Can Self-affirmation Encourage HIV-Prevention? Evidence from Female Sex Workers in Senegal

We test an intervention aiming to increase condom usage and HIV testing in a stigmatized population at high risk of contracting HIV: female sex workers (FSWs) in Senegal. Some sex work is legal in Senegal, and condoms and HIV tests are freely available to registered FSWs-but FSWs may be reluctant to get tested and use condoms, in part because doing so would entail acknowledging their risk of contracting HIV and potentially expose them to stigma. Drawing on self-affirmation theory, we hypothesized that reflecting on a source of personal pride would help participants acknowledge their risk of HIV, intend to use condoms more frequently, and take an HIV test. Prior research suggests that similar self-affirmation interventions can help people acknowledge their health risks and improve their health behavior, especially when paired with information about effectively managing their health (i.e., self-efficacy information). However, such interventions have primarily been tested in the United States and United Kingdom, and their generalizability outside of these contexts is unclear. Our high-powered experiment randomly assigned participants (N = 592 FSWs; N = 563 in the final analysis) to a self-affirmation condition or a control condition and measured their risk perceptions, whether they took condoms offered to them, and whether (after randomly receiving or not receiving self-efficacy information) they took an HIV test. We found no support for any of our hypotheses. We discuss several explanations for these null results based on the stigma attached to sex work and HIV, cross-cultural generalizability of self-affirmation interventions, and robustness of previous findings.

Effects of online self-compassionate writing on stigmatizing and affirming self-perceptions: Potential boundary conditions in undergraduate women

This study investigated the effects of an online self-compassionate writing intervention on stigmatizing and affirming self-views toward the body in a sample of college women (N = 254). Participants were randomly assigned to a self-compassionate writing, attentional-control writing, or wait-list control condition for one week, and completed measures of self-compassion, affirming self-perceptions, and stigmatizing self-perceptions at baseline, one-week post intervention, and one-month post intervention. A series of mixed AN(C)OVAs revealed no significant effects by condition or time on stigmatizing or affirming self-views toward the body when controlling for self-esteem, internalized weight stigma, and eating disorder symptomatology. Follow-up exploratory analyses demonstrated no significant effects by condition on the six facets of self-compassion. Notably, participants were significantly more likely to drop out from the study over time if they were lower in self-compassion and self-esteem, and higher in internalized weight stigma at baseline. These results suggest that online self-compassion writing interventions may need to be longer and more potent, especially for women with more entrenched and stigmatized views about their bodies, as well as potential boundary conditions of cultivating self-compassion in a short-term online intervention.

The effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery. A randomized controlled trial

BACKGROUND

Self-affirmations help one focus on positive outcomes and adapt to new situations both psychologically and physiologically by the repetition of positive affirmation sentences. This method, which has promising results in symptom management, is predicted to have effective results in the management of pain and discomfort in patients undergoing open-heart surgery.

AIM

To investigate the effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery.

METHODS

This study adopted a randomized controlled pretest-posttest follow-up research design. The study was conducted at a public training and research hospital (Istanbul, Turkey) specialized in thoracic and cardiovascular surgery. The sample consisted of 61 patients randomized into two groups: intervention (n = 34) and control (n = 27). The participants of the intervention group listened to a self-affirmation audio recording for three days after surgery. Anxiety levels and perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured daily. The State Trait Anxiety Inventory (STAI) was used to measure the level of anxiety, meanwhile perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured by a 0 to 10 Numeric Rating Scale (NRS).

RESULTS

The control group had significantly higher anxiety than the intervention group three days after surgery (P < 0.001). The intervention group had less pain (P < 0.01), dyspnoea (P < 0.01), palpitations (P < 0.01), fatigue (P < 0.001) and nausea (P < 0.01) than the control group.

CONCLUSIONS

Positive self-affirmation helped reduce anxiety and perceived discomfort in patients who underwent open-heart surgery.

