Defensive Responses to Masculinity Threat: The Role of Precarious Manhood in Reactions to the Male Contraceptive Pill

This study examines how men evaluate a potentially masculinity-threatening message about the availability of a male birth control pill, framed as being released in the near versus distant future. Drawing on research on health-related defense mechanisms and precarious manhood, we hypothesized that men with higher levels of precarious manhood beliefs would react more defensively to the message - exhibiting greater message derogation, avoidance, lower perceived efficacy, and heightened concerns about side effects - especially when the pill was framed as being released soon. We further explored whether these defensive evaluations mediated the relationship between precarious manhood and intentions, moderated by temporal framing. To test these hypotheses, a sample of 398 men (M = 42.90, SD = 12.38) read an article describing a male birth control pill framed as either being released in the near or distant future. Participants then reported their perceptions of the article and the pill, their behavioral intentions, and their precarious manhood beliefs. Regression analyses showed that precarious manhood significantly predicted greater avoidance and higher perceptions of side effects. Moreover, higher perceived side effects mediated the association between precarious manhood and intentions to purchase the pill when it was framed as being released in the near future, but not when framed as being released in the distant future. These findings highlight the role of defensiveness in shaping how men with strong precarious manhood beliefs respond to masculinity-threatening health messages. Careful consideration of message framing, particularly in media presentations of male contraceptives, is crucial to mitigate defensive reactions that could hinder desired behavioral outcomes.

Effectiveness of Self-Affirmation Interventions in Educational Settings: A Meta-Analysis

School and university can be stressful contexts that can become an important source of identity threats when social prejudices or stereotypes come into play. Self-affirmation interventions are key strategies for mitigating the negative consequences of identity threat. This meta-analysis aims to provide an overview of the effectiveness of self-affirmation interventions in educational settings. A peer-reviewed article search was conducted in January 2023. A total of 144 experimental studies that tested the effect of self-affirmation interventions in educational contexts among high school and university students from different social and cultural backgrounds were considered. The average effect of self-affirmation interventions was of low magnitude (dIG+ = 0.41, z = 16.01, p < 0.00), with a 95% confidence interval whose values tended to lie between 0.36 and 0.45 (SE = 0.0253). In addition, moderators such as identity threat, participants' age, and intervention procedure were found. Through a meta-analysis of the impact of self-affirmation interventions in educational contexts, this study suggests that interventions are effective, resulting in a small mean effect size. Thus, self-affirmation interventions can be considered useful, brief, and inexpensive strategies to improve general well-being and performance in educational settings.

Within- and between-person relationships between spontaneous self-affirmations, coping style, and wellbeing

Self-affirmations-responding to self-threatening information by reflecting on positive values or strengths-help to realign working self-concept and may support adaptive coping and wellbeing. Little research has been undertaken on spontaneous self-affirmations in response to everyday threats, and less has been undertaken on the relationships between spontaneous self-affirmations, coping, and wellbeing. This study aimed to test both within- and between-person relationships between spontaneous self-affirmations, coping, and wellbeing, controlling for threat intensity and other outcomes. A repeated survey assessment design was adopted to achieve these aims. Outcome measures included approach coping, avoidance coping, positive affect, negative affect, and eudaimonic wellbeing. It was found that spontaneous self-affirmations positively predicted approach coping and positive affect at both within- and between-person levels, and eudaimonic wellbeing at the between-person level. Overall, spontaneous self-affirmations were positively associated with approach coping and aspects of wellbeing.

Examining the Effect of Self-Determined Appeal Organ Donation Messages and Respective Underlying Mechanism

This study examined how intrinsic motivation and its respective underlying mechanism influence people's attitude and intentions of organ donation. The findings revealed the importance of meeting people's customized psychological needs. For the general population, especially non-organ donors, autonomous appeal message will be more effective in promoting their intention of becoming an organ donor. For registered organ donors, competence-based organ donation messages are more effective in increasing their promotion and seeking behavior of organ donation. This study also discovered underlying mechanisms of intrinsic motivation, such as self-integrity, pride, and sympathy. Pairing underlying mechanism with competence-based messages can maximize the message impact.

Developing a framework for understanding health information behavior change from avoidance to acquisition: a grounded theory exploration

BACKGROUND

Health information avoidance is common in real life, but because it is not always conducive to health promotion and maintenance, people often actively switch to health information acquisition. Understanding this process of active change can facilitate intervention in unreasonable avoidance behaviors. However, studies so far have mostly focused on why and how avoidance takes place, little is known about the process of active change from avoidance to acquisition. We thus use a grounded theory approach (GT) to explore how the active change takes place, and to generate a grounded theoretical framework capable of illustrating stages and influencing factors involved in the active change process.

METHODS

Straussian grounded theory (Corbin & Strauss, 2015) was used to analyze data collected through semi-structured interviews with 30 adults (14 in good health, 11 with disease, 5 in other health status) who had experienced health information behavior change from avoidance to acquisition. These interviews focused on how the change occurred and what effected the change.

