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Simultaneous and Successive Emotion Experiences and Health and Risk Messaging

Summary and Keywords

Emotions are an important part of how audiences connect with health and risk messages. Feelings such as fear, anger, joy, or empathy are not just byproducts of information processing, but they can interact with an individual’s perception and processing of the message. For example, emotions can attract attention to the message, they can motivate careful processing of the message, and they can foster changes in attitudes and behavior. Sometimes emotions can also have counterproductive effects, such as when message recipients feel pressured and react with anger, counterarguments, or defiance. Thus, emotion and cognition are closely intertwined in individuals’ responses to health messages. Recent research has begun to explore the flow and interaction of different types of emotions in health communication. In particular, positive feelings such as joy and hope have been found to counteract avoidant and defensive responses associated with negative emotions such as fear and anger. In this context, research on health communication has begun to explore complex emotions, such as a combination of fear and hope, which can highlight both the severity of the threat, and individuals’ self-efficacy in addressing it. Empathy, which is characterized by a combination of affection and sadness for the suffering of others, is another example of a complex emotion that can mitigate defensive responses, such as anger and reactance, and can encourage insight and prosocial responses.

Keywords: emotion, mood cognitive processing, motivation, persuasion, mixed emotions, emotional flow

Introduction

Health and illness are of great emotional significance for humans. Few things are more frightening than the thought of being affected by a serious, life-threatening illness. Diseases afflicting other people can evoke strong feelings of empathy, especially if close relatives, friends, or children are affected. Positive health information and progress during the recovery process can elicit feelings of joy and hope. Sometimes, anger and frustration may arise from the self-restrictions associated with a healthy lifestyle—especially when individuals are challenged by others to address problematic habits such as smoking, alcohol consumption, or physical inactivity.

Given the emotional significance of health-related information, it is not surprising that emotions play an important role in individuals’ perception and processing of health messages (Lang & Yegiyan, 2008; Myrick, 2015; Nabi, 2015; Witte & Allen, 2000). Emotions are not just a by-product of information processing; they can also influence the perception, interpretation, and behavioral consequences of health messages. For example, emotions can attract individuals’ attention to the message; they can encourage careful processing of the message and can facilitate changes in attitudes and behavior. In some cases, however, emotions can also have counter-productive effects—for instance, when recipients of a message feel pressured, and react with anger and counterarguments (Dillard & Shen, 2005).

Health communication campaigns often use emotional appeals. But only in recent years have the emotional components of health communication matured into an independent research subject (Dillard & Shen, 2005; Lang & Yegiyan, 2008; Myrick, 2015; Nabi, 2015; Shen, 2011; Witte & Allen, 2000). This article gives a short overview of fundamental concepts from the psychology of emotions that have informed research on emotional processes in health communication. Drawing on this conceptual background, research findings on the importance of emotions in health communication are discussed with a special focus on complex emotional processes that involve the simultaneous or successive experience of several emotions within the communication process.

Complexities of Emotions and Their Psychological Background

What are emotions? Fear, anger, sadness, joy, and love are examples of emotions that readily come to mind, and most people seem to have a clear idea of what it means to experience these emotions (Shaver, Schwartz, Kirson, & O'Connor, 1987). Still, it is often emphasized in the field of emotion research how difficult it is to accurately define the concept of emotion (Scherer, 2005). This is mainly due to the complexity of physical and psychological processes associated with emotions, the so-called “emotion components.” Kleinginna and Kleinginna (1981) analyzed different definitions concerning emotions and proposed a working definition that includes the following components of emotion: (a) the subjective component, which exists in the conscious experience of emotional states; (b) the cognitive component, which includes the perception and appraisal of emotion eliciting events; (c) the physiological component, which consists of physical changes such as hormone secretion, muscle tone, heart rate, etc.; and (d) the behavioral component, which includes emotional motivations, action impulses, and the expression of emotion. Such component models of emotions have become a standard approach to defining emotions in psychological research—even if other models use slightly different classifications of emotion components. For example, in the component process model of emotions of Scherer (2005), the expression of emotion is considered a fifth component of emotion that is distinct from the behavioral/motivational component. Scherer (2005) describes emotion components as interrelated subsystems that generate emotions as a result of their interactions. In this context, Scherer (2005, p. 697) defines emotions as “an episode of interrelated, synchronized changes in the states of all or most of the five organismic subsystems in response to the evaluation of an external or internal stimulus event as relevant to major concerns of the organism.”

