Developing and Testing a Self-affirmation Manipulation

Testing a brief, self-guided values affirmation for behavioral activation intervention during COVID-19

This pilot study tested a single-session digital values affirmation for behavioral activation (VABA) intervention. Hypotheses predicted the VABA intervention would be more effective than an active control condition in improving mood, decreasing COVID-19 fear/worry and depressive symptoms, and promoting positively reinforcing behaviors during early weeks of the COVID-19 pandemic. Participants were a diverse sample of undergraduate students (N = 296) under a state-wide lockdown. Students were randomized to either VABA, a 10-min values clarification and affirmation task, or Control, a time- and attention-matched task. Positive and negative affects were assessed pre- and post-intervention. At next-day follow-up, positive and negative affects were reassessed, as well as past 24-h behavioral activation and depressive symptoms. Within-group increases in positive affect were observed in both conditions (VABA d = 0.39; Control d = 0.19). However, VABA produced a significantly larger increase than Control (F[2] = 3.856, p = .022, d = 0.22). At 24-h follow-up, behavioral activation, which was significantly higher in VABA versus Control (t[294] = -5.584, p < .001, d = 0.65), predicted fewer depressive symptoms (R2 change = .019, β = -.134, p = .003). VABA is an ultra-brief intervention that appears to have acute effects on mood-enhancement and behavioral activation.

Effects of a self-affirmation intervention on responses to bowel cancer screening information

OBJECTIVE

To investigate the effect of two brief self-affirmation interventions, immediately prior to reading standard information about bowel cancer screening, on state anxiety, message acceptance and behavioural intention to screen for bowel cancer.

METHODS

242 adults aged 49 were randomised to one of two self-affirmation interventions (health or values) or one of two control conditions, before reading an NHS England bowel cancer screening leaflet. Participant friend and family history of bowel cancer, state anxiety, message acceptance, behavioural intention to screen, trait self-esteem and spontaneous self-affirmation were measured. Data were analysed using between-participants analysis of variance, planned contrasts and moderated regression.

RESULTS

No main effects of experimental condition on levels of state anxiety, message acceptance and behavioural intention were found. However, planned contrasts showed participants who self-affirmed about their health or values (conditions-collapsed) were significantly less anxious and reported significantly higher behavioural intentions compared to participants in the controls (conditions-collapsed). Irrespective of condition, higher levels of spontaneous self-affirmation and trait self-esteem were correlated with lower anxiety, higher intentions, and message acceptance.

CONCLUSION

There was some evidence of the effect of health-based self-affirmation on lowering anxiety; however, further research is needed to explore the effectiveness of different self-affirmation interventions in larger samples.

Comparing self-affirmation manipulations to reduce alcohol consumption in university students

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.

Randomised Controlled Trial of Self-Affirmation Intervention on Students' Academic Performance: Promising Impacts on Students from Migrant Hukou Status

Purpose

Drawing from the sociocultural-self model, this study aims to examine the influence of self-affirmation on the academic outcomes of lower-class migrant students, as well as the psychological mechanism underlying this phenomenon.

Patients and Methods

A field experiment was conducted at a comprehensive secondary school in the southern region of China. Our study sample comprised 1534 immigrant students from diverse regions across the country, with an average proportion of 59.6% of students registered with a rural hukou. The hukou system plays a pivotal role in measuring social class in China, thus it was used as a proxy for lower and higher social class, with rural hukou students considered to be lower-class and urban hukou students considered to be higher-class. Prior to the English test, students in the self-affirmed group were engaged in a brief writing exercise that focused on their core values, whereas the control group wrote about a neutral topic.

Results

The primary outcome of interest was the effect of self-affirmation on English test scores, whereas the secondary outcome was the students' survey stereotype threat. The results exhibit that self-affirmation more significantly improved the English test performance of lower-class students compared to higher-class students, and this positive effect was mediated by reducing stereotype threat.