RESULTS

The core category of Health Information Avoidance Change and 12 categories were identified and integrated to form a theoretical framework termed the Health Information Avoidance Change Model (HIACM). This model describes the process using five non-linear stage variables (initiation, preparation, action, maintenance, and abandonment) and seven moderating factor variables (cognitive change, social stimulus, beliefs and attitudes, intrapsychic literacy, social resources, information source, time and material resources).

CONCLUSIONS

HIACM can be used to explain the process of active change from health information avoidance to health information acquisition. HIAC is a non-linear and holistic process, and it is necessary to dynamically analyze the impact of relevant factors and take targeted intervention measures in stages. HIAC is usually not only an individual behavior, but also a socialized behavior requiring the collaboration of individuals, families, health information providers, healthcare providers, and governments.

Two experimental studies on the differential effects of low and high treatability information on the inclination to engage in cancer prevention

Two 3(control versus LTI versus HTI) × 2(self-affirmation versus no self-affirmation)-experiments were conducted. The first study presented a news message on the treatability of bowel cancer (N = 717); the second study was about skin cancer (N = 342). The dependent variables were the intention to engage in preventive behaviors and message acceptance. The results showed that when participants were exposed to LTI, only when response efficacy was low, a self-affirmation procedure increased their intention to prevent cancer (experiment 1), and increased message acceptance (experiment 2). When participants were exposed to HTI, the self-affirmation procedure did not increase the intention, and even reduced message acceptance. The findings suggest that defensive processes were active in reaction to LTI, but not in reaction to HTI. Although publishing LTI and HTI information in the media serves legitimate goals, it may have positive but also negative unintended effects on preventive behaviors in the population.

Self-affirmation increases acceptance of information on COVID-19 vaccines and promotes vaccination intention

Previous studies have shown that self-affirmation increases acceptance of a message and motivates health behavior change. The present study investigated whether self-affirmation increases the acceptance of persuasive messages on COVID-19 vaccines and promotes vaccination intention. A total of 144 participants were randomly assigned to the self-affirmation (n = 72) or control (n = 72) groups before reading a persuasive message on COVID-19 vaccines. The results revealed that the self-affirmation group showed significantly higher acceptance of persuasive information on COVID-19 vaccines than the control group. Additionally, the self-affirmation group also showed significantly higher post-experiment vaccination intention than the control group. Mediation analysis indicated that increased acceptance of persuasive information significantly mediated the beneficial effects of self-affirmation on post-experiment vaccination intention. The present study demonstrated that self-affirmation could be an effective strategy for increasing the acceptance of persuasive messages on COVID-19 vaccines and promoting vaccination intention.

Effect of self-affirmation on smartphone use reduction among heavy users

Recent studies have shown an association between excessive smartphone use and health problems. Along with such mounting concerns, health risk information on excessive smartphone use has been presented through various media. Such information is usually aimed at making smartphone users understand the associated health risks, thereby preventing excessive use or reducing current use. However, according to self-affirmation theory, such information may pose a threat to heavy smartphone users because it implies that they are engaging in maladaptive behavior. Therefore, to defend themselves, they may not accept the information and may not be highly motivated to reduce their usage. According to self-affirmation theory, such maladaptive defensive responses can be reduced through the affirmation of important values. We examined whether self-affirmation prior to reading health risk information increased heavy users' motivation to reduce smartphone usage. Participants (142 undergraduate students aged 18-22 years) reported their mean daily smartphone use. They then completed a writing task that affirmed/did not affirm an important personal value. Next, they read an article on the health risks of smartphone overuse and reported their motivation to reduce smartphone use. As a result, when heavy users did not self-affirm, they were significantly less motivated to reduce use than light users. However, when heavy users self-affirmed, their motivation was significantly higher than when they did not self-affirm. This effect of self-affirmation was not shown in light users. These results suggest that health risk information combined with self-affirmation is effective in reducing smartphone usage by heavy users.

Examining self-affirmation as a tactic for recruiting inactive women into exercise interventions

Recruitment of insufficiently active individuals into exercise interventions is difficult due to many different barriers, including motivational barriers and negative body image. The present study provided an initial conceptual test of whether self-affirmation can help increase recruitment of insufficiently active women to an exercise intervention. Emerging adult women were randomly assigned to complete a self-affirmation or control task prior to reading the same message concerning the consequences of inactivity. In addition to completing demographic and body image measures at baseline, U.S. undergraduate participants (N = 254) indicated their interest in registering for an intervention and their intention to exercise after the experimental manipulation. Data did not support hypotheses that (1) self-affirmed women would find the message less threatening and less manipulative, (2) self-affirmed women would have higher intentions to exercise, (3) self-affirmed women would be more likely to register interest for a future exercise intervention, and (4) condition and body dissatisfaction would interact such that the intervention would be particularly beneficial for women with high body dissatisfaction. Results revealed that 70% of participants were unwilling to register for an exercise intervention, which indicates that other novel exercise intervention recruitment techniques need to be tested.

Influence of online comments on smokers' E-cigarette attitude: Opinion climate, review fraud, and resistance to persuasion

OBJECTIVE

This study examined the effect of online comments on smokers' attitude toward trying e-cigarettes. It also explored the effect of an unobtrusive forewarning in increasing smokers' resistance to online review fraud.

