Article

The Impact of Self-Affirmation on Health-Behavior Change: A Meta-Analysis

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Abstract

Objectives: Self-affirmation (induced by reflecting upon important values, attributes, or social relations) appears to reduce defensive resistance to health-risk information and increase subsequent readiness for health behavior change. However, these effects of self-affirmation have yet to be subjected to formal, quantitative integration. Consequently, the current article reports a meta-analysis of the impact of self-affirmation on outcomes at 3 key points in the process of health-behavior change: (a) message acceptance, (b) intentions to change, and (c) subsequent behavior. Method: The literature search identified 144 experimental tests of the effects of manipulating self-affirmation on these outcomes. Effect sizes were extracted and meta-analyzed. Results: Across 34 tests of message acceptance (N = 3,433), 64 tests of intentions (N = 5,564), and 46 tests of behavior (N = 2,715), random effects models indicated small but reliable positive effects of self-affirmation on each outcome: acceptance, d+ = .17(CI = .03 to .31); intentions, d+ = .14 (CI = .05 to .23); behavior, d+ = .32 (CI = .19 to .44). Findings held across a range of health problems and behaviors. Conclusions: The results suggest that deploying self-affirmation inductions alongside persuasive health information has positive effects, promoting message acceptance, intentions to change, and subsequent behavior. Though the effects are small in magnitude, they are comparable to those obtained in meta-analyses of other health-behavior change interventions. These findings are relevant to researchers and practitioners working to understand why people resist beneficial health information and how such resistance can be reduced.

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... The current study addresses this question by leveraging insights from self-affirmation theory (Steele, 1988), and applies them to behavioral decisionmaking research. A robust literature has found that self-affirming core values can reduce cognitive dissonance and defensiveness (Epton et al., 2015), However, it is less clear the degree to which selfaffirmations can affect uncertainty-based decision making, both in terms of risky decision making (Study 1) and decision making under ambiguity (Study 2). Knight (1921) indicating a general tendency toward risk aversion when potential gains are at stake. ...
... We propose that bolstering one's self-system against threat might reduce the defensiveness that might arise in the context of uncertainty, thereby decreasing uncertainty aversion. Several studies have demonstrated that the process of self-affirmation, the act of reflecting on core values, is an effective way to reduce defensiveness in a variety of threat-related domains (Epton et al., 2015;Steele, 1988;Sweeney & Moyer, 2015). Of particular practical interest, self-affirmation has been shown to counter defensiveness and encourage positive behaviors in several health and social domains such as tobacco and alcohol use, (e.g., Armitage et al., 2008Armitage et al., , 2011Klein et al., 2011), healthy eating and exercise (e.g., Epton & Harris, 2008), condom use (Sherman et al., 2000), environmental behaviors (Graham-Rowe et al., 2019), and prejudice and political partisanship (e.g., Binning et al., 2010). ...
... We also encourage research on the effects of self-affirmation in other decision-making contexts, particularly those that may involve some threat to the self-concept (which self-affirmation can help abate). Research and theory demonstrate the effects of self-affirmation manipulations across a large range of different behaviors and outcomes, from multi-determined health behavior change at the broad end, to behavioral startle responses at a microlevel of analysis (Crowell et al., 2015;Epton et al., 2015). ...
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Decisions about one’s health are often accompanied by uncertain outcomes, which may be either positively or negatively valenced. The presence of this uncertainty, which can range along a continuum from risk to ambiguity (i.e., decisions in which the outcome probabilities are known or unknown), can be perceived as threatening, and individuals tend to be averse to uncertain outcomes, attempting to avoid uncertainty when possible. We proposed that one way to reduce uncertainty aversion could be to provide opportunities to affirm one’s core values, or “self‐affirmation.” Prior research has suggested that self‐affirmation promotes health behavior by providing a buffer against potential threats to the self. However, the degree to which self‐affirmation affects decision making is still unclear. Across two studies, we tested the effects of a self‐affirmation manipulation on risk (Study 1) and ambiguity (Study 2) preferences for both potential gains and losses. In both studies, we found that, compared to the non‐affirmed group, affirmed individuals were more accepting of uncertainty when the decision involved potential gains, but not for potential losses. Furthermore, for risky decisions, the increased acceptance of uncertainty came at the expense of making choices consistent with the expected value, such that self‐affirmed individuals made more disadvantageous choices than non‐affirmed individuals. Our results suggest both benefits and costs of self‐affirmation in the context of risky choice, an important finding has given the many applications of self‐affirmation in behavioral decision‐making contexts.
... The theory posits that people are vigilant to information that threatens their sense of self-integrity (i.e, perception of the self as morally and adaptively adequate; Cohen & Sherman, 2014), which may promote defensive processing of risk messages (e.g., smokers may be defensive against messages depicting the health consequences of smoking). Such defensiveness will reduce the effectiveness of risk communication campaigns and related preventive efforts (Epton et al., 2015; P. R. Harris et al., 2007). However, if people are allowed to self-affirm (e.g., by reflecting on their most important values or key strengths), including in a domain unrelated to that targeted by the risk communication, then they may display greater acceptance of the risk message, greater motivation to change their behavior, and subsequently change their behavior (Epton et al., 2015;Sweeney & Moyer, 2015). ...
... Such defensiveness will reduce the effectiveness of risk communication campaigns and related preventive efforts (Epton et al., 2015; P. R. Harris et al., 2007). However, if people are allowed to self-affirm (e.g., by reflecting on their most important values or key strengths), including in a domain unrelated to that targeted by the risk communication, then they may display greater acceptance of the risk message, greater motivation to change their behavior, and subsequently change their behavior (Epton et al., 2015;Sweeney & Moyer, 2015). For instance, evidence has shown that self-affirmation is effective in reducing the negative effects of stereotype threat on academic performance (Cohen & Sherman, 2014), improving prospective academic attainment and progression in ethnic minority groups (Goyer et al., 2017), and in enabling health-related behavior change across different behavioral domains (Epton et al., 2015). ...
... However, if people are allowed to self-affirm (e.g., by reflecting on their most important values or key strengths), including in a domain unrelated to that targeted by the risk communication, then they may display greater acceptance of the risk message, greater motivation to change their behavior, and subsequently change their behavior (Epton et al., 2015;Sweeney & Moyer, 2015). For instance, evidence has shown that self-affirmation is effective in reducing the negative effects of stereotype threat on academic performance (Cohen & Sherman, 2014), improving prospective academic attainment and progression in ethnic minority groups (Goyer et al., 2017), and in enabling health-related behavior change across different behavioral domains (Epton et al., 2015). Studies have also shown that self-affirmation improves information processing and problem solving capacity under cognitively taxing conditions (Creswell et al., 2013(Creswell et al., , 2007P. ...
Article
The use of image and performance enhancement drugs (IPEDs) in recreational sport represents an emerging public health and societal problem. The present study investigated whether self-affirmation changed exercisers' intentions to use IPEDs, via the effects of mental construal and message acceptance. Sixty-eight exercisers who self-reported IPEDs use participated in the study and were randomly assigned to either a self-affirmation or a control group. All participants read a health-related message about the consequences of IPEDs and subsequently completed a survey measuring message acceptance, mental construal, doping intentions and IPEDs-related social cognitive variables. There were no significant differences between the self-affirmed and the control groups. Hierarchical linear regression analysis further showed that message acceptance, subjective norms, and situational temptation were significantly associated with intentions to use IPEDs. Our findings raise the possibility that for recreational exercisers IPED’s use is seen mostly as a health-related matter than a socio-moral transgression.
... Evidence suggests the act of self-affirming, although brief, can improve threatened individuals' receptivity to information they might otherwise defensively reject and can increase the chances of subsequent behavior change. 24,25 An extensive body of research has demonstrated beneficial impacts of self-affirmation on health-related cognitions, health behavior, and other health-related responses. 24 Many studies have shown that individuals who self-affirm prior to being exposed to health risk messages related to smoking, 26 alcohol intake, 19,27 fruit and vegetable consumption, 28 sunscreen use, 29 and physical activity 30 report higher levels of message acceptance, lower message derogation, stronger intentions to change and greater success in actual behavior change. ...
... and actual behavior change (d = .32). 25 As an intervention technique, self-affirmation may be a particularly effective and practical method to promote adaptive responses to health risk messages related to sedentary behavior in university students. First, self-affirmation manipulations are relatively easy to implement and can be applied in one-to-one or group settings. ...
... Cumulatively, the above findings contrast previous studies that found that self-affirmation generally promotes greater message acceptance, 18,19,49 less message derogation, 29,44 greater self-risk perceptions, 19,27 more negative affect, 26,27,29 and higher intentions to change behavior. 25,50 However, as noted above, the lack of a manipulation check makes it unclear whether our intervention was ineffective because the manipulation failed, or because the manipulation worked, but self-affirming legitimately did not promote adaptive responses to the message. ...
Article
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Objective: Examine effects of self-affirmation on university students' processing of health risk messages related to sedentary behavior. Participants: Eighty-eight students from a Canadian university (females = 53; males = 35; Mage = 21.74, SD = 5.36) participated during the 2018-2019 academic year. Methods: Participants were randomized to a self-affirmation (n = 43) or control group (n = 45), watched a video conveying sedentary behavior risk messages, and completed measures of acceptance, derogation, risk perceptions, negative affect, and intentions. A one-way between-groups multivariate analysis of variance (MANOVA) examined effects of condition on the combined set of outcome variables. Results: Self-affirmation had no observable effect on any outcome variables. Conclusion: Self-affirmation did not appear to impact students' reactions to sedentary behavior risk messages. Given the lack of a manipulation check, however, this finding must be interpreted with caution. The Trigger and Channel framework offers a useful account of factors that influence self-affirmation effects. Implications and future research directions are discussed.
... However, limited research has found that reflecting on health as a value can also be effective (Iles et al., 2021;Klein et al., 2010). An affirmation in the health domain is particularly attractive in health communication for practical reasons as it would simplify its integration with health messaging (Arpan et al., 2017;Epton et al., 2015). In addition to experimentally induced self-affirmation, individuals can also spontaneously self-affirm when feeling threatened. ...
... Using GPower, we determined that approximately 900 participants would provide adequate power (.80) to detect a small effect size f (.10) in a 2 × 3 factorial design involving six groups. The decision to power the study for detecting a small effect size was based on self-affirmation meta-analyses (e.g., Epton et al., 2015). Prior to exclusions, our sample size was 901; 47 participants missed one or both of our attention checks and were excluded, leaving us with a total sample of 854 participants after exclusions. ...
... Prior research suggests the effectiveness of similar inoculation interventions does not differ by sex (Cook et al., 2017;Guess et al., 2020;, alleviating sample concerns. One of the meta-analyses conducted with studies of self-affirmation in the domain of health did not find sex differences either (Epton et al., 2015). Yet some studies have found that self-affirmation was more beneficial for women versus men when women were part of a negatively stereotyped group (Shnabel et al., 2013) or when they felt more similar to the characters depicted in a PSA about HIV (Sherman et al., 2000). ...
