fear studies

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FEAR-AROUSING COMMUNICATIONS AND PERSUASIONThe impact of vulnerability on processing and accepting fear appeals

Natascha de Hoog


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De Hoog, Natascha

Fear-arousing communications and persuasion: The impact of vulnerability on

processing and accepting fear appeals

ISBN: 90-8559-084-1Drukker: Optima Grafische Communicatie


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FEAR-AROUSING COMMUNICATIONS AND PERSUASIONThe impact of vulnerability on processing and accepting fear appeals

ANGSTCOMMUNICATIES EN OVERTUIGING

De invloed van kwetsbaarheid op verwerking en acceptatie vanangstboodschappen

(met een samenvatting in het Nederlands)

Proefschrift

Ter verkrijging van de graad van doctor aan de Universiteit Utrechtop gezag van Rector Magnificus Prof. dr. W.H. Gispen

ingevolge het besluit van het College van Promoties

in het openbaar te verdedigen op

donderdag 27 oktober 2005 des ochtends te 10.30 uur

door

Natascha de Hoog

geboren op 11 november 1976, te Rotterdam


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Promotor: Prof. dr. W. Stroebe

Co-promotor: Dr. J.B.F. de Wit

The research reported in this thesis was funded by the Research Institute for

Psychology & Health, an institute accredited by the Royal Dutch Academy ofArts and Science.


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Contents

Chapter 1 Introduction 9

Theoretical approaches to the study of fear-arousing

communications 10

A stage model of processing of fear-arousing

communications 24

Overview 28

Chapter 2 The impact of fear appeals on processing and accepting

action recommendations: the key role of vulnerability 33

Experiment 2.1 38

Method 38

Results 41

Discussion 45


action recommendations: the role of response costs 51

Experiment 3.1 55

Method 55

Results 58

Discussion 63


action recommendations: the role of dispositional

optimism and neuroticism 69Experiment 4.1 72

Method 72

Results 75

Discussion 78


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Chapter 5 Getting the whole picture: How biased processing leads

to persuasion 81

Experiment 5.1 86

Method 87

Results 88

Discussion 90

Experiment 5.2 91

Method 91

Results 93

Discussion 94

Experiment 5.3 95

Method 96

Results 97

Discussion 103

General discussion 104

Chapter 6 The impact of fear appeals on information processing

and persuasion: A meta-analysis 109

Method 117

Results 120

Discussion 136

Chapter 7 General discussion 143

References 157

Summary 169

Samenvatting 175


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Chapter 1: Introduction

Each time smokers take a cigarette out of their cigarette pack they are

confronted with a warning displayed on the front of the pack that may read

Smoking causes lung cancer, Smoking can make you infertile or Smoking

causes a slow and painful dead. The warnings on packs of cigarettes are

supposed to make smokers concerned about the hazardous consequences of

smoking in such a way that they will stop smoking, yet most smokers continue

to smoke (Defacto, 2002). Does that mean that the warnings are ineffective? If

these warnings are indeed ineffective, what should be put on a cigarette pack

to convince smokers to quit smoking? For example, would it help if the

message made smokers feel like they themselves were personally at risk to die

from smoking? Or would it help if just as in, for instance, Canada pictures of

people suffering from cancer were displayed on the packs? Alternatively, would

it help if smokers were informed howto stop smoking? These are some of the

questions that will be addressed in the present thesis.

Warnings that are printed on cigarette packs are just one example of fear-

arousing communications. Fear-arousing communications have been used inhealth education campaigns since the 1950s, and have been applied to

numerous different topics. The most well known health education campaigns

that have used fear-arousing communications in the Netherlands are probably

those targeting excessive alcohol consumption (DRANK maakt meer kapot dan

je lief is and Do you know do you care?; NIGZ, 2000), drunk driving (3VO,

2003) and the unsafe use of fireworks (Je bent een rund als je met vuurwerk

stunt; SIRE, 2003). Fear-arousing communications usually consist of two

parts, namely (1) a fear appeal that stresses the severity of and personal

vulnerability to a health risk, and (2) an action recommendation that

emphasizes how to reduce or eliminate the health risk. The basic assumption

underlying fear-arousing communications is that the more one succeeds inmaking individuals concerned about the negative consequences of a certain

behavior, the higher will be the probability that they change their health

impairing behavior.

Over fifty years of empirical research on fear-arousing communications has

resulted in a large body of evidence that shows that high fear messages are

generally more effective than low fear messages in changing individuals

attitudes, intentions and behavior (see Boster & Mongeau, 1984; Sutton, 1982;

Witte & Allen, 2000). However, these empirical studies have not succeeded in

fully explaining the processes underlying the effects of fear-arousing

communications on persuasion. Moreover, insufficient attention has been

devoted to explaining why health education campaigns using fear-arousing

communications are sometimes ineffective in changing individuals healthimpairing behaviors. In addition, fear-arousing communications in both


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Chapter 110

research and practice have mainly focused on the effects of stressing the

severityof a health risk, but much less attention has been paid to the

importance of making individuals feel vulnerable to a health risk.

The current thesis will examine the processes underlying persuasion through

fear-arousing communications, in order to provide more insight into the

conditions under which fear-arousing communications are (in)effective, and,

more importantly, to specify how and why they are (in)effective. A stage model

of the processing of fear-arousing communications is used as the theoretical

framework (Das, de Wit & Stroebe, 2003; Stroebe, 2000), which will be

described in detail in this introduction. I will start of by giving an overview of all

the main theoretical approaches to the study of fear-arousing communications

that have been proposed since the 1950s, ending with a description of the

stage model that has been underlying the experiments reported in this thesis.

This description will be followed by an overview of the experiments reported in

each of the chapters in this thesis.

Theoretical approaches to the study of fear-arousing communications

Drive reduction model

Early research on fear appeals in the 1950s was guided by the assumptions of

the drive reduction model (Hovland, Janis & Kelley, 1953; Janis, 1967). The

main assumption of the drive reduction model is that fear or emotional tension

has the functional properties of a drive. A drive is a motivator for action, and

the stronger the drive, the more motivational function it possesses. According

to the drive reduction model, when individuals are presented with threatening

information they will be motivated to search for responses that reduce the

threat. Whatever response reduces the intensity of the emotional tension

produced by a fear appeal will be reinforced, and will become part of ones

permanent response repertoire. However, when a recommendation fails toreduce the fear level (i.e. if there is residual fear), because the

recommendation is perceived as either irrelevant to the threat or impossible to

carry out, spontaneous responses will be tried out to find a response that

reduces emotional tension. In sum, higher fear should result in more

persuasion, but only if a recommended action is perceived as effective in

preventing the threat.

When the recommendation fails to reduce the fear level, the drive reduction

model (Hovland et al., 1953; Janis & Feshbach, 1953) describes several

defensive reactions to a fear appeal that may serve to reduce fear. The first is

defined as inattention to message content, which results either from motivated

attempts to avoid thinking about the threat or from cognitive factors such as

reduced concentration due to too much fear. Secondly, individuals could reactto a fear appeal with aggression toward the communicator, which shows itself


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Introduction 11

in rejection of the message content or a derogation of the message source.

Thirdly, when no defensive reaction to a health threat is perceived as

successful in reducing emotional tension, delayed defensive avoidance may

occur, which means that individuals will try to actively avoid any subsequent

thinking about the health threat or minimize the importance of the threat.

Especially high levels of fear are proposed to evoke defensive reactions that

could undermine persuasion.

The introduction of these defensive reactions alters the relationship between

the level of aroused fear and persuasion. Although an increasing level of

emotional tension should lead to increased persuasion, at some point the

emotional tension will reach a level at which the reassuring recommendation

will not sufficiently reduce the tension. Residual emotional tension might give

rise to defensive avoidance, causing a decrease in persuasion. This results in a

curvilinear relationship between the level of emotional arousal and persuasion.