Conclusion

Our findings unravel the impact of self-affirmation on the academic performance of migrant students from different social classes and signify the mediating role of stereotype threat in this process. The present study extends previous findings to students from immigrant families in the Chinese cultural context, and these findings demonstrate that self-affirmation can constitute a promising intervention for stereotype threat and achievement gaps due to social class differences in immigrant family groups. Considering that this intervention takes only about 15 minutes of time, entails almost zero cost, does no harm, and that it focuses on disadvantaged immigrant students, it may provide valuable insights for educational policies to be implemented in a new type of migrant city such as Shenzhen.

Brief self-affirmation intervention for adults with psoriasis for reducing anxiety and depression and boosting well-being: Evidence from a randomized controlled trial

BACKGROUND

There are relatively few studies to address mental health implications of self-affirming, especially across groups experiencing a chronic health condition. In this study, short- and longer-term effects of a brief self-affirmation intervention framed in terms of implementation intentions (if-then plans with self-affirming cognitions; S-AII) were evaluated against an active control group (non-affirming implementation intentions; N-AII), matched to the target condition, and mere goal intention condition (a non-active control) in adults with psoriasis. The three pre-registered primary outcomes captured depression, anxiety, and well-being.

METHODS

Adults with psoriasis (N = 175; M_age = 36.53, s.d. = 11.52) were randomized into S-AII, N-AII, or control. Participants' mental health outcomes were assessed prior to randomization (at baseline), at week 2 (post-intervention), and at a 1-month follow-up.

RESULTS

Linear mixed models were used and results were reported on the intention-to-treat principle. Analyses revealed that S-AII exerted significantly more improvement in the course of well-being (ds > 0.25), depressive symptoms (ds > -0.40), and anxiety (ds > -0.45) than the N-AII and control group at 2-week post-intervention. Though the differences between groups faded at 1-month follow-up, the within-group changes over time for S-AII in all mental health outcomes remained significant.

CONCLUSIONS

Brief and low-intensity S-AII intervention exerted in the short-term a considerable impact on mental health outcomes. The S-AII shows promising results as a relevant public mental health strategy for enhancing well-being and reducing psychological distress. Future studies could consider whether these effects can be further enhanced with booster interventions.

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

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

Enhancing well-being and alleviating depressive symptoms in people with HIV/AIDS: An intervention based on if-then plans with self-affirming cognitions

Effective antiretroviral treatment has increased the life expectancy of people living with HIV, and currently, the challenges of prominent importance appear to be mental health issues. This preregistered study among adults living with HIV/AIDS investigated the effectiveness of a brief self‐affirmation intervention framed in terms of if–then plans (i.e. self‐affirming implementation intentions [S‐AII]) against both active and non‐active control conditions, forming non‐affirming implementation intentions and mere goal intentions, respectively. The primary outcomes were defined as a reduction of depressive symptoms and enhancement of well‐being, along with secondary outcomes as positive other‐ and self‐directed feelings. A total of 162 individuals were assessed for eligibility, and 130 (aged 18–74 years) were randomized to the study conditions. Intervention effects were estimated through intention‐to‐treat analysis, using linear mixed models. The S‐AII intervention yielded improvements in overall well‐being over 2 weeks (d = .23), primarily driven by positive changes in emotional (d = .24) and social (d = .30) dimensions of well‐being. There were no significant differences in depression or secondary outcomes. Based on a minimal clinically important difference index, the S‐AII intervention resulted in improvement in well‐being in approximately 40 percent of participants. Nevertheless, further systematic research is needed to optimize self‐affirmation‐interventions, before their application in real‐life contexts.

Evidence of Delayed, Recursive Benefits of Self-Affirmation on Anxiety in Socially Anxious University Students

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.