DESIGN

739 adult smokers participated in an experiment with a 2 comment valence (supportive vs. oppositional) x 3 comment deception warning (no warning vs. early warning vs. late warning) + 1 control (no comment) factorial design. Smokers watched two e-cigarette commercials. The control group received only the ads. The treatment groups saw 10 to 12 comments following each ad.Main Outcome Measure: E-cigarette attitude.

RESULTS

Smokers who read supportive (M = 5.28, SD = 1.37), oppositional (M = 4.96, SD = 1.53), and no comment (M = 5.44, SD = 1.20) showed significant difference on their e-cigarettes attitude, p = .004. When the comment climate was overly in favor of e-cigarettes, warning smokers of review fraud could raise their awareness of comment deception, increase defensive processing, decrease their social identification with commenters, and eventually lower their interest in trying e-cigarettes.

CONCLUSION

The overall opinion climate in the form of aggregated valence of comments could sway smokers' e-cigarette attitude. Smokers could benefit from warnings of online review fraud.

How to Solve the Social Norm Conflict Dilemma of Green Consumption: The Moderating Effect of Self-Affirmation

Social norms are important social factors that affect individual behavioral change. Using social norms to promote green consumption is receiving increasing attention. However, due to the different formation processes and mechanisms of the behavioral influence of the different types of social norms, using social norms to promote green consumption often has social norm conflict situations (injunctive norms + negative descriptive norms). Thus, it is difficult to attain the maximum utility of social norms. The present research found that social norm conflict weakens the role of injunctive norms in promoting green consumption. Specifically, negative descriptive norms weaken the role of injunctive norms in promoting green consumption. Alienation, which manifests through powerlessness and meaninglessness, plays a mediating role in the relationship between social norm conflict and green consumption. Self-affirmation moderates the mediating role of alienation between social norm conflicts and green consumption. Self-affirmation reduces the alienation caused by social norm conflict, thereby alleviating the weakening effect of social norm conflict on green consumption.

Self-Affirmation Moderates Self-Congruency Effect in Health Messaging

Previous research found that health risk messages framed to be congruent with people's independent or interdependent self-construal were not consistently more effective than incongruent messages. We argue that people potentially process the self-construal congruent health risk messages in a biased manner. To test this proposition, we examined the role of self-affirmation, which is expected to reduce defensive processing, in college nonsmokers' responses to an antismoking message congruent vs. incongruent with their dominant self-construals. Results from an online experiment suggested that self-affirmation moderated the self-congruency effect. Specifically, among college nonsmokers endorsing a dominant interdependent self-construal, self-congruency effect emerged only when the group was engaged in self-affirmation. Among college nonsmokers endorsing a dominant independent self-construal, with no prior affirmation, the group reported self-incongruent messages better than the self-congruent messages. After being engaged in self-affirmation, the group reported similar effects for self-congruent and self-incongruent messages. Theoretical and practical implications of our findings are discussed.

Effects of Self-Affirmation Feedback on Exercise Intention of Women in Their Twenties Depending on Construal Level

This study examines how type of instructor feedback influences cognitive processes conducive to participants' health behavior, using a new theoretical approach based on self-affirmation and construal level theory. In Study 1, feasibility self-affirmed feedback (FSF) and desirability self-affirmed feedback (DSF) were qualitatively explored with Vinyasa Yoga instructors, and four FSF and DSF feedback scenarios were developed. In Study 2, 55 (FSF group: 28 and DSF group: 27) women in their twenties participating in a Vinyasa Yoga program were randomly assigned to two experimental self-affirmation feedback groups (FSF and DSF) and exposed to FSF and DSF, respectively, for four weeks based on the scenarios developed in Study 1. The analysis of changes in exercise intention triggered by the participants' exposure to self-affirmation feedback showed that participants exposed to DSF experienced a more positive influence than those exposed to FSF in their continuation intentions of success.

Differential Effects of Content-Oriented Versus User-Oriented Social Media on Risk Perceptions and Behavioral Intentions

Social media have become increasingly important in risk and crisis situations. However, little is known about which types of social media have greater influence on risk perceptions and behaviors. This study pursues two goals related to this question. The first is to explicate the cognitive mechanism underlying the process through which exposure to risk information on social media shapes people's behavioral intentions. The second is to determine whether exposures to risk information on two different types of social media-content-oriented social media focusing on shared interests versus user-oriented social media focusing on social relationships-have different effects on people's risk perceptions and behavioral intentions. Analyzing survey data from 688 adults from the general population of South Korea in the context of carcinogenic hazards, we found that self-reported content-oriented social media exposure (to risk information) was significantly related to both personal-level and societal-level risk perceptions. In addition, content-oriented social media exposure was associated with behavioral intentions indirectly through risk perceptions. However, user-oriented social media exposure had no impact on risk perceptions and behavioral intentions, either directly or indirectly through risk perceptions.