Extensions of the drive reduction model

Extensions of the drive-reduction model were later suggested by Janis (1967)

and McGuire (1968). Janis (1967), with his family of curves model, elaboratedthe prediction of a curvilinear relationship between fear arousal and

persuasion, and proposed that the effects of fear appeals on persuasion were

mediated by reception (i.e., attention and comprehension) of and yielding (i.e.,

acceptance) to message content. Janis proposed that fear arousal would result

in facilitating and interfering effects on reception of and yielding to message

content. Facilitating effects of fear arousal are assumed to be caused by a

heightened awareness and a heightened need for reassurance. A heightened

awareness will result in increased attention to a threat and thinking about ways

to deal with this threat. Whereas a heightened need for reassurance increases

an individuals readiness to accept an action recommendation. These facilitating

effects are proposed to be more prominent in low to moderate fear than inhigher levels of emotional arousal.

Interfering effects of fear arousal on reception of and yielding to message

content, according to Janis (1967), are mainly defensive avoidance tendencies

that interfere with acceptance. Interfering effects are more prominent in high

levels of fear, than low or moderate levels, because of a higher need for

reassurance. The combined effects of facilitating and interfering processes are

proposed to result in a curvilinear relationship between fear arousal and

persuasion: low to moderate fear arousal will lead to higher levels of

persuasion, whereas higher levels of fear will result in decreased persuasion.

McGuires reception-yielding model (1968) describes a similar theory of the

relationship between fear arousal and acceptance as the family of curves model

(Janis, 1967). McGuires reception-yielding model (1968) assumes a curvilinearrelationship between fear arousal and persuasion, and proposes that


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Chapter 112

persuasion depends on the outcome of two processes, reception of the

persuasive message and yielding to the action recommendation in the

message. McGuire proposed that the fear aroused by exposure to a fear-

arousing communication can act as a drive or a cue. When fear acts as a drive,

it can motivate individuals to accept a protective action recommendation.

However, when fear acts as a cue, it can elicit responses that interfere with the

acceptance or reception of a recommended action. The reception-yielding

model proposes that these cues and drives combined result in an overall

curvilinear relationship between the fear aroused and attitude change, in which

a moderate amount of fear arousal should produce the most attitude, intention

and behavior change.

The main contribution of the drive reduction model and its extensions

(Hovland et al., 1953; Janis 1967; McGuire, 1968) has been the focus on

defensive reactions that individuals may display in reaction to a fear-arousing

communication. In addition, a number of issues that are explicitly addressed in

later theories are also already presented in the drive reduction model, albeit

not prominently. For example, the drive reduction model addresses the role of

perceived efficacy of a recommendation and ones ability to carry it out, twoconcepts that were incorporated and featured prominently in later theories.

Support for the assumptions of the drive reduction model comes mainly

from Janis and Feshbachs (1953) classic dental hygiene experiment. Janis and

Feshbach found greater attitude and behavior change when high school

students were presented with mild rather than strong fear appeals regarding

dental hygiene. However, this finding has only rarely been replicated, and most

fear appeal studies have failed to find support for the curvilinear relationship

implied by the drive reduction model and its extension. The majority of

experiments on fear-arousing communications have found that higher levels of

fear lead to more persuasion than lower levels (see Boster & Mongeau, 1984;

Sutton, 1982; Witte & Allen, 2000).The drive reduction models assumption that the persuasiveness of a fear-

arousing communication depends on both the level of fear aroused and the

effectiveness of the recommendation to reduce fear (Hovland et al., 1953),

leads to the prediction of an interaction between these two factors. However,

most fear appeal studies have been unable to find significant fear-efficacy

interactions on persuasion (Chu, 1966; Dabbs & Leventhal, 1966; Griffeth &

Rogers, 1976; Maddux & Rogers, 1983; Rogers & Mewborn, 1976; Rogers &

Thistlethwaite, 1970). Thus, research has resulted in only limited support for

the predictions of the drive reduction model.

Parallel response model

In reaction to the shortcomings of the drive reduction model (Hovland et al.,1953), the parallel response model was developed (Leventhal, 1970). In this


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Introduction 13

model a mediator between environmental threat and action was introduced,

namely threat appraisal, and the notion that emotional arousal is a necessary

antecedent of the adaptation to danger was abandoned. According to the

parallel response model, an environmental threat is cognitively evaluated by

the individual and this appraisal can give rise to two parallel or independent

processes, namely danger control and fear control.

Fear control involves the initiation of responses in an attempt to reduce the

unpleasant feeling of fear and is proposed to be guided largely by internal cues.

Fear control entails an individuals attempt to control the unpleasant affect

evoked by fear arousal by denying or avoiding the threat. Danger control is a

problem solving process, which involves the selection and guidance of

responses aimed at averting the danger. The information used in the danger

control process consists largely of information about the environment. Danger

control involves cognitive appraisal of the coping responses.

According to the parallel response model, fear control and danger control

are two separate processes, which might interfere with one another (Leventhal,

1970). These two processes are parallel instead of sequential, which implies

that the process of danger control, which may lead to adaptive action, ispresumed to occur regardless of whether someone feels frightened. Both

processes affect the selection and guidance of instrumental actions. In fear

control, these actions are directed at controlling subjectively experienced fear

and they may have little or no effect on averting or coping with the actual

threat. In danger control, these actions are directed at coping with the threat.

Therefore, the acceptance of a recommendation is proposed to depend mainly

on the process of danger control.

The importance of the parallel response model to the understanding of fear-

arousing communication lies in its movement away from the notion of fear as

the central explanatory concept in persuasion resulting from fear-arousing

communications. Instead, the parallel response model recognizes thatindividuals responses to fear-arousing communications involve adaptive

behavior motivated by a desire to avert the anticipated danger and

expectations as to how this can be done. However, the parallel response model

lacks precision and it does not specify the conditions that lead to each of the

two processes of fear and danger control. It also does not specify when and

how these two processes interact or how people switch from one process to the

other. The model only broadly categorizes emotional and cognitive responding

as two distinct reactions to a health risk. Because of the parallel response

models lack of precision and specification of relevant processes, it has been

difficult to test this model empirically.


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Chapter 114

Expectancy-value models

Later theoretical models of fear appeals all built on Leventhals danger control

process and tried to specify the cognitive process involved in danger control.

These efforts were guided by the expectancy-value principle that holds that

behavior is a function of its expected consequences and the perceived value of

these consequences. Expectancy-value models assume that decisions between

different courses of action are based on two types of cognition: the subjective

probability that a given action will lead to an expected outcome, and the

evaluation of these action outcomes. Individuals will choose among alternative

courses of action that action that will be most likely to lead to positive

consequences or avoid negative consequences. Expectancy-value models like

Rosenstocks health belief model (1974), Rogers protection motivation theory

(1975, 1983) and Suttons subjective expected utility model (1982), all tried to

assess in a cognitive and rational manner what made individuals engage in

health enhancing behavior.

Health belief model

Even though the health belief model (Rosenstock, 1974) was not developedespecially to examine the effects of fear-arousing communications, but as a

more general model of explaining when individuals engage in health enhancing

behaviors, the model can be, and has been applied on occasion, to fear-

arousing communications (Becker et al., 1977; Kirscht, Becker & Haefner,

1978).

The health belief model (Janz & Becker, 1984; Rosenstock, 1974) assumes

that the likelihood that individuals engage in a certain health enhancing

behavior depends on the extent to which individuals believe that they are

personally susceptible to a particular disease and their perceptions of the

severity of the consequences of a disease. Susceptibility and severity combined

are assumed to determine the perceived threat of the disease. Whenindividuals perceive a threat of contracting a disease, the likelihood of engaging

in a particular health enhancing behavior will depend on the extent to which

individuals believe that the health behavior results in certain benefits that

outweigh the barriers associated wit the health behavior (see Figure 1.1).

In addition, the model proposes that certain cues to action can trigger

health behavior when appropriate beliefs are held. These cues can include a

wide range of triggers, namely individual perceptions of symptoms, social

influence and even health education campaigns. The relationship between the

variables specified by the health belief model has never been explicitly stated,

although in most studies an additive combination is assumed, while a

multiplicative function seems intuitively more plausible, at least for the

combination of vulnerability and severity (see also protection motivationtheory).