Article
We investigated the effectiveness of inoculation and self-affirmation interventions in neutralizing effects of health misinformation. Women ( N=854) recruited via Prolific were randomly assigned to self-affirm (or not) and read an inoculation (versus control) message detailing five common attributes of misinformation. All participants read an article with misinformation about breast cancer screening and reported their reactions to the article. The inoculation (vs control) message reduced the negative effects of misinformation, as assessed by resistance-related measures, attitudes, and intentions. Experimentally induced self-affirmation did not show protective effects against misinformation, but the inoculation intervention was stronger among participants higher in self-reported spontaneous self-affirmation.
... That is, self-affirmation promotes the acceptance of threatening messages by attesting that one's self-worth is not contingent on the behavior described in such messages. A meta-analysis of self-affirmation interventions has shown that self-affirmation is effective for changing not only health-related behavioral intentions but also actual health behavior (Epton et al., 2015). Moreover, self-affirmation interventions have been successfully used to expose individuals to the health implications associated with exercise behavior or lack thereof. ...
... Following the administration of the aforementioned measures, participants were randomized to either the control or intervention (self-affirmation) condition using a random number generator. Participants completed a standard self-affirmation or control task (Cohen et al., 2000;Epton et al., 2015): they first ranked 11 values from most to least important and were subsequently asked to write about the personal importance of the value that they rated as most important (self-affirmation condition) or the importance of their lowest rated value for the average college student (control condition). Next, participants were told that they would be completing an objective memory test in which they would read scientific facts and try to remember as much of the content as possible. ...
... and α = .05. A recent meta-analysis examining the impact of self-affirmation interventions on health-related intentions and behavior found a small to medium effect of self-affirmation on each outcome (Epton et al., 2015). Assuming a small-medium effect (d = .32), ...
Article
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.
... Epton et al found that compared with the nonaffirmation group, the self-affirmation group was more likely to accept high-cost or high-risk information, and change their behavior to complete high-cost or high-risk tasks because they were less sensitive to costs and risks. 46 Furthermore, Wang and Zhao examined the relationship between self-affirmation and individuals' willingness to donate organs and found that self-affirmation enhanced the possibility of individuals to consider future consequences, and reduced the time cost that individuals might think about. 38 Which might suggest that selfaffirmation could increase individuals' donation behavior whether donation's cost was high or low, which meant that self-affirmation might increase individuals' donation behavior even under high-cost level. ...
... Existing studies have found that self-affirmation could promote donation behavior. 38,45 More importantly, selfaffirmation could help people to accept high-cost information and change their behaviors to achieve long-term benefits, 38,46 and self-affirmation could also facilitate selfcontrol when the resource had been exhausted. 48,49 However, whether self-affirmation could increase individuals' donation behavior under high-cost condition has not been fully clarified, whether self-affirmation could increase donation behavior of individuals with low selfcontrol ability and individuals with self-control resource exhaustion has not been fully clarified. ...
... 55 One plausible explanation of this finding is that value affirmation leads to equal consideration for different cost levels and helps individuals to reduce egoistic thoughts. 46 Another plausible explanation of this finding is that value affirmation may improve individual empathy, previous study showed that individuals who experienced self-affirmation could better perceive other's situation and changed their behavior to help others, 56 so individuals who experienced self-affirmation might increase donation behavior even under high-cost condition. ...
Article
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Purpose: Donation behavior plays a crucial role in promoting the development of social and public welfare undertakings. Previous studies have partially explored the influencing factors of donation behavior, but effective methods for boosting individuals' donation behavior remain unclear. Based on the resource dependence theory, our present study further explored the promoting effect of self-affirmation on the relationship among cost, self-control, and individuals' donation behavior, and provided empirical basis for boosting individuals' donation behavior. Methods: In preliminary experiment, Carlson's real donation paradigm was conducted to examine the effect of cost on individuals' donation behavior. In experiment 1, we examined the effects of cost, self-control ability, and self-affirmation on individuals' donation behavior. Individuals with high or low self-control ability were assigned to complete the experimental induction of self-affirmation or non-affirmation. Subsequently, all participants completed the donation task under three cost conditions same as preliminary experiment. In experiment 2, we examined the effects of cost, self-control resource, and self-affirmation on individuals' donation behavior. Participants were assigned to complete the different Stroop task to induce the state of self-control resource exhaustion or non-exhaustion. Then, they completed the priming of self-affirmation or non-affirmation same as experiment 1. Finally, all participants completed the donation task under three cost conditions same as preliminary experiment. Results: The results of preliminary experiment indicated that participants engaged in more donation behavior under low- and medium-cost conditions compared with high-cost condition. The results of experiment 1 demonstrated that self-affirmation exerted a promoting effect on the donation behavior for individuals with low self-control ability under low-, medium-, and high-cost conditions. The results of experiment 2 demonstrated that self-affirmation promoted the donation behavior of individuals with self-control resource exhaustion under low-, medium-, and high-cost conditions. Conclusion: Self-affirmation could promote the donation behavior of individuals with low self-control ability and those with self-control resource exhaustion, whether donation's cost was high or low. Self-affirmation plays a crucial role for boosting individuals' donation behavior.
... Self-affirmation is one technique that may help to reduce the defensive processing of health-risk messages according to self-affirmation theory (SAT). 27,[30][31][32][33] SAT poses that when individuals are presented with health-risk information, they experience a threat to both their physical integrity (including their current or future health) and their self-integrity (i.e. their view of themselves as a 'good' and moral person). ...
... 27,29,34,35 A meta-analysis reported significant, but small, effects of self-affirmation manipulations (SAMs) on the acceptance of health-risk messages (d = 0.17), behavioral intention (d = 0.14) and changes in behavior (d = 0.32). 33 However, evidence specific to the effectiveness of SAMs to reduce alcohol consumption is mixed: while some studies have found significant reductions in alcohol consumption following intervention, 29,34,36,37 others have not. 27,35,38 The effect of SAMs on other variables, such as message acceptance, threat perception, behavioral intention and self-efficacy are equally mixed: while some studies have found no direct effect of SAMs on these variables, 27,34,36,37 one study found a significant effect on plans to reduce alcohol consumption 39 and another study found a significant effect on perceived vulnerability but not on perceived risk. ...
... Participants were university students who volunteered to take part in the research. Sample size calculations were conducted based on the meta-analysis by Epton et al. 33 which reported an average effect of SAMs on behavior of d = 0.32, which equates to an effect size of f = 0.16 for a three group design. An a priori power analysis indicated that 381 participants would be needed for an effect size of f = 0.16 at 80% power with alpha = 0.05. ...
Article
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Objective: Self-affirmation theory proposes that defensive processing prevents people from accepting health-risk messages, which may explain university students’ dismissal of risk-information about binge drinking. SA-interventions may encourage non-biased processing of such information through impacting on interpersonal feelings and self-esteem. This study compared two self-affirmation manipulations on interpersonal feelings, self-esteem, message processing, message acceptance and subsequent alcohol consumption. Participants: UK university students (N = 454). Methods: Participants were randomly allocated to one of three conditions (Self-affirmation Implementation Intention, Kindness Questionnaire, Control) before reading health-risk information about binge drinking. This was followed by measures of interpersonal feelings, self-esteem, message processing, acceptance and behavioral intentions. Alcohol consumption was assessed one week later. Results: The self-affirmation manipulations had non-significant effects on all outcome variables. Conclusion: Consistent with previous research, the results indicate that self-affirmation interventions are not effective for reducing alcohol consumption in university students.
... Self-affirmation is thought to balance the threat to self-integrity posed by a threatening message by affirming an at least equally important aspect of one's identity ). Meta-analyses support a positive, albeit small and variable, effect of self-affirmation on message acceptance, intention to engage in health behaviors, and actual health behaviors (Epton et al., 2015;Sweeney & Moyer, 2015). ...
... Whereas some of these alternatives have been previously evaluated (i.e. health-related versus unrelated affirmations (Cohen & Sherman, 2014;Klein et al., 2010;Sivanathan et al., 2008); essay versus questionnaire methods (Armitage & Rowe, 2011;Epton et al., 2015;Jessop et al., 2009;Knight & Norman, 2016), other elements (i.e. focus on self + values versus values + another person; focus on self versus self + values important to the self ) have yet to receive research attention. ...
... focus on self + values versus values + another person; focus on self versus self + values important to the self ) have yet to receive research attention. Although prior meta-analytic work compared self-affirmation inductions across studies (Epton et al., 2015), a critical comparison of all these approaches in the same context, thus eliminating study variability concerns, is currently lacking (cf. Jessop et al., 2009;McQueen & Klein, 2006). ...
Article
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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.
... These experiences rob OAP of perception of their power because they create negative feelings [26,27]. This discourages individuals from looking at themselves and making healthy choices, which in turn makes it difficult to perform appropriate health behaviors [26,[28][29][30]. Therefore, it is important for OAP to be able to recognize the self-perception of personal power. ...
... The first factor of the HBSO, "Self-perception of personal power" includes items that reflect positive feelings engendered by social relationships, which help to generate good health. Prior research has reported that recognizing personal power is a key component of health behavior [28,30,55]. However, OAP have been reported to lack perceived personal power [22][23][24][25]. ...
... However, OAP have been reported to lack perceived personal power [22][23][24][25]. Therefore, self-perception of personal power is important as a health behavior in OAP because it enables OAP to look at themselves and make better choices for their health [26,[28][29][30]. ...
Article
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Background: To reduce health disparities, prevention of non-communicable diseases (NCD) by performing desirable health behavior in older adults living alone with low socioeconomic status is an essential strategy in public health. Self-perception of personal power and practical skills for daily health are key elements of desirable health behavior. However, methods for measuring these concepts have not been established. This study aimed to develop a health behavior scale for older adults living alone receiving public assistance (HBSO). Methods: The self-administered mail survey covered 2818 older adults living alone receiving public assistance (OAP) randomly selected from the list of people receiving public assistance (Seikatsu-hogo in Japanese) at all 1250 local social welfare offices across Japan. Construct validity was confirmed using confirmatory factor analysis. Internal consistency was calculated using Cronbach's alpha. The self-efficacy for health promotion scale and Health check-up status were administered to assess the criteria-related validity of the HBSO. Results: In total, 1280 participants (response rate: 45.4%) responded, of which 1069 (37.9%) provided valid responses. Confirmatory factor analysis identified 10 items from two factors (self-perception of personal power and practical skills for daily health) with a goodness of fit index of 0.973, adjusted goodness of fit index of 0.953, comparative fit index of 0.954, and root mean square error of approximation of 0.049. Cronbach's alpha was 0.75. The total HBSO score was significantly positively correlated with the self-efficacy for health promotion scale (r = 0.672, p < 0.001) and the group with health check-up had significantly higher HBSO scores than the group without it (p < 0.001). Conclusions: The HBSO is an easy-to-self-administer instrument that is reliable and valid for OAP. The HBSO could facilitate appropriate assessment of OAP who need to improve their health behavior to prevent NCD, and could be used to determine effective support.