Relationship Analysis among Apparel Brand Image, Self-Congruity, and Consumers’ Purchase Intention

Brand image has been a crucial clue to making subjective judgment for consumers to determine the brand, which is critical to making a purchase decision. The influence mechanism from apparel brand images on consumers’ purchase intention was explored for theoretical and positive analysis based on the self-congruity theory. This research first constructed a hypothetical model of apparel brand images influencing consumers’ purchase intention with self-congruity and perceived quality as mediators, in which a questionnaire was designed and conducted to test the theoretical model. The research shows that apparel brand image and perceived quality can significantly influence consumers’ purchase intention. The consumer purchase intention is directly related to clothing brand image provided self-consistency and perceived quality play an intermediary with the regulatory effect of self-motivation and brand familiarity. A positive attitude toward apparel brand image will stimulate consumers to build cognitive clues and associations between the consumers and the brand and strengthen cognitive consistency with the apparel brand’s spirit. The research results are beneficial to textile fashion and clothing enterprises to improve brand building and marketing.

Reasons for indoor tanning use and the acceptability of alternatives: A qualitative study

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.

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

OBJECTIVE

Self-affirmation reduces defensiveness toward threatening health messages. In this study, we compared several possible self-affirmation inductions in order to identify the most effective strategy.

DESIGN

Women at increased risk for breast cancer (i.e. who drink 7+ drinks per week) were recruited through Amazon Mechanical Turk (N = 1,056), randomly assigned to one of 11 self-affirmation conditions, and presented with an article about the link between alcohol intake and breast cancer risk.

MAIN OUTCOME MEASURES

Participants answered questions that measured key indices of message acceptance (risk perception, message endorsement), future alcohol consumption intentions, and action plans to reduce alcohol intake.

RESULTS

Participants who affirmed health vs. non-health values did not differ in behavioral intentions or action plans to reduce alcohol intake. General values vs. health essay affirmations led to higher odds of reporting some vs. no action plans to reduce alcohol consumption. Essay- vs. questionnaire-based inductions led to higher breast cancer worry and intentions to reduce alcohol consumption.

CONCLUSION

Overall, self-affirmation inductions that include an explicit focus on values (general or health-related) and self-generation of affirming thoughts through essay writing, are most potent in changing behavioral intentions and action plans to change future health behavior.

Self-affirmation and responses to cigarette warning labels: The moderating role of message strength

The present research investigated whether message strength moderates the effect of self-affirmation on reactions given to cigarette warning labels. Three hundred eighty-four female (Study 1) and 383 male (Study 2) smokers completed a self-affirmation manipulation and then evaluated either strong or weak warning labels in terms of message derogation. Next, they reported their intentions to quit smoking. Only for the male sample, message strength moderated the effect of self-affirmation on message derogation. However, message strength did not have a moderating role on both message derogation and quit intentions for the female sample and on quit intentions for the male sample.

Understanding self-affirmation effects: The moderating role of self-esteem

OBJECTIVES

Whether people benefit from self-affirmation in overcoming resistance to health messages may depend on their level of self-esteem. However, extant theories offer rival hypotheses about the role of self-esteem. We pitted these hypotheses against each other, building on the argument that how self-esteem shapes self-affirmation effects may depend on how and when people self-affirm.

DESIGN

A 3 (Self-affirmation type: value essay, attribute scale, control task) by 2 (Timing: pre-message, post-message) plus 1 (message-only) experimental, between-subjects design.

METHODS

Participants (N = 422) completed a value essay, an attribute scale, a control task, or no task, either before or after reading a message about health risks of excessive drinking. Participants then completed defensiveness and message acceptance measures.

RESULTS

Self-esteem moderated self-affirmation effects across different types and timing of self-affirmation. While participants with relatively high self-esteem consistently benefited from self-affirmation, participants with relatively low self-esteem experienced adverse effects from self-affirmation. Self-affirmed participants with high self-esteem showed lower psychological discomfort, lower personal risk discounting, and higher message acceptance than unaffirmed participants, while self-affirmed participants with low self-esteem showed higher psychological discomfort, higher personal risk discounting, and lower message acceptance than unaffirmed participants.

CONCLUSIONS

These findings support the proposition that self-esteem serves as affirmational resources, which implies that self-affirmation interventions to reduce defensiveness to health messages may be beneficial for people with high self-esteem but less so for people with lower self-esteem. Similar to much other self-esteem research, self-esteem was negatively skewed, which warrants caution in generalization of the findings across all levels of self-esteem.