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Introduction 15

Figure 1.1. The health belief model

Research on the impact of the components specified by the health belief

model on protective health behavior has generally been supportive. Studies

have found small yet significant positive associations between protective

behavior and perceptions of susceptibility, perceptions of severity, and

perceived benefits, as well as significant negative associations between

perceived barriers and protective behavior (see Harrison, Mullen & Green,

1992; Janz & Becker, 1984).

Protection motivation theory

Protection motivation theory (Rogers, 1975, 1983) also elaborated on theparallel response models process of danger control by specifying the processes

of cognitive appraisal. Rogers identified four message components of fear

appeals that are assumed to motivate individuals to implement a protective

action: severity of a threat, probability of the threats occurrence, the efficacy

of a protective response, and ones ability to perform the protective response.

Protection motivation theory differentiates between threat appraisal and coping

appraisal processes. These two forms of appraisal are assumed to interact with

one another: when both appraisal of the threat and appraisal of the coping

responses are perceived as high, the most protection motivation and

subsequent message acceptance is proposed to occur. There are two versions

of protection motivation theory, namely the original version and a revised

version both will be described in more detail in the next sections.

Perceivedsusceptibility

Perceived severity

Perceived benefits

Perceived barriers

Belief in a

personal healththreat

Belief in theeffectiveness of ahealth behavior

Health behavior


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Chapter 116

The original protection motivation theory

The aim of the original formulation of protection motivation theory (Rogers,

1975) was to specify the message components of fear appeals that were

assumed to motivate individuals to implement a protective action. Rogers

originally distinguished three components of fear appeals that determined an

individuals response to a fear-arousing communication: a) the magnitude of

noxiousness of a depicted event, b) the probability of the events occurrence,

and c) the efficacy of a protective response. According to Rogers, protection

motivation arises from the cognitive appraisal of a depicted event as severe

and likely to occur, along with the belief that an action recommendation is

effective in preventing the occurrence of the aversive event. The primary

assumption was that these three variables have a fundamental influence on the

motivation to implement a protective action, with Rogers assuming a

multiplicative link between the processes. The amount of protection motivation

was thought to be a monotonically increasing function of the product of these

three cognitive appraisals.

Revised protection motivation theoryIn his reformulation of protection motivation theory, Rogers (1983) extended

the model into one that differentiates between threat appraisal and coping

appraisal processes (see Figure 1.2). In addition, Rogers added self-efficacy as

a fourth component of a fear appeal, which is defined as individuals confidence

in their ability to carry out a protective response (Bandura, 1977). Rogers

(1983) also added the concepts of response costs (i.e., perceived costs of

engaging in adaptive behavior) and perceived rewards (i.e., benefits of

maladaptive responses) to the model.

According to Rogers (1983), threat appraisal is an appraisal of vulnerability

to and severity of a threat and of the rewards associated with the maladaptive

response. In appraising the threat, individuals are assumed to continue toengage in maladaptive behaviors if the rewards of performing the maladaptive

behavior are greater than the perceived severity of the threat and their

perceived vulnerability to the threat. Thus, increases in rewards heighten the

probability of a maladaptive response while increases in perception of threat

decrease the probability of a maladaptive response. Coping appraisal involves

the appraisal of response efficacy and self-efficacy of the recommended

protective action and the costs of adaptive responses. In appraising coping

responses, protection motivation theory assumes that increases in perceived

response efficacy and self-efficacy increase the likelihood of adaptive behavior

while increases in response costs decrease the likelihood of adaptive behavior.

These processes of threat appraisal and coping appraisal are assumed to

interact with one another and together result in protection motivation.In sum, according to protection motivation theory (Rogers, 1983; Rogers &


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Introduction 17

Mewborn, 1976), individuals will accept an action recommendation if they feel

vulnerable to a severe health risk and if the recommendation is seen as an

effective way to reduce the threat.

The main contribution of protection motivation theory has been the

specification of some of the important components of fear-arousing

communications. Additionally, protection motivation theory has attempted to

specify the cognitive appraisals of each of these components and the

relationship between these cognitive appraisals and subsequent protective

behavior.

Figure 1.2. Protection motivation theory

Most research on fear appeals has incorporated one or more factorsspecified by protection motivation theory, and all main factors specified in

protection motivation theory have been found to affect measures of

persuasion: Increases in severity, vulnerability, response efficacy and self-

efficacy all result in more attitude, intention and behavior change (see Floyd,

Prentice-Dunn, & Rogers, 2000; Milne, Sheeran, & Orbell, 2000; Witte & Allen,

2000). In addition, decreases in maladaptive response rewards and adaptive

response costs have also been found to promote change in attitudes, intention

and behavior.

However, even though support was found for main effects of severity,

vulnerability, response efficacy and self-efficacy on measures of persuasion,

little support was found for the 3-way interaction between severity,

vulnerability and response-efficacy (Kleinot & Rogers, 1982; Maddux & Rogers,1983; Rogers & Mewborn, 1976; Rogers & Thistlewaite, 1970; Sutton & Eiser,

SeverityVulnerability

IntrinsicrewardsExtrinsic

ResponseefficacySelf-efficacy

Response costs

Threatappraisal

Copingappraisal

Protectionmotivation

Healthbehavior


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Chapter 118

1984) as proposed by the original formulation of protection motivation theory.

More support has been found for the threat appraisal by coping appraisal

interaction predicted by the revised protection motivation theory (Rogers,

1983).

Many studies have found two-way interactions between one of the threat

appraisal variables (i.e., severity or vulnerability) and one of the coping

appraisal variables (i.e., response efficacy or self-efficacy) on outcome

measures such as attitudes, intention, and behavior (Maddux & Rogers, 1983;

Rogers & Thistlewaite, 1970; Mulilis & Lippa, 1990; Wurtele & Maddux, 1987).

However, specific interactions between the four variables have been

inconsistent across studies. Whereas some studies have found that

vulnerability interacts with response efficacy (e.g., Rogers & Thistlewaite,

1970; Mulilis & Lippa, 1990), others have found that severity interacts with

self-efficacy to change attitudes, intentions or behavior (e.g., Maddux &

Rogers, 1983; Wurtele & Maddux, 1987). Moreover, even though a large

number of studies have found some interaction-effects between threat and

coping variables, an equally large number of studies have been unable to find

any of these interaction-effects (see Rogers & Prentice-Dunn, 1997).

Subjective expected utility model

The subjective expected utility model proposed by Sutton (1982) holds that

individuals choose from competing alternatives a course of action that has the

greatest subjective expected utility. A subjective expected utility is defined as a

function of the subjective values or utilities attached to the possible outcomes

of the alternative and the subjective probabilities that the alternative will lead

to those outcomes.

According to the subjective expected utility model, the decision facing

individuals who have been exposed to a fear-arousing communication can be

represented as a choice between continuing the health impairing behavior andtrying to change the behavior (Sutton, 1982; Sutton & Eiser, 1984). The model

proposes that the decision to change health impairing behavior will depend on

three factors: (1) the utility individuals attach to the health impairment; (2)

the reduction in the subjective probability of contracting this health impairment

when individuals successfully change their behavior (probability difference);

and (3) the subjective probability of succeeding in changing ones behavior,

given that an attempt is made (confidence). According to the subjective

expected utility model, these three factors should combine multiplicatively to

determine the decision to try to change behavior.

Studies assessing the effectiveness of Suttons subjective expected utility

model in explaining behavior change have produced limited support. Although

significant effects were found for both the probability difference and the utilityof the health damage on intentions (Sutton & Eiser, 1984; Sutton & Hallet,


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Introduction 19

1988), only mixed support was found for confidence (Hallet & Sutton, 1986;

Sutton & Eiser, 1984). Moreover, no evidence has been found for the

multiplicative combination of utilities and subjective probabilities (Sutton &

Eiser, 1984; Sutton & Hallet, 1988, 1989).