CLINICALTRIALS

gov Identifier: NCT05487430.

Computer passwords as a timely booster for writing-based psychological interventions

Writing-based psychological interventions have been widely implemented to produce adaptive change, e.g., through self-affirmation (reminding people of their most important values). To maintain the long-term effects of these interventions, we developed a form of intervention boosters-using user-customized computer passwords to convey the therapeutic messages. We examined whether computer passwords could enhance the effect of a self-affirmation intervention on the psychological well-being of sexual minority undergraduate students as they begin university. Participants were randomly assigned to either complete a self-affirmation writing exercise and create a self-affirming computer password to use for 6 weeks or complete a control writing exercise and create a control computer password. We found that frequency of password usage moderated the intervention effect, such that frequent use of self-affirming passwords buffered decreases in psychological well-being over the study period. These findings suggest that passwords can serve as a low-cost, low-burden, and timely booster for writing-based psychological interventions.

Does the Weekly Practice of Recalling and Elaborating Episodes Raise Well-Being in University Students?

Increasing well-being is a prominent worldwide goal that can be achieved primarily through social support and environmental factors. However, in times of social distancing or isolation, it is important to also rely on self-managed activities. This study aimed to (a) test the effectiveness of a seven-week well-being intervention, in increasing need satisfaction, self-compassion, emotion regulation, and grateful disposition by curbing need frustration, self-derogation, and emotional suppression, and (b) examine the maintenance and long-term effects of the practices based on recall, elaboration, and writing. One hundred and twenty university students weekly recalled and elaborated for seven consecutive weeks on three recent episodes of gratitude, self-affirmation, goal setting, or meaningful things, according to the group to which they were assigned. Before the intervention, immediately after and one month later, they filled in questionnaires to assess need satisfaction/frustration, self-compassion/derogation, emotion regulation and grateful disposition. The results confirmed an increase in well-being and a decrease in ill-being for all groups (Cohen d for the significant differences ranging from 0.18 to 0.53). The effects were maintained one month later and even increased for self-compassion, self-derogation, need frustration, and emotional reappraisal. A follow-up assessment revealed that a third of the participants continued with the well-being practices. Implications and suggestions for future well-being interventions are discussed.

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

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

The Daily Activity Study of Health (DASH): A pilot randomized controlled trial to enhance physical activity in sedentary older adults

Sedentary behavior increases the risk for multiple chronic diseases, early mortality, and accelerated cognitive decline in older adults. Interventions to reduce sedentary behavior among older adults are needed to improve health outcomes and reduce the burden on healthcare systems. We designed a randomized controlled trial that uses a self-affirmation manipulation and gain-framed health messaging to effectively reduce sedentary behavior in older adults. This message-based intervention lasts 6 weeks, recruiting 80 healthy but sedentary older adults from the community, between the ages of 60 and 95 years. Participants are randomly assigned to one of two groups: 1) an intervention group, which receives self-affirmation followed by gain-framed health messages daily or 2) a control group, which receives daily loss-framed health messages only. Objective physical activity engagement is measured by accelerometers. Accelerometers are deployed a week before, during, and the last week of intervention to examine potential changes in sedentary time and physical activity engagement. Participants undertake structural and functional (resting and task-based) MRI scans, neuropsychological tests, computerized behavioral measures, and neurobehavioral inventories at baseline and after the intervention. A 3-month follow-up assesses the long-term maintenance of any engendered behaviors from the intervention period. This study will assess the effectiveness of a novel behavioral intervention at reducing sedentarism in older adults and examine the neurobehavioral mechanisms underlying any such changes.

The route to improve the effectiveness of negative PSAs

To encourage people to behave in a more socially responsible or healthy way, many public service announcements (PSAs) dramatically illustrate the dire consequences of undesirable social or health behaviors. However, although informative, such negatively-framed PSAs can generate unintended consequences (e.g., a bad mood, low message acceptance). In this research, we investigated two approaches to improve the effectiveness of negatively-framed PSAs: (1) mood elevation and (2) self-affirmation. Using three studies with large samples of consumers, we found that adding mood-elevating or self-affirming elements to a negative PSA can be an effective way to enhance message acceptance. This is especially the case for recipients currently engaging (vs. not engaging) in the undesirable behaviors. Additionally, we designed mood elevation methods that can be implemented in PSAs in practice.