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

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

Examining strategies for addressing high levels of 'I don't know' responding to risk perception questions for colorectal cancer and diabetes: an experimental investigation

OBJECTIVE

Many people say they 'don't know' their risk for common diseases (DK responders). Inadequate health literacy and higher disease information avoidance may suppress risk knowledge and thereby increase DK responding. Study goals were to examine two plausible interventions to address the health education needs of DK responders. Design: Participants were identified in a pre-screener as DK responders for either diabetes or colorectal cancer (CRC) risk perception questions (N = 1276; 35% non-white; 49% inadequate health literacy). They were randomly assigned to read either standard or low literacy risk information about diabetes or CRC, and to undergo a self-affirmation intervention or not. Main outcome measure: DK responding following reading the risk information. Results: Neither intervention reduced DK responding. Multivariable analyses showed that health literacy, information avoidance and believing the disease is unpredictable - but not risk factor knowledge and need for cognition - best predicted participants' conversion from a DK response to a non-DK scale point response. Conclusion: Results confirm that both inadequate health literacy and higher information avoidance are associated with DK responding. DK responders are also disproportionately underserved and less adherent to health behaviors. Because galvanising risk perceptions are central to public health, addressing their information needs is a priority.

From a terror management perspective: The efficacy of self-affirmation on organ donation-related thoughts and intentions in China

In 2015, the Chinese government officially abolished the practice of harvesting organs from executed prisoners. However, the voluntary donor registration rate among the Chinese population is approximately 2% as of January 2020. Guided by self-affirmation theory and terror management theory, the present investigation examined a number of variables that may be related to donor registration intentions and a method to mitigate death thoughts and misconceptions. An online experiment was conducted in which 352 Chinese participants were randomly assigned to either a self-affirmation (i.e., affirming values that are important to the participants) or a no-affirmation condition. Results revealed that self-affirmation lowered death thoughts among the participants, which in turn were positively related to organ donation misperceptions. Inconsistent with terror management theory, the level of death thoughts was not directly related to participants' intentions to register as organ donors. Instead, the relationship between the two was mediated by misperceptions toward organ donation.

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

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

Effect of Psychological Distance on Intention in Self-Affirmation Theory

In previous studies, self-affirmation has been shown to have no effect or have a negative impact on intention to change. We applied construal level theory to examine possible reasons for inconsistencies among findings in existing self-affirmation studies. In Study 1, when female college students in their 20s (N = 113) received health threat information with a psychologically proximal breast cancer message, it induced low-level construal and increased specific physical activity intention. In Study 2, when self-affirmed participants were exposed to health threat information with a psychologically distal Alzheimer's disease message, there was no increase in specific physical activity intention. These results suggest that when a discrepancy exists between the psychological distance of health threat information and the intention reflecting the construal level, no change of intention occurs, even in self-affirmed individuals.

Increasing Receptivity to Messages about E-Cigarette Risk Using Vicarious-Affirmation

Empirical research has found that self-affirmation that precedes exposure to threatening information can reduce resistance and exert a positive effect on attitudes and beliefs. However, the effortful methods currently used to induce self-affirmation (e.g., writing an essay about an important value) limit its applicability. Informed by narrative persuasion literature, we present an experimental study designed to assess the potential of vicarious-affirmation (i.e., affirmation through a relevant exemplar in a fictional story) to influence perceived risk and behavioral intent among college-age electronic cigarette users (N = 832). Similar to traditional self-affirmation, a story that affirmed its character (by winning an award) before introducing tobacco-related risk information, led to greater perceived risk and increased intentions to stop using electronic-cigarettes. Identification with the character led to more positive self-appraisal, which, in turn, reduced message derogation and enhanced perceived risk. We conclude by discussing the theoretical and applied implications of integrating narrative persuasion with self-affirmation theory.