Extended parallel process model

The extended parallel process model (Witte, 1992, 1994) combines and

elaborates ideas from the parallel response model (Leventhal, 1970),

protection motivation theory (Rogers, 1983), as well as the drive-reduction

model (Hovland et al., 1953), and reemphasizes the role of fear in processing

and acceptance of fear-arousing communication. Leventhals parallel response

model forms the basis of the extended parallel process model, with ideas from

protection motivation theory explaining danger control, and portions of the

drive-reduction models explaining fear control. By combining ideas from these

theories the extended parallel process model attempts to explain how, through

danger control processes, fear-arousing communications can be effective in

changing attitudes, intention and behaviors, and how, through fear control

processes, they can be ineffective.According to the extended parallel process model (Witte, 1992) exposure to

a fear-arousing communication initiates two appraisal processes, namely threat

appraisal and coping appraisal. Individuals will appraise the threat that is

portrayed in a fear-arousing communication. The more individuals believe they

are vulnerable to a serious health risk (i.e., high perceptions of threat), the

more motivated they are to engage in coping appraisal. If the health risk is

perceived as irrelevant or insignificant (i.e., low perceptions of threat), the

extended parallel process model proposes there is no motivation to process a

fear-arousing communication any further, and individuals will simply ignore the

remainder of a fear-arousing communication. In contrast, when a health risk is

believed to be severe and individuals feel vulnerable, the extended parallelprocess model assumes that individuals will become scared. The fear aroused

should motivate individuals to take any action that will reduce their fear.

Perceived efficacy of the recommended action (i.e., response efficacy and

self-efficacy) will determine whether individuals, who believe that they are

susceptible to a serious risk, will engage in danger or fear control (see Figure

1.3). Witte (1992, 1994) assumes that individuals will mainly engage in danger

control when they perceive the recommended action as effective in reducing

the health risk, and they will mainly engage in fear control when they perceive

the recommended action as ineffective in reducing the threat, or when they

feel unable to perform the recommended action. In that case (i.e., high

perceived threat and low perceived efficacy) defense motivation is elicited,

which the extended parallel process model defines as individuals focusing oneliminating their fear through denial, defensive avoidance or reactance. In


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Chapter 120

sum, the extended parallel process model assumes that perceived threat

determines the magnitude of the response to a fear-arousing communication,

whereas perceived efficacy determines the direction of the response (i.e.,

danger or fear control).

Figure 1.3. Extended parallel process model

Note Adapted from Witte (1994)

The extended parallel process model has succeeded in integrating ideas of

both protection motivation theory (Rogers, 1983) and the parallel response

model (Leventhal, 1970), and has extended these ideas by identifying how

threat appraisal and coping appraisal relate to each other, and by specifying

the role of perceived fear in threat and coping appraisal.

Research testing the predictions of the extended parallel process model has

mainly been supportive (McMahan, Witte, & Meyer, 1998; Morman, 2000;Witte, 1994; Witte & Morrison, 2000). Studies have found effects of both threat

and efficacy on intention and behavior, with intention and behavior change

being the highest when both perceptions of threat and efficacy were high.

However, the predicted interaction-effect between threat and efficacy has not

always been found (see the previous section on protection motivation theory).

Fear arousal models

Recently, attempts have been made to integrate or elaborate the fear appeal

theories described in the previous sections, by emphasizing the importance of

fear arousal (LaTour, & Rotfeld, 1997; Ruiter, Abraham & Kok, 2001; Tanner,

Hunt & Eppright, 1991). LaTour and Rotfeld (1997) propose an arousal model

in which they assume a positive monotonic relationship between fear arousaland persuasion. They assume that the amount of fear aroused by a threatened

Perceived efficacy(Responseefficacy & Self-efficacy)

Perceived threat(Susceptibility &Severity)

Protectionmotivation

Messageacceptance

Defensemotivation

Messagerejection

Fear

No threat

perceived(no response)


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Introduction 21

event should correspond to the perceived probability of a threatened event.

Integrating ideas from protection motivation theory (Rogers, 1983) into their

model, La Tour and Rotfeld (1997) propose that the perceived probability of

the event, as well as individual feelings of being able to engage in the

protective action, should generate energy, which in turn should have a positive

effect on attitudes and intentions. Fear arousal is proposed to have direct and

indirect effects on persuasion. Fear arousal can affect intentions indirectly

through attitudes or directly by a seemingly instantaneous process that is

followed by a cognitive focus on behavioral intentions.

Ruiter and colleagues (2001) integrated ideas from protection motivation

theory (Rogers, 1983) and the extended parallel process model (Witte, 1992),

emphasized the important role of fear arousal in both threat appraisal and

coping appraisal, and specified conditions under which fear arousal can directly

influence intentions. Their model assumes that exposure to information about a

health risk arouses fear, which may generate fear control processes or affect

protection motivation independently of threat perceptions (Ruiter et al., 2001).

They propose complex and possibly opposing relationships between fear

arousal and protection motivation. Fear arousal is assumed to strengthenthreat perceptions, affect protection motivation, or induce automatic fear

control processes. Fear control processes in turn, are assumed to result in

either protection motivation that heightens intentions, or may lead to denial

and other forms of avoidant coping. In addition, the impact of fear arousal on

protection motivation is proposed to be moderated by the intensity of the

emotion and individual characteristics.

The ordered protection motivation model (Eppright, Tanner, & Hunt, 1994;

Tanner et al., 1991) elaborates ideas from protection motivation theory

(Rogers, 1983) by specifying the role that fear arousal can play in the process

of threat appraisal. The ordered protection motivation model (Tanner et al.,

1991) proposes that when threat appraisal precedes coping appraisal,increased fear arousal will motivate attention to the threat and coping

appraisal. The heightened levels of threat and coping appraisal in turn are

assumed to lead to greater adaptive behavioral intentions. Fear arousal in the

absence of efficacy information is assumed to cause maladaptive responses

that reduce the probability of threat perceptions without removing the actual

danger.

Dual process theories

Even though all major fear appeal theories, as described in the previous

sections, assume that fear arousal and/or cognitive processes mediate

persuasion, none of these theories have made predictions about information

processing, and measures of information processing (e.g., cognitive responses)have been virtually absent in research on fear-arousing communications. This


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Chapter 122

situation changed with the advent of dual-process theories of persuasion

(Chaiken, 1980; Eagly & Chaiken, 1993; Petty & Cacioppo, 1986), which were

also applied to account for the impact of fear-arousing communications on

persuasion (e.g., Gleicher & Petty, 1992; Liberman & Chaiken, 1992). With the

introduction of dual-process theories the emphasis in research on fear appeals

shifted from studying the effects of communication variables on attitudes and

behavior, to studying the processes by which these effects are brought about.

More specifically, attention was drawn to studying the effects of fear appeals on

message processing.

Dual-process theories of persuasion, like the elaboration likelihood model

(Petty & Cacioppo, 1986) and the heuristic-systematic model (Chaiken, 1980;

Eagly & Chaiken, 1993), focus on information processing as well as persuasive

outcomes. Dual-process models differentiate between two distinct modes of

information processing, which differ in the extent to which individuals are

assumed to engage in effortful processing of the information contained in a

message. Although the elaboration likelihood model and the heuristic-

systematic model are different in some ways, their general conceptualization of

these two modes of processing is rather similar.The first mode of information processing is called systematic processing in

the heuristic-systematic model (e.g., Chaiken, 1980), and is named central

route in the elaboration likelihood model (e.g., Petty & Cacioppo, 1986). This

processing mode involves effortful scrutiny of message arguments and other

relevant information. In contrast, the second mode of information processing

(which is called heuristic processing in the heuristic-systematic model, and

named peripheral route in the elaboration-likelihood model) involves use of

heuristics, which are simple rules of inference such as experts are always

right. The peripheral route is defined more broadly, and involves an additional

variety of low-effort mechanisms such as conditioning and social identification.

These mechanisms are based on peripheral cues, stimuli that are capable ofaffecting persuasion but are not related to message content, for example the

source of a communication.1

According to dual process theories (Chaiken, 1980; Petty & Cacioppo,

1986), individuals will base their attitudes about a persuasive message either

on thoughts provoked by the message content or on factors unrelated to the

content, such as cues or heuristics associated with the message. Which mode

of processing will be used depends on individuals motivation and ability to

carefully process a persuasive message. According to dual-process theories,

processing motivation and ability determine the elaboration likelihood of a

message (i.e., scrutiny of issue-relevant arguments contained in the message).

