1. Psychology 415; Social Basis of Health Behavior Automaticity, escape 1 Controlled v. automatic behavior: some core constructs  Critical role of associative learning Cognition Affective responses Physiological activation Immune functioning…  Extrinsic stimuli & self-focused attention: Rosemary’s Baby  Fluid, capacity-based conception of “controlled” behaviors or cognitions  Implicit learning  Imitative learning: key role of “mirror neurons” in learning & behavior  Stereotype activation: cue-based perceptual biases  Progressive mechanization in skill learning  Automatic activation of affective responses: “preferences precede inferences…”  Associative learning & goal activation…

2. Psychology 415; Social Basis of Health Behavior Automaticity, escape 2 Bargh; goal activation

3. Psychology 415; Social Basis of Health Behavior Automaticity, escape 3 Sexual Escape “Honey, you know it don’t count if I was high..." B.B. King, (1971). How Blues Can You Get. I think [alcohol & drugs] also helps them to forget about [AIDS]....some of them...are able to keep their wits about that in the sense of using safe sex, using a condom. But I think others, it makes it less scary. It makes the experience a lot less frightening in terms of HIV and AIDS and not having that in the forefront of their minds when they’re engaging in the activity....there are a lot of... men who would be so-called straight who under the influence of alcohol or with them knowing that they’re going to drink so they can go ahead and sleep with another guy… Well, I don’t like to admit it, but worrying about HIV when I’m out meeting guys is a drag. When I drink, I don’t worry so much...

4. Psychology 415; Social Basis of Health Behavior Automaticity, escape 4 Socio-cultural Models of Sexual Risk / Prevention  Information dissemination  Targeted v. general populations  Indigenous information / attitude change methods  Community based dissemination / diffusion Opinion leaders Settings Churches, etc.  ‘Stages of change’ pre-contemplation contemplation action maintenance

5. Psychology 415; Social Basis of Health Behavior Automaticity, escape 5 Socio-cultural models, cont.  Prevention resources  Condom availability  Needle availability  HIV / STI testing  ART treatment  Community Socialization  ‘Sexualization’ of gay identification  Implicit v. explicit normative standards  Opportunity & exposure Drug availability Risk partner availability  social / personal priorities  cost :: utility

6. Psychology 415; Social Basis of Health Behavior Automaticity, escape 6 Social / cultural models, 3  Legal & Policy Interventions  needle exchange  legalized drug use / sex work  Gay marriage  ‘Homophobia’ / discrimination  Medical practice / training

7. Psychology 415; Social Basis of Health Behavior Automaticity, escape 7 Person – based models of sexual risk  Simple attitude models: Health beliefs x values  "intentions“  Self-efficacy & outcome expectancies  Information & skills Rational Operator: Motivational:  Fear arousal / protection motivation  Self-identity & health motive  Optimism & perceived vulnerability e.g., reactive effects of ART. “Dyscontrol”:  Chronic or acute substance abuse  Ψ symptoms  Sensation seeking / risk taking  “Personality disorder“ / impulsivity  Childhood sexual abuse / PTSD sequalae

8. Psychology 415; Social Basis of Health Behavior Automaticity, escape 8 Risk: Person – based models  Social network  Partner / peer pressure  Sexual context Local norms Safety availability  Chronic stress  Sexual availability e.g., internet norms & availability  Coping skills Avoidant coping  Self-esteem  Bar orientation  Ambivalence “Stress” Vulnerability

9. Psychology 415; Social Basis of Health Behavior Automaticity, escape 9 Stress –vulnerability  Internet use and sexual risk among MSM

10. Psychology 415; Social Basis of Health Behavior Automaticity, escape 10 Internet & sexual risk, 2

11. Psychology 415; Social Basis of Health Behavior Automaticity, escape 11 Stress – vulnerability model of MSM drug use “Escape” expectancies of alcohol / drug use.

12. Psychology 415; Social Basis of Health Behavior Automaticity, escape 12 Cognitive escape modelsVulnerability Performance standards Performance standards Negative affect Negative affect Cognitive restraint Cognitive restraint Expectancies Expectancies Sensation seeking Sensation seeking Cognitive capacity Cognitive capacity Releasing Stimuli Settings Settings Partner characteristics Partner characteristics Substance use Substance use Affect / internal states Affect / internal states Initial “slip” Initial “slip” Financial pressure (?) Financial pressure (?) Cognitive disengagement Concrete action identification Concrete action identification “Automatic” behavior “Automatic” behavior

13. Psychology 415; Social Basis of Health Behavior Automaticity, escape 13 High performance standards Negative affect Escape motive / expectancies + Contextual risk inducements Low level action identification Automatic behavior Escape process

14. Psychology 415; Social Basis of Health Behavior Automaticity, escape 14 Escape, 2 High Performance Standards  Externally imposed  Strong norms & intentions  Inescapable / unalterable Negative affect re: failures  Perceived personal vulnerability + severity  Ought  actual | Ideal  actual discrepancies  Low self-efficacy for instrumental coping  Low outcome expectancies  “ Coping burnout” / fatalism  Fear / shame  Depression / anger Aversive self- awareness

15. Psychology 415; Social Basis of Health Behavior Automaticity, escape 15 Escape, 3 Escape motive / Expectancies  Sexual / alcohol / drug expectancies  Avoidant coping  Cultural / individual support for “escape” Drug norms & availability Drug norms & availability Cultural visibility of / norms for health behavior Cultural visibility of / norms for health behavior Contextual risk inducements  Situational “releasing stimuli” “Exceptional” times / places / people “Exceptional” times / places / people Physical constraints on communication, safety, negotiation Physical constraints on communication, safety, negotiation  Normative environment Implicit / explicit standards for sex, drugs, communication Implicit / explicit standards for sex, drugs, communication “We’re all in” syndrome “We’re all in” syndrome

16. Psychology 415; Social Basis of Health Behavior Automaticity, escape 16 Escape, 3 Low level action identification Deconstructed Action > larger / abstract meaning  Attentional focus “Mechanics” > “Meaning” “Mechanics” > “Meaning” Reward (gain) sensitivity > punishment (loss) sensitivity Reward (gain) sensitivity > punishment (loss) sensitivity  Context sensitivity “Stimulus bound” “Stimulus bound” Sensation seeking Sensation seeking  Irrational thoughts (?)  Strategic substance use Impaired abstract information processing Impaired abstract information processing Self-fulfilling expectancies of affective responses Self-fulfilling expectancies of affective responses

17. Psychology 415; Social Basis of Health Behavior Automaticity, escape 17 Escape, 3 Automatic behavior  Core characteristics Effortless (few attentional demands) Effortless (few attentional demands) Unintentional (independent of larger goals) Unintentional (independent of larger goals) Autonomous (fixed “action pattern” or “script”) Autonomous (fixed “action pattern” or “script”) Uncontrollable (resists conscious change) Uncontrollable (resists conscious change)  “Automatic” maintenance: Associative learning: stimulus environment + “not think” Rx. Associative learning: stimulus environment + “not think” Rx.+ Instrumental learning: strong rewards for cognitive avoidance Instrumental learning: strong rewards for cognitive avoidance Death, destruction and despair (or not…)

18. Psychology 415; Social Basis of Health Behavior Automaticity, escape 18 The wages of cognitive escape

19. Psychology 415; Social Basis of Health Behavior Automaticity, escape 19 AIM study of drug using MSM