Threatening Health Messages Research Articles

Taking advantage of multiple identities to reduce defensiveness to personally threatening health messages.

A host of studies have shown that self-relevant health messages may result in increased defensiveness and rejection of protective recommendations. Drawing on research showing that multiple identities offer psychological resources to deal with identity threats, we sought to examine whether the salience of an alternative identity before people are exposed to a personally relevant health message may buffer the threat and reduce defensive responses. Two studies were conducted on samples of daily smokers asked to read an antismoking message before completing a range of measures of defensiveness. Half of the participants had an alternative identity made salient beforehand (vs. no salience condition). Consistent with our hypotheses, Study 1 (N = 90) showed that this manipulation significantly reduced defensiveness to the message. Study 2 (N = 95) additionally showed that such effects only occurred when the alternative identity overlapped highly with the threatened identity. The theoretical implications of these findings are discussed.

Self-affirmation inductions to reduce defensive processing of threatening health risk information

Objective Self-affirmation reduces defensiveness toward threatening health messages. In this study, we compared several possible self-affirmation inductions in order to identify the most effective strategy. Design Women at increased risk for breast cancer (i.e. who drink 7+ drinks per week) were recruited through Amazon Mechanical Turk (N = 1,056), randomly assigned to one of 11 self-affirmation conditions, and presented with an article about the link between alcohol intake and breast cancer risk. Main Outcome Measures Participants answered questions that measured key indices of message acceptance (risk perception, message endorsement), future alcohol consumption intentions, and action plans to reduce alcohol intake. Results Participants who affirmed health vs. non-health values did not differ in behavioral intentions or action plans to reduce alcohol intake. General values vs. health essay affirmations led to higher odds of reporting some vs. no action plans to reduce alcohol consumption. Essay- vs. questionnaire-based inductions led to higher breast cancer worry and intentions to reduce alcohol consumption. Conclusion Overall, self-affirmation inductions that include an explicit focus on values (general or health-related) and self-generation of affirming thoughts through essay writing, are most potent in changing behavioral intentions and action plans to change future health behavior.

Self-compassion and resistance to persuasion

Objective Persuasive health messages sometimes induce resistance. This article explores the link between self-compassion and resistance to health messages that threaten autonomy. Design A pilot study (N = 100) tested whether threatening health messages versus non-threatening messages damage needs for autonomy, which translates into emotional resistance and behavioural intentions of resistance. The main study (N = 83) tested self-compassion and reactant traits as moderators of observable health-behaviour (soft drink consumption) faced with threatening messages versus non-threatening messages. Outcome Measures The pilot study tested whether threatening health messages create resistance using self-reports of anger and resistant behavioural intentions. Observable health-behaviour (soft drink vs. water consumption) was measured in the main study. Results The pilot study showed that the perceived threat to autonomy, which was induced by threatening health messages about soft drink consumption, creates resistance (self-reports of anger and resistant behavioural intentions). The main study shows that the most self-compassionate people act in favour of the arguments of the threatening messages (drinking water rather than soft drinks), whereas the least self-compassionate do not. Conclusion These innovative results are discussed in regard to the compliance role of self-compassion through self-regulatory functions.

Impact of Self-Affirmation on Responses to Health Warning Messages: Does Consideration of Future Consequences Matter?

ABSTRACT Self-affirmation theory has inspired numerous studies that have tried to understand the effects of self-affirmation on defensive processing of threatening health messages and subsequent behavior. Despite the overall positive effects of self-affirmation, psychological processes through which self-affirmation exerts such impact remain unclear. We examined Consideration of Future Consequences (CFC) as a potential moderator of the effects of self-affirmation on responses to graphic cigarette warning warnings, in an attempt to shed light on the psychological processes. We conducted an experimental study in which 925 African American smokers were instructed to self-affirm (or not) prior to viewing graphic cigarette warning labels. We found that smokers with stronger present time orientation (PTO) experienced higher defensive responses as measured by anger, perceived message manipulation, and message derogation, after viewing graphic cigarette warning labels; whereas smokers with stronger future time orientation (FTO) reported less message derogation. PTO interacted with self-affirmation in predicting defensive processing measures, such that self-affirmation reduced message derogation at lower levels of PTO and increased message derogation and perceived message manipulation at higher levels of PTO. Self-affirmation also had a conditional indirect effect on smoking intentions and intention to quit smoking through measures of defensive processing. We discuss implications of our study.