At low levels of motivation and ability, heuristic processing prevails, while at

increasing levels of motivation and ability systematic processing becomesincreasingly dominant, and the impact of heuristic mechanisms fades.


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Introduction 23

The elaboration likelihood model proposes several factors that can influence

individuals motivation and ability to process information systematically (Petty

& Cacioppo, 1986). The abilityto process information systematically is

assumed to depend on, among others; the amount of distraction from a

message, message repetition, prior knowledge, and message

comprehensibility. Motivation to process information systematically is proposed

to depend on among others: personal relevance, need for cognition, and

personal responsibility. One of the most important factors proposed by dual

process theories to influence motivation for systematic processing is the

personal relevance of a persuasive communication. Personal relevance refers to

the importance of a communication for an individual (Petty & Cacioppo, 1986).

Higher levels of personal relevance are assumed to increase processing

motivation and, consequently, elaboration likelihood (see Johnson & Eagly,

1989). This concept of personal relevance is related to the concept of personal

vulnerability/susceptibility used by most fear appeal theories (e.g., Rogers,

1983; Witte, 1992). Both concepts refer to the importance of a persuasive

message for an individual.

When an individual is both motivated and able to carefully process apersuasive message, systematic processing will occur (Petty & Cacioppo,

1986). Persuasion then is assumed to depend on the quality of the arguments

contained in the message: strong supporting arguments will lead to more

persuasion than weak supporting arguments. When an individual is not

motivated or unable to process a persuasive message, heuristic processing can

occur. If that is the case, persuasion will not depend on intensive processing of

the message content, and the quality of the arguments used in the persuasive

message will have no effect on the individuals attitudes. Instead, any kind of

cognitive, affective or social cue or heuristic may produce attitude change

(e.g., number of arguments used in an action recommendation or emotions

evoked by the message).Whereas dual-process theories initially only focused on accuracy-motivation

(i.e., the motivation to hold correct attitudes), as described previously, later

alternative motives were incorporated into dual-process theories, which were

elaborated into the multiple-motive heuristic-systematic model (Chaiken,

Liberman, and Eagly, 1989; Chen & Chaiken, 1999). This model proposes a

range of motives that systematic and heuristic processing may serve in

addition to accuracy-motivation, including defense motivation. Defense

motivation is the desire to form or to defend particular attitudinal positions.

Defense-motivated individuals strive to confirm the validity of a preferred

position and to denounce non-preferred ones, and this is assumed to result in

biased message processing. Thus, defense-motivated individuals will process

information in a way that best supports individual beliefs.Applying dual-process theories to fear-arousing communications, fear


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Chapter 124

arousal is assumed to have two effects, namely act as a motivator to induce

recipients to engage in intensive and thoughtful message processing, and

induce defense motivation, which will lead to biased message processing

(Gleicher & Petty, 1992; Liberman & Chaiken, 1992). Whereas the unbiased or

accuracy-motivated perceiver assesses the validity of attitude-relevant

information in the interest of achieving a well-founded position, the processing

goal of defense-motivated recipients is to confirm the validity of a preferred

position and disconfirm the validity of non-preferred positions. Thus, defense-

motivated individuals will process and perceive information in ways that best

support their own beliefs. This implies that information that is congruent with a

particular preferred position will be judged as more valid than information that

is incongruent with this position (e.g., Ditto & Lopez, 1992; Pyszczynski &

Greenberg, 1987).

Studies that assessed the impact of vulnerability and severity on the

processing of fear-arousing communications have found evidence for the

biased processing of health threat information. These studies in particular have

shown that individuals are more critical of evidence that is highly health

threatening than of less threatening evidence (Ditto & Lopez, 1992; Janis &Terwilliger, 1962; Kunda, 1987; Liberman & Chaiken, 1992; Reed & Aspinwall,

1998; Sherman, Nelson, & Steele, 2000). Thus, these studies support the

assumptions of biased processing through defense motivation.

A stage model of processing of fear-arousing communications

The fear appeal theories and the dual-process theories of attitude change

described in the previous sections have provided two distinct theoretical

frameworks to explain the persuasive impact of fear-arousing communications.

These two different outlooks on the workings of fear appeals have been

integrated and extended in one theoretical framework, the stage model ofprocessing of fear-arousing communications (Das et al., 2003; Stroebe, 2000).

The stage model integrates ideas derived from dual-process theories (e.g.,

Chaiken, 1980), with those of earlier theories of fear-arousing communications

(Leventhal, 1970; Rogers, 1983; Witte, 1992) into a theoretical framework that

emphasizes the importance of severity of and, in particular, vulnerability to a

health risk in promoting the acceptance of fear-arousing communications. In

addition, the stage model elaborates the processing of fear-arousing

communications by specifying the cognitive processes that occur, depending on

perceived severity and vulnerability.

In line with most fear appeal theories (e.g., Rogers, 1983; Witte, 1992), the

stage model assumes that individuals exposed to a fear-arousing

communication engage in two types of appraisal, namely appraisal of thehealth risk, and appraisal of coping strategies available for reducing or


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Introduction 25

eliminating the health risk. The model further observes that these two

appraisal processes parallel the two components of fear-arousing

communications, namely the fear appeal, which emphasizes the severity of and

vulnerability to the health risk, and the action recommendation, which provides

information on how to avoid the health risk. Expanding upon the differentiation

between appraisal of threat and appraisal of coping (e.g., Rogers, 1983; Witte,

1992), the stage model makes specific differential predictions for the appraisal

processes at each of these two stages, based on assumptions derived from

dual-process theories of attitude change (e.g., Chaiken, 1980).

Appraisal of the magnitude of a threat, based on the information in a fear

appeal about the severity of and personal vulnerability to a risk, is assumed to

determine both individuals processing mode (i.e., depth of processing) and

their processing goal (i.e., accuracy or defense motivation), which is visually

represented in Figure 1.4. According to the stage model, if a health risk is

trivial and individuals do not feel vulnerable to the health risk (i.e., low

vulnerability and low severity), they are unlikely to be motivated to invest

much effort in thinking about the contents of the communication and they

might rely on heuristic processing modes.

Figure 1.4. The impact of severity and vulnerability on processing mode and goal

Severity

Low High

Low Heuristic processing

Accuracy motivation

Systematic processing

Accuracy motivation

Vulnerability

High Systematic processing

Accuracy motivation

Systematic processing

Defense motivation

In contrast, if individuals feel vulnerable to a minor health risk (i.e., high

vulnerability and low severity), the feeling of vulnerability should be sufficient

motivation to invest effort into systematically processing the contents of the

communication. This is in line with the assumption from dual-process theories

that personal relevance, which is a similar concept to perceived vulnerability, is

an important motivator for systematic processing (e.g., Eagly & Chaiken,

1993).

Similarly, if individuals do not feel vulnerable, but a health risk is depicted

as severe (i.e., low vulnerability and high severity), individuals are likely to

invest effort in processing the contents of a communication describing a severe

risk, because it is useful to be well informed about a serious health risk, even if

the danger is not immanent. In other words, the stage model proposes that


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Chapter 126

systematic processing can also occur in the absence of high personal relevance.

In this respect the stage models assumption about information processing

differs from the dual-process theories that state that personal relevance is an

important precondition for the motivation for systematic processing (e.g., Eagly

& Chaiken, 1993).

The situation the stage model elaborates on most is the condition in which

both vulnerability and severity are high. According to the stage model, if

individuals are exposed to information about a severe health risk and if they

feel vulnerable to this risk (i.e., high vulnerability and high severity) they will

feel personally threatened. In this situation, individuals will especially

experience threat to their self-definitional belief of being healthy, which will

arouse defense motivation as well as the motivation to carefully scrutinize the

information given. The stage model assumes that processing will be systematic

instead of heuristic because any communication describing a serious personal

health threat is likely to require a thorough evaluation (Chaiken et al., 1989).