Combining a UV photo intervention with self-affirmation or self-compassion exercises: implications for skin protection

The current study tested whether self-affirmation or self-compassion exercises, shown to increase message acceptance, could maximize the benefit of a UV photo intervention on skin protection cognitions. College women (N = 167) were randomly assigned to: (1) view a UV photo or Black and White (no-UV) photo of their face and (2) write a self-affirmation, self-compassion, or neutral essay. Participants who saw their UV photo reported healthier cognitions, including greater perceived vulnerability and intentions to protect skin. Within the self-compassion condition, participants who saw their UV photo were also more likely to take the sunscreen packets offered. However, neither self-affirmation nor self-compassion enhanced the effect of the UV photo. Within the UV condition, women who completed these exercises had similar (and occasionally less healthy) cognitions and behavior as those who wrote a neutral essay. The benefits of self-affirmation and self-compassion in conjunction with health messages may be limited to higher risk groups who experience more message defensiveness than the current sample.

How Confidence in Prior Attitudes, Social Tag Popularity, and Source Credibility Shape Confirmation Bias Toward Antidepressants and Psychotherapy in a Representative German Sample: Randomized Controlled Web-Based Study

Background

In health-related, Web-based information search, people should select information in line with expert (vs nonexpert) information, independent of their prior attitudes and consequent confirmation bias.

Objective

This study aimed to investigate confirmation bias in mental health–related information search, particularly (1) if high confidence worsens confirmation bias, (2) if social tags eliminate the influence of prior attitudes, and (3) if people successfully distinguish high and low source credibility.

Methods

In total, 520 participants of a representative sample of the German Web-based population were recruited via a panel company. Among them, 48.1% (250/520) participants completed the fully automated study. Participants provided prior attitudes about antidepressants and psychotherapy. We manipulated (1) confidence in prior attitudes when participants searched for blog posts about the treatment of depression, (2) tag popularity —either psychotherapy or antidepressant tags were more popular, and (3) source credibility with banners indicating high or low expertise of the tagging community. We measured tag and blog post selection, and treatmentefficacy ratings after navigation.

Results

Tag popularity predicted the proportion of selected antidepressant tags (beta=.44, SE 0.11; P<.001) and blog posts (beta=.46, SE 0.11; P<.001). When confidence was low (−1 SD), participants selected more blog posts consistent with prior attitudes (beta=−.26, SE 0.05; P<.001). Moreover, when confidence was low (−1 SD) and source credibility was high (+1 SD), the efficacy ratings of attitude-consistent treatments increased (beta=.34, SE 0.13; P=.01).

Conclusions

We found correlational support for defense motivation account underlying confirmation bias in the mental health–related search context. That is, participants tended to select information that supported their prior attitudes, which is not in line with the current scientific evidence. Implications for presenting persuasive Web-based information are also discussed.

Trial Registration

ClinicalTrials.gov NCT03899168; https://clinicaltrials.gov/ct2/show/NCT03899168 (Archived by WebCite at http://www.webcitation.org/77Nyot3Do)

Does other-affirmation increase self-directed exposure to and persuasiveness of a threatening anti-alcohol message?

OBJECTIVE

Self-affirmation of personal values can reduce defensive responses to threatening health promotion messages, probably because it induces a positive and expansive view of the self. However, coping with threat is also an interpersonal process. We developed other-affirmation inductions that focus on values held by others. Two studies examined the effects of common affirmation inductions modified for other-affirmation: affirmation of a specific value (kindness) and affirmation of a personally chosen value.

DESIGN

Randomized and controlled three-group (self-, other-, or no-affirmation conditions) single-factor design. Outcomes were time spent in self-directed viewing the message and self-reported outcomes that included intentions to reduce drinking, evaluations of the message, and risk perceptions.

METHODS

Students were randomized to self-, other, or no-affirmation conditions and asked to read a threatening anti-alcohol message.

RESULTS

Self- and other-affirmation increased message viewing time in Study 1. In both studies, other-affirmation increased self-reported outcomes, and study 1 showed this effect to be more prominent in females. In Study 1, the effects of self- and other-affirmation on message exposure were greater in participants with defensive coping styles, and other-affirmation effects were mediated by more positive views of others and their values. This mediation was independent of self-affirmation.

CONCLUSION

Other-affirmation increased self-reported outcomes and, in Study 1, reduced defensiveness to and improved viewing times to an anti-alcohol message. Other-affirmation could be useful, because it may be suited to particular subpopulations, such as females, and can be easily incorporated into mass-reach health communications. Statement of contribution What is already known on this subject? Self-affirmation of personally important values can reduce defensive responding to threatening health communications. Self-affirmation effects have been shown to be mediated by feelings of connectedness. What does this study add? Affirmation of personally important values in others can improve effects of a health communication. Other-affirmation effects may be greater in those with defensive coping styles. Other-affirmation was mediated by enhanced perceptions of others and their values.