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

OBJECTIVE

Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might strengthen self-affirmation's effects in response to disease prevention messages, given that prevention-focused individuals are likeliest to be persuaded by those messages after self-affirmation attenuates defensiveness.

DESIGN

In Study 1, participants were self-affirmed before a message about sexually transmitted infections. In Studies 2 and 3, individuals were self-affirmed prior to a message about alcohol and cancer risk.

MAIN OUTCOME MEASURES

Studies assessed intentions to use condoms, intentions to reduce alcohol, and willingness to drink alcohol in specific scenarios.

RESULTS

In Study 1, self-affirmation facilitated condom use intentions among those higher in prevention focus. In Studies 2 and 3, self-affirmation facilitated lower willingness to consume alcohol among those high in prevention focus. A meta-analysis across the three studies indicated that self-affirmation improved intentions and willingness under high, but not low, prevention focus (d = 0.20, p = .003).

CONCLUSION

These findings demonstrate that health prevention-focus can strengthen self-affirmation's effects, thereby improving responsiveness to health communications about behaviors that increase disease risk.

Self-affirmation enhances the processing of uncertainty: An event-related potential study

We proposed that self-affirmation can endow people with more cognitive resource to cope with uncertainty. We tested this possibility with an event-related potential (ERP) study by examining how self-affirmation influences ambiguous feedback processing in a simple gambling task, which was used to investigate risk decision-making. We assigned 48 participants randomly to the affirmation and non-affirmation (i.e., control) groups. All participants accepted the manipulation first and then completed the gambling task with an electroencephalogram (EEG) recording, in which participants might receive a positive (winning), negative (losing), or ambiguous (unknown valence) outcome after they made a choice. We considered both the feedback-related negativity (FRN) and P3 components elicited by the outcome feedback, which reflected the amount of cognitive resources being invested in the early and late stages of the outcome feedback processing, respectively. ERP results showed that ambiguous feedback elicited a larger FRN among affirmed participants than unaffirmed participants but exerted no influence on the P3. This finding suggests that self-affirmation may help coping with uncertainty by enhancing the early processing of uncertainty.

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

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

Autobiographical recall of mastery experiences is a mechanism of self-affirming under social identity threat

Autobiographical memories are relevant to many areas of psychological functioning. So far, however, there is no evidence whether personal memories can also be instrumental for self-affirmation. We conducted two experiments, varying national identity threat among U.S. Americans recruited through MTurk. In Study 1, participants spontaneously recalled autobiographical memories after being exposed to varying levels of threat. When the threat was identity-relevant, those who spontaneously recalled mastery autobiographical memories had higher collective self-esteem than those who did not. In Study 2, we instructed participants to recall either mastery autobiographical memories or routine memories. When the threat was identity-relevant, collective self-esteem was again higher for mastery recall compared to routine recall, moderated by national identification and self-esteem. We also found a general, self-affirmative effect of autobiographical memories, regardless of threat relevance or recall content. Findings provide a first empirical demonstration that autobiographical recall can enhance self-affirmation in identity threat situations.

Coping with stress: A pilot study of a self-help stress management intervention for patients with epileptic or psychogenic nonepileptic seizures

PURPOSE

Many patients with epilepsy or psychogenic nonepileptic seizures (PNES) experience high levels of stress. Although psychological interventions have been developed for seizure disorders, few patients can currently access them. We aimed to assess the acceptability and feasibility of a self-help intervention targeting stress in patients with seizures, and to provide preliminary evidence for its effectiveness.