Emotions thus constitute a special form of affective states, which differ from other affective states, such as moods or attitudes (Scherer, 2005). What distinguishes emotions from other affective states is that they are elicited by specific events that are appraised as relevant to the organism’s concerns. Emotions emerge in a relatively abrupt manner, and can interrupt previous thought and action processes. They are relatively short lived and of high intensity. Moods, conversely, are diffuse affective states that are characterized by the predominance of a subjective feeling. Despite the absence of a concrete eliciting event, the subjective feelings associated with moods (e.g., irritability, nervousness, or serenity) can influence thoughts and behavior. Compared to emotions, moods tend to have a relatively long duration and lower intensity. They are not typically associated with a specific eliciting event, and can even manifest in the absence of an identifiable stimulus. Attitudes also have a strong affective component that is directed at a specific attitude object. Unlike emotions and moods, however, attitudes are not dependent on situational reactions, but rather consist of dispositional appraisal, feeling, and action tendencies towards the attitude object.

The underlying processes that give rise to emotions are still a matter of scholarly debate (for an overview see, Bartsch & Hübner, 2004). On the one hand, emotions have been linked to innate, evolutionary mechanisms that are embodied in the structure of the human brain (LeDoux, 1996). On the other hand, acquired skills and cultural patterns of emotion-related thoughts and actions also seem to play an important role (Averill, 1980). Both innate and learned aspects of emotional response patterns are integrated in appraisal theories of emotion elicitation (Frijda, 1986; Lazarus, 1991; Scherer, 2001). Appraisal theories assume that emotions arise as a result of the cognitive appraisal of situations, which may be driven by both innate or cultural needs and concerns. Appraisal criteria that are relevant in the process of emotion elicitation include the novelty, pleasantness, goal relevance, controllability, certainty, and normative adequacy of the emotion-eliciting situation. Each emotion is linked to a specific pattern of appraisal. For example, fear is typically elicited in situations that are novel, unpleasant, uncertain, uncontrollable, and against a person’s goals. Typical anger-eliciting situations are also characterized by appraisals of unpleasantness and counterproductiveness towards a person’s goals. However, in the case of anger, the person feels in control and justified to assert their goals. As a consequence of the link between cognitive appraisal patterns and emotions, a person’s emotional response to a given situation changes with their appraisal of a given situation. For instance, a threatening and uncontrollable situation elicits fear, as long as the outcome remains uncertain. As soon as the outcome of a situation is certain (be it desirable or undesirable), the fear will change, either into relief or into sadness.

In the context of media, emotion-eliciting appraisals are often characterized by a particular complexity and variety of situational features that factor into the appraisal process. Emotions in everyday life generally relate to a specific situation that is associated with positive or negative consequences for the person. Within the context of media use, emotions often arise from vicarious experiences, in which the situation is appraised from the perspective of other persons represented in the media (Scherer, 1998). At the same time, the audience finds itself in a situation of media use that differs from the situation of the persons portrayed in the media, and that is consequently associated with different appraisals (Mangold, Unz, & Winterhoff-Spurk, 2001)—for instance, when the viewer is safely sitting on the couch while watching a person struggle with a life-threatening situation in a horror movie. Wirth, Schramm, and Böcking (2006) refer to a total of six possible frames of situational references for emotion eliciting appraisals: (a) the media content; (b) the situation of media use; (c) aesthetic aspects of the media content; (d) memories or daydreams of the media user; (e) interactions between the media content and the situation of the user; and (f) interactions between the media content and the social context of media use. Due to the multidimensional nature of possible frames of reference for appraisal processes, emotions are rarely experienced in their pure form during media use. Typically, media users experience several emotions simultaneously or sequentially (Nabi, 2015).

Further complexities arise from the cultural context of appraisal processes. Research on cultural psychology has drawn attention to implicit meanings that shape emotion eliciting appraisals and has examined how those meanings are socially acquired and distributed across ethnic groups and temporal-spatial regions of the world (Shweder, Haidt, Horton, & Joseph, 2008). This line of research has characterized psychological processes as “content-laden,” and “contingent on the implicit meanings, conceptual schemes, and ideas that give them life” (Shweder et al., 2008, p. 410; see also Mesquita, 2001; Mesquita, Frijda, & Scherer, 1997). For example, Hindu culture has eight to nine basic emotions or “mental states” that can hardly be translated into English (Shweder et al., 2008).