Self-Affirmation Does Not Change Smokers’ Explicit or Implicit Attitudes Toward Smoking Following Exposure to Graphic Cigarette Warning Labels

ABSTRACT Self-affirmation has shown promise in promoting prohealth attitudes following exposure to threatening health messages by reducing defensive processing of such messages. We examine the impact of self-affirmation prior to viewing graphic cigarette warning labels on implicit and explicit attitudes toward smoking in a sample of African American smokers (N = 151). Participants held negative explicit and implicit attitudes toward smoking. We found no direct effect of self-affirmation on either implicit or explicit attitudes. Self-affirmation and risk level did not interact to predict either attitude type. We discuss findings in terms of self-affirmation theory, attitude measurement, and the meta-cognitive model of attitude change.

Greater benefit of self-affirmation for prevention-focused individuals prior to threatening health messages

Objective Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might strengthen self-affirmation’s effects in response to disease prevention messages, given that prevention-focused individuals are likeliest to be persuaded by those messages after self-affirmation attenuates defensiveness. Design In Study 1, participants were self-affirmed before a message about sexually transmitted infections. In Studies 2 and 3, individuals were self-affirmed prior to a message about alcohol and cancer risk. Main Outcome Measures Studies assessed intentions to use condoms, intentions to reduce alcohol, and willingness to drink alcohol in specific scenarios. Results In Study 1, self-affirmation facilitated condom use intentions among those higher in prevention focus. In Studies 2 and 3, self-affirmation facilitated lower willingness to consume alcohol among those high in prevention focus. A meta-analysis across the three studies indicated that self-affirmation improved intentions and willingness under high, but not low, prevention focus (d = 0.20, p = .003). Conclusion These findings demonstrate that health prevention-focus can strengthen self-affirmation’s effects, thereby improving responsiveness to health communications about behaviors that increase disease risk.

Just a Spoonful of Sugar Helps the Messages Go Down: Using Stories and Vicarious Self-Affirmation to Reduce e-Cigarette Use

ABSTRACTWhile prior research has demonstrated the benefits of self-affirming individuals prior to exposing them to potentially threatening health messages, the current study assesses the feasibility of inducing self-affirmation vicariously through the success of a character in a narrative. In Study 1, college-age participants who regularly use e-cigarettes (N = 225) were randomly assigned to read one of two versions of a story depicting a college student of their own gender. The versions were identical except in the vicarious self-affirmation (VSA) condition, the main character achieves success (i.e., honored with a prestigious award) before being confronted by a friend about the dangers associated with their e-cigarette use; whereas in the vicarious control condition, the achievement is mentioned after the risk information. Results of the posttest and 10-day follow-up demonstrated that VSA reduced messages derogation, while increasing self-appraisal and perceived risk. The effect of VSA on e-cigarette outcomes was moderated by frequency of use, with heavier users benefiting the most. Study 2 (N = 152) confirmed that traditional value affirmation works with our stimuli on a comparable population.

Self-Transcendent Values and Neural Responses to Threatening Health Messages.

Prioritizing self-transcendent values such as family and friends more than nontranscendent values such as wealth and privilege is associated with lower stress response. In this study, we tested whether having self-transcendent values can reduce specific responses in the brain in the context of potentially threatening health communications. Sedentary adults (N = 67) who would likely feel threatened by health messages that highlight the risk of sedentary behavior were recruited. Participants indicated the degree to which they prioritize self-transcendent values more than nontranscendent values. Using functional magnetic resonance imaging, participants' neural responses to health messages were assessed within neural regions implicated in threat responses, including bilateral amygdala and anterior insula (AI). A tendency to prioritize self-transcendent more than nontranscendent values was associated with lower reactivity during exposure to health messages within anatomically defined regions of left amygdala (t(55) = -2.66, p = .010, 95% confidence interval [CI] = -0.08 to -0.01), right amygdala (t(55) = -2.22, p = .031, 95% CI = -0.06 to 0.0), and left AI (t(55) = -2.17, p = .034, 95% CI = -0.04 to 0.0), as well as a mask functionally defined to be associated with "threat" using an automated meta-analysis (t(55) = -2.04, p = .046, 95% CI = -0.05 to 0.0). No significant effect was obtained within the right AI (t(55) = -1.38, p = .17, 95% CI = -0.04 to .01). These effects were partially enhanced by reinforcing important values through self-affirmation, remained significant after accounting for self-reported social connection, and were specific to health message processing (versus generic self-related information). Attenuated neural reactivity to potentially threatening health messages may be a novel way that prioritizing self-transcendent values could lead to positive health behaviors.