Self-rated health is prospectively associated with uptake of screening for the early detection of colorectal cancer, not vice versa

Self-rated health (SRH) is a consistent predictor of mortality and other health outcomes. One of the mechanisms hypothesized to explain its validity as a predictor is that SRH affects the adoption of health behaviors. The present study examined the prospective association between SRH and performance of a recommended colorectal cancer (CRC) screening test. One thousand four hundred and seventy-six men and women aged 50-74 years, eligible for CRC screening, who had undergone the test a year before were interviewed 1-2 weeks (long interview, before testing) or 2 months (short interview, after testing) following the mailing of a test kit. Test performance was ascertained using an HMO's computerized data set. Respondents in the long interview group who rated their health as 'higher than others' performed the screening test 2 months following the invitation more than those who rated their health as similar to or lower than that of others (65.4, 61.6, and 49.1%, respectively, χ=8.02, P=0.018). At the same time, these respondents perceived the risk of CRC as significantly lower than that of those who rated their health as comparable with or lower than that of others. In a multivariate logistic regression of CRC screening behavior that included demographic and perceptual variables, age, intentions, and SRH were found to be significant predictors. Among respondents in the short interview, who tested before the interview, there was no significant association between SRH and behavior. SRH prospectively predicts uptake of CRC screening better than other perceptual variables, after accounting for demographic variables.

A self-affirmation exercise does not improve intentions to vaccinate among parents with negative vaccine attitudes (and may decrease intentions to vaccinate)

Two studies investigated the effectiveness of a self-affirmation exercise on vaccine safety beliefs and intent to vaccinate future children. In Study 1, a sample of 585 parents with at least one child under the age of 18 in the home participated through Amazon’s MTurk. Participants were randomly assigned to one of four conditions in a 2 x 2 design. Participants read either correcting information refuting a link between the measles, mumps, and rubella (MMR) vaccine and autism or a control passage about bird feeding. Additionally, participants either completed a self-affirmation exercise where they reflected on their personal values or in a control condition in which they reflected on least-personally-important values that might be important to others. Participants exposed to the correcting information were less likely to believe that vaccines cause serious side effects, but no less likely to believe that the MMR vaccine causes autism. For parents with initially positive vaccine attitudes, there was no effect of condition on intent to vaccinate a future child. For parents with initially negative vaccine attitudes, self-affirmation was ineffective in the presence of correcting information and resulted in less intention to vaccinate in the absence of correcting information. This effect was partially replicated in Study 2 (N = 576), which provided no correcting information but otherwise followed the same procedure as Study 1.

You Should Know Better: Can Self-Affirmation Facilitate Information-Seeking Behavior and Interpersonal Discussion?

This study explores whether self-affirmation has the capacity not merely to reduce the perceived threat associated with health-related information but also to facilitate interpersonal discussion and affect health information-seeking behavior. The context for the study is the ongoing California drought, which serves as suitable context to examine the intersection of self-affirmation and information-seeking behavior because it involves a threatening message (the destructive consequences of the drought) and highlights discrepancies between actual (water waste) and prosocial (water conservation) behavior. Results of a month-long longitudinal panel study demonstrate significant effects of self-affirmation on interpersonal discussion, information seeking, knowledge, and water-conserving behavior across time. Implications for theorizing longer term effects of self-affirmation and practical implications for promoting behavioral change through the enhancement of knowledge and self-esteem are considered.

Predicting Avoidance of Skin Damage Feedback Among College Students

BACKGROUND

Showing people a personal ultraviolet (UV) photograph depicting skin damage can be an effective method for changing sun protection cognitions and behaviors.

PURPOSE

We examined whether people opt not to see their UV photograph if given a choice. We also examined predictors of avoidance of skin damage feedback.

METHODS

College students (N = 257) completed questionnaires, viewed example UV photographs, and received the opportunity to see a UV photograph of their face.

RESULTS

Over one-third of participants opted not to see their UV photograph. Greater perceived risk of sun damage and having fewer coping resources corresponded with greater avoidance, particularly among participants who reported infrequent sun protection behavior.

CONCLUSION

The health benefits of UV photography are realized only if people are willing to view the photograph. Our findings suggest the need for interventions that increase receptivity to viewing one's UV photograph.

Targeting modulates audiences' brain and behavioral responses to safe sex video ads

Video ads promoting condom use are a key component of media campaigns to stem the HIV epidemic. Recent neuroimaging studies in the context of smoking cessation, point to personal relevance as one of the key variables that determine the effectiveness of public health messages. While minority men who have sex with men (MSM) are at the highest risk of HIV infection, most safe-sex ads feature predominantly Caucasian actors in heterosexual scenarios. We compared brain respons of 45 African American MSM to safe sex ads that were matched (i.e. 'Targeted') to participants' sexual orientation and race, and 'Untargeted' ads that were un matched for these characteristics. Ad recall, perceived 'convincingness' and attitudes towards condom use were also assessed. We found that Targeted ads were better remembered than the Untargeted ads but perceived as equally convincing. Targeted ads engaged brain regions involved in self-referential processing and memory, including the amygdala, hippocampus, temporal and medial prefrontal cortices (MPFC) and the precuneus. Connectivity between MPFC and precuneus and middle temporal gyrus was stronger when viewing Targeted ads. Our results suggest that targeting may increase cognitive processing of safe sex ads and justify further prospective studies linking brain response to media public health interventions and clinical outcomes.

