Just Read: Methods for reducing unconscious bias, implications for transgender person health and medical care

Turner RN, Crisp RJ. Imagining intergroup contact reduces implicit prejudice. Br. J. Soc. Psychol. 2010;49(Pt 1):129–42. [Accessed March 25, 2014].

Continuing on in the exploration of unconscious bias in preparation for the 2nd Annual Kaiser Permanente LGBTQI Health Symposium, the question arises – “If people harbor biases that they are not consciously aware of, how can they be reduced or eliminated?” In other words, “what’s the treatment?”

These two papers offer a great review of what’s known about what is called “debiasing” and a technique that they show to be effective, and potentially especially useful in the area of trans person health – imagined contact.

It sounds farfetched at first – but follow along:

There’s good evidence that intergroup contact results in reduction of implicit bias

I’d like to caution my health professional colleagues about what effective intergroup contact is:

optimal intergroup contact would be of equal status, involve cooperation to achieve common goals, and should be supported by important societal institutions. 

Given this definition (described by Allport in 1954 and validated through a significant meta-analysis in 2006), I’d argue that intergroup contact with a person in a patient-physician dyad doesn’t fit this definition, especially in the case of people who are transgender, given the relatively alarming data about how human beings in this group are treated in health care (see: When Health Care Isn’t Caring | Lambda Legal).

This is where concepts of extended contact and imagined contact come in. extended contact is described by “seeing an in-group member showing tolerance towards the out-group” and imagined contact involves what it describes, imagining contact with a person in the out-group (social psychology for “person not like you”).

Imagined contact works. Here’s the recipe

Running through a “mental script” of the interaction is required. It can’t be just “imagine a person who is ____”

A positive tone is required. There’s evidence that without a positive tone, this exercise can actually reinforce implicit bias.

Here’s an example:

We would like you to spend the next 2 min imagining yourself meeting an elderly stranger for the first time. Imagine that during the encounter, you find out some interesting and unexpected things about the person

Followed by:

‘List the interesting and unexpected things you learnt about this person’

And… explicit and implicit attitudes showed significant improvements (in this case for elderly people). This was a controlled study, and important to remember that testing of implicit attitudes works at a subconscious level, so it’s difficult to game a study like this.

Why is this relevant in the trans person health?

Imagined contact is useful in situations where direct or extended intergroup contact is less feasible. With approximately 700,000 or 0.3% of adults in the US who are transgender, this makes the benefits of contact more likely for this group. 

In addition, this intervention is simple to do and can be done in many settings.

The authors caution that this technique is intended as a bridge to actual contact, rather than as a substitute.

Where does implicit bias come from?

This research also leads to the idea of where implicit bias comes from in the first place – if positive imagined contact reduces it, isn’t it possible that negative imagined contact increases it. And are there examples of negative imagined contact in society around people who are trans? Let us count the ways….starting with this example: Update: Woman Identified In Apparent Suicide Leap Onto Walnut Creek Freeway – Police & Fire – Walnut Creek, CA Patch, when human beings are referred to by the group they are in rather than as individuals (read the byline).

Why does this matter for health? (again)

While explicit attitudes are associated with deliberative behaviours,implicit measures are associated with more subtle, indirect, and spontaneous non-verbal behaviours

These behaviors can result in inferior, or even devastating health outcomes, in a tip of the iceberg kind of way (again, see: When Health Care Isn’t Caring | Lambda Legal)