1. Self-affirmation, Implementation Intentions, and Behavior Change William Klein National Cancer Institute Peter Harris University of Sussex Rebecca Ferrer National Cancer Institute Society for Personality and Social Psychology February 14, 2014

2. Self-Affirmation and Threatening Health Messages Self-Affirmation and Threatening Health Messages Seminal studies by Sherman et al. (2000) Other threatening health information Cigarette warning labels (Harris et al., 2007) Personalized risk feedback (Klein et al., 2010) Other populations Sunbathers (Jessop et al., 2009) Low SES (Armitage et al., 2009)

3. Explanatory Mechanisms Physiological Cognitive Affective Motivational

4. Question: Mechanisms are important, but does self- affirmation have any behavioral effects? Question:

5. “Small behavioral wins” (Cohen & Sherman, 2014) Intentions, intentions, intentions Intentions, intentions, intentions Smoking cessation leaflets (Armitage et al., 2008) Smoking cessation leaflets (Armitage et al., 2008) Click link to online screening test (van Koningsbruggen & Das, 2009) Click link to online screening test (van Koningsbruggen & Das, 2009) Condoms/leaflets (Sherman et al., 2000) Condoms/leaflets (Sherman et al., 2000) Leaflets re: fruits/veggies (Napper et al., in press) Leaflets re: fruits/veggies (Napper et al., in press) Taking sunscreen (Jessop et al., 2009) Taking sunscreen (Jessop et al., 2009)

6. More Sustained Behavior Change Fruit and vegetable @ 1 week (Epton & Harris, 2008) Fruit and vegetable @ 1 week (Epton & Harris, 2008) Alcohol use @ 1-2 mos. (Armitage et al., 2011) Alcohol use @ 1-2 mos. (Armitage et al., 2011) Exercise @ 1 week (Cooke, Harris, & Wright, in press) Exercise @ 1 week (Cooke, Harris, & Wright, in press) BMI/weight/waist size @ 3 mo. (Logel & Cohen, 2012) BMI/weight/waist size @ 3 mo. (Logel & Cohen, 2012) Sun protection @ 2 weeks (Schuez, Schuez, & Eid, 2013) Sun protection @ 2 weeks (Schuez, Schuez, & Eid, 2013)

7. More Sustained Behavior Change In conjunction with positive affect intervention vs. usual treatment control (at 12 mo. follow-up) In conjunction with positive affect intervention vs. usual treatment control (at 12 mo. follow-up) Exercise in coronary patients (Peterson et al., 2012) Exercise in coronary patients (Peterson et al., 2012) Medication adherence in hypertensive African Americans (Ogedegbe et al., 2012) Medication adherence in hypertensive African Americans (Ogedegbe et al., 2012) But examples of no change (e.g., Reed & Aspinwall, 1998) But examples of no change (e.g., Reed & Aspinwall, 1998)

8. Role of Plans and Implementation Intentions Implementation intentions (i.e., if then-plans) more likely translate intentions into action (Gollwitzer & Sheeran, 2006) Implementation intentions (i.e., if then-plans) more likely translate intentions into action (Gollwitzer & Sheeran, 2006) Self-affirmation increases self-efficacy and response efficacy, so… Self-affirmation increases self-efficacy and response efficacy, so… might it increase plan-making? might it increase plan-making? might self-affirmation effects be enhanced by implementation intention opportunities? might self-affirmation effects be enhanced by implementation intention opportunities?

9. Some Hints from Existing Studies Armitage et al. (2011): one condition suggested that participants think about a value when desiring a drink Armitage et al. (2011): one condition suggested that participants think about a value when desiring a drink Epton and Harris (2008): message had easy steps to incorporate foods into diet (“add extra vegetables to pizza”) Epton and Harris (2008): message had easy steps to incorporate foods into diet (“add extra vegetables to pizza”) Jessop et al. (2013): detrimental effects of implementation intentions combined with self- affirmation Jessop et al. (2013): detrimental effects of implementation intentions combined with self- affirmation

10. Study 1 (Ferrer et al., 2012) 265 female drinkers 265 female drinkers Self-affirmed or not Self-affirmed or not Article linking alcohol and breast cancer Article linking alcohol and breast cancer Usual measures – processing, attitudes, risk perceptions, etc. Usual measures – processing, attitudes, risk perceptions, etc. Open-ended response to: Open-ended response to: “If you have any interest in altering your alcohol consumption in the next 7 days, how will you go about it? Please list any steps that you think you will take to reduce your alcohol consumption.” - 80% provided one or more steps - Coded for degree of specificity and feasibility

11. Ferrer et al., 2012, Social Psychological and Personality Science Specific plans to reduce consumption

12. Study 2 1116 females, national TESS sample, M age = 46 1116 females, national TESS sample, M age = 46 Written emotion induction Written emotion induction Self-affirmed or not Self-affirmed or not Alcohol and breast cancer article Alcohol and breast cancer article Open-ended response to: Open-ended response to: “If you have any interest in altering your alcohol consumption in the next 7 days, how will you go about it? Please list any steps that you think you will take to reduce your alcohol consumption.”

13. Ferrer et al., in preparation Specific plans to reduce consumption

14. Ferrer et al., in preparation Specific plans to reduce consumption

15. Study 3 (Harris et al., in press) N = 332 members of U. Sheffield community (72% female, M age = 22.3) N = 332 members of U. Sheffield community (72% female, M age = 22.3) Self-affirmed or not Self-affirmed or not Article about benefits of fruits and vegetables Article about benefits of fruits and vegetables Implementation intentions or not (thought bubble format) Implementation intentions or not (thought bubble format) Follow-up consumption at 7 days and 3 months Follow-up consumption at 7 days and 3 months

16. Harris et al., in press, Health Psychology Fruit and veggie consumption

17. Harris et al., in press, Health Psychology Fruit and veggie consumption

18. Harris et al., in press, Health Psychology Fruit and veggie consumption

19. Conclusions Self-affirmation may promote not only attitude change but also plans to address threat Making available opportunities to address threat might enhance the effect of self-affirmation Unclear how implementation intentions are related to behavior – does self-affirmation influence this association?

20. Future Research Under what conditions do implementation intentions undermine self-affirmation? (Jessop et al., 2013) Are plans and implementation intentions recursive? Does self-affirmation affect the way in which plans and implementation intentions are expressed?

21. Thank You! Collaborators Margo Barker Hannah Bergman Irina Brearley Rod Bond David Creswell Kaitlin Graff Amber Koblitz John Levine Paschal Sheeran Dikla Shmueli Funding National Cancer Institute National Science Foundation