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date: 21 July 2017


Summary and Keywords

Self-affirmation theory posits that people are motivated to maintain an adequate sense of self-integrity. It further posits that the self-system is highly flexible such that threats to one domain of the self can be better endured if the global sense of self-integrity is protected and reinforced by self-resources in other, unrelated domains. Health and risk communication messages are often threatening to the self because they convey information that highlights inadequacies in one’s health attitudes and behaviors. This tends to lead to defensive response, particularly among high-risk groups to whom the messages are typically targeted and most relevant. However, self-affirmation theory suggests that such defensive reactions can be effectively reduced if people are provided with opportunities to reinforce their sense of self-integrity in unrelated domains. This hypothesis has generated substantial research in the past two decades.

Empirical evidence so far has provided relatively consistent support for a positive effect of self-affirmation on message acceptance, intention, and behavior. These findings encourage careful consideration of the theoretical and practical implications of self-affirmation theory in the genesis and reduction of defensive response in health and risk communication. At the same time, important gaps and nuances in the literature should be noted, such as the boundary conditions of the effects of self-affirmation, the lack of clarity in the psychological mechanisms underlying the observed effects, and the fact that self-affirmation can be easily implemented in some health communication contexts, but not in others. Moreover, the research program may also benefit from greater attention to variables and questions of more direct interest to communication researchers, such as the role of varying message attributes and audience characteristics, the potential to integrate self-affirmation theory with health communication theories, and the spontaneous occurrence of positive self-affirmation in natural health communication settings.

Keywords: self-affirmation, self-integrity, threat, defensive response, message acceptance, intention, behavior, risk, cognitive dissonance, persuasion

Health communication often seeks to change attitudes and behavior. Although such efforts bear many similarities to other forms of persuasive communication, such as commercial advertising, they also face a unique challenge. That is, health messages often convey unpleasant risk information that casts the target audience in a somewhat negative light. A commonly observed phenomenon in health communication, therefore, is defensive response. Recipients of health messages, particularly those to whom the messages are most relevant, are often found to engage in biased, self-protective processing of the information, the end result of which is typically message rejection and failed persuasion (van ‘t Riet & Ruiter, 2013).

Health communication researchers have studied the phenomenon of defensive response from a variety of theoretical perspectives. One perspective that has gained increasing attention in the past two decades is self-affirmation (Steele, 1988). This theory presents a comprehensive framework that sheds light not only on why defensive reactions occur, but also on how such reactions can be reduced. Evidence so far has supported the theory’s key predictions, although significant heterogeneity and important gaps also exist in the literature. This article introduces the basic tenets of self-affirmation theory, explicates its relevance to health communication, describes the typical procedures used to induce self-affirmation in research, evaluates the current evidence base in the health domain, discusses the practical implications of the research findings, and recommends directions for future research from a communication point of view. The intent of this article is not to provide a comprehensive literature review, but to highlight key learnings from this line of research that might be of particular interest to communication researchers, practitioners, and students.

Self-Affirmation Theory

According to self-affirmation theory, people are motivated to maintain an adequate sense of self-worth or self-integrity. In other words, people generally would like to see themselves as “adaptively and morally adequate, that is, as competent, good, coherent, unitary, stable, capable of free choice, capable of controlling important outcomes, and so on” (Steele, 1988, p. 262). While this conception of the self may strike some as being overly general or broad, it reflects a key assumption of self-affirmation theory—that is, the self matters on the global level. Cognitions about any particular fraction or domain of the self may serve to reinforce or weaken the global sense of self-adequacy. But the overarching goal of the self-system is to maintain a favorable general view of the self, not necessarily a positive view of any specific aspect of it. On the basis of this key assumption, self-affirmation theory advances several important propositions (Steele, 1988). First, perceived threat to the global sense of moral and adaptive adequacy will motivate efforts to reaffirm the self. Second, efforts to self-affirm may seek to address the threat, or the perception of the threat, directly; they may alternatively seek to restore the global sense of self-integrity by affirming other valued self attributes that may not be directly relevant to the threatened domain. Third, the means of self-affirmation is determined by availability, perceived effectiveness, and cost. In any given situation, the adopted method to self-affirm will be one that is readily available, capable of returning the self to a state of perceived adequacy, and relatively low in cost in terms of time, effort, and other resources.

The motivation to maintain a positive sense of self and the flexibility of the self-system are acknowledged by many other theories. However, self-affirmation theory is unique in that it argues specifically that the self can be protected from a current or imminent threat by affirming valued self-aspects that are unrelated to the threat. Self-affirmation was initially proposed as an alternative explanation for cognitive dissonance (Festinger, 1957). According to cognitive dissonance theory, people experience psychological discomfort when they possess conflicting or inconsistent cognitions (e.g., the fact that I smoke and the knowledge that smoking can lead to lung cancer). Such discomfort will then motivate people to resolve the inconsistency. Commonly employed strategies include changing the relevant cognitions (e.g., by quitting smoking), denying or diminishing the importance of dissonant cognitions (e.g., dismissing the health risks of smoking as untrue), introducing new consonant cognitions to reduce the relative weight of dissonant cognitions (e.g., taking into account additional “benefits” of smoking, such as weight control), and so on. All of these options focus on the specific domain in which the inconsistency occurs and aim at resolving the inconsistency through changing issue-relevant cognitions.

