Psychotherapy and Social Change: Utilizing Principles of Cognitive-Behavioral Therapy to Help Develop New Prejudice-Reduction Interventions

Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation

OBJECTIVES

Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety.

METHODS

Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity.

RESULTS

Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety.

CONCLUSIONS

The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.

Nonjudgmental Regard of Others: Investigating the Links Between Other-Directed Trait Mindfulness and Prejudice

Although researchers predict that experiencing greater trait mindfulness should be related to less prejudiced attitudes towards others, the evidence has been inconsistent. We suggest that this is due to the narrow operationalizations of mindfulness that have been utilized thus far. Specifically, research to date has relied solely on mindfulness as it pertains to the self. We therefore examined an expanded definition of mindfulness to study the role of nonjudgmental attitudes towards others and its relation with prejudice. Using a new measure of Nonjudgmental Regard towards Others (NRO), the current study found that Ideological Acceptance, or judgments of another's actions, ideas, and personality, and Emotion Acceptance, or acceptance of another's emotions and emotional expressions, were independently associated with prejudiced attitudes towards numerous different outgroups such as drug users, people who are overweight, homosexuals, and people with disabilities. Furthermore, they were able to explain variance over and above the Five Facet Mindfulness Questionnaire, Social Dominance Orientation and Right-Wing Authoritarianism. Having a nonjudgmental regard towards others, not just the self, may be an important component of mindfulness that has not yet been explored.

Using Digital Technology to Overcome Racial Disparities in Child and Adolescent Psychiatry

Racial inequity in mental health care quality is influenced by many systems-level factors, as elucidated by critical race theory, structural competency, and other keystone frameworks.¹ A growing body of literature also suggests provider-level bias to be a key driver.^1-3 There is specific evidence that racism is an important driver of health inequities among youth⁴ and that it is mediated, in part, by provider-level processes related to diagnosis and treatment.² For example, in child and adolescent psychiatry, youth who are Black, Indigenous, and People of Color (BIPOC) experience disproportionate rates of delayed diagnosis and treatment of autism spectrum disorder, overdiagnosis of conduct disorder, and underdiagnosis of attention-deficit/hyperactivity disorder.⁴ Black and multiracial adolescents are at highest risk of suicide,⁵ yet are least likely to receive preventive psychotherapy.⁴.

Associative Learning Processes in the Formation of Intergroup Anxiety and Avoidance in Society

Laboratory-based aversive conditioning studies have reliably induced fear toward an image of an outgroup member by pairing the image with a fear-inducing, aversive stimulus. However, laboratory-based studies have been criticized for being simplistic in comparison to the complexities of the real world. The current study is the first to apply an aversive conditioning framework to explain the formation of intergroup fear and subsequent anxiety toward, and avoidance of, the outgroup outside the laboratory. Two samples recalled details of their first negative encounter with an African American (N = 554) or Muslim (N = 613) individual, respectively. Congruent with learning theory, participants who reported an unpleasant event with an outgroup member reported more fear during the encounter than did those who did not report experiencing an unpleasant event. Additionally, the intensity of unpleasantness during the first encounter indirectly predicted outgroup avoidance, via retrospectively recalled fear and current levels of intergroup anxiety.