... However, it is important to note that the study was substantially underpowered. Prior to data collection, we conducted a sensitivity analysis for an independent samples t-test using G*Power (Faul et al., 2007) to estimate how large a sample was required to detect a small effect size (d =.35, see Epton et al., 2015 andSweeney &Moyer, 2015 meta-analyses for discussion of effect size variability in selfaffirmation manipulations). After inputting the following parameters: ! ...
... Therefore, future research should work to replicate validity findings and also implement different validation procedures (e.g., test-retest reliability,Kimberlin & Winterstein, 2008).In addition to revising the existing HATE-CARE scale, we recommend replicating Study 3. Either an exact replication with a larger sample or a similar design with a different, possibly more effective, self-affirmation manipulation. The success of self-affirmation manipulations varies, likely because of assorted effect sizes(Epton et al., 2015;McQueen & Klein, 2006;Sweeney & Moyer, 2015). Furthermore, future researchers may benefit from conducting more nonconfirmatory research on self-affirmation manipulation procedures to better establish the derivation chain for self-affirmation before implementing it as an independent variable in a confrontation setting. ...
Article
The present research sought to examine the effects of self-affirmation on women’s confrontation approaches following exposure to sexism. However, before examining the effects of self-affirmation, we needed a way to measure confrontation approaches. In Study 1, participants read either prototypical HATE or CARE confrontations and assessed the response. Researchers then conducted an exploratory factor analysis to create a novel scale that can assess approaches to confrontation. Study 1 also established the reliability of the HATE and CARE subscales (α = .956 and α = .929, respectively). Study 2 sought to establish the construct validity of the new measure. Study 2 implemented the same procedure as Study 1 and a confirmatory factor analysis revealed that while there is room to improve the new measure, the model fit is not necessarily bad. Finally, Study 3 explored the effects of self-affirmation on women’s confrontation approaches after exposure to sexism. After manipulating self-affirmation, women participated in an imagined scenario where they responded to a male colleague making sexist comments. We hypothesized that (1) self-affirmed women would directly confront the sexism less than non-affirmed women, (2) self-affirmed women would have lower HATE scores than non-affirmed women, (3) self-affirmed women would have higher CARE scores than non- affirmed women, (4) self-affirmed women would have lower perceived responsibly to confront compared to non-affirmed women, and (5) self-affirmed women would have lower negative state affect than non-affirmed women. Results of the statistical analyses supported Hypothesis 1. Implications for the findings of the three studies are discussed.
... Rights reserved. 29.2% had a low engagement in behaviors that reduce their risk (wHBS 0-6 points). In contrast, for those who reported themselves to be at lower or equal risk of CVD, 23.3% had a low wHBS (p < 0.0001). ...
... Risk calculators likely have a less dramatic impact on subgroups whose engagement in riskreducing behaviors is low. Behavioral science research demonstrates that subgroups may be more responsive to practices and interventions that highlight social comparisons and social identities [28], mitigate defensiveness [29], and recognize fatalistic perspectives. Our study sheds useful light on some of the individuals and/or combined characteristics of subgroups (i.e., men, adults never married, adults with less education) less likely to engage in these ideal health behaviors. ...
Article
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Purpose Despite cancer and cardiovascular disease (CVD) sharing several modifiable risk factors, few unified prevention efforts exist. We sought to determine the association between risk perception for cancer and CVD and engagement in healthy behaviors. Methods Between May 2019 and August 2020, we conducted a cross-sectional survey of adults ≥ 40 years residing in Brooklyn neighborhoods with high cancer mortality. We considered one’s perceived risk of cancer and CVD compared to age counterparts as the primary exposures. The primary study outcome was a weighted health behavior score (wHBS) composed of 5 domains: physical activity, no obesity, no smoking, low alcohol intake, and healthy diet. Modified Poisson regression models with robust error variance were used to assess associations between perceived risk for cancer and CVD and the wHBS, separately. Results We surveyed 2448 adults (mean [SD] age, 61.4 [12.9] years); 61% female, 30% Non-Hispanic White, and 70% racial/ethnic minorities. Compared to their age counterparts nearly one-third of participants perceived themselves to be at higher CVD or cancer risk. Perceiving higher CVD risk was associated with an 8% lower likelihood of engaging in healthy behaviors (RR 0.92; 95% CI 0.86–0.99). Perceiving greater cancer risk was associated with a 14% lower likelihood of engaging in healthy behaviors (RR 0.86; 95% CI 0.79–0.95). The association between cancer risk and wHBS attenuated but remained significant (aRR 0.90; 95% CI 0.82–0.98) after adjustment. Conclusion Identifying high-risk subgroups and intervening on shared risk behaviors could have the greatest long-term impact on reducing CVD and cancer morbidity and mortality.
... The purpose of this group of studies is to explore how to reduce the optimistic bias of participants, thereby mitigating the negative impact on health behavior. The intervention methods that have received considerable attention include self-affirmation (Klein et al., 2010;Epton et al., 2015), perceived control (Jansen et al., 2018), and self-efficacy (Morisset et al., 2010). ...
... On the other hand, this discovery has important practical significance for formulating effective policy interventions. Previous studies have shown that self-affirmation effectively increased the self-efficacy of participants, thereby reducing optimistic bias and improving health behaviors (Klein et al., 2010;Epton et al., 2015;Lü and Zhao, 2017). The existence of dual reference points means that the negative impact of optimistic bias on health behavior can also be mitigated by intervening in individual perceptions of social norms. ...
... In addition, it is most frequently framed in terms of self-affirmation theory (Sherman & Cohen, 2006), which may not be consistent with ACT theory. For example, in their meta-analysis of the values affirmation interventions within self-affirmation theory, Epton et al. (2015) suggest that values affirmation tasks function by "bolstering or restor ing a perception of oneself as adaptively and morally adequate" (p. 187). ...
... Values affirmation writing also re sulted in more weight loss and lower body mass index (BMI) after 2 months among col lege women compared to a control condition (Logel & Cohen, 2011). In their meta-analy sis that included 41 studies, Epton et al. (2015) concluded that there is a consistent, though small, positive impact of values affirmation interventions on health-related behav ior change. ...
Chapter
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While the concept of values has been present in behavioral traditions dating back to Skinner, the analysis of the role of values in modern contextual behavioral science (CBS) in relation to motivation has greatly expanded over the past 30 years. In particular, values are important in a modern understanding of the role of human language in modifying how reinforcement occurs. This chapter outlines values work as a foundational component of Acceptance and Commitment Therapy (ACT) and analyzes values through a CBS and Relational Frame Theory lens. The chapter includes an extensive review of the empirical literature on the role of values in ACT and discusses values measures commonly used in CBS research and clinical practice. Finally, we offer recommendations for next steps to expand our understanding of this essential process.
... The Digital Bodies intervention consisted of one hour-long interactive session. The session begun with a short self-affirmations exercise activity, where participants were asked to describe one thing that is important to them and why (adapted from Epton, Harris, Kane, van Koningsbruggen, & Sheeran, 2015). Used at the start of interventions, the technique can help to overcome participants' initial resistance to health promotion messages (Epton et al., 2015). ...
... The session begun with a short self-affirmations exercise activity, where participants were asked to describe one thing that is important to them and why (adapted from Epton, Harris, Kane, van Koningsbruggen, & Sheeran, 2015). Used at the start of interventions, the technique can help to overcome participants' initial resistance to health promotion messages (Epton et al., 2015). The main body of the intervention was delivered via cognitive dissonance building techniques and critical literacy skills development (Lewis-Smith et al., 2019) to encourage adolescents' own critical reflections on appearance ideals, and also to develop the skills needed to challenge these ideals. ...
Article
Background: A growing body of research has linked social media use to negative body image. Aims: The present research aimed to evaluate the efficacy of Digital Bodies, a brief classroom-based intervention that aims to improve adolescents' body image. Methods: British adolescents (N = 290; Age M = 12.81; SD = 0.40; Range = 12-13; Female = 151) were cluster randomized to intervention or waiting list control groups. Measures of body satisfaction, appearance ideal internalization (thin and athletic ideal internalization) and self-objectification were completed at baseline (T1), 1-week post-intervention (T2) and 8-week follow-up (T3). Results: Multi-level modelling showed adolescents in the intervention group reported improved body satisfaction at T2, in comparison to the control, and crucially this effect was sustained at T3. Additionally, girls reported less thin ideal internalization at T2 relative to the control, but this effect was not sustained at T3. No other intervention effects were found. Conclusions: Overall, the findings provide initial support for the efficacy of Digital Bodies as an intervention for improving adolescents' body satisfaction.
... Although a previous experiment did not find a direct effect of self-demands on boundary expansion using a self-affirmation task, the identity threat from actual life experiences should create a relatively stronger effect. In contrast to the previously documented small effects of self-affirmation (Epton, Harris, Kane, van Koningsbruggen, & Sheeran, 2015), pandemic-induced demands on the self are likely to produce a more robust association with boundary expansion. Further, prior research has shown that a greater challenge to the self-concept promotes higher levels of narrative engagement (Johnson et al., 2015(Johnson et al., , 2016. ...
... Participants' sense of identity threat amid the pandemic remained significantly associated with boundary expansion after controlling for other individual differences. A likely explanation for the differences between the present results and the null findings in Johnson et al. (2016) is the larger variance in identity threat during a public event compared to the well-documented small effects of the self-affirmation task used in the latter (Epton et al., 2015). Further, the present study confirmed that individuals who are high in search for life meaning could indeed become more absorbed and satisfied with story exposure by experiencing greater boundary expansion (H3), which conceptually replicates a finding in the previous work; in both the present study and Johnson et al. (2016), those low on search for meaning did not exhibit this link. ...
Article
The COVID-19 pandemic created a historic opportunity to study the link between identity threat and individuals’ temporary expansion of the boundaries of the self (TEBOTS) through stories. Concurrently, the relationship between eudaimonic entertainment processes and self-expansion, particularly feeling moved and self-awareness, was examined. A quasi-experiment was conducted with an online sample (N = 172) that was randomly assigned to watch either a tragic drama or comedy. Results showed that key TEBOTS predictions were largely confirmed for boundary expansion and the outcomes of narrative engagement and entertainment gratifications. Although identity threat was negatively associated with positive coping with the pandemic, this relationship turned positive when mediated by boundary expansion. Further, exposure to tragedy raised feelings of “being moved,” which, in turn, was linked to self-perceptual depth and expanded boundaries of the self downstream. The present findings suggest that self-expansion through story consumption could benefit viewers’ positive reframing of challenging life experiences.
... The purpose of this group of studies is to explore how to reduce the optimistic bias of participants, thereby mitigating the negative impact on health behavior. The intervention methods that have received considerable attention include self-affirmation (Klein et al., 2010;Epton et al., 2015), perceived control (Jansen et al., 2018), and self-efficacy (Morisset et al., 2010). ...