Complex Interactions of Emotions With Cognitive Information Processing

Emotions are not only a result of cognitive appraisal processes; they also affect cognitive information processing. Thus, during the course of media use, emotional and cognitive processes interact and influence each other. The influence of emotions on cognitive processing begins at the stage of attention. Emotions can trigger or reinforce the so-called orientating response that directs an individuals’ attention to the media message, thus creating a prerequisite for further cognitive processes such as encoding, storage, and retrieval of information (Lang, 1990).

Moreover, emotions can influence individuals’ motivation to engage in cognitive elaboration of the media content (Lang & Yegiyan, 2008; Schwarz & Clore, 2003), such that negative and mixed feelings can stimulate more careful processing of media messages. In terms of emotional framing (Nabi, 2003), emotions can also predispose media users to attend to specific types of information that are relevant to the emotion’s typical appraisal profile. For example, in the context of drunk driving, the experience of fear has been associated with a focus on information about security and protection issues, while anger was associated with a focus on information related to issues of responsibility, justice, and punishment of misconduct (Nabi, 2003). Another way in which emotional involvement can increase audiences’ cognitive involvement with media messages is through eudaimonic appreciation (Bartsch & Schneider, 2014; Oliver & Raney, 2011; Vorderer & Reinecke, 2012; Wirth, Hofer, & Schramm, 2012). Eudaimonic appreciation is an experiential state that is characterized by the perception of deeper meaning, the feeling of being moved, and the motivation to reflect on the media content. Processes of reflection that are elicited during the experience of eudaimonic appreciation typically go beyond the specific media content, and connect the content to broader contexts of personal meaning.

Taken together, emotions tend to direct the focus of individuals’ cognitive processing to emotionally relevant aspects of the media content, and they can stimulate the cognitive processing of those emotionally relevant aspects in various ways. If the arguments of a media message are convincing, such elaborate processing can, in fact, result in sustained attitude change (Petty, Barden, & Wheeler, 2002).

This does not mean, however, that while under the influence of emotions all aspects of the media content will be thoroughly processed. For example, emotional involvement can reduce audiences’ critical distance from media content, meaning that information and attitudes derived from the content will be incorporated into an individual’s worldview without further reflection (Busselle & Bilandzic, 2009; Green & Brock, 2002). Entertainment education approaches (Moyer-Gusé, 2008; Slater & Rouner, 2002) have drawn attention to the usefulness of absorbing stories as a way to circumvent an individual’s critical counterarguments against health messages if the story absorbs the viewer’s attention to a degree that leaves no cognitive resources for counter-arguing. In other contexts, however, the non-reflective ingestion of media content can also lead to undesirable cultivation effects, such that images and stories from the media are integrated into audiences’ world view regardless of their reality status (Gerbner, Gross, Morgan, & Signorielli, 1994)—for example, exposure to unrealistic body ideals and acceptance of cosmetic surgery (Harrison, 2003).

In addition to their cognitive effects, emotions can also influence individuals’ motivation to engage in behavioral changes advocated by health messages. The motivational component of emotions can manifest itself as either behavioral activation (approach motivation) or behavioral inhibition (avoidant motivation) (Dillard & Nabi, 2006; Lang, 2006). In addition to these general motivational tendencies, the appraisal processes that give rise to emotions are associated with specific motivational implications. For example, the appraisal of uncertainty, which is part of the appraisal profile of emotions like fear and hope, can encourage information-seeking behavior (e.g., health checkups) to change the state of uncertainty about a possible health threat (Rippetoe & Rogers, 1987). Another example of how emotion-related appraisals can motivate behavioral change is the normative appraisal of one’s own behavior. In the case of behavioral patterns, such as drinking and driving, which could potentially harm oneself or others, feelings of shame and guilt, and associated appraisals of normative inadequacy can encourage behavioral changes to realign one's own behavior with social norms (Agrawal & Duhachek, 2010).