Self-affirmation theory argues that the deep-level motivation to resolve cognitive dissonance does not arise from inconsistency per se, but from the threat such inconsistency poses to one’s global sense of self-integrity. According to self-affirmation theory, the resolution strategies documented in the dissonance literature are but a subset of potential correctives to restore global self-adequacy. When opportunities to protect and reinforce the self in unrelated domains become available, one does not have to change or adjust issue-relevant cognitions to get rid of the inconsistency. They can use these alternative self-resources to bolster their self-concept and become more tolerant of the threat. Thus, a smoker needs not always resort to quitting, denial, or rationalization to resolve the conflict between their behavior and the health risks their behavior poses; he can comfortably live on with his habit as long as he can find alternative, sufficiently potent affirmations to offset the threat, such as the knowledge that he values his family, cares about the environment, is committed to community service, and so forth. A series of early studies have shown that self-affirmation in unrelated domains can indeed eliminate the typical effect of cognitive dissonance on attitude change (e.g., Steele & Liu, 1983).

In the past three decades, self-affirmation has evolved from an alternative explanation of cognitive dissonance to a systematic theory about the self. Recent application and extension of the theory have focused on the role of self-affirmation in the management of threat and psychological defense (Cohen & Sherman, 2014; Sherman, 2013). A key interest in this research is the ability of self-affirmation to reduce defensive response to self-threats. Substantial evidence has accumulated to demonstrate this effect in a variety of contexts. But it is in health, and more specifically, in the domain of health communication, where the most research has been conducted.

Self-Affirmation in Health Communication

Self-affirmation theory provides two key insights into health communication; one is often assumed but not always fully explicated, the other a provocative hypothesis that has generated substantial empirical research in the last 20 years or so. The first insight has to do with why people react to health messages defensively. The premise of this insight is fairly straightforward: Health is a valued self-attribute and a salient dimension of self-concept for many people. Health messages, however, often highlight important problems or deficiencies in one’s health knowledge and/or behavior, thus challenging the global perception of the self as being adaptively adequate. As a result, health messages are often perceived as threats to the self, and motivation to fend off or reduce such threats tends to arise following exposure (Harris & Epton, 2009).

According to self-affirmation theory, defensive reactions to health messages are, in fact, a form of spontaneous self-affirmation people may engage in after experiencing threat from such messages. Although the motivating power of perceived threat and the possibility of maladaptive responses to health messages are also acknowledged by other theories (e.g., Witte, 1992), self-affirmation offers a unique perspective into the genesis and preconditions of such reactions. First, for defensive reactions to occur, the health messages have to be perceived as a significant threat to one’s global self-concept. If health is not a central aspect of the self, or if the perceived threat is mild, there will be little motivation to reaffirm the self. Second, defensive reactions are not the only means of self-affirmation. However, they are often deployed because they tend to hold important advantages over alternative affirmation methods in terms of availability, perceived effectiveness, and cost. In other words, defensive reactions are frequently used to cope with threats because they are easy to implement, address the threat directly, and are often quick and effective at alleviating the perceived threat. Alternative correctives, such as changing one’s health behavior, may be equally effective at eliminating the threat, but they are generally more “costly” in terms of time, effort, and resources. At the same time, admitting “wrongdoing” and the need to correct one’s behavior may also have its own negative implications for the global self-concept, thus representing a more treacherous road toward self-affirmation. For all of these reasons, defensive reactions to threatening health information tend to occur with regularity, particularly among those to whom the information is most relevant (van ‘t Riet & Ruiter, 2013).

The link between perceived threat to the self and defensive response to health information is an important lesson from self-affirmation theory. The second key insight from the theory focuses on strategies to weaken this link, thus reducing the likelihood of defensive reactions to health messages. This has been the focus of much empirical testing in the past 20 years (Epton, Harris, Kane, van Koningsbruggen, & Sheeran, 2015; Harris & Epton, 2009; Sweeney & Moyer, 2015). As noted earlier, self-affirmation theory posits that it is the global sense of self-adequacy that truly matters in self-management. Thus, when the self is threatened by a health message, the perceived threat can be alleviated by affirming other valued but unrelated self-aspects. Lowered perceived threat will then decrease the motivation to react defensively, leading to more open and objective processing and evaluation of the incoming health information. To the extent that defensive response tends to weaken the impact of otherwise persuasive content, the unbiased mode of information processing induced by self-affirmation in unrelated domains will generally lead to enhanced message effects. But this may not be the case if, for example, the message is weak to begin with (Harris & Epton, 2010).

