The brain uses coding to quickly determine two concepts, like us (in-group) or not like us (out-group), and nonthreatening or threatening. When the brain determines that someone is not like us, the ventromedial prefrontal cortex is activated. When the brain codes that someone is like us, the dorsomedial prefrontal cortex is activated. When the brain codes threatening, the activity shifts to the emotional area of our brain, the amygdala. The brain's emotional area interprets and usually reacts incorrectly much more quickly than the analytical area because the amygdala plays a significant role in deciding and activating
our fight-or-flight mode. This information brings into question whether how our brain codes someone determines healthcare professionals' interest in the person's overall well-being and the amount of empathy offered. There is an identified correlation between the preference's strength and the amygdala's activation. Because our reactions from unconscious biases are directly related to the activation of the amygdala, they can be considered a protective mechanism coded by the environments in which we interact daily (Cardiology, 2020; Sellaro et al., 2015).
Table 1. Areas of the Brain Amygdala
● Part of the limbic system, which is the center for emotions, behavior, and memory ● Highly active in fight-or-flight mode ● Functions in regulating anxiety, aggression, fear conditioning, emotional memory, and social cognition ● Has been identified as playing a role in disease processes such as anxiety and depression, sleep debt, and anger issues ● Is roughly 10% of the volume of the brain ● Part of the brain thought to be involved in executive functions related to the social, emotional, and motivational aspects of behavior ● Involved in higher levels of thought and interconnected throughout the brain ● Thought to contribute to our individual personality ● Functions in self-knowledge, motivation, emotional regulation, and updating goal- directed behavior ● Plays a major role in semantic processes of auditory and verbal stimuli ● Is associated with the representation of semantic knowledge ● Injuries to this area are highlighted by impairment to verbal and nonverbal semantic knowledge ● Not certain the roles this area plays in daily life ● Is a highly connected and metabolically active area ● May a play a primary role in supporting internally directed cognition such as emotions, memory, and meditation ● Functional imaging shows abnormalities with disease processes such as Alzheimer’s disease, autism, and depression ● A highly active area of the brain during the conscious resting state ● One of the largest network hubs in the brain ● Processes visual information ● Involved in attention, mental imagery, music processing, and spatial navigation ● Involved in attention focusing and updating representations from the environment ● Activated when searching for information from memories to make inferences about people and situations ● Active in understanding memory and the social domain together
Prefrontal cortex
Medial prefrontal cortex
Anterior temporal cortex/lobes
Posterior cingulate cortex
Precuneus
Temporoparietal junction
Note: From AbuHasan et al., 2022; Hoffman et al., 2015; Leech & Sharp, 2013; Pedrazzini & Ptak, 2019; Tanaka & Kirino, 2021 Implicit Cognitive Processing
Implicit cognitive processing (ICP) examines the implicit and explicit influences within our memory processes (Lucas et al., 2019). Some memories are unconsciously kept, meaning there is no known retrieval of the memory when it is used in determining how we should react to the environment. Instead, we see pieces pulled from our memories and used in our behaviors as daily habits, thought conditioning, and cognitive assumptions. The brain continues to reshape itself to reflect the environment in which we live. ICP plays Cognitive Biases There are many types of cognitive biases (i.e., thinking, reasoning, and remembering biases). These biases can cause diagnostic errors on the part of the healthcare provider and negative choices on the part of the patient. Here are a few types of bias, along with examples seen in healthcare (Berthet, 2022).
a role in the brain's neuroplasticity (which will be further discussed in this course in relation to mitigation strategies) by continually adjusting to reflect the common occurrences within the environment. ICP has been used to develop policies, procedures, rules, regulations, and laws where implicit biases can unintentionally influence outcomes. Examples include the introduction of blind auditions and blind job interviews as well as removing gender markings from resumes before a hiring team views them. Affinity bias: Tending to gravitate to or favor people who remind us of ourselves. An example is a high-achieving female physician who is overlooked for a position by a mostly male hiring panel. This is considered an affinity bias due to the natural preference to associate and work with people who are like us.
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