The motivating effect of emotions is of particular importance in the context of health communication, given that most health messages are not only intended to inform audiences, and to change their attitudes, but are also aimed to motivate changes in health-relevant behavior. The following sections provide an overview of specific emotions and research contexts in the field of health communication in which these emotions have been studied. After a short introduction into the research on the effects of discrete emotions such as fear, anger, guilt, disgust, hope, and humor, the focus will be on the complex interactions of emotions in the process of health communication involving the simultaneous or successive experience of several emotions.

Research Findings on Specific Emotions in Health Communication

Fear

Emotions such as fear, anxiety, dread, and terror are associated with negative appraisals and feelings, hence individuals tend to avoid these emotions in everyday life. In the context of health communication, however, fear appeals are often used both to emphasize the seriousness of health risks and to encourage behavioral changes (Nabi, 2015; Witte & Allen, 2000). Fear increases the perception of risks and threats (Witte, Meyer, & Martell, 2001), and this perception of risk is, in turn, an important predictor of behavioral intentions (Myrick & Oliver, 2014; So & Nabi, 2013). Yet the effectiveness of fear appeals has been called into question by some researchers (Hastall, 2010), because the helpfulness of fear and risk awareness per se seems limited—except if fear appeals are accompanied by the experience of self-efficacy, that is, individuals’ confidence in dealing with the threat effectively (Leshner, Bolls, & Thomas, 2009). Otherwise, fear appeals can actually diminish the effectiveness of health messages or can even lead to boomerang effects that counteract the intention of the message (Hastings, Stead, & Webb, 2004).

Anger

One of the reasons why fear appeals can lead to adverse reactions is recipients’ anger towards health messages that are perceived as patronizing or manipulative. The concept of reactance (Brehm, 1966; Dillard & Shen, 2005) deals with individuals’ resistance to attempts of persuasion in cases where the persuasive message is perceived as a threat to one’s personal freedom. Such perceived threats to individuals’ freedom of opinion and action can lead to boomerang effects—meaning that the message achieves the opposite of its intended effect. According to Dillard and Shen (2005), anger and negative thoughts about the messages are closely related indicators of reactance that both contribute to the boomerang effect. Findings from a study of Shen (2011) on anti-smoking campaigns, suggest that the effectiveness of fear appeals is limited by the fact that such messages not only increase risk awareness but also increase individuals’ reactance to the message. If recipients perceive a health message as a threat to their personal freedom of opinion and action, then they develop reactance, and tend to devalue the cause of the threat or deny the existence of the threat completely (Dillard & Shen, 2005).

On the other hand, anger can serve as a signal that important concerns are at stake, which can motivate recipients to seriously consider the message (Turner, 2007). According to Turner’s Anger Activism Model, anger elicited by health messages can lead to attitude and behavior change “when (a) the target audience is pro-attitudinal, and (b) the audience has strong perceptions of efficacy” (Turner, 2007, p. 115). A low level of anger and a high level of perceived efficacy at dealing with the risk are particularly helpful to facilitate persuasion effects.

Guilt

Like anger and fear, the emotion of guilt is associated with negative appraisals and unpleasant feelings (Baumeister, Stillwell, & Heatherton, 1994). Of particular interest in the case of health messages, guilt is associated with appraisals of moral wrongdoing and personal responsibility, which constitute powerful motivations for behavioral change (O’Keefe, 2000). On the other hand, strong guilt appeals can backfire in that they elicit anger and reactance (Nabi, 2015; O’Keefe, 2000, 2002). Guilt appeals seem to be more effective in interpersonal contexts (e.g., drunk driving), where a person’s own health behavior is associated with a responsibility for others (Baumeister et al., 1994; Nabi, 2015; O’Keefe, 2000). Moreover the message should offer an action that leads to guilt reduction (O’Keefe, 2000). As Boudewyns, Turner, and Paqzuin (2013) have pointed out, it is important to distinguish between guilt and shame. Despite their different outcomes, guilt and shame are sometimes confounded in health communication. For example, guilt appeals that elicit shame can lead to negative emotions such as anger and to rejection of message (Boudewyns et al., 2013).