Providing Freshmen with a Good “Starting-Block”

Abstract. Grounded in social-psychological literature, this experimental study assessed the effects of two so-called “wise” interventions implemented in a student study program. The interventions took place during the very first week at university, a presumed pivotal phase of transition. A group of 375 freshmen in psychology were randomly assigned to three conditions: control, social belonging, and self-affirmation. Following the intervention, students in the social-belonging condition expressed less social apprehension, a higher social integration, and a stronger intention to persist one month later than the other participants. They also relied more on peers as a source of support when confronted with a study task. Students in the self-affirmation condition felt more self-affirmed at the end of the intervention but didn’t benefit from other lasting effects. The results suggest that some well-timed and well-targeted “wise” interventions could provide lasting positive consequences for student adjustment. The respective merits of social-belonging and self-affirmation interventions are also discussed.

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

OBJECTIVE

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Leveraging Self-Affirmation to Improve Behavior Change: A Mobile Health App Experiment

Background

mHealth interventions can help to improve the physical well-being of participants. Unfortunately, mHealth interventions often have low adherence and high attrition. One possible way to increase adherence is instructing participants to complete self-affirmation exercises. Self-affirmation exercises have been effective in increasing many types of positive behaviors. However, self-affirmation exercises often involve extensive essay writing, a task that is not easy to complete on mobile platforms.

Objective

This study aimed to adapt a self-affirmation exercise to a form better suited for delivery through a mobile app targeting healthy eating behaviors, and to test the effect of differing self-affirmation doses on adherence to behavior change goals over time.

Methods

We examined how varied self-affirmation doses affected behavior change in an mHealth app targeting healthy eating that participants used for 28 days. We divided participants into the 4 total conditions using a 2×2 factorial design. The first independent variable was whether the participant received an initial self-affirmation exercise. The second independent variable was whether the participant received ongoing booster self-affirmations throughout the 28-day study. To examine possible mechanisms through which self-affirmation may cause positive behavior change, we analyzed three aspects of self-affirmation effects in our research. First, we analyzed how adherence was affected by self-affirmation exercises. Second, we analyzed whether self-affirmation exercises reduced attrition rates from the app. Third, we examined a model for self-affirmation behavior change.

Results

Analysis of 3556 observations from 127 participants indicated that higher doses of self-affirmation resulted in improved adherence to mHealth intervention goals (coefficient 1.42, SE 0.71, P=.04). This increased adherence did not seem to translate to a decrease in participant attrition (P value range .61-.96), although our definition of attrition was conservative. Finally, we examined the mechanisms by which self-affirmation may have affected intentions of behavior change; we built a model of intention (R²=.39, P<.001), but self-affirmation did not directly affect final intentions (P value range .09-.93).

Conclusions

Self-affirmations can successfully increase adherence to recommended diet and health goals in the context of an mHealth app. However, this increase in adherence does not seem to reduce overall attrition. The self-affirmation exercises we developed were simple to implement and had a low cost for both users and developers. While this study focused on an mHealth app for healthy eating, we recommend that other mHealth apps integrate similar self-affirmation exercises to examine effectiveness in other behaviors and contexts.

Effects of Social Norms Information and Self-Affirmation on Sugar-Sweetened Beverage Consumption Intentions and Behaviors

The separate and combined efficacy of a social norms and a self-affirmation intervention to motivate decreased sugar-sweetened beverage (SSB) consumption was examined in two experiments. College students were randomly assigned to receive information about SSB consumption risks, norms, both, or neither. In addition, participants performed either a self-affirmation or control task. Self-affirmation only weakly affected SSB consumption intentions and behaviors. However, participants in Experiment 2 who received risks information, norms information, or both reported greater SSB reduction intentions than did those who received no information. Two-weeks later, those who received both types of information reported more frequent behavior change preparations, and it appears this effect may have been partially mediated by the changes in intentions to reduce SSB consumption.

Using Self-affirmation to Increase the Effects of Emotive Health Warnings on Smoking: A Randomized Exploratory Trial

Introduction

Emotive health messages are widely used tools in tobacco control. However, under some circumstances, they can be less effective than desired by eliciting defensive responses in smokers.