This is your stomach speaking: Anthropomorphized health messages reduce portion size preferences among the powerless

As food portion sizes increase, so too does the amount of energy consumed. The purpose of this study was therefore to determine whether the portion size preferences of individuals could be reduced. Across two experiments, this paper shows that a personally threatening health message that has been endorsed by a digestive system featuring anthropomorphic cues can reduce portion size preferences for energy dense foods and beverages, but only among those who feel powerless. This effect emerges because partially anthropomorphizing an internal body system transforms that system into an agent of social influence. The powerless, who are more sensitive to social influence than the powerful, will consequently be more attuned to threatening health information that has been endorsed by this partially anthropomorphized body system, shaping their behavioral preferences. Anthropomorphizing elements of the self may therefore represent a novel means for motivating behavior change.

Dispositional Mindfulness Predicts Adaptive Affective Responses to Health Messages and Increased Exercise Motivation.

Feelings can shape how people respond to persuasive messages. In health communication, adaptive affective responses to potentially threating messages constitute one key to intervention success. The current study tested dispositional mindfulness, characterized by awareness of the present moment, as a predictor of adaptive affective responses to potentially threatening health messages and desirable subsequent health outcomes. Both general and discrete negative affective states (i.e., shame) were examined in relation to mindfulness and intervention success. Individuals (n=67) who reported less than 195 weekly minutes of exercise were recruited. At baseline, participants' dispositional mindfulness and exercise outcomes were assessed, including self-reported exercise motivation and physical activity. A week later, all participants were presented with potentially threatening and self-relevant health messages encouraging physical activity and discouraging sedentary lifestyle, and their subsequent affective response and exercise motivation were assessed. Approximately one month later, changes in exercise motivation and physical activity were assessed again. In addition, participants' level of daily physical activity was monitored by a wrist worn accelerometer throughout the entire duration of the study. Higher dispositional mindfulness predicted greater increases in exercise motivation one month after the intervention. Importantly, this effect was fully mediated by lower negative affect and shame specifically, in response to potentially threatening health messages among highly mindful individuals. Baseline mindfulness was also associated with increased self-reported vigorous activity, but not with daily physical activity as assessed by accelerometers. These findings suggest potential benefits of considering mindfulness as an active individual difference variable in theories of affective processing and health communication.

Attentional effects of self-affirmation in response to graphic antismoking images.

Self-affirmation has been shown to reduce defensive responding to threatening information. However, little is known about the cognitive and attentional processes underlying these effects. In the current eye-movement study, the authors explored whether self-affirmation affects attention allocation (i.e., number of fixations) among those for whom a threatening health message is self-relevant. After a self-affirmation manipulation, 47 smokers and 52 nonsmokers viewed a series of cigarette packs displaying high or low threat smoking-related images accompanied by a brief smoking message containing risk, coping or neutral textual information. Self-affirmed smokers made more fixations to the cigarette packs than did nonaffirmed smokers (across both high and low threat images), whereas self-affirmed nonsmokers made fewer fixations to the cigarette packs than did nonaffirmed nonsmokers (again across both image types). The textual information did not moderate responses. Findings indicate attention-increasing effects of self-affirmation among those for whom the information is self-relevant (smokers) and attention-decreasing effects of self-affirmation among those for whom the information is not self-relevant (nonsmokers). Such findings are consistent with the calibration model of self-affirmation (Griffin & Harris, 2011) in which self-affirmation increases sensitivity to the self-relevance of health-risk information. The use of an implicit measure of visual orienting informs our understanding of the working mechanisms of self-affirmation when encoding health information, and may also hold practical implications for the design and delivery of graphic warning labels. (PsycINFO Database Record

Self-affirmation alters the brain’s response to health messages and subsequent behavior change

Health communications can be an effective way to increase positive health behaviors and decrease negative health behaviors; however, those at highest risk are often most defensive and least open to such messages. For example, increasing physical activity among sedentary individuals affects a wide range of important mental and physical health outcomes, but has proven a challenging task. Affirming core values (i.e., self-affirmation) before message exposure is a psychological technique that can increase the effectiveness of a wide range of interventions in health and other domains; however, the neural mechanisms of affirmation's effects have not been studied. We used functional magnetic resonance imaging (fMRI) to examine neural processes associated with affirmation effects during exposure to potentially threatening health messages. We focused on an a priori defined region of interest (ROI) in ventromedial prefrontal cortex (VMPFC), a brain region selected for its association with self-related processing and positive valuation. Consistent with our hypotheses, those in the self-affirmation condition produced more activity in VMPFC during exposure to health messages and went on to increase their objectively measured activity levels more. These findings suggest that affirmation of core values may exert its effects by allowing at-risk individuals to see the self-relevance and value in otherwise-threatening messages.

Self-affirmation and responses to health messages: a meta-analysis on intentions and behavior.