... On the other hand, this discovery has important practical significance for formulating effective policy interventions. Previous studies have shown that self-affirmation effectively increased the self-efficacy of participants, thereby reducing optimistic bias and improving health behaviors (Klein et al., 2010;Epton et al., 2015;Lü and Zhao, 2017). The existence of dual reference points means that the negative impact of optimistic bias on health behavior can also be mitigated by intervening in individual perceptions of social norms. ...
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Data were collected from 896 participants in three Chinese cities affected by the COVID-19 pandemic to varying degrees through an online survey platform. A conditional process model was then proposed for the impact of optimistic bias on self-protection behaviors during the COVID-19 pandemic from the perspective of social norms. Statistical analysis demonstrates that optimistic bias has a negative impact on self-protection behaviors through message acceptance. Perceived social norms moderate this relationship in the following ways: (1) The higher the perceptions of social norms, the smaller the negative impact of optimistic bias on message acceptance, and the smaller the positive impact of message acceptance on self-protection behaviors. (2) Within a certain range, the higher the perceptions of social norms, the smaller the negative impact, both direct and indirect, of optimistic bias on self-protection behaviors. (3) The direct and indirect effects of optimistic bias on self-protection behaviors become insignificant when perceptions of social norms are very strong. Comparing the data of the three cities shows that higher risk is associated with a stronger role of social norms in moderating the relationship between optimistic bias and self-protection behaviors. The above results suggest that there may be both internal (optimistic bias) and external (social norms) reference points in individual decision-making regarding health behaviors. The theoretical and practical significance of the dual reference points are discussed.
... Several factors underpin this working hypothesis. First it is a direct extension from research showing the benefits of experimentally manipulated (i.e., non-spontaneous) selfaffirmation for physical health (e.g., Epton et al., 2014) and for psychological wellbeing (e.g., Howell, 2017;Schüz & Schüz, 2017). Second, it is consistent with the theoretical understanding of how engaging in self-affirmation enables the individual to go beyond defensive responding to threats (e.g., by better contextualizing them; Sherman & Cohen, 2006). ...
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In two online studies, we test whether spontaneous self-affirmation (measured by the Spontaneous Self-Affirmation Measure, SSAM) predicts better mental health and coping and the role that self-esteem and dispositional optimism play in these relationships. Study 1 (N = 110) was cross-sectional. In study 2 (N = 192) we collected the mental health measures one month post-baseline. Consistent with pre-registered hypotheses, the SSAM predicted less anxiety, depression and avoidant coping, and greater wellbeing and non-avoidant coping; however, relationships involving self-esteem and optimism varied with the reported source of self-affirmation measured by the SSAM (strengths, values, social relations). Overall, the findings are generally consistent with the hypothesis that spontaneous self-affirmation tends to function as a resource that fosters positive coping with threats.
... Self-affirmation of core values can also foster prosocial behavior (Schwartz, 2010), creativity at work (Jiang, 2018), and pro-environmental attitudes and behavior (Graham-Rowe et al., 2019). Values-based interventions can improve health care follow-through (Epton et al., 2015) and promote healthy lifestyles more effectively than alternative approaches (e.g., Anshel et al., 2010;Hardcastle et al., 2015). ...
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Values provide a foundation for decision making, behavior, and emotional reaction; they are often used by practitioners to design effective interventions for self-awareness and personal growth. This report describes a novel, user-friendly method that identifies core values with a hierarchical ipsatization procedure (HIP) that is transparent and efficient. Response bias, validity, and user satisfaction were examined in a study in which 602 respondents completed a survey asking them to rate 80 values and use HIP to identify their 4 most inspiring and motivating values. HIP enabled selecting these 4 core values from 80 candidates in 5-7 min, with minimal evidence of response bias. The selections made during HIP were consistent with the rating data, providing evidence for HIP's concurrent validity. 88% of the respondents felt the 4 values identified by HIP inspired and motivated them more than any other values they could think of. These findings suggest HIP is a useful tool for identifying core values, especially in applied settings.
... In selfaffirmation research, an essential aspect of the participants' self is affirmed (e.g., by writing about a personally important value), after which they are presented with an unrelated but potentially threatening persuasive message (e.g., about health risks). Research generally finds that self-affirmation reduces defensive responses and increases attitude change (e.g., Epton et al., 2015). Although self-affirmation generally occurs outside of an interpersonal context, it may provide some of the same benefits or operate via some of the same mechanisms as psychological safety. ...
Article
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Interpersonal contexts can be complex since they can involve two or more people who are interdependent, each of whom is pursuing both individual and shared goals. Interactions consist of individual and joint behaviors that evolve dynamically over time. Interactions are likely to affect people’s attitudes because the interpersonal context gives the conversation partners a great deal of opportunity to intentionally or unintentionally influence each other. However, despite the importance of attitudes and attitude change in interpersonal interactions, this topic remains understudied. We briefly review the features of interpersonal contexts and build the case that understanding people’s sense of psychological safety is key to understanding interpersonal influences on people’s attitudes. Specifically, feeling psychologically safe can make individuals more open-minded, increase reflective introspection, and decrease defensive processing. Psychological safety impacts how individuals think, make sense of their social world, and process attitude-relevant information. These processes can result in attitude change, even without any attempt at persuasion. We review the literature on interpersonal threats, receiving psychological safety, providing psychological safety, and interpersonal dynamics. We then detail the shortcomings of current approaches, highlight the unanswered questions, and suggest avenues for future research that can contribute to developing this field.
... In selfaffirmation research, an essential aspect of the participants' self is affirmed (e.g., by writing about a personally important value), after which they are presented with an unrelated but potentially threatening persuasive message (e.g., about health risks). Research generally finds that self-affirmation reduces defensive responses and increases attitude change (e.g., Epton et al., 2015). Although self-affirmation generally occurs outside of an interpersonal context, it may provide some of the same benefits or operate via some of the same mechanisms as psychological safety. ...
Article
Interpersonal contexts can be complex since they can involve two or more people who are interdependent, each of whom is pursuing both individual and shared goals. Interactions consist of individual and joint behaviors that evolve dynamically over time. Interactions are likely to affect people’s attitudes because the interpersonal context gives the conversation partners a great deal of opportunity to intentionally or unintentionally influence each other. However, despite the importance of attitudes and attitude change in interpersonal interactions, this topic remains understudied. We briefly review the features of interpersonal contexts and build the case that understanding people’s sense of psychological safety is key to understanding interpersonal influences on people’s attitudes. Specifically, feeling psychologically safe can make individuals more open-minded, increase reflective introspection, and decrease defensive processing. Psychological safety impacts how individuals think, make sense of their social world, and process attitude-relevant information. These processes can result in attitude change, even without any attempt at persuasion. We review the literature on interpersonal threats, receiving psychological safety, providing psychological safety, and interpersonal dynamics. We then detail the shortcomings of current approaches, highlight the unanswered questions, and suggest avenues for future research that can contribute to developing this field.
... Value-focus tunes people more closely to the truth about unpleasant realities and reduces defensive bias (Cohen, Aronson, & Steele, 2000;Correll, Spencer, & Zanna, 2004;Sherman & Cohen, 2002). This makes them more willing to acknowledge and try to change unhealthy habits (e.g., Kang et al., 2018;Sherman, Nelson, & Steele, 2000; for reviews see Cohen & Sherman, 2014;Epton, Harris, Kane, van Koningsbruggen, & Sheeran, 2015;Sherman, 2013). Value-focus also reduces defensive selfenhancement and rationalization after dissonance and self-image threats (e.g., Sherman & Kim, 2005;Steele, 1988;Steele & Liu, 1983;Steele, Spencer, & Lynch, 1993). ...
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Fidelity with self-transcendent values is hailed as a hallmark of mature and magnanimous character by classic psychological and philosophical theories. Dozens of contemporary experiments inspired by self-affirmation theory have also found that when people are under threat, focus on self-transcendent values can confer magnanimity by improving psychological buoyancy (less anxious and more courageous, determined, and effective) and decreasing belligerence (less defensive, extreme, and hostile). The present research was guided by the postulate that both aspects of magnanimity—its buoyancy and its freedom from belligerence—arise from the approach motivated states that self-transcendent foci can inspire. Experimental manipulations of self-transcendent foci (values, spirituality, compassion) heightened state approach motivation as assessed by electroencephalography (Study 1, n = 187) and self-report (Study 2, n = 490). Further, even though the heightened approach motivation was transient, it mediated a longer-lasting freedom from moral (Study 1) and religious (Study 2) belligerence. Importantly, self-transcendent-focus effects on approach motivation and belligerence occurred only among participants with high trait meaning search scores. Results support an interpretation of meaningful values and spiritual ideals as self-transcendent priorities that operate according to basic motivational mechanics of abstract-goal pursuit. The transient, approach-motivated state aroused by transcendence-focus causes longer lasting relief from preoccupation with threat, leaving people feeling buoyant and generous. Relevance of results for self-affirmation theory and the psychology of spirituality are discussed.
... Self-affirmed participants have also been shown to respond to personally relevant health-risk information less defensively, rendering them more open to persuasion and, ultimately, to healthy behavior change (Epton et al., 2015;Sweeney & Moyer, 2015). Thus, self-affirmation has been shown to be effective at facilitating increased fruit and vegetable consumption (Epton & Harris, 2008), reduced alcohol intake (Armitage et al., 2011), and greater physical activity (Jessop et al., 2014). ...
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The present research examines the relationship between individual differences in the extent to which people report self-affirming when faced with a threat (spontaneous self-affirmation) and well-being. Across three studies (total N = 515), spontaneous self-affirmation consistently emerged as a significant linear predictor of hedonic and eudaimonic well-being outcomes, both cross-sectionally and longitudinally. A self-affirmation manipulation eliminated this association for two indices of well-being, primarily by boosting the well-being scores of those lower in spontaneous self-affirmation. Furthermore, spontaneous self-affirmation was found to partially mediate associations between socioeconomic status and well-being. These findings highlight individual differences in spontaneous self-affirmation as a potentially important contributor to well-being and suggest that consideration of spontaneous self-affirmation might further our understanding of the relationship between socioeconomic status and well-being.
... MI is a person-centered counseling approach based on empathetic listening that supports self-efficacy, emphasizes autonomy in decision making, acknowledges and works with resistance, and seeks to resolve ambivalence about a behavior (Britt et al., 2004;Copeland et al., 2015), which could make it particularly useful in the context of vaccine discussions with cancer survivors. In the absence of providers having dedicated time to engage in MI, additional self-affirmation strategies that involve asking cancer survivors to reflect on important values, attributes, or social relations in response to COVID-19 vaccine information could also be used in patient-centered communication approaches to address vaccine hesitancy given evidence suggesting self-affirmation has positive effects on message acceptance, intentions to change, and resultant behavior (Epton et al., 2015). ...