The hypothesis that self-affirmation in unrelated domains can thwart defensive processing of threatening health messages is a provocative one. Most theories about health communication emphasize the importance of issue-relevant variables and their interaction in a well-defined behavioral context. Consequently, efforts to improve message impact often involve manipulation of message content, sometimes pushing the envelope of both creative capacity and communication ethics (Ruiter, Abraham, & Kok, 2001). Self-affirmation theory, however, suggests that seemingly irrelevant affirmations can bring important changes to how people react to and process health information, potentially enhancing message impact. The task of self-affirmation is by design a positive experience. At the same time, the process of self-affirmation does not necessitate any additional adjustment of key elements of the message, lessening the strain on message designer’s creativity and resources. On both accounts, the self-affirmation theory has broadened our perspective on health message/intervention design in important ways.

The relevance of self-affirmation to health communication is centrally reflected in its theoretical explanation of defensive response to threatening health messages and the hypothesized effect of unrelated affirmation on defense reduction. Before reviewing the relevant evidence, it will be helpful to first look at how self-affirmation is typically accomplished in empirical testing.

Typical Procedures to Induce Self-Affirmation

Self-affirmation can occur organically in naturally settings, responding to life’s many large and small challenges to one’s sense of self-worth and self-integrity. Research documenting spontaneous self-affirmation has found that many mundane activities can serve self-affirmation functions, such as browsing one’s own Facebook profile (Toma & Hancock, 2013). In research on the effect of self-affirmation on defensive response to health messages, self-affirmation is typically experimentally induced. The induction methods have shown some variety, but most studies have used manipulations that are quite similar (McQueen & Klein, 2006). Some familiarity with the typical induction procedures will help put into perspective the theoretical and practical significance of the accumulated findings.

The most widely used manipulation of self-affirmation in the health context is the value essay method (Epton et al., 2015). This procedure typically begins by identifying personally important values for each participant. Sometimes this is accomplished through a pretest survey that is taken some time before the main study; other times participants are simply asked at the beginning of the study to select from a list of personal values those that are most important to them. Participants assigned to the affirmed condition will then be asked to reflect on their most important values and write essays on, for example, how those values have guided them on important occasions and have made them feel good about themselves. Those assigned to the no affirmation condition will either reflect and write on unimportant values or complete an alternative task that has no self-affirming potential, such as recalling all the foods they have consumed recently.

Another frequently used manipulation directs participants’ attention to positive personal characteristics, such as kindness and honesty, instead of values. The procedure is generally similar to the one described above. After identifying important personal attributes, either through a prior survey or an immediately preceding selection task, participants will reflect on these attributes for some time, often writing down experiences where the attributes have served them well and cast a positive light on their character. Because attributes such as kindness are almost universally favorable, some studies have omitted the step to identify desirable personal attributes and simply asked all participants in the affirmation condition to reflect on their kindness, honesty, generosity, and so forth.

Whether the focus of the manipulation is personal values or attributes, the self-affirmation manipulation seeks to reinforce a positive sense of self-integrity, such that the participants will be better able to withstand the threat posed by the forthcoming health message. Two things need to be noted with the typical self-affirmation procedures. First, such procedures generally take the form of an independent exercise preceding (and sometimes following) the presentation of health messages. As such, they are part of the context for health communication, not a component of the health messages per se. Second, many self-affirmation studies do not include a manipulation check. Indeed, how to appropriately conduct manipulation check for self-affirmation remains an unresolved question in the literature (McQueen & Klein, 2006). The challenge in conducting such checks is that almost any self-referencing activities, such as providing self-ratings, can morph into a self-affirming experience (Reed & Aspinwall, 1998), thus confounding the self-affirmation manipulation. Because of this problem, even those studies with manipulation checks—if such checks involve self-evaluation within the context of the same study (as opposed to an independent test with a separate sample)—begs the questions of whether the checks were truly a measure of success of the manipulation and whether including such checks have influenced study results in ways unbeknown to the researchers. All things considered, it appears that forgoing manipulation checks is a justifiable choice in self-affirmation research.

State of the Current Evidence

The hypothesized effect of self-affirmation on defensive processing of health risk information has drawn substantial attention. The review below will focus on this hypothesis and address three related questions: Does self-affirmation work? When does it work? And how does it work?

Does Self-Affirmation Work?

Two recent meta-analyses show that self-affirmation generally improves the outcomes of health communication (Epton et al., 2015; Sweeney & Moyer, 2015). Epton et al. (2015) examined the effect of self-affirmation on three key outcomes in the process of health behavior change: message acceptance, intention to change, and subsequent behavior. A total of 44 published and unpublished studies were included in their meta-analysis, furnishing 144 effect sizes. A small but positive effect of self-affirmation was found on each of the three outcomes: message acceptance, d = 0.17 (95% CI = 0.03−0.31); intention, d = 0.14 (95% CI = 0.05−0.23); and behavior, d = 0.32 (95% CI = 0.19−0.44). Using somewhat different inclusion criteria, Sweeney and Moyer (2015) meta-analyzed 16 studies focusing on only intention and behavior. Their findings were largely consistent with Epton et al. (2015). A small but positive effect of self-affirmation was found on both outcomes: intention, d = 0.26 (95% CI = 0.04−0.48); and behavior, d = 0.27 (95% CI = 0.11−0.43).