The present study aimed to quantify the magnitude of the effect of self-affirmation manipulations on health messages' influence on both intentions and behavior. A systematic search was conducted for experimental studies comparing participants who self-affirmed prior to reading a threatening health message to those who did not self-affirm. Effect sizes for health intentions and behaviors were aggregated using a random-effects model. Data from 16 studies were included. The aggregate effect sizes for intentions and behavior were significant and small in magnitude (d+ = .26, 95% confidence interval [CI] = .04-.48; d+ = .27, 95% CI = .11-.43, respectively). A meta-regression analysis revealed that among studies assessing both outcomes, the size of an effect on intentions did not predict the size of an effect on behavior, β = .03, 95% CI = -.30-.36. Type of health behavior (damaging vs. promoting), timing of the health behavior (proximal vs. distal), type of self-affirmation manipulation (values vs. kindness), and the specificity of the health message (single vs. multiple health issues) did not moderate the effect of self-affirmation on intentions or behavior. Self-affirmation influences health messages' effect on intentions and behavior; however, with the present study finding that intention effect sizes did not predict behavior effect sizes, and with past studies of heath behavior change finding that intentions do not always translate to behavior, little research supports a causal intention-behavior relation among self-affirmation studies. Future research is needed to address which specific health-related responses explain why self-affirmation elicits health behavior change.

Open‐mindedness can decrease persuasion amongst adolescents: The role of self‐affirmation

ObjectivesSelf-affirmation (e.g., by reflecting on important personal values) has been found to promote more open-minded appraisal of threatening health messages in at-risk adults. However, it is unclear how self-affirmation affects adolescents and whether it has differential effects on the impact of these messages amongst those at relatively lower and higher risk. The current study explored moderation by risk.DesignParticipants were randomly assigned to either a self-affirmation or a control condition before receiving a health message concerning physical activity.MethodsOlder adolescents (N = 125) completed a self-affirmation or control writing task before reading about the health consequences of not meeting recommendations to be physically active for at least 60 min daily. Most of the sample did not achieve these levels of activity (98%, N = 123). Consequently, the message informed these participants that – unless they changed their behaviour – they would be at higher risk of heart disease. Participants completed measures of responses to the message and behaviour-specific cognitions (e.g., self-efficacy) for meeting the recommendations.ResultsFor relatively inactive participants, self-affirmation was associated with increased persuasion. However, for those who were moderately active (but not meeting recommendations), those in the self-affirmation condition were less persuaded by the message.ConclusionsWhilst self-affirmation can increase message acceptance, there are circumstances when the open-mindedness it induces may decrease persuasion. The evidence provided in this study suggests that caution may be needed when recommendations are challenging and it could be considered reasonable to be sceptical about the need to change behaviour.

Combining self-affirmation with implementation intentions to promote fruit and vegetable consumption.

The current study tested whether self-affirmation in the context of a threatening health message helps promote a health behavior (fruit and vegetable consumption) over a 3-month period, and whether adding a manipulation to support the translation of intentions into behavior (an implementation intentions induction) enhances the impact of self-affirmation. Participants (N = 332, 71% women) reported their baseline consumption and were randomly assigned to condition in a 2 (self-affirmation: yes, no) × 2 (implementation intentions: formed, not formed) between-subjects factorial design. They completed a self-affirmation/control task and then read a health communication advising eating at least 5 portions of fruit and vegetables daily. Next participants reported intentions for behavior change, after which they formed/did not form relevant implementation intentions. Consumption was measured again 7 days and 3 months postintervention. Self-affirmed (vs. nonaffirmed) participants reported eating more fruit and vegetables at both follow-ups. Forming (vs. not forming) implementation intentions was also beneficial for consumption. At 7 days, there was also a significant self-affirmation × implementation intentions interaction: consumption was highest when self-affirmed participants also formed implementation intentions. The present study offers new evidence concerning the impact and durability of self-affirmation on health behaviors and the role of implementation intentions in enhancing the impact of self-affirmation.

Reactions to threatening health messages.

BackgroundThreatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness) may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence that threatening health messages in the form of distressing imagery in anti-smoking and anti-alcohol campaigns cause defensive reactions.MethodsWe simulated both Brown et al. experiments, asking participants to estimate the reactions of the original study subjects to the threatening health information (n = 93). Afterwards, we presented the actual original study outcomes. One week later, we assessed whether this knowledge of the actual study outcomes helped participants to more successfully estimate the effectiveness of the threatening health information (n = 72).ResultsResults showed that participants were initially convinced of the effectiveness of threatening health messages and were unable to anticipate the defensive reactions that in fact occurred. Furthermore, these estimates did not improve after participants had been explained the dynamics of threatening communication as well as what the effects of the threatening communication had been in reality.ConclusionsThese findings are consistent with the hypothesis that the effectiveness of threatening health messages is intuitively appealing. What is more, providing empirical evidence against the use of threatening health messages has very little effect on this intuitive appeal.