Disgust

Disgust is associated with a feeling of sickness caused by an object or habit. Thus, messages with disgust-inducing content can motivate recipients to avoid these objects or habits (Bates & Chadwick, 2015; Leshner et al., 2009; Morales, Wu, & Fitzsimons, 2012). According to Wu and Morales (2012), health messages that combine fear and disgust are effective in drawing attention to health threats. For example, disgust-inducing pictures have been effective in campaigns to change risk behaviors such as smoking, alcohol, and drug abuse (Lupton, 2015). In the case of recipients who are already highly aware of risk behaviors presented as disgusting, such health campaigns might lead to feelings of shame (Lupton, 2015).

Hope and Happiness

Positive moods and emotions, such as hope and happiness, can encourage individuals to confront and cope with frightening, but important information. They can give health messages a positive and encouraging frame, thereby helping recipients to focus on their self-efficacy of dealing with the threat (Chadwick, 2015; Raghunathan & Trope, 2002; Trope & Pomerantz, 1998). According to Chadwick (2015), hope encourages people to take action; hence, messages using hope appeals are particularly effective if the message aims to encourage the audience to perform a behavior (e.g., wearing sun protection) rather than to avoid a behavior (e.g., not smoking). In addition, feelings of joy can help to bolster individuals’ self-esteem and can thus encourage them to process threatening health information, instead of simply avoiding or rejecting the message (Agrawal, Menon, & Aaker, 2007). Such interaction effects of positive and negative emotions are discussed in greater detail in the following sections on mixed and complex emotions.

Humor

Another positive emotion that is often used in health campaigns is humor. Humorous health ads generate more attention and hold it for longer (Blanca & Brigauda, 2014; Moyer-Gusé, Mahood, & Brookes, 2011). Importantly, humor can be used in health messages to bypass defensive reactions, especially in messages dealing with threatening issues, such as cancer prevention, suicide prevention, or sexually transmitted diseases. Negative reactions like reactance or defensive processing, which are often associated with feelings of fear and anger, can be mitigated with humor (Chen & Lee, 2014; Nabi, 2015). Moreover, for audiences to fully understand the punchline, careful and attentive processing of the humorous message is required (Slater & Rouner, 2002). The mental effort required to process the humorous subtext and to understand the joke detracts from the attention and cognitive resources required to critically process the message and to engage in counter-arguing. Thus, recipients of a humorous message are less likely to counter-argue, even if the message is not consistent with their own attitudes. This is due to the fact that their cognitive focus is on following the plot rather than on critically challenging the information presented (Moyer-Gusé et al., 2011; Slater & Rouner, 2002). In addition, humor may signal to audiences that counter-arguing is not necessary, because the message is “just for fun” (Moyer-Gusé et al., 2011; Nabi, Moyer-Gusé, & Byrne, 2007). On the other hand, humor appeals can sometimes be counterproductive in that they distract individuals’ attention from the essence of the message, so that the actual health message is overlooked and cannot lead to the intended behavioral effects. Given that humor is associated with a state of ease and lightheartedness, it may prompt audiences to underestimate the severity of consequences of one’s own actions (e.g., an undesired pregnancy, see Nabi et al., 2007).

Interaction Effects of Emotions in Health Messages

As evident from this discussion, an isolated observation of discrete emotions such as fear, anger, guilt, disgust, hope, and humor falls short of capturing the complex interaction effects between different emotions that can be elicited either simultaneously or sequentially during exposure to health messages. In particular, a number of negative emotions, including fear, guilt, and disgust, have been found to elicit anger and reactance, whereas positive emotions such as hope, happiness, and humor have been found to either support or counteract the effects of negative emotions. The following sections examine these interactions more systematically, with a special focus on (a) sequence effects of different emotions within the message, (b) interaction effects with preexisting moods and emotions, and (c) the simultaneous experience of mixed emotions during message exposure.

Emotional Flow: Sequence Effects of Different Emotions Within the Message

Health messages are complex media stimuli that generally elicit more than one emotion. The concept of emotional flow (Nabi, 2015) focuses on the importance of sequence effects of different emotions in health communication. For example, a transition from negative to positive emotions can reduce defensive information processing and can reinforce individuals’ perception of self-efficacy (Carrera, Muñoz, & Caballero, 2010; Nabi, 2015). Thus, the combination of fear appeals and self-efficacy information can elicit successive feelings of fear and hope. Feelings of fear that are initially important in conveying the seriousness of health risks are offset by a hopeful outlook at the end of the message. Moreover, feelings of hope are associated with an activating motivational tendency, which can encourage preventative behavior (Nabi, 2015).