METHOD

Patients were recruited from outpatient neurology clinics and randomized to an immediate intervention group (n = 39), who received the intervention at baseline, or a delayed intervention group (n = 43), who received the intervention one-month postbaseline. Participants completed self-report questionnaires measuring stress (Smith Stress Symptom Inventory [SSSI]), anxiety (Generalized Anxiety Disorder 7-item Scale [GAD-7]), depression (Neurological Disorders Depression Inventory for Epilepsy [NDDI-E]), quality of life (European Quality of Life - 5 Dimensions [EQ-5D]), and seizure severity and frequency (Liverpool Seizure Severity Scale [LSSS-3]) at baseline, and at one- and two-month follow-up. Participants also provided telephone feedback. The intervention consisted of a self-help stress management workbook based on an integrative stress model framework.

RESULTS

Although the rate of participants failing to return follow-up information at two months was approximately 50%, those who completed the trial found the intervention acceptable; with the majority rating it as helpful (63.6%) and that they would recommend it to others with seizures (88.1%). A significant reduction in self-reported stress (P = .01) with a medium effect size (d_z = 0.51) was observed one-month postintervention. There were no significant changes in any other measures.

CONCLUSION

The intervention was perceived to be acceptable, safe, and helpful by participants. It could be a useful complementary treatment option for reducing stress experienced by patients living with seizure disorders. Further evaluation in a larger trial is warranted.

Adapting a self-affirmation intervention for use in a mobile application for smokers

Self-affirmation interventions can reduce defensive responses to threats to the self, but have had limited reach to the general population. We sought to create an effective and feasible version of the Kindness Questionnaire self-affirmation intervention for use on a mobile device outside the traditional university laboratory setting and by non-student participants. In an online experiment, 603 cigarette smokers (M_age= 37.5 years, SD = 10.2) were randomly assigned to one of six conditions in a 2 (Self-Affirmation: Self-Affirmation, No Self-Affirmation Control) × 3 (Example Type: Written, Imagined, No Examples) fully-crossed design. Participants read a message about the health harms of smoking. None of the self-affirmation variations were effective or feasible: the self-affirmation showed null effects on the primary outcomes of message acceptance, perceived message effectiveness, and reactance. It also backfired by reducing intentions to quit smoking and risk perceptions. Participants spent little time reading the health message, and those in the written self-affirmation condition infrequently provided detailed responses. Translating interventions developed and tested for efficacy in laboratory settings to "real-world" settings is necessary but challenging.

Preventing adverse information effects on health outcomes: A self-affirmation intervention reduced information-induced cognitive decline in gastrointestinal cancer patients

RATIONALE

Nocebo studies show that informing patients about treatment side effects can adversely impact expectancies and symptom reporting.

OBJECTIVE

The current study examined how to inform patients fully about treatment side effects without increasing their occurrence. Extending theoretical assumptions about self-affirmation from the social-psychological to the medical domain, we tested whether allowing cancer patients to self-affirm prior to informing them about potential cognitive decline reduced the occurrence of Adverse Information Effects (AIE) on cognitive problem reporting (CPR) and verbal memory performance.

METHOD

Participants were 90 Dutch and Belgian gastrointestinal cancer patients with and without chemotherapy experience. Patients were randomized across three experimental conditions (information about chemotherapy-related cognitive problems with or without self-affirmation; no-information control) before completing an online questionnaire. Data were collected from May until August 2015. Main dependent variables were CPR and verbal memory performance. Stigma consciousness was included as a moderator.

RESULTS

Informing patients about chemotherapy-related cognitive problems increased CPR and decreased scores on two out of three memory measures. Self-affirmation reduced these AIE. Stigma conscious patients reported more problems in the information than the self-affirmation group.

CONCLUSIONS

Nocebo effects may be reduced by allowing patients the opportunity to restore their self-integrity at the implicit level. Self-affirmation has the potential to reduce AIE in patient populations without withholding relevant information about potential treatment side effects.