Article
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Due to cancer survivors’ increased vulnerability to complications from COVID-19, addressing vaccine hesitancy and improving vaccine uptake among this population is a public health priority. However, several factors may complicate efforts to increase vaccine confidence in this population, including the underrepresentation of cancer patients in COVID-19 vaccine trials and distinct recommendations for vaccine administration and timing for certain subgroups of survivors. Evidence suggests vaccine communication efforts targeting survivors could benefit from strategies that consider factors such as social norms, risk perceptions, and trust. However, additional behavioral research is needed to help the clinical and public health community better understand, and more effectively respond to, drivers of vaccine hesitancy among survivors and ensure optimal protection against COVID-19 for this at-risk population. Knowledge generated by this research could also have an impact beyond the current COVID-19 pandemic by informing future vaccination efforts and communication with cancer survivors more broadly.
... Self-affirmation has also been used in the health setting (Sherman & Cohen, 2006) as an intervention that promotes positive response to health risk information. Self-affirmed individuals have been found to display greater message acceptance, stronger motivation for change, and healthier post-intervention behavior (Epton et al., 2015). ...
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Dealing with threat is a ubiquitous experience for people everywhere. The extent to which we experience threat, however, differs, as do the means employed to address it. For instance, focusing on unthreatened aspects of the self (i.e., self-affirmation) helps us cope with prejudice, discrimination, and stigma. Individuals differ substantially in their threat experience, as some groups are more discriminated against, which also differs per national context. We discuss previous findings on social identity threat and how salient it is for some groups. We then inspect how affirmation interventions addressing threat and investigated in Western contexts fare in non-Western contexts. We describe the need to move beyond relatively well-represented non-Western settings (e.g., Asia) and include contexts that are religiously more diverse. We therefore present data on the use of self-affirmation from the sectarian context of Lebanon and elaborate on how the larger cultural context may impact reactions to affirmation interventions.
... In the domain of health, self-affirmation interventions are particularly effective for stigmatized groups-on average, effects are lower for nonstigmatized group members (Epton, Harris, Kane, van Koningsbruggen, & Sheeran, 2014). In addition, self-affirmation interventions are most effective when targeting threat, whether the threat of being an African American entering a race-discordant health setting (Havranek et al., 2012) or of being a smoker receiving information about smoking (Harris et al., 2007). ...
... Indeed, studies show that receiving self-affirmations before exposure to persuasive information can increase the acceptance of such messages and promote intentions to change health behaviors (Epton et al., 2015;Ferrer & Cohen, 2019;Harris & Epton, 2009). In a pioneering work, Reed and Aspinwall (1998) showed that caffeine users who affirmed their kindness had higher acceptance of caffeinerelated health threat information than non-affirmed caffeine users. ...
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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 vacacines and promoting vaccination intention.
... Another distinguishing feature of the follow-up task is the psychoeducation that emphasized the importance of engaging in potentially threatening social activities and interactions as a means of reducing social anxiety symptoms. A meta-analysis of the effects of self-affirmation on health behavior change in response to threatening health information indicates small but reliable positive effects on: (a) acceptance of the information, (b) intention to act on the it, and (c) subsequent behavior change (Epton et al., 2015). Conceivably, therefore, greater acceptance of the psychoeducation or the intention to act on it in the present study may have contributed to the reduction of symptoms and behavior changes evident in the self-affirmed. ...
Article
Introduction: Persons with social anxiety disorder (SAD) often experience social interactions as threatening and commonly avoid them or perform poorly in them (Asher et al., 2017). Self-affirmation is an intervention shown to help individuals engage effectively in situations they perceive as threatening (Sherman & Hartson, 2011). We hypothesized that self-affirmation would allow socially anxious individuals to participate in more social activities, do so more effectively, and with less stress and anxiety. Methods: Following completion of baseline measures, 75 socially anxious university students were randomly assigned to complete a self-affirming or control writing task. They subsequently completed the Trier Social Stress Test for Groups (TSST-G), and received SAD psychoeducation designed to promote social engagement over the coming month, after which they were reassessed on baseline measures of social anxiety. Results Self-affirmation demonstrated no benefit at the time of engagement in the TSST-G. However, at follow-up, self-affirmed students reported significantly less discomfort, anxiety, and distress related to a variety of social behaviors as well as more engagement in those behaviors, relative to baseline, compared with non-affirmed students. Moreover, significantly more affirmed than non-affirmed participants reported clinically significant reductions in symptoms of SAD at follow-up. Discussion These results help to broaden our conceptualization of self-affirmation and provide support for its potential utility in treatment for those with SAD.
... Some of these self-beliefs have been linked with transforming health beliefs into health behavior. For instance, when individuals receive threatening health information, interventions designed to remind them of their self-esteem and what they value (i.e., self-affirmation interventions) allow them to more easily accept the information and act on changing their health behavior (Epton et al., 2015). Similarly, an intervention that invoked positive affect and encouraged hypertensive individuals to self-affirm when they found it difficult to take their medication led to significantly greater medication adherence 12 months later, compared with a control intervention (Ogedegbe et al., 2012). ...
Article
Relationship partners affect one another’s health outcomes through their health behaviors, yet how this occurs is not well understood. To fill this gap, we present the Dyadic Health Influence Model (DHIM). The DHIM identifies three routes through which a person (the agent) can impact the health beliefs and behavior of their partner (the target). An agent may (a) model health behaviors and shape the shared environment, (b) enact behaviors that promote their relationship, and/or (c) employ strategies to intentionally influence the target’s health behavior. A central premise of the DHIM is that agents act based on their beliefs about their partner’s health and their relationship. In turn, their actions have consequences not only for targets’ health behavior but also for their relationship. We review theoretical and empirical research that provides initial support for the routes and offer testable predictions at the intersection of health behavior change research and relationship science.
... Some of these self-beliefs have been linked with transforming health beliefs into health behavior. For instance, when individuals receive threatening health information, interventions designed to remind them of their self-esteem and what they value (i.e., self-affirmation interventions) allow them to more easily accept the information and act on changing their health behavior (Epton et al., 2015). Similarly, an intervention that invoked positive affect and encouraged hypertensive individuals to self-affirm when they found it difficult to take their medication led to significantly greater medication adherence 12 months later, compared with a control intervention (Ogedegbe et al., 2012). ...
Article
Relationship partners affect one another’s health outcomes through their health behaviors, yet how this occurs is not well understood. To fill this gap, we present the Dyadic Health Influence Model (DHIM). The DHIM identifies three routes through which a person (the agent) can impact the health beliefs and behavior of their partner (the target). An agent may (a) model health behaviors and shape the shared environment, (b) enact behaviors that promote their relationship, and/or (c) employ strategies to intentionally influence the target’s health behavior. A central premise of the DHIM is that agents act based on their beliefs about their partner’s health and their relationship. In turn, their actions have consequences not only for targets’ health behavior but also for their relationship. We review theoretical and empirical research that provides initial support for the routes and offer testable predictions at the intersection of health behavior change research and relationship science.
... However, health messages that target behavior can result in negative responses if readers experience a threat to their selfidentity [1][2][3][4][5]. Specifically, defensive responding to online health messages may include less acceptance of the message, greater perceived threat, and less intent to change, which are all fundamental to health behavior change [6]. Therefore, finding ways to spread health messages in a manner that is well-received is vital. ...
Article
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Although physical activity interventions are efficacious for decreasing depressive symptomatology severity, there are several barriers to accessing treatment, supporting the need for intervention delivery in more accessible and cost-effective modes. However, individuals may respond defensively to health messages if perceiving them as threatening, and thereby fail to change behaviors. Although online, health-based interventions are effective in leading to behavior change, limited research has been conducted to identify ways in which people respond differently to online health messages. Therefore, the aim of this study was to investigate how individuals differ in their acceptance and interpretation of online health-related messages as threatening, as well as their desire to improve health behaviors based on their current depressive and physical activity levels. A total of 197 participants (MAGE = 36.17 years, SDAGE = 12.52 years) drawn from Amazon Mechanical Turk (MTurk) were asked to read a message regarding the importance of physical activity for health. Their defensiveness and behavior change intentionality were evaluated in relation to physical activity and depressive symptomatology. Individuals who engaged in less physical activity were more accepting of the health message, more likely to find the article threatening, agree that less exercise was related to negative health issues, and agree they should increase their physical activity. Individuals with higher self-ratings of depressive symptomatology were less accepting of the health message, found the article more threatening, and believed it to be less important to increase their physical activity levels. However, neither physical activity nor depression symptom severity were related to whether an individual would actually increase their physical activity. There was no statistically significant correlation between physical activity and depression. Explanations for these findings are provided.
... Self-affirmation can be understood as using self-esteem resources, which induces open-mindedness towards personally relevant information and supports an individual facing threatening information or coping with negative feedback (Demetriades & Walter, 2016;Dijkstra & van Asten, 2014). The usage of selfaffirmation was suggested promoting willingness to seek information and decrease information avoidance (Epton et al., 2015;Howell & Shepperd, 2012;Taber et al., 2015Taber et al., , 2016. Dispositional optimism is a personality trait describing an individual's degree of positive expectations about the future (Carver & Scheier, 2014). ...
Article
Background: Health challenges can cause feelings of uncertainty that individuals intend to reduce, increase, or maintain. Those goals are connected to different information seeking and avoidance behaviors, building four uncertainty preferences. Aims: We aim to understand what drives people to seek or avoid information through a more differentiated look at the underlying uncertainty preferences and their determinants. Our starting point to explain different uncertainty preferences are stable, individual traits determining individuals’ efficacy assessments. Method: We conducted a secondary analysis of an online survey among the German public in a sample with stratified demographic characteristics ( N = 3,000). The questionnaire measured different uncertainty preferences as well as coping efficacies and communication efficacy. Regression analyses determined the relevance of these predictors for the four uncertainty preferences. Results: The considered efficacy assessments explained a greater amount of variance in uncertainty preferences applying information seeking than information avoidance, but the influencing patterns are similar. Only health literacy as a communication efficacy was positively associated with both preferences applying information seeking and negatively associated with both preferences applying information avoidance. Limitations: The concept of uncertainty preferences should be critically assessed concerning its completeness. The low explanatory power of efficacy assessments for preferences underlying information avoidance strategies shows that further research is needed to identify relevant predictors. Conclusion: The findings suggest that efficacy assessments provide cognitive resources for goal-oriented uncertainty management, but a deeper understanding of specific underlying mechanisms of the different preferences requires further examination.
... This scale is higher in reliability compared with the study from which it was adapted (α = .63; Klein et al., 2015) and is consistent with how message acceptance was operationalized according to a meta-analysis (Epton et al., 2015), thus providing some evidence that these items assessed the intended construct. Message effectiveness (α = .76; ...
Article
Information about the health effects of alcohol consumption can be ambiguous (i.e., lacking in reliability, credibility, or adequacy) and thus may promote maladaptive health behavior. Guided by Construal Level Theory and a conceptual taxonomy of uncertainty in health care, we tested the hypothesis that manipulating construal level would promote adaptive responses to ambiguous health information. We examined the effects of ambiguous health information about alcohol on health cognitions, message responses, and intentions, as well as whether manipulating construal moderated these effects. Alcohol users (n = 135, Mage = 20.15, 68.9% female) were randomly assigned to either a high-level or low-level construal task and then to read either an ambiguous or unambiguous health communication about the health effects of alcohol. Participants responded similarly to ambiguous health information as they did to unambiguous health information and participants in a high-level construal did not generally report differences compared with those in a low-level construal. Findings suggest that ambiguous health information might not always lead to maladaptive effects. More research is needed to examine moderators of the relationship between ambiguous health information and health outcomes, as well as to understand how and when using construal manipulations are effective in different health contexts.
