference.

However, some experts question the magnitude of the nocebo effect in SAMSON’s results. “It’s easy for me to believe that 50% to 60% of statin side effects are nocebo, but not 90%,” Steven E. Nissen, MD, chief academic officer and Lewis and Patricia Dickey Chair in Cardiovascular Medicine at the Cleveland Clinic, said in an interview. “Some patients who have tried very hard to take statins have a real disorder” that prevents them from taking statins.

Howard agrees that his results shouldn’t be extrapolated to all patients who take statins. “In a larger trial, you might find a 70% or 95% nocebo effect,” he said. What’s important “is that the nocebo effect dominates in a majority of patients on a statin and that real side effects are much rarer than we thought.”

For physicians, that means explaining the nocebo effect. “We have to have very important conversations with our patients rather than just writing a prescription, actually telling them what to expect,” said Lloyd-Jones, also chair of preventive medicine at Northwestern Medicine Feinberg School of Medicine.

A Bad Rap Fuels the Nocebo Effect

Although much less studied than the placebo effect, the nocebo response has been demonstrated in a variety of therapies in experimental and real-world settings. A recent review article in the New England Journal of Medicine cited several striking examples. When New Zealand pharmacies switched to a new formulation of thyroid hormone replacement medication, reports of adverse events increased 2000-fold, even though the drug’s active ingredient remained unchanged. Nearly a third of study participants taking the β-blocker atenolol for cardiac disease and hypertension developed sexual adverse effects and erectile dysfunction when they were warned of the potential side effects compared with 16% who weren’t informed of possible adverse effects. Patients have blocked the analgesic effects of the potent opioid remifentanil when falsely told it would increase pain.

“The nocebo effect has been described in biosimilars used in autoimmune diseases, when patients believe the drugs are less effective than the original biologics,” Luana Colloca, MD, PhD, the review’s first author and associate professor in the Department of Pain and Translational Symptom Science at the University of Maryland School of Nursing, said in an interview.

“We know that allergic reactions can be amplified by nocebo, such as people continuing to have symptoms of gluten-intolerance even after receiving a negative diagnosis,” Colloca added. And 30% of women receiving chemotherapy for breast cancer developed anticipatory nausea from previously neutral environmental cues, such as meeting an oncology nurse at the grocery store or being in a room painted the same color as the infusion room, her review noted.

The greater a patient’s negative perception of a therapy, the stronger the nocebo response. “The patients we give statins to are the same patients who get prescriptions for angiotensin-converting enzyme inhibitors, hypertension treatment, and aspirin,” Howard said. “Patients don’t start ramipril for hypertension and say they feel terrible. People view statins much more negatively and with more skepticism.”

Concerns about statins began when the US Food and Drug Administration (FDA) required statin labels to list rhabdomyolysis as a potential serious adverse effect after an early statin was withdrawn from the market. “That made some doctors edgy about statins,” and, in turn, patients, Howard said.

Then as professional societies advised that statins could benefit a greater number of people, a baseless claim began circulating “that statins were developed to enrich the pharmaceutical industry and that doctors are in bed with big pharma, pushing cholesterol drugs,” Nissen said. Companies selling “natural” products to lower cholesterol have also contributed to perceptions that statins are harmful.

A new study that tracked statin adverse effects reported to the FDA’s Adverse Event Report System found that significantly more nocebo-related subjective adverse events than harms substantiated by clinicians have been reported in the last decade. Complaints of nocebo-effect symptoms—but not objective adverse events—peaked whenever the FDA issued a statin warning. One such warning occurred in 2010 when an increased risk of myopathy was observed with high-dose simvastatin.

Bad publicity has also dogged bisphosphonates after reports emerged of women developing esophageal ulcers after taking the drug to treat osteoporosis. “These patients took the bisphosphonate incorrectly—dry swallowing it or taking it while lying down—and they refluxed alendronic acid into the esophagus,” David Karpf, MD, adjunct clinical professor of endocrinology, gerontology, and metabolism at Stanford University School of Medicine, said in an interview.

In the large population-based fracture-prevention trial that Karpf led, serious gastric adverse events were higher in the placebo group than in the bisphosphonate group. “We told participants that the drug is effective in preventing fractures and is generally well tolerated, and lo and behold, we had excellent compliance in the trial,” he said.

“I think the nocebo effect demonstrated in the SAMSON study is generalizable to any drug that has been studied in large populations and shown to be well tolerated but with some side effects, like bisphosphonates,” Karpf added. Drugs approved to treat asymptomatic chronic diseases have passed a high bar for safety, and, therefore, should be more tolerable to patients, he said. But at the same time, the nocebo effect may be stronger for drugs used to prevent disease in asymptomatic patients. “People aren’t getting any therapeutic satisfaction from taking a statin, but they are reading about muscle damage when they Google statins,” said Howard.

These Symptoms Aren’t Phony

Clinicians generally have an inkling about which patients may be vulnerable to the nocebo effect, such as those with a history of anxiety or depression. Other tip-offs are patients who say they’re very sensitive to medications or hate taking them or who mention a long list of symptoms that their previous physicians couldn’t diagnose, according to Arthur Barsky, MD, professor of psychiatry at Harvard Medical School.

Lack of trust in the clinician can also prompt a nocebo response. “A patient reporting side effects can often be a commentary on the doctor-patient relationship,” Barsky said in an interview. “If you aren’t sure your doctor has made the right diagnosis or you aren’t comfortable with your doctor, it’s easier to say you’ll stop taking a drug because it causes headaches than to say, ‘I don’t trust you.’”