Aims

This study tests whether enhancing a currently used emotive graphic smoking health warning with a self-affirmation component reduces cigarette consumption and whether potential effects are stronger in heavier smokers, as suggested by previous research.

Methods

Participants (n = 265) were randomly allocated to a self-affirmation (reflecting on personal values and positive traits using a questionnaire) or matched control condition before viewing an emotive graphic health message from a current Australian government public health campaign. The primary outcome (cigarettes per day [CPD]) was assessed both before and a week following the intervention.

Results

No main effect of self-affirmation on smoking, but as hypothesized, a significant interaction between baseline smoking and self-affirmation was found that showed that heavier smokers (>21 CPD) who self-affirmed significantly reduced CPD compared to nonaffirmed smokers.

Conclusions

These findings support the use of self-affirmation to enhance smoking awareness campaigns in heavier smokers.

Implications

This study shows that enhancing emotive graphic smoking health messages with self-affirmation (the act of reflecting on positive aspects of oneself) increases their effectiveness in heavier smokers. This suggests that self-affirmation might be a particularly useful tool for health promotion targeting heavier smokers. This study adds to previous research in that it is the first to test the add-on effects of self-affirmation to current graphic health messages on smoking rather than smoking-related cognitions.

A randomized controlled trial of a brief online intervention to reduce alcohol consumption in new university students: Combining self-affirmation, theory of planned behaviour messages, and implementation intentions

OBJECTIVES

Excessive alcohol consumption increases when students enter university. This study tests whether combining (1) messages that target key beliefs from the theory of planned behaviour (TPB) that underlie binge drinking, (2) a self-affirmation manipulation to reduce defensive processing, and (3) implementation intentions (if-then plans to avoid binge drinking) reduces alcohol consumption in the first 6 months at university.

DESIGN

A 2 (self-affirmation) × 2 (TPB messages) × 2 (implementation intention) between-participants randomized controlled trial with 6-month follow-up.

METHODS

Before starting university, students (N = 2,951) completed measures of alcohol consumption and were randomly assigned to condition in a full-factorial design. TPB cognitions about binge drinking were assessed immediately post-intervention (n = 2,682). Alcohol consumption was assessed after 1 week (n = 1,885), 1 month (n = 1,389), and 6 months (n = 892) at university. TPB cognitions were assessed again at 1 and 6 months.

RESULTS

Participants who received the TPB messages had significantly less favourable cognitions about binge drinking (except perceived control), consumed fewer units of alcohol, engaged in binge drinking less frequently, and had less harmful patterns of alcohol consumption during their first 6 months at university. The other main effects were non-significant.

CONCLUSIONS

The findings support the use of TPB-based interventions to reduce students' alcohol consumption, but question the use of self-affirmation and implementation intentions before starting university when the messages may not represent a threat to self-identity and when students may have limited knowledge and experience of the pressures to drink alcohol at university. Statement of contribution What is already known on this subject? Alcohol consumption increases when young people enter university. Significant life transitions represent potential teachable moments to change behaviour. Interventions with a strong theoretical basis have been found to be more effective. What does this study add? A brief online intervention delivered to students before they start university can reduce alcohol consumption. The theory of planned behaviour can be used to inform the design of interventions to change health behaviour.

Integrating Self-Affirmation with Health Risk Messages: Effects on Message Evaluation and Response

This study tested a new method of using self-affirmation theory to increase adaptive responses to health risk messages. Participants' self-concepts were affirmed via text integrated with risk messages (public service announcements/PSAs) rather than by methods used in most previous studies that have limited applicability for campaigns employing mediated messages. Participants were exposed to health risk PSAs either including or not including affirming text to examine relative effects on message evaluation and adaptive responses. The moderating effect of personal relevance of the behavior on responses was also examined. Participants exposed to PSAs with integrated, affirming text (affirmed participants) reported more positive attitudes toward the PSA, greater self-efficacy, and greater intention to reduce risky behavior than participants exposed to messages without affirming text (non-affirmed participants). Compared to non-affirmed participants, affirmed participants also reported weaker perceptions of risk severity and equivalent perceptions of susceptibility. The personal relevance of the behavior did not moderate any effects of self-affirmation. Implications for health campaigns that employ mass-mediated messages are discussed.