... Meta-analytic evidence has suggested that optimistically biased risk perceptions, defined as underestimated probabilistic assessments of certain events, are a critical determinant of risky health behaviour (e.g., Brewer et al., 2007;Epton et al., 2015). This kind of misperception has been found to be associated with the spread of contagious diseases at the community level (e.g., Abdulkareem et al., 2020;Ferrer & Klein, 2015;Williams et al., 2010). ...
Article
The present paper examines the extent to which conspiracy beliefs about the COVID-19 outbreak and distrust of epidemiological science are likely to predict optimistically biased risk perceptions at the individual and group levels. We explored the factor structure of coronavirus conspiracy beliefs and their associations with trust in science in predicting risk perceptions using survey data collected in Ukraine ( N = 390), Turkey ( N = 290), and Germany ( N = 408). We further expected conspiracy beliefs and distrust of science to predict people’s willingness to attend public gatherings versus maintaining preventive physical distancing through optimistically biased risk perceptions. Metric noninvariance for key constructs across the samples was observed so the samples were analysed separately. In Ukraine, a two-factor structure of conspiracy beliefs was found wherein COVID-19 bioweapon (but not COVID-19 profit) beliefs were negatively associated with public gathering through optimistically biased individual risk perceptions. In Turkey and Germany, conspiracy beliefs showed a single-factor solution that was negatively associated with preventive distancing and positively related to public gathering through optimistically biased public risk metaperceptions. The hypothesis about the direct and indirect effects of trust in science on risky health behaviour was partially confirmed in all three samples. The observed discrepancies in our findings are discussed.
... Valued living has shown to have a wide range of psychological benefits. For example, the meta-analysis conducted by Epton et al. (2015) found that affirming one's personal values increases acceptance of potentially threatening health information, promotes intentions to change, and fosters adaptive behavior. Valued living has also been associated with life satisfaction, increased vitality, and psychological wellbeing (e.g., Gloster et al., 2017;Serowik et al., 2018;Wilson et al., 2010). ...
Article
Objective: To examine the psychometric properties of the Spanish version of the Valuing Questionnaire (VQ) in Colombian clinical and nonclinical samples. Method: The VQ was administered to a total sample of 1820 participants, which included undergraduates (N = 762), general population (N = 724), and a clinical sample (N = 334). The questionnaire packages included measures of experiential avoidance, cognitive fusion, mindfulness, life satisfaction, and psychological difficulties. Results: Across the different samples, internal consistency was good (global Cronbach’s alpha of .83 for Progress and .82 for Obstruction). Measurement invariance was found across samples and gender, and the two-factor model obtained a good fit to the data. The latent means of Progress and Obstruction of the clinical sample were lower and higher, respectively, than the latent means of the nonclinical samples. Correlations with other variables were in the expected direction. Conclusion: The Spanish version of the VQ showed good psychometric properties.
Chapter
In diesem Kapitel beschreiben wir einige der gängigsten Theorien und Modelle, die im Kontext von Gesundheitsverhalten relevant sind. Diese Theorien und Modelle bilden die Grundlage für die Entwicklung und Evaluation von Maßnahmen zur Gesundheitsförderung. Die Evidenz zu Annahmen dieser Theorien und Modelle kann dann eine Entscheidungshilfe für die inhaltliche Ausgestaltung von Interventionen sein. Wir unterscheiden zwischen Theorien, die als zentrale Einflussgröße auf Verhalten die Motivation (auch Absicht, Intention oder Ziele genannt) annehmen, und Theorien, die Verhaltensänderung als eine Abfolge von unterschiedlichen Denkweisen („mindsets“) verstehen. Außerdem stellen wir einige aktuelle Ansätze vor, die Umwelt- und soziale Faktoren in die Erklärung von Gesundheitsverhalten einbinden, die die gesundheitliche Versorgung mitberücksichtigt sowie die miteinander interagierende Verhaltensweisen genauer modellieren.
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Self-integrity plays a vital role in the psychological wellbeing of older adults. The present study investigated whether or not the confrontation with negative, self-stereotyped information leads to a deterioration of older adults' self-integrity. Additionally, the current study attempted to examine the mediating effects of sense of coherence and empathy on the relationship between self-stereotype and self-integrity. A total of 825 Chinese older adults aged 55 or above from Xi'an and Beijing were recruited as research participants. A self-stereotype scale, sense of coherence scale, interpersonal reactivity index and self-integrity scale were used. Results showed that self-stereotypes are negatively associated with sense of coherence, empathy and self-integrity. Furthermore, sense of coherence and empathy are positively associated with self-integrity and played important roles in mediating the relationship between self-stereotype and self-integrity. Findings of this study can contribute to an improved understanding of the mechanism of associations between self-stereotype and self-integrity in older adults. Lastly, results obtained can provide guidance for effectively improving older adults' self-integrity to limit the negative effects of self-stereotypes.
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Purpose: Despite the established causal links to skin cancer, skin ageing and eye inflammation, people continue to use indoor tanning devices (hereafter 'sunbeds'). Understanding the reasons underlying the use of sunbeds is essential for developing effective interventions. The purpose of this study was to collate all existing evidence from qualitative papers published to date that had assessed motivations for using sunbeds. Methods: Six databases were searched from inception to February 2020 for qualitative studies that explored adults' experiences of using sunbeds. Sixteen studies met the inclusion criteria, and a narrative evidence synthesis was used to collate findings from each primary study. Results: Users of sunbeds were motivated primarily by aesthetic concerns but also by perceived psychological benefits (well-being, confidence and 'fitting in') and physical benefits (improvement in skin conditions such as acne, acquiring vitamin D and preventing sunburn). People also chose indoor tanning over alternatives such as fake tans because they considered the alternatives unacceptable and did not consider indoor tanning a serious health risk. To date, no studies have explored alternatives to meeting non-aesthetic needs related to the use of sunbeds. Conclusions: This comprehensive explanation for the practice of indoor tanning provides the basis for development of complex interventions to reduce the harm caused by using sunbeds. Effective interventions should include promotion of alternatives, such as different methods of relaxing, to satisfy underlying motivations, changing social norms and correcting misperceptions about health benefits.
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Doping is considered a major threat of modern sport. Since the establishment of the anti-doping system emphasis was placed on the detection and punishment approach in the fight against doping. Recently a shift to education as a preventive tool against doping has been made. In this effort several anti-doping educational interventions have been developed. These interventions have been found modestly effective in educating athletes against doping. To move education, forward a virtual reality game is proposed. Virtual reality has been found effective in changing attitudes, intention and behavior. Therefore, virtual reality can be suitable in addressing the appearance and performance related reasoning underlying the decision making towards the use of performance and appearance enhancing substances. The present paper describes the conceptual basis of VIRAL project that aims to develop the first virtual reality game for doping prevention in competitive and recreational sports. The VIRAL project will a) utilize cutting-edge behavioural science research about the risk and protective factors against doping use to inform the development of an anti-doping virtual reality program, b) use an “open innovation” framework to co-design the anti-doping virtual reality program and c) apply and evaluate the effectiveness of the doping prevention VR program in changing young people’s learning, motivation, beliefs and behaviour towards doping. Overall, the VIRAL project is expected to develop anti-doping educational material that will address the needs of young athletes and will be able to educate against doping through innovative learning pedagogies.
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Background: Informing patients about chemotherapy-related cognitive symptoms (CRCS) may increase perceived cognitive symptoms. This longitudinal randomized study evaluated this Adverse Information Effect (AIE) in breast cancer patients and examined whether self-affirmation (SA) can reduce AIEs (ClinicalTrials.gov identifier: NCT04813965). Patients and methods: Before (neo) adjuvant chemotherapy, 160 newly diagnosed breast cancer patients were randomly allocated to receive: standard information on side-effects (control), standard information with additional information about CRCS (information), or standard and additional information with a subsequent self-affirmative text (information+SA). Online-questionnaires assessed the perceived frequency (MOS-cog) and severity (MDASI-cog) of cognitive symptoms before chemotherapy (baseline, T0), and 2.5-months (T1) and 6.5-months (T2) post-chemotherapy. Higher scores indicate less frequent, and more severe symptoms, respectively. Baseline-to-follow-up analyses using a mixed-effects modeling approach compared groups over time. Results: At T0-T2, 148, 140 and 133 patients responded, respectively (attrition rates: 8%, 5%, 5%). Frequency (ES = -0.36, P =.003) and severity (ES = 0.54, P <.001) of symptoms worsened from baseline to T1, without differences between groups. At T2, symptom frequency remained stable for informed (ES=-0.3, P =.021) and self-affirmed (ES=-0.3, P =.019) patients, but returned to baseline levels for controls. At T2, symptom severity remained increased for informed patients (ES = 0.3, P =.006), but normalized for self-affirmed patients (ES = 0.2, P =.178) and controls. Conclusion: No AIEs occurred until T2. The initial overall increase in perceived cognitive symptoms recovered at T2 for controls, but not for patients who received additional information about CRCS. Self-affirmation attenuated these longer-term AIEs for the perceived severity but not the frequency of symptoms.
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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. This article is protected by copyright. All rights reserved.
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Background Oral anti-cancer treatments such as adjuvant endocrine therapies (AET) for breast cancer survivors are commonly used but adherence is a challenge. Few low-touch, scalable interventions exist to increase ET adherence. Purpose To evaluate the acceptability, feasibility, and initial efficacy of a low-touch, remotely-delivered values plus AET education intervention (REACH) to promote AET adherence. Methods A mixed-methods trial randomized 88 breast cancer survivors 1:1 to REACH or Education alone. Wisepill real-time electronic adherence monitoring tracked monthly AET adherence during a 1-month baseline through 6-month follow-up (FU) (primary outcome). Patient-reported outcomes were evaluated through 3- and 6-month FU (secondary). Multiple indices of intervention feasibility and acceptability were evaluated. Qualitative exit interviews (n = 38) further assessed participants’ perceptions of feasibility/acceptability and recommendations for intervention adaptation. Results The trial showed strong feasibility and acceptability, with an eligible-to-enrolled rate of 85%, 100% completion of the main intervention sessions, and “good” intervention satisfaction ratings on average. For Wisepill-assessed AET adherence, REACH outperformed Education for Month 1 of FU (p = .027) and not thereafter. Participants in REACH maintained high adherence until Month 4 of FU, whereas in Education, adherence declined significantly in Month 1. Conditions did not differ in self-reported adherence, positive affective attitudes, future intentions, or necessity beliefs. REACH trended toward less negative AET attitudes than Education at 3-month FU (p = .057) reflecting improvement in REACH (p = .004) but not Education (p = .809). Exploratory moderator analyses showed that average to highly positive baseline AET affective attitudes and oncologist-patient communication each predicted higher adherence following REACH than Education; low levels did not. Participants identified recommendations to strengthen the interventions. Conclusions REACH, a low-touch values intervention, showed good feasibility and acceptability, and initial promise in improving objectively-assessed AET adherence among breast cancer survivors (relative to education alone). Future research should target improving REACH’s tailoring and endurance.
