When We Should Worry More: Using Cognitive Bias Modification to Drive Adaptive Health Behaviour

Lies Notebaert,Jessica Chrystal,Emily A Holmes,Patrick J F Clarke,Colin Macleod,Gozde Ozakinci

doi:10.1371/journal.pone.0085092

Abstract

A lack of behavioural engagement in health promotion or disease prevention is a problem across many health domains. In these cases where people face a genuine danger, a reduced focus on threat and low levels of anxiety or worry are maladaptive in terms of promoting protection or prevention behaviour. Therefore, it is possible that increasing the processing of threat will increase worry and thereby enhance engagement in adaptive behaviour. Laboratory studies have shown that cognitive bias modification (CBM) can increase or decrease anxiety and worry when increased versus decreased processing of threat is encouraged. In the current study, CBM for interpretation (CBM-I) is used to target engagement in sun protection behaviour. The goal was to investigate whether inducing a negative rather than a positive interpretation bias for physical threat information can enhance worry elicited when viewing a health campaign video (warning against melanoma skin cancer), and consequently lead to more adaptive behaviour (sun protection). Participants were successfully trained to either adopt a positive or negative interpretation bias using physical threat scenarios. However, contrary to expectations results showed that participants in the positive training condition reported higher levels of worry elicited by the melanoma video than participants in the negative training condition. Video elicited worry was, however, positively correlated with a measure of engagement in sun protection behaviour, suggesting that higher levels of worry do promote adaptive behaviour. These findings imply that more research is needed to determine under which conditions increased versus decreased processing of threat can drive adaptive worry. Various potential explanations for the current findings and suggestions for future research are discussed.

Highlights

The lack of engagement in appropriate disease prevention or health protection presents a real problem in many health domains
We hypothesized that (1) participants encouraged to adopt a negative interpretation bias would experience more worry when confronted with a health campaign video than participants encouraged to adopt a positive interpretation bias and (2) that the more worry was elicited by the video, the more participants would engage in adaptive behaviour
Previous research has shown that encouraging people who suffer from pathological levels of worry to adopt a positive interpretation bias leads to fewer worry symptoms [10,11]

Summary

Introduction

The lack of engagement in appropriate disease prevention or health protection presents a real problem in many health domains. Many health campaigns endeavour to persuade people to engage in adaptive prevention or protection behaviour. Often this is done by attempting to instil a heightened sense of fear or worry by increasing people’s awareness of their susceptibility to the risk, or of the severity of the outcome. Research has shown that such ‘fear appeals’ can be quite effective in producing adaptive behaviour [3]. The construct of worry has been identified as a driver for adaptive health behaviour. The majority of research supports a positive relationship between worry and engagement in prevention/protection behaviour, in high risk populations [4]

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