Alcohol pictorial health warning labels: the impact of self-affirmation and health warning severity

BACKGROUND

We examined whether enhancing self-affirmation among a population of drinkers, prior to viewing threatening alcohol pictorial health warning labels, would reduce defensive reactions and promote reactions related to behaviour change. We also examined how health warning severity influences these reactions and whether there is an interaction between self-affirmation and severity.

METHODS

In this experimental human laboratory study, participants (n = 128) were randomised to a self-affirmation or control group. After the self-affirmation manipulation was administered, we tracked participants' eye movements while they viewed images of six moderately-severe and six highly-severe pictorial health warning labels presented on large beer cans. Self-reported responses to the pictorial health warning labels were then measured, including avoidance, reactance, effectiveness, susceptibility and motivation to drink less. Finally, participants reported their self-efficacy to drink less and their alcohol use.

RESULTS

There was no clear evidence that enhancing self-affirmation influenced any outcome. In comparison to moderately-severe health warnings, highly-severe health warnings increased avoidance and reactance and were perceived as more effective and increased motivation to drink less.

CONCLUSIONS

These findings call into question the validity of the self-affirmation manipulation, which is purported to reduce defensive reactions to threatening warnings. We discuss possible explanations for this null effect, including the impact of participants' low perceived susceptibility to the risks shown on these pictorial health warning labels. Our finding that highly-severe health warnings increase avoidance and reactance but are also perceived as being more effective and more likely to motivate people to drink less will inform future health warning design and have implications for health warning label theory.

Racial (vs. self) affirmation as a protective mechanism against the effects of racial exclusion on negative affect and substance use vulnerability among black young adults

Affirming one's racial identity may help protect against the harmful effects of racial exclusion on substance use cognitions. This study examined whether racial versus self-affirmation (vs. no affirmation) buffers against the effects of racial exclusion on substance use willingness and substance use word associations in Black young adults. It also examined anger as a potential mediator of these effects. After being included, or racially excluded by White peers, participants were assigned to a writing task: self-affirmation, racial-affirmation, or describing their sleep routine (neutral). Racial exclusion predicted greater perceived discrimination and anger. Excluded participants who engaged in racial-affirmation reported reduced perceived discrimination, anger, and fewer substance use cognitions compared to the neutral writing group. This relation between racial-affirmation and lower substance use willingness was mediated by reduced perceived discrimination and anger. Findings suggest racial-affirmation is protective against racial exclusion and, more generally, that ethnic based approaches to minority substance use prevention may have particular potential.

Racial (vs. self) affirmation as a protective mechanism against the effects of racial exclusion on negative affect and substance use vulnerability among black young adults

Affirming one's racial identity may help protect against the harmful effects of racial exclusion on substance use cognitions. This study examined whether racial versus self-affirmation (vs. no affirmation) buffers against the effects of racial exclusion on substance use willingness and substance use word associations in Black young adults. It also examined anger as a potential mediator of these effects. After being included, or racially excluded by White peers, participants were assigned to a writing task: self-affirmation, racial-affirmation, or describing their sleep routine (neutral). Racial exclusion predicted greater perceived discrimination and anger. Excluded participants who engaged in racial-affirmation reported reduced perceived discrimination, anger, and fewer substance use cognitions compared to the neutral writing group. This relation between racial-affirmation and lower substance use willingness was mediated by reduced perceived discrimination and anger. Findings suggest racial-affirmation is protective against racial exclusion and, more generally, that ethnic based approaches to minority substance use prevention may have particular potential.

Self-affirmation improves self-control over snacking among participants low in eating self-efficacy

OBJECTIVE

Individuals low in eating self-efficacy are at particular risk of engaging in unhealthy eating behaviours, including the consumption of high calorie snacks. The elevated levels of snacking displayed by these individuals can largely be attributed to their experiencing low self-control over the avoidance of such foods (Hankonen, Kinnunen, Absetz, & Jallinoja, 2014). Interventions are thus required to boost self-control over snacking among those low in eating self-efficacy. Self-affirmation has been shown to boost self-control among individuals with depleted resources in other domains (Schmeichel & Vohs, 2009). The purpose of the current study was to test the hypothesis that a self-affirmation manipulation would similarly increase self-control over snacking for individuals low in eating self-efficacy.