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The notion of "engagement," which plays an important role in various domains of psychology, is gaining increased currency as a concept that is critical to the success of digital interventions. However, engagement remains an ill-defined construct, with different fields generating their own domain-specific definitions. Moreover, given that digital interactions in real-world settings are characterized by multiple demands and choice alternatives competing for an individual's effort and attention, they involve fast and often impulsive decision-making. Prior research seeking to uncover the mechanisms underlying engagement has nonetheless focused mainly on psychological factors and social influences and neglected to account for the role of neural mechanisms that shape individual choices. This article aims to integrate theories and empirical evidence across multiple domains to define engagement and discuss opportunities and challenges to promote effective engagement in digital interventions. We also propose the affect-integration-motivation and attention-context-translation (AIM-ACT) framework, which is based on a neurophysiological account of engagement, to shed new light on how in-the-moment engagement unfolds in response to a digital stimulus. Building on this framework, we provide recommendations for designing strategies to promote engagement in digital interventions and highlight directions for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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There remains an urgent need for effective communication about the importance of widespread adherence to behavioral recommendations to control the COVID-19 pandemic that will also reduce resistance to such guidance. We examined two strategies for COVID-19 communication- (1) self-affirmation (reflecting on a personal value in order to boost self-integrity and reduce defensiveness to potentially threatening information); and (2) manipulating self/other message framing - and moderation of these strategies by COVID-19 risk. 600 participants (Mage = 32.55, 51% female) were recruited for an online study and, after assessment of risk factors for severe COVID-19 infection, were exposed to the experimental manipulations. Three classes of defensive responses were considered as outcomes of interest: reactance, attitudinal responses, and behavioral responses. We found that participants derogated the self-focused message more than the other-focused message. Further, other-focused messaging and/or self-affirmation were more likely to elicit positive responses among individuals at higher risk for COVID-19 complications. Our findings suggest having individuals affirm values prior to viewing COVID-19 messages, and framing messages in terms of the importance of protecting others, may be beneficial strategies for encouraging responsiveness - particularly if the targets of such messages are at risk of COVID-19 complications themselves.
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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.
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Rationale Using indoor tanning devices is associated with substantial health consequences, such as an increased risk of melanoma and other skin cancers. Many people including minors and some at high risk of skin cancer continue to use these devices. In the absence of effective restrictions on use, it is important that behaviour change interventions are designed to reduce indoor tanning. Objective To explore reasons for use of indoor tanning devices and the acceptability of alternatives in adult users residing in North-West England. Methods Participants were required to be current indoor tanners aged 18 years and above and were recruited online. Twenty-one participants took part in either a focus group or semi-structured interview. An inductive thematic analysis was conducted. Results Six themes were identified: psychological benefits; improving physical health; denial of health risks; alternatives do not meet psychological needs; alternatives do not meet physical needs; and perceived side-effects. Participants used indoor tanning devices to improve their self-esteem and to prevent sun damage to their skin (by gaining a ‘base tan’). Participants appeared to justify their usage by responding defensively to avoid accepting they were at risk, exaggerating the benefits of indoor tanning, and discounting alternatives to indoor tanning. Alternatives to indoor tanning were perceived as risky for health, inadequate to provide the desired aesthetic, and incapable of meeting their self-esteem needs. Conclusions Interventions to reduce indoor tanning behaviour should increase sources of self-esteem other than appearance, increase media literacy and address defensive responses to information around indoor tanning and alternatives. Further research is needed to develop these interventions and assess their feasibility.
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Adolescence can be a tumultuous period with numerous threats to self‐integrity. A 3‐year field experiment tested whether repeated affirmations of self‐integrity can help lessen the impact of psychological threat on adolescent (11–14 years old) students’ core course GPA over time. A diverse cohort of students (N = 163) was randomly assigned to a control condition or to an affirmation condition, in which teachers repeatedly administered classroom writing exercises that affirmed students’ personal values. Results showed that affirmation lessened a downward trajectory of GPA over time. In contrast to previous research, this effect occurred among all ethnic groups rather than only among stereotype‐threatened ethnic minority groups. Affirmation did not reduce self‐reported psychological threat, but it severed its relationship with performance: Among control students, psychological threat predicted lower GPA. Among affirmed students, psychological threat was unrelated to performance. Beyond their practical implications, these results make two theoretical contributions. First, affirmation can have broader benefits than those previously documented among negatively stereotyped groups, if timed to co‐occur with different sources of threat that emerge over a long developmental window. Second, the effect of affirmation may not be so much to reduce threat as to disrupt its adverse cognitive and motivational effects.
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Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7]. In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA Completing a Systematic Review Is an Iterative Process The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985, 1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is found to be well supported by empirical evidence. Intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control; and these intentions, together with perceptions of behavioral control, account for considerable variance in actual behavior. Attitudes, subjective norms, and perceived behavioral control are shown to be related to appropriate sets of salient behavioral, normative, and control beliefs about the behavior, but the exact nature of these relations is still uncertain. Expectancy— value formulations are found to be only partly successful in dealing with these relations. Optimal rescaling of expectancy and value measures is offered as a means of dealing with measurement limitations. Finally, inclusion of past behavior in the prediction equation is shown to provide a means of testing the theory*s sufficiency, another issue that remains unresolved. The limited available evidence concerning this question shows that the theory is predicting behavior quite well in comparison to the ceiling imposed by behavioral reliability.
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Health-risk information can elicit negative emotions like anticipated regret that may positively affect health persuasion. The beneficial impact of such emotions is undermined when target audiences respond defensively to the threatening information. We tested whether self-affirming (reflecting on cherished attributes) before message exposure can be used as strategy to enhance the experience of anticipated regret. Women were self-affirmed or not before exposure to a message promoting fruit and vegetable consumption. Self-affirmation increased anticipated regret and intentions reported following message exposure and consumption in the week after the intervention; regret mediated the affirmation effect on intentions. Moreover, results suggest that anticipated regret and intentions are serial mediators linking self-affirmation and behavior. By demonstrating the mediating role of anticipated regret, we provide insights into how self-affirmation may promote healthy intentions and behavior following health message exposure. Self-affirmation techniques could thus potentially be used to increase the effectiveness of health communication efforts.
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Body dissatisfaction (BD)-a health concern in its own right-often is positioned early in the causal chain toward eating pathology, and is a practical point of intervention for those aiming to reduce its negative health consequences. One approach to reducing people's resistance to receipt of other unwanted health information (e.g. about smoking) has been through the application of self-affirmation theory. This theory asserts that the self needs to maintain its integrity and, as such, when incoming information is threatening, one's defensive shields are activated and it is deflected. One way to reduce defensiveness, however, is to bolster some other aspect of the self. We applied a one-shot, self-affirmation-based manipulation via a randomised controlled design (N = 86) to a group of body-dissatisfied college women and compared its effects to a control group. All hypotheses predicted by self-affirmation theory were supported: Women who were self-affirmed exhibited (a) greater openness to threatening information about the dangers of BD, (b) lower BD, and (c) greater intention to reduce criticism of their bodies. The present study provided an experimental test of a mechanism of action which might prove useful in a comprehensive intervention program. © 2012 The Authors. Applied Psychology: Health and Well-Being © 2012 The International Association of Applied Psychology.
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An experiment tested whether a positive experience (the endorsement and recall of one's past acts of kindness) would reduce biased processing of self-relevant health-risk information. Women college students (N = 66) who reported high or low levels of daily caffeine use were exposed to both risk-confirming and risk-disconfirming information about the link between caffeine consumption and fibrocystic breast disease (FBD). Participants were randomly assigned to complete an affirmation of their kindness via questionnaire or to a no-affirmation condition. Results indicated that the affirmation manipulation made frequent caffeine drinkers more open, less biased processors of risk-related information. Relative to frequent caffeine drinkers who did not affirm their kindness, frequent caffeine drinkers in the affirmation condition oriented more quickly to the risk-confirming information, rated the risk-confirming information as more convincing than the risk-disconfirming information, and recalled less risk-disconfirming information at a 1-week follow-up. They also reported greater perceived personal control over reducing their level of caffeine consumption. Although frequent caffeine drinkers in the affirmation condition initially reported lower intentions to reduce their caffeine consumption, there was no evidence that they were less likely to decrease their caffeine consumption at the follow-up. The possibility that positive beliefs and experiences function as self-regulatory resources among people confronting threats to health and well-being is discussed.
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This critical review assesses whether evaluation studies can answer three key questions about behaviour change interventions: 'Do they work? How well do they work? How do they work?' Reviews of intervention evaluations are examined, particularly those addressing decreasing unprotected sexual intercourse and smoking. Selection of outcome measures and calculation of effect sizes are discussed. The article also considers the extent to which evaluation reports specify (i) discrete intervention techniques and (ii) psychological mechanisms that account for observed behavioural change. It is concluded that intervention descriptions are often not specific about the techniques employed and that there is no clear correspondence between theoretical inspiration and adoption of particular change techniques. The review calls for experimental testing of specific theory-based techniques, separately and in combination.
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The present study tests whether a self-affirmation intervention (i.e., requiring an individual to focus on a valued aspect of their self-concept, such as honesty) can increase physical activity and change theory of planned behavior (TPB) variables linked to physical activity. Eighty young people completed a longitudinal intervention study. Baseline physical activity was assessed using the Godin Leisure-Time Physical Activity Questionnaire (LTPAQ). Next, participants were randomly allocated to either a self-affirmation or a nonaffirmation condition. Participants then read information about physical activity and health, and completed measures of TPB variables. One week later, participants again completed LTPAQ and TPB items. At follow up, self-affirmed participants reported significantly more physical activity, more positive attitudes toward physical activity, and higher intentions to be physically active compared with nonaffirmed participants. Neither attitudes nor intentions mediated the effects of self-affirmation on physical activity. Self-affirmation can increase levels of physical activity and TPB variables. Self-affirmation interventions have the potential to become relatively simple methods for increasing physical activity levels.
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Objectives Self-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. Methods Older 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 60min 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. Conclusions Whilst 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.
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The objective of this systematic review of studies using self-affirmation manipulations was to identify research gaps and provide information to guide future research. We describe study characteristics, categories of manipulations, and report effects on various dependent variables. Our search strategies yielded 47 eligible articles (69 studies). Manipulations varied by affirmation domain (values or personal characteristics), attainment (participant- or investigator-identified), and procedure (scale, essay, feedback, etc.). Most dependent variables were cognitive. Strong effects of self-affirmation were found for attitudes and persuasion/bias, but future work is needed for variables with mixed results including risk cognitions, intentions, and behavior. Suggestions and considerations for future research involving self-affirmation manipulations are discussed.
