As part of my degree I completed a dissertation. In my dissertation I focussed on cognitive dissonance and self-affirmation and how this impacts behaviour change. Specifically, I looked at the effect of self-affirmation on health risk message acceptance, intention and exercise behaviour in undergraduate students. This gave me the opportunity to dive into the research surrounding these topics and develop a well-rounded understanding of these topics.
Here is the main part of my dissertation that discusses these topics...
1.0 Introduction
Overweight and obesity is an ever-growing issue both in the UK and globally, with an estimated 1 in 4 UK adults being classified as obese in 2018 (NHS 2019). Obesity is characterized as having a body mass index of 30 or more (Clark et al., 2011), which stated by Conway and Rene (2004), increases an individual’s risk of cardiovascular disease, type 2 diabetes, stroke, cancer, depression and many other health issues. Consequently, this increases an individual’s risk of hospitalisation. The NHS (2020) states that over 11,000 hospital admissions in 2018/19 were with the primary diagnosis of obesity and that this has been an upward trend since 2014/15. The cost of obesity is not only physical but also financial, with the NHS expecting to pay out an estimated £10 billion per year, by the year 2050 to deal with the physical costs of obesity (Government Office for Science 2017). The ever-expanding figures evidently portray the developing problem of obesity with both the causes and potential risks, but there are also many ways to prevent it.
1.1 Promoting health and well-being
Exercise is one of the few guaranteed non-invasive and cost-effective methods for health and well-being advancement. It is deemed one of the most important behaviours in relation to promoting long-term weight loss and the prevention of weight regain (Jakicic and Davis 2011), and subsequently reduces the risk of type 2 diabetes and colon cancer by 50%, coronary heart disease and stroke by 35%, and depression and early death by 30% (NHS 2018). It is recommended by the American College of Sports Medicine (2011) that the majority of adults should partake in a total of 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise, and two to three resistance/flexibility training sessions per week. This is to improve physical and mental health among adults which is essential for optimal daily living. However, many individuals are not considered active by these standards, with only an estimated 67% of UK adults (19 and over) being considered physically active in 2018 (NHS 2020).
Further insights into exercise participation levels by age category show that individuals tend to become less active as they get older, therefore in the UK 19 to 24 year olds were considered the most active age group (74%). However, there is still a large proportion of 19 to 24 year olds who are not active despite these benefits (NHS 2020). It was even found by a systematic review that university students face levels of depression that are considerably higher than those found in the general population (Ibrahim 2012). The research also suggests that physical activity levels can decline with age, with Yang et al., (2006) stating that those who are more physically active when they are younger are more likely to stay active as they get older. The NHS (2020) further support this narrative, stating that the amount of adults who are overweight or obese increases with age among both men and women. Therefore, the encouragement of regular exercise at a younger age may impact both men and women to be physically active as they get older, reducing the associated risks of overweight and obesity and also potential mental health decline.
1.2 Message interpretation and the role of defensive processing
As stated previously, although exercise is considered to be very beneficial due to its physical, mental and social benefits, many people still choose not to participate in regular exercise. Psychological research has produced many theories and explanations for individual cognitive functioning and behaviour, providing essential reasonings for an individual’s thoughts, feelings and actions. Defensive processing is the manner in which an individual receives information that contradicts their own feelings, beliefs or actions triggering self-protection. In a study by Sherman and Cohen (2006) it states that defensive processing can be damaging, notably when it leads to an individual rejecting important health information, as this can prevent attitude change and thus participation in healthy behaviours such as regular exercise. The American Psychological Association (APA; 2020b) state that defensive processing involves evading attitude-conflicting information and obtaining attitude-consistent information, with the possibility of developing contradictory information in a highly critical fashion in order to counter it. Therefore, individuals may avoid information that contradicts their beliefs as it may lead to a sense of internal discomfort.
1.3 Defensive theory, practices and the ‘self-system’
The psychological state in which an individual holds two or more beliefs that contradict each other is referred to as cognitive dissonance (APA 2018a), and has subsequently lead to the Cognitive Dissonance Theory (Festinger 1962). This theory argues that individuals are driven to maintain consistency within themselves, and when a discrepancy or contradiction occurs they experience an unpleasant state that drives them to moderate the dissonance. Further research suggests that those whom receive information that is pertinent to them are more likely to engage and employ defensive practices (Block and Williams 2002). Cognitive dissonance creates an internal discomfort that individuals want to reduce, thus they avoid attitude-inconsistent information whilst acquiring attitude-consistent information to provide consonance. The development of this theory has preceded the advancement of other psychological theories derived to focus on how the ‘self’ can reconcile the dissonance process regarding behaviour.
Self-Affirmation Theory (Steele 1988) is one psychological theory derived from the theory of Cognitive Dissonance that proposes the existence of a ‘self-system’ that allows individuals to continuously justify themselves to themselves, in order to maintain global self-integrity. This essentially means that people will go out of their way to explain themselves to themselves in order to avoid dissonance and maintain the self as morally adequate. Steele (1988) further states in this theory that individuals are not only concerned by the internal inconsistency, but the threat it may cause on the perceived view of the self, and they therefore will engage in a specific type of response to that threat. There are three different types of response to a threat; accommodating (accepting the information and using it as a basis for attitude and behaviour change), defensive bias (dismissing, denying or avoiding the information) or self-affirmation (affirming other aspects of the self in order to allow restoration of self-integrity and adaptive behaviour) (Sherman and Cohen 2006). Self-affirmation (SA) is triggered by information that threatens the perceived adequacy of the self. An individual may encounter a threat to the self in one realm but by affirming an aspect of the self in another realm, can lead to the individual being more open about the potentially threatening information. Therefore, they are more likely to objectively assess the information that would otherwise induce a defensive reaction. Hence, SA has thus been employed in many psychological studies as a behaviour change strategy (Harris and Epton 2009).
1.4 Changing health behaviour
Behaviour change interventions have been designed to alter the prevalence of behaviour(s) in order to generate advancements in individuals’ and populations’ health (Conner and Norman 2005). Self-affirmation is commonly utilised to mediate a defensive response within an individual and thus is presented in behaviour change interventions to alter predictor variables and behaviour outcomes. Predictor variables, often referred to as underlying constructs, can be assessed directly via Likert item scales. For example, attitudes, intention, message acceptance and risk are underlying constructs derived from psychological behaviour change theories such as the Theory of Planned Behaviour (Ajzen 2002). Self-affirmation interventions are typically indirect as people often affirm themselves on values separate from the threatening domain than directly relevant to it (Cohen and Sherman 2014). In a study by Crocker et al., (2008) the findings suggest that those who self-affirm via values affirmation were able to reduce defensiveness and report positive other-directed feelings such as love and connectedness. Therefore, SA can be implemented into an intervention allowing individual’s to self-affirm via a SA task, writing about values that are of importance to them, thus allowing them to accordingly maintain the concept of self-integrity within their ‘self-system’.
References:
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