Note that only one of these meta-analyses had message acceptance as a key outcome (Epton et al., 2015). The coding of message acceptance in this meta-analysis was also fairly broad, including not only measures of information processing and evaluation, but also beliefs about the link between risk behavior and negative health outcomes (p. 190). Given that the primary hypothesized effect of self-affirmation is to reduce defensive processing of health messages, relevant evidence on this front deserves a closer look.

In many studies, defensive responses to health messages, and their reduction, are inferred from the positive effect of self-affirmation on either behavior per se or proximal predictors of behavior, such as attitude and intention. Some studies, however, have also included specific measures of defensive processing, or information processing more generally, as study outcomes. The most often used measures include message derogation and positive message evaluation. Evidence based on these outcomes is somewhat mixed. Message derogation, for example, was found to decrease after self-affirmation among high risk individuals in some studies (e.g., van Koningsbruggen & Das, 2009), but not in others (e.g., Armitage & Arden, 2016). Measures of message evaluation, on the other hand, have more consistently shown that self-affirmation can lead to more favorable message ratings among high-risk individuals (e.g., Good & Abraham, 2011), although null effects also exist (e.g., Dillard, McCaul, & Magnan, 2005). Other types of message response, such as source credibility (e.g., Armitage, Harris, & Arden, 2011) and negative emotional responses (e.g., anger; Zhao & Nan, 2010) have also been examined. Evidence on these fronts is limited although generally positive.

Yet another line of research to bear on the effect of self-affirmation on defensive processing focuses on sensitivity to argument strength. Drawing on the dual process theories of persuasion (e.g., Petty & Cacioppo, 2011), this research argues that self-affirmation reduces bias by increasing open and objective processing of threatening information. As a result, self-affirmed individuals should show greater differentiation in their responses to strong vs. weak messages, regardless of their prior positions. This corollary hypothesis links self-affirmation to a well-respected theoretical tradition in persuasion and takes advantage of an established empirical paradigm focusing on manipulating message strength. However, somewhat surprisingly, few studies have tested this hypothesis. The most widely cited study in this area tested messages advocating tuition increase and found that, among highly involved participants, self-affirmation increased separation between the effects of strong vs. weak arguments (Correll, Spencer, & Zanna, 2004). A rare study in the health domain examined the responses of female caffeine drinkers to messages linking caffeine intake to breast cancer (Klein, Harris, Ferrer, & Zajac, 2011, study 2). Self-affirmation was found to increase risk perceptions and intention to reduce caffeine consumption only among those exposed to a strong message. Overall, evidence in this area is still very limited.

When Does Self-Affirmation Work?

The meta-analyses are helpful to show that, overall, there is robust evidence that self-affirmation can enhance the effectiveness of health communication messages. Notably, both meta-analyses also revealed significant heterogeneity in the outcomes. Few moderators were identified, however, perhaps due to relatively small sample size in the examination of individual moderators. In the Epton et al. (2015) analysis, proximity of the health hazard, value essay manipulation (vs. other techniques), and smaller number of white participants were found to be associated with greater effects of self-affirmation. Moderation analysis by Sweeney and Moyer (2015) did not reveal any significant moderators.

A close read of the literature, however, suggests that there are important boundary conditions for self-affirmation beyond the few moderators identified by the meta-analyses. The most important, and most widely researched, is individual risk status. The effects of self-affirmation on defensive response to health messages is premised on the assumption that such messages are threatening to one’s sense of self-integrity. For this reason, self-affirmation research in the health domain has paid the most attention to groups to whom the health issues and related message are most personally relevant (Harris & Epton, 2009). The general expectation is that the hypothesized effects of self-affirmation should be most pronounced among these high-relevance groups. A number of studies have examined the effects of self-affirmation among high- vs. low-risk individuals, and the difference in results between the two groups is worth noting.

First, consistent with self-affirmation theory, the effects of self-affirmation are most distinctive and favorable among high-risk individuals. For example, in a recent study (Memish, Schüz, Frandsen, Ferguson, & Schüz, 2016), smokers were self-affirmed before viewing graphic messages about the health consequences of smoking. Baseline smoking was found to moderate the effect of self-affirmation such that self-affirmed heavy smokers smoked fewer cigarettes per day at one-week follow-up compared to non-affirmed heavy smokers. Similar favorable findings on high-risk individuals have also been reported in studies examining other health issues (e.g., van Koningsbruggen & Das, 2009).