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Web-based tailored intervention programs show considerable promise in effecting health-promoting behaviors and improving health outcomes across a variety of medical conditions and patient populations. This meta-analysis compares the effects of tailored versus nontailored web-based interventions on health behaviors and explores the influence of key moderators on treatment outcomes. Forty experimental and quasi-experimental studies (N = 20,180) met criteria for inclusion and were analyzed using meta-analytic procedures. The findings indicated that web-based tailored interventions effected significantly greater improvement in health outcomes as compared with control conditions both at posttesting, d = .139 (95% CI = .111, .166, p <.001, k = 40) and at follow-up, d = .158 (95% CI = .124, .192, p < .001, k = 21). The authors found no evidence of publication bias. These results provided further support for the differential benefits of tailored web-based interventions over nontailored approaches. Analysis of participant/descriptive, intervention, and methodological moderators shed some light on factors that may be important to the success of tailored interventions. Implications of these findings and directions for future research are discussed.
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Objective: Health promotion often faces the problem that populations with high behavioral risk profiles respond defensively to health promotion messages by negating risk or reactant behavior. Self-affirmation theory proposes that defensive reactions are an attempt of the self-system to maintain integrity. In this article, we examine whether a self-affirmation manipulation can mitigate defensive responses to personalized visual risk feedback in the skin cancer prevention context (ultraviolet [UV] photography), and whether the effects pertain to individuals with high behavioral risk status (high personal relevance of tanning). Method: We conducted a full-factorial randomized controlled trial (N = 292; age 11-71) following a 2 * 2 design (UV photo yes/no, self-affirmation yes/no). Follow-up period was 2 weeks. Subsequent tanning behavior, sun avoidance intentions, and risk perception. Results: A multivariate analysis of variance (MANOVA) revealed a three-way interaction between risk feedback, the self-affirmation manipulation, and risk status for the three outcome measures. Follow-up analyses of variance (ANOVAs) indicated that high-risk individuals receiving only the risk feedback intervention reacted defensively and reported higher exposure. A self-affirmation manipulation mitigates this reactance effect both on the level of cognitions and behavior. Conclusion: Self-affirmation has influential implications not only for Social Psychology but also for health prevention measures. The findings support the effectiveness of self-affirmation in reducing reactant and defensive reactions to personalized visual risk feedback. Interactions with health risk status indicate that self-affirmation might increase the effectiveness of health promotion messages in high-risk populations.
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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.
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To the extent that stereotype and identity threat undermine academic performance, social psychological interventions that lessen threat could buffer threatened students and improve performance. Two studies, each featuring a longitudinal field experiment in a mixed-ethnicity middle school, examined whether a values affirmation writing exercise could attenuate the achievement gap between Latino American and European American students. In Study 1, students completed multiple self-affirmation (or control) activities as part of their regular class assignments. Latino American students, the identity threatened group, earned higher grades in the affirmation than control condition, whereas White students were unaffected. The effects persisted 3 years and, for many students, continued into high school by lifting their performance trajectory. Study 2 featured daily diaries to examine how the affirmation affected psychology under identity threat, with the expectation that it would shape students' narratives of their ongoing academic experience. By conferring a big-picture focus, affirmation was expected to broaden construals, prevent daily adversity from being experienced as identity threat, and insulate academic motivation from identity threat. Indeed, affirmed Latino American students not only earned higher grades than nonaffirmed Latino American students but also construed events at a more abstract than concrete level and were less likely to have their daily feelings of academic fit and motivation undermined by identity threat. Discussion centers on how social-psychological processes propagate themselves over time and how timely interventions targeting these processes can promote well-being and achievement. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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Often, health behavior seems to be governed not only by reasoned attitudes and goal-directed behavior but also by impulsive influences. The notion of a conflict between reflective and impulsive processing which is incorporated in prominent dual-system accounts (e.g., Metcalfe & Mischel, 1999; Strack & Deutsch, 2004) may yield important benefits for the understanding and prediction of health-related behavior. In this article, we suggest a basic framework for the prediction of health-related behavior which combines (a) reflective influences (as measured via self-report), (b) impulsive influences (as measured via implicit measures), and (c) situational or dispositional moderators that shift the weight between reflective and impulsive influences. The practical utility of such a framework is demonstrated by drawing on recent evidence from several areas of health psychology such as eating, drinking, drug abuse, and sexual behavior. Implications for the understanding of health behavior and applied health interventions are discussed. Impulsive versus reflective influences on health behavior: a theoretical framework and empirical review I have no self-control when it comes to eating snacks. I'll start off watching a movie with a bag of potato chips and think to myself, one bag should last the entire movie . . . I'll pace myself, and eat one chip at a time every three minutes and finish the bag with the closing credits. Everything starts off fine. I am the very model of patience and sophistication. But there's this point, maybe half-way through the bag, where an uncontrollable change comes over me. Suddenly, I'm like the Tasmanian Devil on crack. I can't get those chips into my mouth fast enough. I start breaking my own rules, eating them two or three at a time, inverting the bag, tearing it to pieces to get the final crumbs of salty goodness into me, licking my fingers, and feeling like a winner after discovering lost reservoirs of chip crumbs in the folds of my shirt. Then the previews end, and I'm left without anything to eat during the movie. As captured nicely in this short passage from the internet article ''potato chips'' by Daniel Isaac (2008), people time and again experience that sticking to a preconceived plan may fail in the heat of temptation: Some end up eating or drinking more than they admit is good for them, some consume toxic substances, and some embark on sexual adventures with unknown risks. Pleasurable as they are for the moment, such behaviors often lead to negative health outcomes in the long run, ranging from regret the next day to premature
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Objectives: Health behavior theories focus on the role of conscious, reflective factors (e.g., behavioral intentions, risk perceptions) in predicting and changing behavior. Dual-process models, on the other hand, propose that health actions are guided not only by a conscious, reflective, rule-based system but also by a nonconscious, impulsive, associative system. This article argues that research on health decisions, actions, and outcomes will be enriched by greater consideration of nonconscious processes. Methods: A narrative review is presented that delineates research on implicit cognition, implicit affect, and implicit motivation. In each case, we describe the key ideas, how they have been taken up in health psychology, and the possibilities for behavior change interventions, before outlining directions that might profitably be taken in future research. Results: Correlational research on implicit cognitive and affective processes (attentional bias and implicit attitudes) has recently been supplemented by intervention studies using implementation intentions and practice-based training that show promising effects. Studies of implicit motivation (health goal priming) have also observed encouraging findings. There is considerable scope for further investigations of implicit affect control, unconscious thought, and the automatization of striving for health goals. Conclusion: Research on nonconscious processes holds significant potential that can and should be developed by health psychologists. Consideration of impulsive as well as reflective processes will engender new targets for intervention and should ultimately enhance the effectiveness of behavior change efforts.
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Objective: The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g. food-frequency questionnaire versus weighed record). Methods: A comprehensive search of electronic databases was carried out for publications from 1980 to 1999. Findings from the review were then commented upon and added to by a group of international experts. Results: Recommendations have been developed to aid in the design, validation and use of FFQs. Specific details of each of these areas are discussed in the text. Conclusions: FFQs are being used in a variety of ways and different study designs. There is no gold standard for directly assessing the validity of FFQs. Nevertheless, the outcome of this review should help those wishing to develop or adapt an FFQ to validate it for its intended use.
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Substantial numbers of clinical trials continue to be reported only in summary reports that present insufficient methodological details to permit informed judgments about the likely validity of the conclusions. Using a cohort of 176 controlled trials reported in summary form, we tested the hypotheses that they would be more likely to be followed by full reports if, on the basis of the information provided in the summary report, (1) the trial was judged to be methodologically sound, (2) the results favored the test treatment, and (3) the sample size was relatively large. The results of univariate and multivariate analyses provided support for only the third of these hypotheses. Investigators, as well as those who fund and sanction the conduct of clinical research, should make greater efforts to ensure that clinical trials are reported properly. (JAMA. 1990;263:1401-1405)
Article
Objective: 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. Methods: 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. Results: 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. Conclusions: 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.
Article
There is limited evidence that self-affirmation manipulations can promote health behavior change. The purpose of this study was to explore whether the efficacy of a self-affirmation manipulation at promoting exercise could be enhanced by an implementation intention intervention. Participants (Study 1 N = 120, Study 2 N = 116) were allocated to one of four conditions resulting from the two (self-affirmation manipulation: no affirmation, affirmation) by two (implementation intention manipulation: no implementation intention, implementation intention) experimental design. Exercise behavior was assessed 1 week post-intervention. Contrary to prediction, those participants receiving both manipulations were significantly less likely to increase the amount they exercised compared to those receiving only the self-affirmation manipulation. Incorporating an implementation intention manipulation alongside a self-affirmation manipulation had a detrimental effect on exercise behavior; participants receiving both manipulations exercised significantly less in the week following the intervention.
Article
We demonstrate the differential effects of framing health hazards as occurring every day versus every year, two reference periods that objectively refer to the present but subjectively seem different. Through three studies, we show that every day framing makes risks appear more proximal and concrete than every year framing, resulting in increased self-risk perceptions, intentions to exercise precau- tionary behavior, concern and anxiety about the hazard, and effectiveness of risk communication. Across different health domains, we show that, while temporal frames moderate self-positivity biases (study 1), difficulty of preventive behaviors (study 2) and outcome valence (study 3) moderate temporal framing effects. Four hundred and forty thousand Americans succumb each year to the deadly effects of tobacco smoke. (Brody 2001)
Article
Why do people resist evidence that challenges the validity of long–held beliefs? And why do they persist in maladaptive behavior even when persuasive information or personal experience recommends change? We argue that such defensive tendencies are driven, in large part, by a fundamental motivation to protect the perceived worth and integrity of the self. Studies of social–political debate, health–risk assessment, and responses to team victory or defeat have shown that people respond to information in a less defensive and more open–minded manner when their self–worth is buttressed by an affirmation of an alternative source of identity. Self–affirmed individuals are more likely to accept information that they would otherwise view as threatening, and subsequently to change their beliefs and even their behavior in a desirable fashion. Defensive biases have an adaptive function for maintaining self–worth, but maladaptive consequences for promoting change and reducing social conflict.
Article
We examined effects of self-affirmation on feelings of vulnerability and behavioral intentions following exposure to personally threatening messages varying in message strength. In Experiment 1, female alcohol consumers read a strong message linking alcohol to breast cancer risk. Self-affirmed participants exhibited higher feelings of vulnerability concerning consumption levels and personal risk. In Experiment 2, female caffeine consumers read a weak or strong message linking caffeine to breast disease. Self-affirmed participants reported greater feelings of vulnerability to breast disease and greater intentions to reduce caffeine consumption (relative to control participants) only when reading the strong message. Effects on intentions were mediated by effects on feelings of vulnerability. These studies show that feelings of vulnerability can mediate effects of self-affirmation on intentions to change behavior under threat, although only in the presence of strong messages.