Wise Additions Bridge the Gap between Social Psychology and Clinical Practice: Cognitive-Behavioral Therapy as an Exemplar

Progress in clinical science, theory, and practice requires the integration of advances from multiple fields of psychology, but much integration remains to be done. The current article seeks to address the specific gap that exists between basic social psychological theories and the implementation of related therapeutic techniques. We propose several "wise additions," based upon the principles outlined by Walton (2014), intended to bridge current social psychological research with clinical psychological therapeutic practice using cognitive behavioral therapy as an example. We consider how recent advances in social psychological theories can inform the development and implementation of wise additions in clinical case conceptualization and interventions. We specifically focus on self and identity, self-affirmation, transference, social identity, and embodied cognition, five dominant areas of interest in the field that have clear clinical applications.

Communicating to increase public uptake of pandemic flu vaccination in the UK: Which messages work?

BACKGROUND

Vaccination is considered the most effective preventive measure against influenza transmission, yet vaccination rates during the 2009/10 influenza A/H1N1 pandemic were low across the world, with the majority of people declining to receive the vaccine. Despite extensive research on the predictors of uptake of influenza vaccination, little research has focused on testing the effectiveness of evidence and theory-based messages.

AIMS

To examine the persuasiveness of messages promoting vaccination and antiviral use either as health-enhancing or as risk-reducing, as well as messages which conveyed evidence-based information about the costs and benefits of vaccination, or which applied anticipated regret as a motivator for vaccine uptake.

METHOD

We conducted 11 focus groups with forty-one members of the general population in England including young and older adults, those with lower education, parents, and those with elevated health risk. The data were analysed using thematic analysis.

RESULTS

The factual, evidence-based messages were well received with participants finding them the most convincing and useful, particularly where they gave cost-benefit comparisons. Health-enhancing messages were received with scepticism and concern that the messages were not honest about the potential lack of safety of vaccination. In contrast, risk-reduction messages were perceived as being more balanced and credible. Messages aiming to elicit feelings of anticipated regret for not getting vaccinated were generally perceived as patronising and unprofessional.

CONCLUSIONS

Vaccination messages should be kept brief, but convey balanced, evidence-based information, and be transparent in their communication of potential side-effects. The general public seem to prefer messages that are factual and emphasise the costs and benefits of vaccination, particularly with regards to vaccine safety.

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.

The psychology of change: self-affirmation and social psychological intervention

People have a basic need to maintain the integrity of the self, a global sense of personal adequacy. Events that threaten self-integrity arouse stress and self-protective defenses that can hamper performance and growth. However, an intervention known as self-affirmation can curb these negative outcomes. Self-affirmation interventions typically have people write about core personal values. The interventions bring about a more expansive view of the self and its resources, weakening the implications of a threat for personal integrity. Timely affirmations have been shown to improve education, health, and relationship outcomes, with benefits that sometimes persist for months and years. Like other interventions and experiences, self-affirmations can have lasting benefits when they touch off a cycle of adaptive potential, a positive feedback loop between the self-system and the social system that propagates adaptive outcomes over time. The present review highlights both connections with other disciplines and lessons for a social psychological understanding of intervention and change.

Sequencing the threat and recommendation components of persuasive messages differentially improves the effectiveness of high- and low-distressing imagery in an anti-alcohol message in students

OBJECTIVES

Distressing imagery is often used to improve the persuasiveness of mass-reach health promotion messages, but its effectiveness may be limited because audiences avoid attending to content. Prior self-affirmation or self-efficacy inductions have been shown to reduce avoidance and improve audience responsiveness to distressing messages, but these are difficult to introduce into a mass-reach context. Reasoning that a behavioural recommendation may have a similar effect, we reversed the traditional threat-behavioural recommendation health promotion message sequence.

DESIGN

2 × 2 experimental design: Factor 1, high- and low-distress images; Factor 2, threat-recommendation and recommendation-threat sequences.

METHODS

Ninety-one students were exposed to an identical text message accompanied by high- or low-distress imagery presented in threat-recommendation and recommendation-threat sequences.

RESULTS

For the high-distress message, greater persuasion was observed for the recommendation-threat than the threat-recommendation sequence. This was partially mediated by participants' greater self-exposure to the threat component of the message, which we attribute to the effect of sequence in reducing attentional avoidance. For the low-distress message, greater persuasion was observed for the threat-recommendation sequence, which was not mediated by reading time allocated to the threat.

CONCLUSIONS

Tailoring message sequence to suit the degree of distress that message developers wish to induce provides a tool that could improve persuasive messages. These findings provide a first step in this process and discuss further steps needed to consolidate and expand these findings. Statement of contribution What is already known on this subject? Health promotion messages accompanied by distressing imagery might, under some circumstances, persuade individuals to engage in healthier behaviour. Audiences can respond defensively to distressing imagery, but may be less inclined to do so when an easily followed behavioural recommendation is presented before imagery. Current literature is divided on whether presenting a behavioural recommendation before a threat component accompanied by distressing images will improve the persuasiveness of messages. What does this study add? We show that, when a behavioural recommendation precedes a threat containing distressing images, persuasiveness of a threatening message is stronger than a threat-recommendation sequence. We show that a recommendation-threat sequence improves persuasiveness of distressing imagery because it reduces attentional avoidance.