METHODS

At baseline, participants (N = 70) completed measures of dietary restraint and eating self-efficacy. In the main study, participants completed either a self-affirmation or a control task immediately before undertaking a joystick category judgment task that assessed self-control over snacking.

RESULTS

Hierarchical multiple regression analysis revealed the predicted significant interaction between eating self-efficacy and self-affirmation, demonstrating that self-affirmation moderated the association between eating self-efficacy and self-control over snacking. Johnson-Neyman regions of significance confirmed that for participants low in eating self-efficacy the self-affirmation manipulation resulted in higher levels of self-control. Unexpectedly, however, for participants high in eating self-efficacy the self-affirmation manipulation was found to be associated with lower levels of self-control.

CONCLUSIONS

Findings supported the hypothesis that a self-affirmation manipulation would boost self-control over snacking among individuals low in eating self-efficacy. Self-affirmation may thus provide a useful technique for strengthening self-control in relation to the avoidance of unhealthy foods among individuals who find it difficult to manage challenging dietary situations.

Optimism and Spontaneous Self-affirmation are Associated with Lower Likelihood of Cognitive Impairment and Greater Positive Affect among Cancer Survivors

BACKGROUND

Optimism and self-affirmation promote adaptive coping, goal achievement, and better health.

PURPOSE

The aim of this study is to examine the associations of optimism and spontaneous self-affirmation (SSA) with physical, mental, and cognitive health and information seeking among cancer survivors.

METHODS

Cancer survivors (n = 326) completed the Health Information National Trends Survey 2013, a national survey of US adults. Participants reported optimism, SSA, cognitive and physical impairment, affect, health status, and information seeking.

RESULTS

Participants higher in optimism reported better health on nearly all indices examined, even when controlling for SSA. Participants higher in SSA reported lower likelihood of cognitive impairment, greater happiness and hopefulness, and greater likelihood of cancer information seeking. SSA remained significantly associated with greater hopefulness and cancer information seeking when controlling for optimism.

CONCLUSIONS

Optimism and SSA may be associated with beneficial health-related outcomes among cancer survivors. Given the demonstrated malleability of self-affirmation, these findings represent important avenues for future research.

A brief psychological intervention to protect subjective well-being in a community sample

PURPOSE

Governments are using measures of subjective well-being in preference to more objective measures of social progress (e.g., gross domestic product), yet interventions to address well-being are often costly. The present study tests the ability of a brief psychological intervention based on self-affirmation theory (Steele in Advances in experimental social psychology, Academic Press, New York, 1988) to protect subjective well-being among a community sample likely to have diminished well-being (i.e., women aged 46 years and older, Inglehart in Int J Comp Sociol 43: 391-408, 2002. doi: 10.1177/002071520204300309).

METHODS

One hundred and forty women aged 46 years and older completed baseline measures of subjective well-being, interpersonal feelings and self-esteem at baseline before being randomized to a self-affirmation or control group. Subjective well-being, interpersonal feelings and self-esteem were assessed again at follow-up.

RESULTS

Results showed that, controlling for baseline subjective well-being, the well-being of women who had self-affirmed was significantly higher at follow-up than those in the control condition. Affirming the self did not significantly influence interpersonal feelings or self-esteem, compared with the control condition.

CONCLUSIONS

The findings suggest that a low-cost brief psychological intervention based on self-affirmation theory, with potentially large public health "reach," could be used to protect subjective well-being-a key aim of government policies.

Experimentally induced states of mind determine abstinent smokers' level of craving in reaction to smoking-cues

Introduction

The present study aims to contribute to our knowledge on the causes of variations in experienced craving of (ex)smokers. The general idea is tested that when (ex)smokers are exposed to a smoking-cue, their level of craving is determined by the momentary state of mind through which the smoking-cue is interpreted.