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

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

A Pilot Test of Self-Affirmations to Promote Smoking Cessation in a National Smoking Cessation Text Messaging Program

Background

Although effective smoking cessation treatments, including mHealth interventions, have been empirically validated and are widely available, smoking relapse is likely. Self-affirmation, a process through which individuals focus on their strengths and behaviors, has been shown to reduce negative effects of self-threats and to promote engagement in healthier behavior.

Objective

To assess the feasibility of incorporating self-affirmations into an existing text messaging-based smoking cessation program (Smokefree TXT) and to determine whether self-affirmation led to greater engagement and higher cessation rates than the standard intervention.

Methods

Data were collected from smokers (n=1261) who subscribed to a free smoking cessation program and met eligibility criteria. The intervention lasted 42 days. The original design was a 2 (Baseline affirmation: 5-item questionnaire present vs absent) × 2 (Integrated affirmation: texts present vs absent) factorial design. Only 17 eligible users completed all baseline affirmation questions and these conditions did not influence any outcomes, so we collapsed across baseline affirmation conditions in analysis. In the integrated affirmation conditions, affirmations replaced approximately 20% of texts delivering motivational content.

Results

In all, 687 users remained enrolled throughout the 42-day intervention and 81 reported smoking status at day 42. Among initiators (n=1261), self-affirmation did not significantly improve (1) intervention completion, (2) days enrolled, (3) 1-week smoking status, or (4) 6-week smoking status (all Ps>.10); and among the 687 completers, there were no significant effects of affirmation on cessation (Ps>.25). However, among the 81 responders, those who received affirmations were more likely to report cessation at 6 weeks (97.5%; 39 of 40) than those not given affirmations (78.1%; 32 of 41; χ²(1)=7.08, P=.008).

Conclusion

This proof-of-concept study provides preliminary evidence that self-affirmation can be integrated into existing text-based cessation programs, as the affirmations did not lead to any adverse effects (ie, less engagement or lower rates of cessation). Among those who reported smoking status at the end of the intervention period (6.4% of eligible respondents), affirmations facilitated cessation. This study provides a “proof-of-concept” that brief, low-touch interventions may be integrated into a text messaging program with potential benefits, minimal disruption to the program or users, and little cost. Many questions remain regarding how self-affirmation and similar approaches can promote engagement in population interventions.

Expelling Stress for Primary School Teachers: Self-Affirmation Increases Positive Emotions in Teaching and Emotion Reappraisal

The aim of the present pilot study was to assess the effect of a brief work-related self-affirming implementation intention (WS-AII) on the well-being of primary school teachers. Participants were randomly allocated to one of two conditions: one in which they were asked to create a WS-AII or one in which they were asked to create a control implementation intention (C-II). State anxiety was measured pre- and post-manipulation, self-efficacy at post-manipulation only, and emotions in teaching and emotion regulation at baseline and at a two-week follow-up. There were statistically significant differences between the WS-AII condition and the control. Teachers who created work-related self-affirming implementation intentions reported an immediate reduction in state anxiety. Positive effects extended over the two-week period, with teachers in the WS-AII condition also reporting more positive emotions in teaching and the use of reappraisal emotion regulation strategies rather than emotion suppression. Results suggest that the integration of the WS-AII into existing organisational practice may be of benefit to the well-being of teachers and other highly stressed workers.

Online Self-Affirmation Increases Fruit and Vegetable Consumption in Groups at High Risk of Low Intake

BACKGROUND

This study tested the efficacy of self-affirmation in promoting fruit and vegetable consumption in a sample of participants comprising two groups at high risk of low consumption: young adults and mothers of school-aged children with low social economic status (SES).