Patients who report nocebo symptoms are feeling real distress—but misattributing it to the drug. In reality, their symptoms may be caused by aging, not eating well, stress, or the underlying disease itself. “For patients with difficult lives, side effects to statins can be a nidus for their emotional pain,” Jennifer Robinson, MD, MPH, professor of epidemiology at the University of Iowa College of Public Health and lead author of statin guidelines for the National Lipid Association, said in an interview.

It’s important for clinicians to acknowledge nocebo symptoms as real but “to discount their medical significance by telling patients that the symptoms they are experiencing aren’t harmful or aren’t an indication that the drug is dangerous,” Barsky said. “The more you are worried about what a drug will do to your body, the more you will monitor side effects and the more intense they will become.”

If patients appear hesitant about starting or continuing a particular drug, clinicians should ask what their worries are, Colloca suggested. “The nocebo effect can occur if a patient has incorrect information about a drug or has had prior negative medication experiences,” she said. Physicians can point to trials of the drug showing that participants in the placebo group had similar adverse effects as those on the active drug. “Allaying the patient’s concerns can make the drug more tolerable,” Colloca said.

Physicians may also be able to head off a nocebo effect by emphasizing a drug’s efficacy, tolerability, and safety rather than mentioning rare adverse effects. “I tell patients that statins have been studied in a quarter of a million people and are safer than aspirin,” Robinson said.

When switching patients with rheumatoid arthritis from a biologic therapy to a less costly biosimilar, Roy Fleischmann, MD, clinical professor of medicine at the University of Texas Southwestern Medical Center, takes pains to explain the efficacy and safety of the biosimilar and that the vast majority of patients respond well to it. “There is a perception—among physicians, too—that if a drug is cheaper, the quality is not as good as the original biologic,” Fleischmann said in an interview. “It’s important for physicians to assure themselves and convey to their patients that the biosimilar has been manufactured according to FDA standards.”

Although clinicians must disclose a drug’s potentially dangerous adverse effects, patients can decide if they also want to be informed about potential minor adverse effects. So-called authorized concealment avoids priming patients to experience adverse effects through the potent power of suggestion.

Among patients who initially say they cannot tolerate a statin, up to 90% can successfully return to daily moderate or high-intensity statin therapy when physicians use strategies to mitigate the nocebo effect, according to Robinson. It may take trials of a few different statins or starting a patient on a 5-mg dose once a week and gradually increasing the dose to overcome nocebo adverse effects, she said.

SAMSON’s Howard said he’ll rechallenge patients with a different statin but disagrees with the strategy of inching patients along on low doses to increase tolerability. “You can’t tell patients that the side effects aren’t caused by statins and then start them at a low dose of another one,” he said. “Either you believe that the side effects are due to the nocebo effect, or you believe they are biochemical and then you go with a low dose. Sending mixed messages isn’t helpful.”

For patients at low risk of myocardial infarction or stroke who continue to experience muscle pain after trying 2 different statins, Howard will switch them to the nonstatin ezetimibe. “But if the goal of the statin is for secondary prevention, you are duty-bound to try a lot harder with these patients, whether that means rechallenging with another statin or using a PSCK9 [proprotein convertase subtilisin/kexin type 9] inhibitor,” Howard said.

“We have effective drugs to treat major diseases that have a huge societal impact, such as diabetes, heart disease, osteoporosis,” said Stanford University’s Karpf. “But we need to work harder to improve patients’ adherence to these lifesaving therapies. I think the SAMSON study is one step in that direction.”

Alcohol conditioned contexts enhance positive subjective alcohol effects and consumption

Alcohol conditioned contexts enhance positive subjective alcohol effects and consumption. Joseph A. Lutz, Emma Childs. Behavioural Processes, February 3 2021, 104340. https://doi.org/10.1016/j.beproc.2021.104340

Highlights

• Alcohol-paired environments enhanced positive subjective responses to alcohol.

• Alcohol-paired environments promoted alcohol drinking.

• Conditioning strength predicted early drinking in a context-dependent manner.

• Human CPP is a viable model to study alcohol environment associations.

• This approach may reveal the mechanisms by which contexts induce drinking.

• The model may be used to test strategies to prevent context-induced drinking.

Abstract: Associations between alcohol and the places it is consumed are important at all stages of alcohol abuse and addiction. However, it is not clear how the associations are formed in humans or how they influence drinking, and there are few effective strategies to prevent their pathological effects on alcohol use. We used a human laboratory model to study the effects of alcohol environments on alcohol consumption. Healthy regular binge drinkers completed conditioned place preference (CPP) with 0 vs. 80 mg/100 ml alcohol (Paired Group). Control participants (Unpaired Group) completed sessions without explicit alcohol-room pairings. After conditioning, participants completed alcohol self-administration in either the alcohol- or no alcohol-paired room. Paired group participants reported greater subjective stimulation and euphoria, and consumed more alcohol in the alcohol-paired room in comparison to the no alcohol-paired room, and controls tested in either room. Moreover, the strength of conditioning significantly predicted drinking; participants who exhibited the strongest CPP consumed the most alcohol in the alcohol-paired room. This is the first empirical evidence that laboratory-conditioned alcohol environments directly influence drinking. The results also confirm the viability of the model to examine the mechanisms by which alcohol environments stimulate drinking and to test strategies to counteract their influence on behavior.

Abbreviations: CPPconditioned place preferenceALC80mg alcohol/100ml bloodNo ALC0mg alcohol/100ml bloodBrACbreath alcohol concentrationHRheart rateBPblood pressure

Keywords: Alcoholconditioned place preferencecontextcueshumanself-administration