In contrast, among low-risk individuals, there is evidence suggesting that self-affirmation may lead to less desirable outcomes. Many of the studies that have examined both high- and low-risk individuals have shown opposite trends for the two groups. In van Koningsbruggen and Das (2009), for example, self-affirmation significantly reduced both intentions to take an online diabetes test and the actual test-taking behavior among those at low risk for Type 2 diabetes. In another study, self-affirmation significantly decreased favorable reactions to graphic cigarette health warnings among occasional smokers, while its effects among everyday smokers were largely indistinct, albeit trending in a positive direction (Zhao, Peterson, Kim, & Rolfe-Redding, 2014). These findings raise concerns as to whether self-affirmation can be safely used with low-risk individuals.

How Does Self-Affirmation Work?

A recent synthesis of the self-affirmation literature concludes that “the field currently lacks a consensual theoretical account of why self-affirmation works” (Epton et al., 2015, p. 194). Indeed, a striking imbalance characterizes the research on self-affirmation. On one hand, there is relatively consistent evidence for the effects of self-affirmation on message acceptance, intention, and behavior among high-risk individuals. On the other hand, little is known on how such effects of self-affirmation transpire beyond the general theoretical propositions of the initial theory. A number of mechanisms have been suggested, but few have received consistent testing and support. Evidence pertinent to a few of these suggested mechanisms is briefly noted below.


In an early study applying self-affirmation theory to health persuasion, self-affirmation was found to enhance orientation to risk information about caffeine consumption (Reed & Aspinwall, 1998). This effect was confirmed by other studies that found self-affirmation to decrease attentional bias away from threatening words in alcohol risk messages (Klein & Harris, 2009) and increase frequency of eye fixations to graphic health warnings on cigarette packets (Kessels, Harris, Ruiter, & Klein, 2016). Together, these studies suggest that self-affirmation can increase attention to relevant health information and decrease avoidance, which is an often-employed defensive strategy in health communication.

Accessibility and Recall

Consistent with the attention effects noted above, a reaction time study found that that self-affirmation increased the accessibility of threat-related cognitions after exposure to health risk information (van Koningsbruggen, Das, & Roskos-Ewoldsen, 2009). In the Reed and Aspinwall (1998) study, self-affirmation was found to result in less recall of risk-disconfirming information after one week; recall of risk-confirming information did not vary as a function of self-affirmation.

Mode of Processing

As reviewed earlier, an often-evoked explanation for the effect of self-affirmation on defensive responses to health messages is that self-affirmation can enhance open and objective information processing. Direct testing of this idea is limited, with the strongest supportive evidence coming from a study using a hypothetical tuition raise scenario instead of a realistic health communication context (Correll et al., 2004; also see Klein et al., 2011). Interestingly, there is also evidence that self-affirmation may decrease message elaboration if the information is nonthreatening (Brinol, Petty, Gallardo, & DeMarree, 2007).

Level of Construal

Related to mode of processing, but conceptualized from a different point of view, there is growing interest in recent research on the effect of self-affirmation on level of construal, i.e., the level of abstractness and structured-ness in one’s mental representation of an event, object, or behavior (Trope & Liberman, 2010). According to this perspective (Sherman, 2013), self-affirmation can broaden a person’s self-definition in relation to a threat to the self. This in turn will lead people to think “outside the box” and to assess relevant information about the threat more objectively. This proposition has received some support in psychological research (Wakslak & Trope, 2009). A recent study extended this idea to the health communication context and found that self-affirmation led to higher levels of temporal construal, which in turn were associated with more favorable responses to organ donation messages (Wang & Zhao, 2016).

Other Potential Mechanisms

Several other mediators of the effects of self-affirmation have been suggested, such as self-control (Schmeichel & Vohs, 2009) and other-directed feelings (Crocker, Niiya, & Mischkowski, 2008). In addition, newly emergent neuroimaging evidence shows that self-affirmation can activate self-related processing and valuation/reward brain regions (Dutcher et al., 2016; Falk et al., 2015). These neural activities may, in turn, influence how individuals process and respond to personally relevant yet threatening health information. These potential mediating mechanisms are promising leads awaiting continued research.

Summary of Current Evidence: Supportive With Gaps

Research on self-affirmation in health communication contexts has grown rapidly over the past 20 years (Cohen & Sherman, 2014; Epton et al., 2015; Sweeney & Moyer, 2015). The current evidence, on the whole, suggests that self-affirmation is an effective strategy to reduce defensive reactions to threatening health messages, particularly among those at high risk. At the same time, there are nuances and gaps in the literature that raise legitimate questions about when and how self-affirmation works.