In a similar vein, a positive outlook can increase the effectiveness of guilt appeals. Health messages that utilize guilt appeals can actually anger recipients and thus lead to reactance. However, feelings of anger can be mitigated if the message also illustrates the consequences for interpersonal relationships and makes appropriate recommendations (e.g., protecting your child from second-hand smoke, by quitting or by not smoking in the child’s presence). Feelings of guilt can be relieved by perceptions of self-efficacy if opportunities of improvement are presented, which can make the message less threatening and more convincing (Nabi, 2015).

As already noted, humor in health messages can be a double-edged sword (Nabi, 2015). On the one hand, humor can increase audiences’ attention (Blanca & Brigauda, 2014), but on the other hand, it can also distract recipients from the seriousness of the message. In this context, the emotional flow concept can help specify the optimal place of humor within the sequence of emotions elicited during health messages. For example, if health messages elicit successive feelings of fear and humorous pleasure, the fear stemming from unpleasant topics, such as breast cancer screening, can be mitigated and preventative behavior can be reinforced (Nabi, 2015).

Narrative formats are particularly suited for the purpose of integrating the sequence of several emotions (Nabi & Green, 2015). Throughout the course of the story, characters are shown in different situations, confronting threatening issues, and overcoming them. Narratives can also link changes of emotion with significant places, thereby increasing their accessibility in recipients’ memory. Thus, the embedding of successive emotions in a meaningful narrative can increase the probability that recipients will contemplate the message and will eventually change their attitude and behavior concerning health-related issues.

Interaction Effects of Message Emotions With Preexisting Moods and Emotions

In addition to the flow of emotions within a health message, recipients’ initial moods and emotions prior to their contact with the message may affect how the message is processed. For example, a positive mood state before contact with health information can help reduce reactance, thereby facilitating the processing of personally relevant negative information. Das and Fennis (2008) found that strong coffee drinkers were more likely to thoroughly process a message on the harmful effects of caffeine if they were first put in a positive mood. The mood-as-resource model (Raghunathan & Trope, 2002) explains this facilitating effect of positive moods as follows: Processing of negative information that presents a threat to one’s self-image is associated with short-term affective costs. However, it can also benefit the individual in the longer run to acknowledge such negative information, because it can promote the development of a more realistic and mature self-concept, which integrates both positive and negative information about the one’s self. Thus, the processing of negative self-relevant information can stimulate self-improvement and personal growth. Therefore, in the case of ego-threatening health messages, a positive mood may reassure individuals that they can “afford” the affective costs of processing this information and may help them to overcome their reactance to the message.

Consistent with these theoretical assumptions, Keller, Lipkus, and Rimer (2003) found that participants who were in a good mood experienced positive effects from messages with loss frames that focused on the potential losses associated with certain behaviors (e.g., skin cancer risk increases with exposure to strong sunlight). Thus, for participants who were in a good mood, the main focus was long-term goals, such as maintaining one’s health by attending to relevant health information—even if the information was negative for their own self-image. Conversely, for recipients in a bad mood, gain frames (e.g., the skin stays healthy when protected against excessive strong sunlight) were more effective, because they elicited less anxiety. Thus, for participants in a negative mood, it seemed that their main focus was on short-term mood effects, making them less willing to consider negative loss-related health information (Keller et al., 2003).

Some health campaigns use popular actors, athletes, and other celebrities, because preexisting emotions of sympathy for popular testimonials can positively affect the acceptance of health messages (Brown, Basil, & Bocarnea, 2003). This positive effect is attributed to sympathy, including physical and social attractiveness of the media personae, perceived similarity with one’s self, as well as wishful identification with characteristics that the recipient does not him/herself possess (Brown et al., 2003; Hartmann, Klimmt, & Vorderer, 2001). Akin to the buffer effect of positive moods, positive emotions associated popular media figures can thus serve as an emotional resource that can mitigate anxiety and reactance towards health messages.