Self-image and suicide in a Swedish national eating disorders clinical register

OBJECTIVE

Using a prospective design, to examine the relation between self-image (assessed using the Structural Analysis of Social Behavior) and suicide attempts/completions in women with anorexia nervosa-restricting type (ANR), anorexia nervosa-binge/purge type (ANBP), bulimia nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS); and to assess whether these self-image variables add unique predictive value to suicide when considering other baseline predictors.

METHOD

Women (N=2269) aged 12 to 45 (M=22.1) presenting to specialist eating disorders clinics in Sweden between 2005 and 2009 were identified through the Stepwise Eating Disorders Quality Register. Data on age, body mass index, eating disorder severity (Eating Disorder Examination-Questionnaire scores), psychiatric comorbidity, global assessment of functioning, and self-image were abstracted from Stepwise and included as baseline predictors or covariates. Suicide information (prior attempt and attempt/completion after Stepwise registration) was obtained from the National Patient Register and Cause of Death Register.

RESULTS

Prevalence of detected suicide attempts/completions over the study period was 9.2%. Negative self-image variables were associated with prior suicide attempts in ANR and EDNOS and later suicide attempts/completions in women with BN. In a stepwise Cox proportional hazards model, only low self-affirmation predicted time to suicide attempts/completions in women with BN when accounting for age and prior suicide attempt.

CONCLUSION

Assessing self-image might assist with identifying women with BN at elevated risk for suicide.

The eye movement desensitization and reprocessing procedure prevents defensive processing in health persuasion

In the present study, the method of eye movement desensitization and reprocessing (EMDR) is studied to understand and prevent defensive reactions with regard to a negatively framed message advocating fruit and vegetable consumption. EMDR has been shown to tax the working memory. Participants from a university sample (n = 124) listened to the persuasive message in a randomized laboratory experiment. In the EMDR condition, they were also instructed to follow with their eyes a dot on the computer screen. The dot constantly moved from one side of the screen to the other in 2 seconds. In addition, a self-affirmation procedure was applied in half of the participants. EMDR led to a significant increase in persuasion, only in recipients in whom the persuasive message could be expected to activate defensive self-regulation (in participants with a moderate health value and in participants with low self-esteem). In those with a moderate health value, EMDR increased persuasion, but only when recipients were not affirmed. In addition, EMDR increased persuasion only in recipients with low self-esteem, not in those with high self-esteem. These results showed that EMDR influenced persuasion and in some way lowered defensive reactions. The similarities and differences in effects of EMDR and self-affirmation further increased our insight into the psychology of defensiveness.

Self-affirmation and motivational interviewing: integrating perspectives to reduce resistance and increase efficacy of alcohol interventions

To promote efforts at reducing problematic alcohol use and improving health outcomes, the present review proposes an integration of a social psychological approach - self-affirmation theory - with a clinical psychology intervention - motivational interviewing. Motivational interviewing (MI) is a popular empirically-designed treatment approach that has shown moderate success at reducing drinking and improving health, especially with resistant drinkers. Experiments informed by self-affirmation theory have found that people exhibit reduced defensiveness to threatening health messages and increased intentions to reduce alcohol consumption when affirmed. This review focuses on the mechanisms by which self-affirmation reduces resistance and how these mechanisms are complementary to the MI approach. Further, the review outlines suggestions for conducting and integrating self-affirmation into a MI intervention and provides recommendations for future empirical research.

Self-affirmation, intentions and alcohol consumption in students: a randomized exploratory trial

AIMS

This study tests whether enhancing alcohol risk messages with self-affirmation, the process of focusing on cherished aspects of oneself, increases intentions to reduce alcohol consumption and reduces actual alcohol consumption. It was also examined whether these effects differed by risk status as indicated by standard drinks consumed in an average week.

METHODS

Participants (n = 121) were randomly allocated to a self-affirmation or matched control condition before viewing emotive graphic alcohol warning posters in a questionnaire-based study.

RESULTS

There were significant increases in intentions to reduce alcohol consumption in self-affirmed participants, and these effects were stronger in participants with higher behavioural risk. Intentions in turn significantly predicted a reduction in self-reported alcohol consumption.

CONCLUSIONS

These findings support the use of self-affirmation to enhance alcohol awareness campaigns, particularly in individuals with high behavioural risk.