According to the stage model, defense motivation can manifest itself not only

in avoidance reactions, as previous fear appeal models have proposed (e.g.,

Witte, 1992), but more likely is evident in systematic processing that is biased.The direction of the bias aroused by defense motivation is proposed to vary

with the type of appraisal. The stage model proposes a negative processing

bias in the appraisal of the threat and a positive processing bias in the

appraisal of coping strategies.

In appraising the health risk (Stage 1), defense-motivated individuals will

attempt to minimize the threat by critically looking at the content of a fear

appeal. They will try to criticize and downplay the information in order to

reduce the threat. Defense-motivated individuals will engage in a biased search

for inconsistencies and logical errors, and their evaluation of evidence will

consequently be biased in the direction of their preferred conclusion (Ditto &

Lopez, 1992; Liberman & Chaiken, 1992; Sherman et al., 2000). If thisstrategy proves unsuccessful, because even biased processing is constrained

by evidence and rules of inference (Kunda, 1987), individuals will have to

accept that they are personally at risk.

In this case, the subsequent processing of a recommendation will be biased

as well (Stage 2), but in the opposite direction. Under defense motivation, an

action recommendation is proposed to be maximized. Because an action

recommendation contains a possible solution to the health risk, it can moderate

the negative emotions and cognitions evoked by the threat appraisal. At this

stage, the processing goal of defense-motivated individuals will, thus, be to

find the protective action effective, because then these individuals can feel

save.

Even though the easiest way would be to accept the recommendationwithout scrutinizing the arguments contained in the message, it is not likely


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Introduction 27

that heuristic processing strategies will prevail when serious personal health

risks are involved (e.g., Chaiken et al., 1989). The processing will instead

involve attempts to make the recommendation appear highly effective by

means of a biased search for arguments supporting the effectiveness of the

protective action, and through biased evaluation of these arguments. In other

words, defense motivation will lead to a positive bias in the processing of the

action recommendation, and consequently heighten the motivation to accept a

solution to a particular threat, regardless of the quality of the arguments

supporting this recommendation.

This prediction of the stage model is contrary to predictions of most fear

appeal theories that assume an interaction between perceptions of threat and

efficacy (e.g., Hovland et al., 1953; Rogers, 1983; Witte, 1992). Most fear

appeal theories propose that high perceptions of threat will only lead to

persuasion if the recommended action is effective. The stage model, however,

assumes that defense-motivated individuals will be motivated to perceive any

recommendation as effective, as long as it is at least somewhat plausible,

because engaging in a recommended action will make these individuals feel

save.The stage model makes some more specific predictions with respect to the

effectiveness of a fear-arousing communication. Whereas other fear appeal

theories often hold the same predictions for all measures of persuasion, the

stage model makes the important distinction between measures of persuasion

that assess attitudes and those that measure behavioral intentions or behavior.

Attitudes about a protective action are assumed to be based mainly on an

evaluation of the provided information. Individuals are proposed to have more

positive attitudes towards a protective action if the recommendation is

supported by strong arguments rather than weak arguments, and, because of

more elaboration, when a health risk is described as more serious. Yet, when it

comes to measures of persuasion that have behavioral implications (i.e.,intentions and behavior), the stage model assumes that individuals will only be

motivated to engage in the protective action if they actually feel vulnerable.

After all, why should one invest effort into avoiding a risk, if one does not feel

personally at risk?

The only direct test of the predictions of the stage model can be found in a

series of experiments reported by Das, de Wit and Stroebe (2003). These

studies assessed the effects of the severity of and vulnerability to a health risk

on the processing and acceptance of an action recommendation, which was

supported by high or low quality arguments. In these experiments, the fear

appeal described the health consequences of stress as either severe or mild

and the recommended protective action advocated a stress management

training, which was either supported by strong or weak arguments. Theassignment to different stress vulnerability conditions was based on self-


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Chapter 128

measures of perceived vulnerability in Experiments 1 and 2, but was

manipulated in Experiment 3.

Consistent with predictions from the stage model, these experiments

revealed a positive bias in the processing of the action recommendation under

high vulnerability: Vulnerable respondents reported more positive thoughts

about the action recommendation than non-vulnerable respondents did,

regardless of the quality of arguments supporting the recommendation.

Furthermore, vulnerability proved to be the only determinant of engaging in

the recommended action: Vulnerable respondents had higher intentions and

reported more behavior change than non-vulnerable respondents.

However, findings were less consistent for predictions concerning attitudes

towards the recommendation. In particular, the impact of argument quality on

attitudes towards the recommended action varied across experiments, thus

weakening the case for systematic processing. Attitudes were affected by both

vulnerability and argument quality in Experiment 1 and 2, with respondents

having more positive attitudes when they felt vulnerable than when they did

not, and when the recommendation was supported by strong arguments rather

than weak arguments. However, this pattern was not replicated in Experiment3, in which argument quality failed to have any effect on attitudes, and an

interaction-effect between vulnerability and severity was found. Vulnerable

respondents were found to have more positive attitudes towards the

recommendation, than non-vulnerable respondents, but only when the

negative consequences of stress were depicted as severe.

Further shortcomings of these earlier experiments are that: (1) only one

study experimentally manipulated vulnerability; (2) the experiments only

focused on the processing of the action recommendation, and no attention was

given to the processing of the fear appeal; (3) no attempt was made to analyze

additional factors that might influence the impact of fear-arousing

communications on persuasion.

Overview

The present thesis will further examine the processing of fear-arousing

communications from the perspective of the stage model of the processing of

fear-arousing communications. Experiments will be reported that examine the

processing of both the fear appeal and the recommended action, and the

subsequent effects on persuasion. In these experiments severity of and

vulnerability to different health risks will be manipulated/varied, as will be

aspects of the recommended action (e.g., argument quality, source expertise,

and response costs), and aspects outside the communication (e.g., personality

factors). The aim of this thesis is to provide more insight into the conditionsunder which fear-arousing communications are (in)effective, and, more


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Introduction 29

importantly, to specify how and why they are (in)effective.

In Chapters 2 through 4, the processing of the action recommendation is

examined, using an experimental design that manipulates respondents

vulnerability to Repetitive Strain Injury (RSI) (i.e., mouse-arm) through false-

feedback on a bogus RSI-test, after which respondents are presented with a

message depicting the consequences of RSI as severe. This is followed by a

message describing an action recommendation (i.e., stress management

training), which is supported by either strong or weak arguments.

According to the stage model, exposure to the severe negative

consequences of RSI should induce systematic processing in all respondents,

and the quality of the arguments used in the recommendation should,

therefore, affect attitudes towards and cognitive responses about this

recommendation. In addition, making respondents feel vulnerable to these

negative consequences of RSI should arouse defense motivation. Defense-

motivated individuals are assumed to be motivated to accept an action

recommendation. They should, therefore, have more positive thoughts about

the recommendation, regardless of argument quality. Attitudes toward the

recommendation are assumed to remain unbiased by defense motivation, andshould be determined purely by argument quality. Regarding intentions to

engage in the recommendation, and actual signing up for it, it is expected that

only individuals who feel vulnerable should want to do so.

The experiment reported in Chapter 2 additionally examines the role of the

expertise of the source to which the recommendation is attributed in the

processing and acceptance of fear-arousing communications. Source expertise

can act as a heuristic cue (e.g., Eagly & Chaiken, 1993) and is manipulated to

further examine depth of information processing by attributing the action

recommendation either to a professor in medicine or to a housewife. Since the

stage model assumes that with a severe health risk all individuals should

process the content of the recommended action systematically, and not merelyrely on heuristic cues to evaluate the efficacy of the recommendation, the

source to which a recommendation is attributed should have little impact on

attitudes.

In the study reported in Chapter 3 the experiment presented in Chapter 2 is

replicated and extended. In this study, the impact of the costs of engaging in

the proposed protective action is examined by manipulating the amount of

effort that is required (response costs). Because of the stage models

assumption of a positive bias in the processing of action recommendations, the

effort required to engage in the protective action should have less impact on

intention and behavior when individuals feel vulnerable to the health risk.