Mixed Affect: Simultaneous Experience of Emotions During Message Exposure

In some cases, health messages can elicit several emotions at the same time. Of particular interest is the combination of positive and negative emotions (e.g., fear and hope, sadness and happiness), which are referred to as mixed emotions or mixed affect (Myrick & Oliver, 2014; Nabi, 2015). Empathy appeals provide a particularly promising form of mixed emotional appeals in health communication. Empathy is characterized by the simultaneous experiencing of positive and negative emotions, especially sadness, happiness, and affection (Myrick & Oliver, 2014; Oliver, Dillard, Bae, & Tamul, 2012). In the case of empathy appeals, health threats are presented by exemplifying others who have actually experienced the negative consequences. The occurrence of negative events is part of the appraisal profile of sadness, which is felt vicariously by the empathic person for the person affected. At the same time, empathy involves a positive affective component of affection and interpersonal warmth. Moreover, empathy can be associated with feelings of happiness if positive events occur for the other person. In a study on skin cancer prevention messages, Myrick and Oliver (2014) found a positive influence of such mixed emotions of sadness and happiness on feelings of empathy, and on the acceptance of preventative measures, such as the application of sunscreen and the willingness to pass on the message to others.

Empathy appeals that present health risks in the form of another person’s suffering also provide a way to circumvent reactance. A study of Shen (2011) on anti-smoking messages showed a higher effectiveness with empathy appeals compared to fear appeals. In the case of empathy appeals, lower levels of reactance were observed than for fear appeals. Thus, by mitigating negative effects associated with reactance, such as anger and a sense of being manipulated, empathy appeals can help increase individuals’ readiness to process the messages (Shen, 2011).

Another important area of application for empathy appeals is the reduction of prejudice and social stigma towards people with physical or mental disabilities. According to the empathy-attitude model (Batson et al., 1997), empathic feelings play an important role in the process of de-stigmatization. This model assumes that empathy felt towards an individual who is a member of a stigmatized group can lead to increased valuing of this individual’s welfare. Assuming that the individual’s plight is (partly) due to his or her membership in a stigmatized group, the altruistic motivation generalizes to the group as a whole. This is reflected in more positive attitudes and an increased desire to help the group. For example, Bartsch, Oliver, Nitsch, and Scherr (2016) found that empathic responses to video clips featuring Paralympic athletes resulted in more positive attitudes and behavioral intentions towards persons with disabilities in general. Even empathic responses to fictional characters can be helpful in reducing stigmatization. For example, Ritterfeld and Jin (2006) found that empathy with a film character experiencing mental illness contributed to stigma reduction. A related line of research has examined destigmatizing effects of para-social relationships with media characters—a concept that is closely related to empathy. Consistent with the para-social contact hypothesis, a study by Hoffner and Cohen (2012) found de-stigmatization effects on individuals’ para-social relationships with a mentally disabled person. Thus, empathy appeals can foster the de-stigmatization of people with illness and disabilities and can thereby help to improve social integration and the overall quality of life of those affected.

It is important to note in this context, however, that not all forms of empathy are equally conducive to reducing stigmatization. In their study on de-stigmatizing effects of video clips about the Paralympics, Bartsch et al. (2016) distinguished between three forms of empathy, based on the social comparison processes involved: elevation (empathy associated with upward comparison), pity (empathy associated with downward comparison), and empathic closeness (comparison at eye level). Among the three types of empathic feelings, the strongest positive mediation effect, linking empathy and de-stigmatization, was via feelings of closeness. Feelings of elevation and admiration towards the Paralympic athletes also positively contributed to the de-stigmatization of persons with disabilities. By contrast, feelings of pity, which involve downward social comparison, had a negative effect, that is, they seemed to increase rather than decrease the stigmatization of persons with disabilities. Such counterproductive effects of pity in the context of de-stigmatization can be explained by a sense of false superiority and social distance associated with processes of downward social comparison.

Feelings of elevation have only recently been considered in the context of health communication. As noted, elevation can be conceptualized as a subtype of empathic, other-oriented feelings that are elicited “when witnessing acts of virtue or moral beauty” (Algoe & Haidt, 2009, p. 106). The experience of elevation is typically associated with mixed affective responses, and with physical reactions such as tears, goose bumps, a lump in the throat, or a warm sensation in the chest (Oliver, Hartmann, & Woolley, 2012; Silvers & Haidt, 2008). In motivational terms, elevation is associated with a desire to embody moral virtues (Aquino, McFerran, & Laven, 2011; Oliver, Hartmann, & Woolley, 2012), and with prosocial action tendencies (Aquino et al., 2011; Schnall, Roper, & Fessler, 2010). Such prosocial tendencies can be addressed in health messages by presenting preventive health behavior as an act of caring for not only one’s self but for others as well (Myrick, 2015). For example, Myrick and Oliver (2014) found that feelings of elevation elicited by health messages motivated individuals to share or forward the message to family, friends, or patients.