Preserving integrity in the face of performance threat: self-affirmation enhances neurophysiological responsiveness to errors

Self-affirmation produces large effects: Even a simple reminder of one's core values reduces defensiveness against threatening information. But how, exactly, does self-affirmation work? We explored this question by examining the impact of self-affirmation on neurophysiological responses to threatening events. We hypothesized that because self-affirmation increases openness to threat and enhances approachability of unfavorable feedback, it should augment attention and emotional receptivity to performance errors. We further hypothesized that this augmentation could be assessed directly, at the level of the brain. We measured self-affirmed and nonaffirmed participants' electrophysiological responses to making errors on a task. As we anticipated, self-affirmation elicited greater error responsiveness than did nonaffirmation, as indexed by the error-related negativity, a neural signal of error monitoring. Self-affirmed participants also performed better on the task than did nonaffirmed participants. We offer novel brain evidence that self-affirmation increases openness to threat and discuss the role of error detection in the link between self-affirmation and performance.

Avoidance Denial Versus Optimistic Denial in Reaction to the Threat of Future Cardiovascular Disease

Two distinctly different denial-based threat orientations (avoidance denial and optimistic denial) were examined using a message about the future risk of cardiovascular disease (CVD) for young adults. Participants ( N = 101) completed measures of denial-based dispositional threat orientations, current eating, comparative risk, and objective risk for CVD. They then read a high-threat message about CVD and rated their reactions of threat, denial, and worry. One month later, eating patterns in the past month were assessed. Both types of dispositional denial processes were associated with more self-distancing denial, but showed distinctly different, sometimes opposite, patterns of relationships with perceptions of threat, worry, and optimistic self-risk for CVD. In addition, the two denial-based processes were driven by different factors. The implications of these two denial-based threat orientations for the development of theory on denial and health messages, as well as the design of messages to change behavior, are discussed.

Mood as a resource in dealing with health recommendations: how mood affects information processing and acceptance of quit-smoking messages

OBJECTIVE

An experimental study tested the effects of positive and negative mood on the processing and acceptance of health recommendations about smoking in an online experiment. It was hypothesised that positive mood would provide smokers with the resources to systematically process self-relevant health recommendations.

DESIGN

One hundred and twenty-seven participants (smokers and non-smokers) read a message in which a quit smoking programme was recommended. Participants were randomly assigned to one of four conditions: positive versus negative mood, and strong versus weak arguments for the recommended action.

MAIN OUTCOME MEASURES

Systematic message processing was inferred when participants were able to distinguish between high- and low-quality arguments, and by congruence between attitudes and behavioural intentions. Persuasion was measured by participant's attitudes towards smoking and the recommended action, and by their intentions to follow the action recommendation.

RESULTS

As predicted, smokers systematically processed the health message only under positive mood conditions; non-smokers systematically processed the health message only under negative mood conditions. Moreover, smokers' attitudes towards the health message predicted intentions to quit smoking only under positive mood conditions.

CONCLUSION

Findings suggest that positive mood may decrease defensive processing of self-relevant health information.

Appearance matters: the frame and focus of health messages influences beliefs about skin cancer

OBJECTIVES

This study sought to ascertain whether the health message 'framing effect', which has been observed for several diseases, occurs for messages concerning the consequences of skin cancer for one's appearance or one's health. Specifically, the effect of the frame and focus of health messages on intentions to perform skin protection behaviours and the perceived threat of skin cancer was investigated.

DESIGN

Consistent with previous research and to avoid carry-over effects, a two-factor, between-groups (message frame: gain vs. loss × message focus: appearance vs. health) design was used.

METHODS

Participants (N= 390) were recruited using convenience sampling and presented with one of four health messages, which were embedded in a questionnaire concerning beliefs about skin cancer (intentions to perform different skin protection behaviours, the perceived threat of skin cancer) and body consciousness. The health messages were framed in terms of loss (risks of sun exposure) or gain (benefits of skin protection) and focused on the consequences of sun exposure for one's appearance or one's health. The primary outcome measures were responses on rating scales concerning the perceived threat of skin cancer, intentions to perform different skin cancer protection behaviours, and body consciousness.

RESULTS

Perceived threat of skin cancer was found to be greater for appearance-focused messages and intentions to perform different skin protection behaviours were greater for loss-framed messages. These findings held when individual differences in body consciousness were controlled for.

CONCLUSIONS

These findings suggest that, for the communication of information about skin cancer to be effective, messages must focus on the impact of sun exposure and inadequate skin protection for people's appearance, not just their health. Moreover, to maximize effectiveness, health messages about skin cancer should take account of dispositional differences in the importance placed upon one's appearance.

Preferences for genetic and behavioral health information: the impact of risk factors and disease attributions

Increased availability of genetic risk information may lead the public to give precedence to genetic causation over behavioral/environmental factors, decreasing motivation for behavior change. Few population-based data inform these concerns. We assess the association of family history, behavioral risks, and causal attributions for diseases and the perceived value of pursuing information emphasizing health habits or genes. 1,959 healthy adults completed a survey that assessed behavioral risk factors, family history, causal attributions of eight diseases, and health information preferences. Participants' causal beliefs favored health behaviors over genetics. Interest in behavioral information was higher than in genetic information. As behavioral risk factors increased, inclination toward genetic explanations increased; interest in how health habits affect disease risk decreased. Those at greatest need for behavior change may hold attributions that diminish interest in information for behavior change. Enhancing understanding of gene-environment influences could be explored to increase engagement with health information.