Methods

A cue-reactivity paradigm in temporary abstinent smokers is applied to trigger craving responses under different experimentally induced states of mind. Craving is assessed with a three-item self-report measure. In study 1 (N = 120) a self-affirmation procedure is applied right before abstinent smokers were exposed to their own smoking paraphernalia. In study 2 (N = 140) abstinent smokers received bogus feedback inducing a high or low self-efficacy and strong or weak positive outcome expectations.

Results

Study 1 showed a significant interaction: When involvement was high, self-affirmation increased the level of craving but when involvement was low self-affirmation lowered craving. Study 2 also showed a significant interaction: Only when the positive outcome expectation of smoking were high, self-efficacy lowered the level of craving. All analyses were controlled for the number of cigarettes smoked a day and number of past quit attempts.

Conclusions

The present studies provide experimental evidence that levels of craving can be determined by momentary states of mind. This theoretical perspective can be integrated in existing conditioning and social cognitive learning perspectives on craving and substance use.

Writing content predicts benefit from written expressive disclosure: Evidence for repeated exposure and self-affirmation

Expressive disclosure regarding a stressful event improves psychological and physical health, yet predictors of these effects are not well established. The current study assessed exposure, narrative structure, affect word use, self-affirmation and discovery of meaning as predictors of anxiety, depressive and physical symptoms following expressive writing. Participants (N = 50) wrote on four occasions about a stressful event and completed self-report measures before writing and three months later. Essays were coded for stressor exposure (level of detail and whether participants remained on topic), narrative structure, self-affirmation and discovery of meaning. Linguistic Inquiry and Word Count software was used to quantify positive and negative affect word use. Controlling for baseline anxiety, more self-affirmation and detail about the event predicted lower anxiety symptoms, and more negative affect words (very high use) and more discovery of meaning predicted higher anxiety symptoms three months after writing. Findings highlight the importance of self-affirmation and exposure as predictors of benefit from expressive writing.

Self-affirming trait kindness regulates disgust toward one's physical appearance

In two studies, self-affirming the behavioral trait of kindness was examined as a method of regulating state disgust toward one's physical appearance. In Study 1, 56 participants (37 women, 19 men, Mage=33.16 years) completed either a questionnaire designed to self-affirm kindness or a control equivalent and rated their disgust, anger, sadness, and happiness toward their appearance and behavior. In Study 2, 116 individuals (83 women, 33 men, Mage=24.90 years) participated in the same experiment over the internet in an ecologically valid context. When controlling for trait self-disgust, the self-affirmed in Study 1 reported significantly less disgust toward their appearance (ηp(2)=.12, p=.011). This effect was replicated in Study 2, but driven by lower state disgust levels in those higher in trait self-disgust (f(2)=.10, p=.001). Affirming valued traits, like kindness, may be a useful tool for regulating disgust toward body image.

The role of current affect, anticipated affect and spontaneous self-affirmation in decisions to receive self-threatening genetic risk information

One reason for not seeking personally threatening information may be negative current and anticipated affective responses. We examined whether current (e.g., worry) and anticipated negative affect predicted intentions to seek sequencing results in the context of an actual genomic sequencing trial (ClinSeq®; n = 545) and whether spontaneous self-affirmation mitigated any (negative) association between affect and intentions. Anticipated affective response negatively predicted intentions to obtain and share results pertaining to both medically actionable and non-actionable disease, whereas current affect was only a marginal predictor. The negative association between anticipated affect and intentions to obtain results pertaining to non-actionable disease was weaker in individuals who were higher in spontaneous self-affirmation. These results have implications for the understanding of current and anticipated affect, self-affirmation and consequential decision-making and contribute to a growing body of evidence on the role of affect in medical decisions.