Effects of Self-Affirmation on Daily Versus Occasional Smokers’ Responses to Graphic Warning Labels

There is growing evidence that self-affirmation can reduce defensive processing of threatening health messages among high risk individuals. However, how self-affirmation might influence low risk individuals is less clear. This study examined the effect of self-affirmation on daily versus occasional smokers’ reactions to graphic on-pack warning labels. Results showed a relatively consistent pattern of interaction wherein self-affirmation decreased favorable reactions to the warning labels among occasional smokers, whereas its effect on daily smokers was mostly nonsignificant. Potential explanations of these findings are offered and their practical implications are discussed.

When Does Self-Affirmation Reduce Negative Responses to Antismoking Messages?

Previous research has shown that self-affirmation can reduce individuals’ defensive processing of threatening health messages. In this study, we examine two audience characteristics—smoking experience and trait reactance—that might regulate the effects of self-affirmation on negative message responses within the context of college smoking. Results of a controlled experiment indicate that self-affirmation worked to reduce negative message responses among smokers who were low in trait reactance. For smokers high in trait reactance and nonsmokers, the effect of self-affirmation was either unclear or went in a direction that led to even greater defensive processing.

Evidence that self-affirmation reduces alcohol consumption: Randomized exploratory trial with a new, brief means of self-affirming.

To test the ability of a new, brief means of affirming the self (the "self-affirming implementation intention") to decrease alcohol consumption against a standard means of self-affirmation (the self-affirming "kindness" questionnaire) and an active control condition; to test whether self-affirmation effects can be sustained beyond the experimental session; and to examine potential moderators of the effects. Two hundred seventy-eight participants were randomly allocated to one of three conditions: control questionnaire, self-affirming questionnaire, and self-affirming implementation intention. All participants were exposed to a threatening health message, designed to inform them about the health risks associated with consuming alcohol. The main outcome measure was subsequent alcohol intake. There were significant public health gains and statistically significant decreases (>1 unit/day) in alcohol consumption in the two experimental conditions but not in the control condition. At the end of the study, participants in the control condition were consuming 2.31 units of alcohol per day; people in the self-affirming questionnaire condition were consuming 1.52 units of alcohol per day; and people in the self-affirming implementation intention condition were consuming 1.53 units of alcohol per day. There were no significant differences between the self-affirming questionnaire and self-affirming implementation intention, and adherence did not moderate the effects. Self-affirmation also improved message processing, increased perceived threat, and led to lower message derogation. The findings support the efficacy of a new, brief self-affirmation manipulation to enhance the effectiveness of health risk information over time. Further research is needed to identify mediators of the effects of self-affirmation on health behavior change.

Mediation by illness perceptions of the effect of personality and health threat communication on coping with the diagnosis of diabetes

(1) To examine the relationship of personality traits and diabetes health threat communication (DHTC) to the coping strategies of newly diagnosed diabetes patients; (2) to determine to what extent these postulated effects are mediated by illness representations (IRs). A longitudinal prospective study based on the common sense model. Patients were assessed shortly after diagnosis and 2 years after the diagnosis of diabetes. Personality traits (Mini-markers) were assessed at baseline. The DHTC Questionnaire was completed at baseline and 2 years. The Revised Illness Perception Questionnaire and the coping orientation to problems experienced were completed at 2 years. Mediation by IRs of the potential influence of personality and DHTC on coping behaviour was assessed by the method of Baron and Kenny. Multiple regression analyses showed that educational level, agreeableness, openness/intellect, conscientiousness, and perceptions of a more reassuring health message since diagnosis were related to more adaptive coping (e.g., active coping, planning). The association of openness and perceived reassuring health message with active coping showed complete mediation by illness coherence and personal control. Openness led to seeking emotional support mediated by perceived personal control. Coherence associated with (partial mediation) the relation of openness to planning. Similarly, personal control and coherence mediated the relation of openness to positive reinterpretation and growth (PRG). Agreeableness had a direct relationship with active coping and PRG but led to planning and seeking instrumental support mediated by perceived treatment effectiveness. Perceptions of a threatening health message were associated with seeking instrumental and emotional support and this was mediated by symptom perception but threat had a direct relationship with planning. Both personality traits and health threat communication predict the way individuals cope with diabetes. The relationships of these factors are largely mediated through measurable IRs. The results suggest targets for intervention to achieve greater problem-focused coping.