METHODS

Baseline fruit and vegetable consumption was recorded for 85 participants (n = 26 mothers with low SES). Following randomisation to condition (Self-Affirmed or Non-Affirmed), participants viewed targeted, online, health recommendations about fruit and vegetable consumption. Fruit and vegetable intake was reported online every day for the following seven days.

RESULTS

Self-affirmed participants reported consuming significantly more portions of fruit and vegetables (SA M = 3.96, NA M = 2.81). Analyses of simple slopes indicated that the effect was greatest amongst lowest baseline consumers.

CONCLUSIONS

The findings demonstrate the efficacy of self-affirmation in increasing fruit and vegetable consumption in individuals who are at risk of having a low intake and whose consumption put them at the greatest risk of negative health outcomes. Application of these findings could help to reduce health care costs, through the use of cost-effective online interventions and reductions in treatment costs. Further research is needed to capitalise on the increased tailoring that online intervention allows in order to optimise the effects of self-affirmation.

How Multiple Social Identities Are Related to Creativity

The present research examined whether possessing multiple social identities (i.e., groups relevant to one's sense of self) is associated with creativity. In Study 1, the more identities individuals reported having, the more names they generated for a new commercial product (i.e., greater idea fluency). In Study 2, multiple identities were associated with greater fluency and originality (mediated by cognitive flexibility, but not by persistence). Study 3 validated these findings using a highly powered sample. We again found that multiple identities increase fluency and originality, and that flexibility (but not persistence) mediated the effect on originality. Study 3 also ruled out several alternative explanations (self-affirmation, novelty seeking, and generalized persistence). Across all studies, the findings were robust to controlling for personality, and there was no evidence of a curvilinear relationship between multiple identities and creativity. These results suggest that possessing multiple social identities is associated with enhanced creativity via cognitive flexibility.

Self-affirmation activates brain systems associated with self-related processing and reward and is reinforced by future orientation

Self-affirmation theory posits that people are motivated to maintain a positive self-view and that threats to perceived self-competence are met with resistance. When threatened, self-affirmations can restore self-competence by allowing individuals to reflect on sources of self-worth, such as core values. Many questions exist, however, about the underlying mechanisms associated with self-affirmation. We examined the neural mechanisms of self-affirmation with a task developed for use in a functional magnetic resonance imaging environment. Results of a region of interest analysis demonstrated that participants who were affirmed (compared with unaffirmed participants) showed increased activity in key regions of the brain's self-processing (medial prefrontal cortex + posterior cingulate cortex) and valuation (ventral striatum + ventral medial prefrontal cortex) systems when reflecting on future-oriented core values (compared with everyday activities). Furthermore, this neural activity went on to predict changes in sedentary behavior consistent with successful affirmation in response to a separate physical activity intervention. These results highlight neural processes associated with successful self-affirmation, and further suggest that key pathways may be amplified in conjunction with prospection.

Evidence that brief self-affirming implementation intentions can reduce work-related anxiety in downsize survivors

BACKGROUND AND OBJECTIVES

Workers were recruited from a UK further education college during a period of organizational downsizing. This study assessed the effects of a brief health psychology intervention on work-related stress in downsize survivors.

DESIGN AND METHODS

Sixty-six employees were randomly allocated to one of two conditions: one in which they were asked to create a work-related self-affirming implementation intention (WS-AII) or a control. Feelings of anxiety and depression were measured before and after the intervention or control task and three weeks later. Job satisfaction, self-efficacy, and self-esteem were also measured.

RESULTS

There were statistically significant differences between the WS-AII condition and the control. Workers who created WS-AIIs reported an immediate reduction in anxiety. This reduction was also observed in their appraisal of job-related anxiety three weeks later. There were no significant effects of WS-AIIs on depression, job satisfaction, or self-esteem. There was, however, a significant effect on self-efficacy with workers in the WS-AII condition reporting greater self-efficacy.

CONCLUSIONS

The present findings suggest that the integration of brief health psychology interventions, such as the WS-AII, into existing organizational practice may be of benefit to the well-being of employees.

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

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

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

OBJECTIVES

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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