Implications for Health Communication Practice

Although research on self-affirmation in the health context is still growing, some of the trends noted in the previous section are clear enough to have implications for health communication practice. First and foremost, it is clear from the accumulated evidence that self-affirmation can be a productive tool to thwart message resistance among high-risk populations. The significance of this implication cannot be overstated. Substantial literature exists to show that health messages often do not work, or they backfire, particularly among those to whom the messages are most relevant (van ‘t Riet & Ruiter, 2013). This has become a source of considerable frustration among health communication researchers and practitioners. With its demonstrated effectiveness in reducing defensive responses among high-risk individuals, there is no reason why self-affirmation should not become a valuable tool for those working with vulnerable and challenging populations.

Self-affirmation is also highly attractive because its effect does not stop at message response, but persists through the entire behavioral change process. Health communication—and persuasion in general—tends to show diminishing impact from the early stages of exposure and processing to the later stages of attitude change and behavioral enactment (McGuire, 1985). For this reason, observable behavioral effect is an important consideration in choosing communication intervention strategies. On this front, self-affirmation has exceptional appeal: Meta-analyses have consistently demonstrated effects on both intention and behavior (Epton et al., 2015; Sweeney & Moyer, 2015); not only that, the analysis of Epton et al. actually showed somewhat stronger effect on intention and behavior than on message acceptance, although the difference was not subjected to statistical significance testing. Reasons for this latter trend are not yet clear. But the fact that self-affirmation reliably delivers behavior effect should be encouraging to health communication practitioners who are interested in employing this unique strategy.

In addition to robust evidence for its effectiveness, self-affirmation is also relatively easy to implement under some, but not all, circumstances. The manipulation techniques widely used in the research literature can be readily deployed in intervention settings that allow for individual-level or group interaction. Indeed, the typical procedure of self-affirmation bears many similarities to expressive writing and motivational interviewing. Although their theoretical underpinnings are different, arguments have been made that these approaches can be easily integrated to enhance the overall effectiveness of health communication interventions (Ehret, LaBrie, Santerre, & Sherman, 2013).

Although there is reason for enthusiasm for the utility of self-affirmation in health communication, the current literature also suggests two important caveats. First, and related to the point above, self-affirmation has been extensively tested as a debiasing strategy independent of, and often preceding, the presentation of the health message. How to successfully integrate self-affirmation into the message per se has not been adequately addressed by current research (for a rare example, see Dillard et al., 2005). Until a successful and reliable within-message implementation strategy becomes available, it is not yet clear how self-affirmation can be productively used in large-scale public communication campaigns that do not permit extensive engagement with the audience through writing tasks or other invasive methods.

Second, health communication practitioners should be careful about using self-affirmation with low-risk populations. As reviewed earlier, current evidence seems to suggest that self-affirmation has the potential to weaken interest in health protective behavior among those not at risk. In some situations, this may reflect a more accurate reading on the part of low-risk individuals of their risk status, and thus is unlikely to result in deleterious consequences (Griffin & Harris, 2011). But whether this is the case is not always easy to ascertain. In the spirit of “first do no harm,” it seems advisable not to self-affirm low-risk individuals before exposing them to health risk messages, unless the appropriateness of reduced interest in self-protection is clearly established.

Future Research—A Communication Perspective

The rapid growth of self-affirmation research has led to multiple efforts to synthesize the literature recently, some specifically focusing on health (Cohen & Sherman, 2014; Epton et al., 2015; Sherman, 2013; Sweeney & Moyer, 2015). These reviews, mostly authored by psychologists, have generated useful insights for the future development of self-affirmation research. It should be noted, however, that communication researchers have become increasingly active in this area of research as well, bringing with them questions that are more reflective of the central interests of the communication science (e.g., Kim & Niederdeppe, 2016; Wang, Hickerson, & Arpan, 2015; Zhao & Nan, 2010). The discussion here is intended to highlight a few areas where communication researchers should be able to make important contributions to the future growth of the self-affirmation theory and application in health contexts.

Message Factors

A central interest in health communication research, and communication research in general, is how different message attributes may influence communication outcomes (O’Keefe, 2006). Self-affirmation theory has at least one direct implication for message design. That is, threatening messages are more likely to engender defensive responses than non-threatening messages. Consequently, self-affirmation should have greater utility when used with threatening rather than non-threatening messages. This idea is often noted in self-affirmation research but rarely tested in a systematic manner, even though it has considerable relevance to the validity of the theory. Some studies have measured perceived threat as an outcome variable (e.g., Harris, Mayle, Mabbott, & Napper, 2007). But without systematic message variation, it will be difficult to ascertain whether self-affirmation is truly productive with (and only with) threatening messages. One study by communication researchers has looked at the potential differential impact of self-affirmation on smokers’ response to anti-smoking messages couched in gain (non-threatening) vs. loss (threatening) frames (Zhao & Nan, 2010). It was found that self-affirmation increased receptivity to loss-framed messages but decreased favorable reactions to gain-framed messages. While generally supporting the idea of self-affirmation working as predicted with threatening messages, it also raises the question of whether self-affirmation is safe to use with non-threatening messages. Complicating the picture further, another study using a similar design in the context of skin cancer prevention failed to detect the predicted interaction between self-affirmation and framing (Mays & Zhao, 2015). Instead, a negative main effect of self-affirmation regardless of message frame was obtained. Although these studies are too limited to enable broad conclusions, the mixed evidence so far suggests that further examination of the dynamic between message threat and self-affirmation is needed.