In Chapter 4, the focus moves away from the influence of components of a

fear-arousing communication, towards the impact of individual differences ofrecipients on the effects of a fear-arousing communication. The experiment


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Chapter 130

presented in Chapter 4 explores the role of two personality factors,

dispositional optimism and neuroticism, on the processing and acceptance of

fear-arousing communications. It is expected that these personality factors

should have some effect on processing and acceptance of fear-arousing

communications, but these effects are assumed to not overrule the expected

effects of manipulated vulnerability and argument quality.

Respondents high on neuroticism exposed to a fear-arousing communication

are expected to react with more negative emotions, but because of their known

avoidant or inactive ways of coping (Costa & McCrae, 1987), neuroticism

should not have much of an effect on any of the other dependent variables,

especially those that have behavioral implications. In contrast, optimistic

respondents are expected to experience less negative emotions, and, because

of their general positive outlook on life and known active and problem-focused

coping (Scheier & Carver, 1985), optimists should have more positive reactions

to the action recommendation, affecting cognitive responses, attitudes, as well

as intentions and behavior.

Chapter 5 will examine the processing of both the fear appeal and the action

recommendation, attempting to shed more light on the processes that lead toacceptance of fear-arousing communications. Three experiments are reported

that use a slightly different design to the one used in the experiments reported

in the previous chapters, and focus on different health risks (e.g., alcohol

consumption and hypoglycemia). In addition, in these experiments the severity

of the consequences is manipulated (low/high), instead of holding high severity

constant.

The first experiment focuses on the processing of a fear appeal. This study

varies vulnerability to alcohol consumption based on respondents self-

measures of perceived vulnerability. Respondents read a message depicting the

negative consequences of alcohol consumption as either mild or severe, and no

protective action is specifically recommended in detail. In accordance with theassumptions of the stage model, a fear appeal should generate thoughts that

reveal attempts to minimize the threat, which would indicate a negative

processing bias. Because defense motivation is assumed to be aroused

especially when respondents feel vulnerable and when the consequences of the

health risk are depicted as severe, respondents who feel vulnerable and are

exposed to the severe negative consequences of alcohol consumption should

experience more negative emotions and have more minimizing thoughts than

respondents in all other conditions.

The second experiment replicates and extends Experiment 1. Instead of

relying on respondents self-measures, respondents vulnerability to

hypoglycemia (i.e., low blood glucose levels) is manipulated by bogus feedback

on a hypoglycemia test. This is again followed by a message depicting thenegative consequences of hypoglycemia as either mild or severe, and no


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Introduction 31

protective action is specifically offered. In addition, Experiment 2 also includes

as an extra factor a manipulation of message source, but in this experiment the

focus is on source credibility (instead of source expertise as in Chapter 2), by

attributing the severity message either to a scientific journal or to a popular

women magazine. Source credibility is manipulated to provide an explicit test

of the depth of processing expectations. When the likelihood of systematic

processing is low, source credibility can operate as a heuristic cue and should,

hence, affect the persuasive impact of a message mainly in heuristic processing

(i.e., when both vulnerability and severity are low).

Lastly, the third experiment focuses on both the processing of the fear

appeal and the subsequent action recommendation. The experiment is similar

to Experiment 2, only this time a protective action is specifically recommended,

in the form of stress management training. This recommendation is supported

by weak or strong arguments.

In Chapter 6, a shift is made from original experiments to the body of

previous empirical research on fear appeals, by looking at how the results of

the experiments presented in this thesis relate to findings in earlier empirical

studies on fear-arousing communications. An extensive meta-analysis of fearappeal experiments published to date will be reported in this chapter. In this

meta-analysis the effects of both vulnerability and severity as well as other

communication variables on the processing and acceptance of fear-arousing

communications are examined, attempting to find more general support for the

assumptions derived from the stage model. Finally, Chapter 7 summarizes and

discusses the findings reported in the previous chapters, as well as dwells on

their theoretical and practical implications.

All empirical chapters in this thesis (Chapters 2 through 6) were written as

separate papers that have been published or have been submitted for

publication in scientific journals. Therefore, there is some similarity and

repetition between chapters, especially in the introduction and methodsections. Because these chapters consist of separate papers they can be read

independently.

1In the remainder of this chapter, the names specified by the heuristic-systematic model

will be used for the two modes of information processing. Thus, where the terms

systematic and heuristic processing are used one could also read central route and

peripheral route processing.


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Chapter 2: The impact of fear appeals on processing andaccepting action recommendations: the key role ofvulnerability1

Fear appeals are still widely used in health education, even though the

mechanisms mediating their impact are not well understood. The experiment

presented in this article assesses predictions derived from a recently developed

stage model of fear-arousing communications (Das, de Wit & Stroebe, 2003;

Stroebe, 2000), a theoretical framework which builds on previous fear appeal

theories (Leventhal, 1970; Rogers, 1983; Witte, 1992), cognitive stress theory

(Lazarus & Folkman, 1984), as well as on dual process theories of attitude

change (Chaiken, 1980; Chaiken, Liberman & Eagly, 1989; Petty & Cacioppo,

1986). To test our model we studied the impact of a single strong fear-

arousing communication on the acceptance of an action recommendation. To

examine some of the processes underlying changes in attitude, intention and

behavior, we manipulated respondents vulnerability to a severe health risk, as

well as two factors presumed to influence the acceptance of a recommended

protective action, namely the expertise of the communicator and the strengthof the arguments contained in the action recommendation.

Theoretical approaches to the study of fear-arousing communications

Most research on fear appeals has been conducted before the advent of dual

process theories of attitude change. Initially, this research was theoretically

guided by reinforcement theory (Hovland, Janis & Kelley, 1953). Later

cognitive theories were applied, such as the parallel response model

(Leventhal, 1970), protection motivation theory (Rogers, 1975, 1983), and

more recently the extended parallel process model (Witte, 1992). These later

theories abandoned the notion central to reinforcement theory that fear is a

necessary antecedent of behavioral adaptation to danger.According to Leventhal (1970), appraisal of an environmental threat can

give rise to two independent processes, namely danger control and fear

control, with danger control involving the instrumental actions the individual

performs in order to reduce the threat. Actions in the service of fear control,

such as avoidance actions (including defenses) as well as attempts to control

the emotional response (e.g., drinking alcohol) frequently have no effect on

1 This chapter has been published as: De Hoog, N., Stroebe, W., & de Wit, J.B.F. (2005).

The impact of fear appeals on processing and acceptance of action recommendations.

Personality and Social Psychology Bulletin, 31(1), 24-33.


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Chapter 234

danger. Whereas protection motivation theory focused exclusively on

elaborating Leventhal's danger control process, Wittes extended parallel

process model reemphasized the role of fear by elaborating conditions under

which fear control is likely to affect danger control. However, even though

research on fear appeals resulted in evidence that high fear messages produce

more change than low fear messages (e.g., Boster & Mongeau, 1984; Sutton,

1982; Witte & Allen, 2000), these empirical studies have not succeeded in

completely clarifying the theoretical assumptions about underlying mechanisms

(Eagly & Chaiken, 1993, pp. 442-446).

With the advent of dual process theories of attitude change (e.g., Chaiken,

1980; Petty & Cacioppo, 1986), research began to focus on the processing of

the arguments contained in a communication as well as on the outcome of

persuasion. According to dual process theories, fear arousal can have two

effects, namely (1) act as a motivator to induce recipients to engage in

intensive and thoughtful message processing, and (2) induce defense

motivation, which will lead to biased message processing (Gleicher & Petty,

1992; Liberman & Chaiken, 1992).

In contrast to the unbiased or accuracy-motivated perceiver who assessesthe validity of attitude-relevant information in the interest of achieving a valid

position, the processing goal of defense-motivated recipients is to confirm the

validity of a preferred position and disconfirm the validity of non-preferred

positions. Thus, defense-motivated individuals will process information in ways

that best support their own beliefs. This implies that information that is

congruent with a particular preferred position will be judged as more valid than

information that is incongruent with this position (Ditto & Lopez, 1992; Lord,

Ross & Lepper, 1979; Pyszczynski & Greenberg, 1987).