Self-affirmation facilitates cardiovascular recovery following interpersonal evaluation

Self-affirmation is known to reduce defensive psychological responses to ego threats. The current experiment tested the hypothesis that self-affirmation reduces physiological responses to a form of ego threat-interpersonal evaluation. Participants wrote an essay and received either neutral or insulting evaluative feedback about their essay, ostensibly from another participant. Then participants wrote about a core personal value (self-affirmation) or about a less important value (no self-affirmation). Lastly, participants played a competitive reaction time game that permitted them to blast their purported evaluator with noise. Noise blasts did not vary across conditions, but mean arterial blood pressure increased in response to being evaluated and returned to baseline more quickly following self-affirmation. Further, insulting (versus neutral) evaluative feedback caused a greater increase in heart rate, except among those who self-affirmed following the evaluation manipulation. These results suggest that self-affirmation facilitates the return to baseline cardiovascular activity following interpersonal evaluation.

The self in moral judgement: How self-affirmation affects the moral condemnation of harmless sexual taboo violations

People frequently condemn harmless sexual taboo behaviours. Based on self-affirmation theory, we predicted that providing an opportunity to self-affirm decreases the tendency to morally condemn harmless sexual taboos. In Experiment 1, we found evidence that self-affirmation decreases the moral condemnation of harmless sexual taboos and ruled out that this was due to a decrease in how disgusting participants considered taboo acts. In Experiment 2, we replicated this effect and demonstrated the mediating role of self-directed threat emotions. These results demonstrate that the tendency to morally condemn harmless sexual taboos arises in part from the need to protect self-integrity. We discuss the implications for the role of the self and emotions in moral judgements and interventions aimed at increasing the acceptability of harmless sexual taboos.

Self-affirmation and nonclinical paranoia

BACKGROUND AND OBJECTIVES

This experiment examined whether reflecting on a core value-value-affirmation-was effective in attenuating state paranoia in students.

METHODS

University students (N = 55) were randomised to either a value-affirmation or non-affirmation control condition before exposure to a paranoia-induction manipulation (high self-awareness plus failure feedback). Paranoid cognitions were measured before (T1) and after (T2) the value-affirmation task and after the paranoia-induction task (T3). Depressive cognitions were also measured at T3.

RESULTS

Affirming a valued domain had a direct and significant effect on reducing state paranoia prior to the paranoia-induction task (T2), such that the overall impact of the paranoia-induction on state paranoia was not significantly different from baseline. This effect was not attributable to differential changes in depression across groups.

LIMITATIONS

Use of a nonclinical sample limits generalisation to clinical groups. Repeat testing of key variables is a limitation, although this was necessary to assess change over time, and use of randomisation increased the internal validity of the study.

CONCLUSIONS

These findings suggest that self-affirmation is effective in reducing state paranoia in a nonclinical sample.

Mediators and moderators of behavior change in patients with chronic cardiopulmonary disease: the impact of positive affect and self-affirmation

Among patients with chronic cardiopulmonary disease, increasing healthy behaviors improves outcomes, but such behavior changes are difficult for patients to make and sustain over time. This study aims to demonstrate how positive affect and self-affirmation improve health behaviors compared with a patient education control group. The patient education (PE control) patients completed a behavioral contract, promising to increase their physical activity or their medication adherence and received an educational guide. In addition to the contract and guide, the positive affect/self-affirmation intervention (PA intervention) patients also learned to use positive affect and self-affirmation to facilitate behavior change. Follow-up was identical. In 756 patients, enrolled in three randomized trials, the PA intervention resulted in increased positive affect and more success in behavior change than the PE control (p < .01). Behavior-specific self-efficacy also predicted success (p < .01). Induction of positive affect played a critical role in buffering against the adverse behavioral consequences of stress. Patients who experienced either negative psychosocial changes (p < .05) or interval negative life events (p < .05) fared better with the PA intervention than without it. The PA intervention increased self-efficacy and promoted success in behavior change by buffering stress.