The relevance of framing to self-affirmation is rather straightforward. But there are other interesting directions to extend self-affirmation research, in juxtaposition with important message strategies. Indeed, communication researchers have recently brought the insights of self-affirmation into the study of narrative persuasion (Kim & Niederdeppe, 2016) and entertainment media use (Johnson, Slater, Silver, & Ewoldsen, 2016). Findings from these studies suggest that messages with transporting powers may serve a self-maintenance purpose, which can be alleviated by self-affirmation. This raises the interesting question of whether self-affirmation would be counterproductive with narrative health messages. Questions like this are important topics for future research and can contribute to our understanding of both self-affirmation and narrative persuasion.

Audience Characteristics

Another area of interest to communication researchers is the interaction between audience characteristics and self-affirmation. So far self-affirmation research has examined only one audience attribute in a more or less systematic fashion—risk status (see previous discussion). While risk is a critical factor for both the theoretical premises of self-affirmation and the practice of health communication, it is conceivable that other audience factors may also moderate the effect of self-affirmation. One such example is trait reactance (Brehm, 1966). It stands to reason to expect higher trait reactance individuals to be more resistant to self-threatening health messages. The extent to which self-affirmation can mitigate such a tendency is thus a question of both theoretical and empirical interest. One study that has investigated this topic found that self-affirmation only worked with smokers low in trait reactance; for those high in reactance, the effect of self-affirmation was indistinct (Nan & Zhao, 2012).

Other audience characteristics can be brought into the picture to enrich our understanding of self-affirmation in health communication contexts. For example, as reviewed earlier, there is research showing that self-affirmation can boost resources of self-regulation (Schmeichel & Vohs, 2009) and elevate level of construal (Wakslak & Trope, 2009). Correspondingly, individual regulatory focus and temporal perspective have been noted to influence audience response to different message strategies in recent health communication research (Kees, Burton, & Tangari, 2010; Zhao, Nan, Iles, & Yang, 2015). Convergence of these parallel lines of research should generate exciting opportunities for future studies.

Integration With Communication Theories

Another avenue of productive new research is an effort to integrate self-affirmation theory with health communication theories. As noted earlier, there is uncertainty in the literature as to what mediating mechanisms are responsible for the effects of self-affirmation. Given that most of these effects are observed in the context of health communication, there is reason to believe that adding a communication perspective to the theoretical deliberation may bring about new and useful insights. A recent example of such effort is a study that tried to link self-affirmation theory to the extended parallel process model (EPPM) (Napper, Harris, & Klein, 2014). Specifically, this study posited that the effects of self-affirmation may be mediated by the key predictors in EPPM, perceived threat and perceived efficacy. At the same time, it also posited that self-affirmation may moderate the relationships among perceived threat, perceived efficacy, and intention to adopt message recommendations by affecting the threshold at which threat and efficacy trigger protective motivations. Findings of the study supported the moderation hypothesis, but not the mediation hypothesis. Thus, it is not yet clear whether and to what extent EPPM can offer a compelling explanation for the effects of self-affirmation. But efforts such as this are certainly worthwhile.

An interesting finding in the Napper et al. (2014) study is that self-affirmation did not influence perceived threat or perceived efficacy, although it did influence behavioral intention. This finding echoes the mixed evidence in the literature on the effects of self-affirmation on risk perceptions (Harris & Epton, 2009, 2010), which poses an interesting contrast to the relatively robust evidence for the effect of self-affirmation on intention and behavior. This pattern of findings suggests that at least some of the effects of self-affirmation may lie beyond the usual pathway of influence anchored by reassessment of personal risk and the ensuing attitude and belief change. Given the evidence that self-affirmation may lead to other-directed positive affect (Crocker et al., 2008), it might be productive to explore additional paths of influence focusing on normative mechanisms of change, such as those delineated in the theory of normative social behavior (Rimal, 2008).

Spontaneous Self-Affirmation in Health Communication

Most self-affirmation research to date has relied on induced affirmation to test its hypotheses. But both theory and anecdotal experience suggest that self-affirmation occurs frequently in daily life, in response to both stable and situational self-maintenance needs (Toma & Hancock, 2013). A series of recent studies showed that positive spontaneous self-affirmation (as opposed to defensive response) is associated with a number of positive health outcomes and behaviors (e.g., Emanuel, Howell, Taber, Ferrer, Klein, & Harris, 2016; Taber, Howell, Emanuel, Klein, Ferrer, & Harris, 2016). An interesting direction to extend this research is to see whether such positive spontaneous self-affirmation is associated with increased responsiveness and receptivity to health communication as occurring in people’s natural life environments. It would also be interesting and instructive to document specific positive affirmation strategies people employ in such situations.