A stage model of processing of fear-arousing communications

Integrating ideas from dual process theories of persuasion, previous fearappeal theories and cognitive stress theory (Lazarus & Folkman, 1984), we

developed a stage model of processing of fear-arousing communications (Das

et al., 2003; Stroebe, 2000). In line with cognitive stress theory, our model

assumes that individuals exposed to fear-arousing communications engage in

two types of appraisal, namely (1) appraisal of the threat, and (2) appraisal of

coping strategies available for reducing or eliminating the threat. These two

appraisal processes parallel the two components of fear-arousing

communications, namely the fear appeal, which emphasizes the severity of the

health risk and individual vulnerability, and the action recommendation, which

provides information on how to avoid the health risk.

Expanding upon the differentiation between appraisal of threat and

appraisal of recommendations (e.g., Leventhal, 1970; Witte, 1992), our stage


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Chapter 236

At this stage, the processing goal of defense-motivated individuals will be to

find the protective action effective, because then they can feel safe. Although

the easiest way to feel reassured would be to accept the recommendation

without scrutinizing the arguments contained in the message, it is not likely

that shallow processing strategies will prevail when serious health risks are

involved. We, therefore, propose that vulnerability to a severe health risk

motivates individuals to process the action recommendation in a manner that is

both biased and deep. The processing will involve attempts to make the

recommendation appear highly effective by means of a biased search for

arguments supporting the effectiveness of the protective action, and through

biased evaluation of these arguments. This type of processing is likely to result

in increased persuasion regardless of the quality of the arguments supporting

the recommendation.

If an individual does not feel vulnerable, a health risk, no matter how

severe, is unlikely to arouse defense motivation. Yet, even non-vulnerable

individuals are likely to invest effort in processing the contents of a

communication depicting a severe risk, because it may be useful to be

informed about a serious health risk, even if the danger is not immanent. Inthis respect, our stage model differs from dual process theories that state that

personal relevance is a precondition for deep information processing.

The appraisal processes are less elaborate under conditions of low severity,

because if a health risk is trivial and the individual does not feel at risk, he/she

is unlikely to invest great effort in thinking about the arguments contained in

the communication. Even if the individual does feel vulnerable to a trivial

health risk, there is no reason to be defensive. For these reasons the current

study focuses on reactions following exposure to a message depicting severe

health consequences.

An important distinction with respect to persuasion that is emphasized by

our stage model is that between outcome measures that rely on attitudes andthose that assess behavioral intentions or behavior (Fishbein & Ajzen, 1975).

In deriving predictions about the impact of action recommendations one has to

distinguish between the impact of fear appeals on attitude towards the

recommendation and on intention to act on it. For individuals who do not feel

vulnerable, a severe health risk will lead to a positive attitude towards a

protective action, if the recommendation is supported by strong arguments and

to a negative (or less positive) attitude if it is supported by weak arguments.

Yet, individuals will only be motivated to engage in the protective action, if

they feel vulnerable. After all, why should one invest effort into avoiding a

health risk, if one does not feel personally at risk?

How does our stage model differ from earlier theories, such as Leventhals

parallel response model (1970), Wittes extended parallel process model


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the key role of vulnerability 37

(1992) or Rogers protection motivation theory (1983)? We share with these

theories the assumption that the emotional response to a threat is an

independent (i.e., parallel) response to the threat and not a mediator of the

instrumental action. Furthermore, we build on these theories with regard to

key factors for threat perceptions (i.e., severity and susceptibility) and efficacy

perceptions. However, our theoretical reasoning also differs from that of these

models. Whereas Leventhal and Witte emphasize the distinction between two

parallelmodes of coping, namely problem-focused (danger control) versus

emotion-focused coping (fear control) our stages refer to the distinction

between primary (threat) and secondary (coping) appraisal. Furthermore, we

relate these two types of appraisal to modes and motives of information

processing, whereas none of the earlier theories make assumptions about

information processing. Finally, neither Leventhal, Witte or Rogers make

differential predictions regarding outcome measures.

Empirical evidence

Most of the studies, which assessed the impact of vulnerability on the

processing of fear-arousing communications, have focused exclusively on theprocessing of fear appeals (Stage 1). There is now ample evidence that people

are more critical of evidence, which is highly health-threatening, than of less

threatening evidence (Ditto & Lopez, 1992; Janis & Terwilliger, 1962; Kunda,

1987; Liberman & Chaiken, 1992; Reed & Aspinwall, 1998; Sherman et al.,

2000). Much less research has been conducted on the processing of action

recommendations (Stage 2), and the few studies on this topic either failed to

manipulate vulnerability experimentally (Jepson & Chaiken, 1990) or failed to

include measures of cognitive processing (Gleicher & Petty, 1992).

The only direct tests of the predictions from our stage model are three

experiments by Das et al. (2003). These studies assessed the effect of the

severity of, and vulnerability to a threat on the processing and acceptance ofan action recommendation, which was supported by high or low quality

arguments. Consistent with predictions, these studies revealed a positive bias

in the processing of the action recommendation under high vulnerability:

Vulnerable respondents reported more positive thoughts about the

recommendation than non-vulnerable respondents. Furthermore, vulnerability

proved to be the only determinant of individuals intention to engage in the

recommended action. Findings were less consistent for attitudes. In particular,

impact of argument quality on attitudes varied across experiments, thus

weakening the case for deep processing. A further shortcoming of this research

program was that only one study experimentally manipulated vulnerability.

Therefore, the present study was conducted in order to clarify inconsistencies

and provide further support for the assumptions of our stage model.


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Chapter 238

Design overview

Extending the research by Das and colleagues (2003), the present study

focused on the processing and acceptance of the action recommendation

(Stage 2). We used the health consequences of RSI (Repetitive Strain Injury;

mouse arm) for the fear appeal. Respondents vulnerability to RSI was

manipulated, as was argument quality in the action recommendation. To allow

a further test of whether respondents processing of the message was deep or

shallow, we also manipulated a second factor that traditionally has been used

in dual-process research to identify depth of processing, namely source

expertise. Source expertise operates as a heuristic cue and should affect the

impact of a message mainly for shallow processing.

Severity of the health consequences was not manipulated but kept constant

and high in all conditions. We expected that a severe health risk would induce

deep processing and that argument quality would therefore affect attitudes and

cognitive responses. Since we expected that with a severe health risk all

individuals would process the content of the recommendation and not rely on

heuristic cues, our source expertise manipulation should have little impact on

attitudes. We further expected that inducing vulnerability to a severe healthrisk would arouse defense motivation. Since individuals who feel vulnerable to

a serious health risk should be motivated to accept the action recommendation,

they should overestimate the effectiveness of the recommendation and have

more positive thoughts about the action, regardless of argument quality. We

therefore predicted a main effect of vulnerability on cognitive responses and an

interaction of argument quality and vulnerability on attitude, with argument

quality having a stronger impact on low rather than high vulnerable individuals.

With regard to respondents intentions and with regard to their actions, we

predicted only a main effect of vulnerability. Since individuals who do not feel

vulnerable, should not seek to engage in the recommended action, however

effective it might be there should be no effect of argument quality on intentionsof low vulnerability individuals. Under high vulnerability, respondents might be

more willing to adopt a recommendation supported by strong rather than weak

arguments, but their defense motivation is likely to mitigate against such an

effect. The fact that Das et al. (2003) found only a vulnerability main effect on

intention in all three studies supports this assumption.

Experiment 2.1

Method

Participants and design

The experiment was based on data from 124 (39 male, 85 female) students of

Utrecht University, who participated in the experiment for payment of 4. Four


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the key role of vulnerability 39

respondents who expressed suspicion of the vulnerability manipulation, and

two respondents who were already suffering from RSI were not included in this

analysis. Respondents were run individually and were randomly assigned in

equal numbers to the conditions of a 2(vulnerability: high or low) x 2(argument

quality: strong or weak) x 2(source expertise: high or low) between-subjects

factorial design.

Independent variables

Vulnerability. Respondents were given false feedback after completing a

bogus RSI test. Half the respondents were told they were very vulnerable to

RSI (Very

fear studies

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