Conclusion: A Useful Theory for Health Communication

Self-affirmation theory has provided important insights into two related questions of great interest to health communication researchers and practitioners: Why do people, particularly those at high risk, react defensively to health messages that are intended to benefit them? How can such defensive reactions be reduced? The answers, the theory suggests, lie in people’s intrinsic motivation to maintain an adequate sense of self-integrity and a flexible self-system that allows the global sense of self to remain intact by affirming values and attributes that are unrelated to the threatened self-domain. These insights have generated a sizable body of research in the context of health messaging. The current evidence affords an encouraging outlook on the utility of self-affirmation to reduce defensive responses to threatening health information in high-risk populations. But important questions remain on the mechanisms underlying the effects of self-affirmation and the boundary conditions of such effects. Self-affirmation is still a relatively young research tradition, and much of its theory testing is conducted in the context of health communication. Communication researchers and practitioners should stand ready to both contribute to and gain from this vibrant area of research.

Further Reading

Cohen, G. L., & Sherman, D. K. (2014). The psychology of change: Self-affirmation and social psychological intervention. Annual Review of Psychology, 65(1), 333–371.Find this resource:

Epton, T., Harris, P. R., Kane, R., van Koningsbruggen, G. M., & Sheeran, P. (2015). The impact of self-affirmation on health-behavior change: A meta-analysis. Health Psychology, 34(3), 187–196.Find this resource:

Harris, P. R., & Epton, T. (2009). The impact of self-affirmation on health cognition, health behavior, and other health-related responses: A narrative review. Social and Personality Psychology Compass, 3(6), 962–978.Find this resource:

Harris, P. R., & Epton, T. (2010). The impact of self-affirmation on health-related cognition and health behaviour: Issues and prospects. Social and Personality Psychology Compass, 4(7), 439–454.Find this resource:

Johnson, B. K., Slater, M. D., Silver, N. A., & Ewoldsen, D. R. (2016). Entertainment and expanding boundaries of the self: Relief from the constraints of the everyday. Journal of Communication, 66(3), 386–408.Find this resource:

Kim, H. K., & Niederdeppe, J. (2016). Effects of self-affirmation, narratives, and informational messages in reducing unrealistic optimism about alcohol-related problems among college students. Human Communication Research, 42(2), 246–268.Find this resource:

McQueen, A., & Klein, W. M. P. (2006). Experimental manipulations of self-affirmation: A systematic review. Self and Identity, 5(4), 289–354.Find this resource:

Napper, L. E., Harris, P. R., & Klein, W. M. P. (2014). Combining self-affirmation with the extended parallel process model: The consequences for motivation to eat more fruit and vegetables. Health Communication, 29(6), 610–618.Find this resource:

Sherman, D. K. (2013). Self-affirmation: Understanding the effects. Social and Personality Psychology Compass, 7(11), 834–845.Find this resource:

Sherman, D. K., & Cohen, G. L. (2006). The psychology of self‐defense: Self‐affirmation theory. In Advances in experimental social psychology (Vol. 38, pp. 183–242). New York: Elsevier.Find this resource:

Steele, C. M. (1988). The psychology of self-affirmation: Sustaining the integrity of the self. Advances in Experimental Social Psychology, 21, 261–302.Find this resource:

Sweeney, A. M., & Moyer, A. (2015). Self-affirmation and responses to health messages: A meta-analysis on intentions and behavior. Health Psychology, 34(2), 149–159.Find this resource:

Zhao, X., & Nan, X. (2010). Influence of self-affirmation on responses to gain- versus loss-framed antismoking messages. Human Communication Research, 36(4), 493–511.Find this resource:


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Harris, P. R., & Epton, T. (2009). The impact of self-affirmation on health cognition, health behavior, and other health-related responses: A narrative review. Social and Personality Psychology Compass, 3(6), 962–978.Find this resource:

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Harris, P. R., Mayle, K., Mabbott, L., & Napper, L. (2007). Self-affirmation reduces smokers’ defensiveness to graphic on-pack cigarette warning labels. Health Psychology, 26(4), 437–446.Find this resource:

Johnson, B. K., Slater, M. D., Silver, N. A., & Ewoldsen, D. R. (2016). Entertainment and expanding boundaries of the self: Relief from the constraints of the everyday. Journal of Communication, 66(3), 386–408.Find this resource:

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Kim, H. K., & Niederdeppe, J. (2016). Effects of self-affirmation, narratives, and informational messages in reducing unrealistic optimism about alcohol-related problems among college students. Human Communication Research, 42(2), 246–268.Find this resource:

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Napper, L. E., Harris, P. R., & Klein, W. M. P. (2014). Combining self-affirmation with the extended parallel process model: The consequences for motivation to eat more fruit and vegetables. Health Communication, 29(6), 610–618.Find this resource:

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