Moreover, Fiske, Cuddy, Glick, and Xu (2002) found that feelings of admiration (which are akin to elevation) were typically associated with unequivocally positive stereotypes toward social reference groups that were rated high on both likability and competence. Thus, as reported above, feelings of elevation were associated with positive effects on social inclusion and de-stigmatization of persons with illnesses and disabilities (Bartsch et al., 2016).

Research on the role of mixed and complex emotions in health communication is only beginning to emerge. However, in addition to empathy and elevation, several lines of research are worth noting that might inform health communication research. For example, research on mixed emotions such as poignancy and nostalgia suggests that simultaneous experience of positive and negative emotions can be important for coping processes, to face and accept negative life changing events and can be important for healing processes (Bower, Kemeny, Taylor, & Fahey, 1998; Ersner-Hershfield, Mikels, Sullivan, & Carstensen, 2008). Nostalgia can stimulate memories of important persons and events from the past, which become part of the present again, accompanied with feelings of love and social support (Sedikides & Wildschut, 2016). Thus, nostalgia might be associated with health benefits in that it helps individuals to cope with distress (Sedikides & Wildschut, 2016). Another emerging line of research has revisited the concept of catharsis (Khoo & Graham-Engeland, 2014; Khoo & Oliver, 2013), suggesting that confronting and contemplating painful thoughts and emotions can lead to processes of meaning-making and positive reappraisal with beneficial effects on health and well-being.

Conclusion

This article began with an overview of fundamental concepts in emotion research that can explain the complex interactions between emotion and cognition during individuals’ processing of health messages. Drawing on these insights from the psychology of emotions, a variety of specific research topics were considered in the field of health communication that have helped elucidate the close interaction between emotional, cognitive, and motivational factors in audiences’ processing of health messages. Concerning negative emotions, research has focused on how emotions such as fear, guilt, disgust, and sadness can draw attention to the seriousness of health issues and can encourage careful processing of health messages promoting information seeking and preventive behavior. On the other hand, negative responses such as anger and reactance can lead to boomerang effects that run counter to the message’s intention. In the case of positive emotions like hope, humor, happiness, and affection, the main focus of health communication research is on their mitigating effects, which can counteract defensive responses such as message avoidance and reactance. Such mitigating effects are aimed at easing message recipients when confronted with unpleasant truths. However, under certain circumstances, mitigation effects can distract the recipient from processing the message seriously. With the complexity of helpful as well as counterproductive effects that both positive and negative emotions can have, research on emotional flow has examined how positive and negative emotions can best be combined within the sequence of emotional elements during a health message.

From this overview of the available research it is evident that emotions in health communication are examined not only with the intent of understanding the feelings evoked in audiences, but also to harness their potential to support cognitive, motivational, and behavioral effects. In this context, research has often focused on specific emotions such as fear, anger, guilt, disgust, hope, or humor while abstracting from the complexities of how these emotions interact with other emotions evoked in the process of message reception. Mixed, complex, and successive emotions have only recently become a topic of research in health communication. Studies that deal with mixed emotions, such as empathy and elevation, or that examine the sequence and flow of emotions, point to the complexity and flexibility of appraisal processes and emotions that can occur over the course of even a short health communication message. In particular, the multi-faceted nature of cognitive appraisal processes and resulting emotions can have the effect of enriching negative and threatening health information with positive, self-assuring components, which can help increase the acceptance and effectiveness of the message.

Further Reading

Batson, C. D., Chang, J., Orr, R., & Rowland, J. (2002). Empathy, attitudes, and action: Can feeling for a member of a stigmatized group motivate one to help the group? Personality and Social Psychology Bulletin, 28(12), 1656–1666.Find this resource:

    Brehm, J. W. (1966). A theory of psychological reactance. New York: Academic Press.Find this resource:

      Mesquita, B., Frijda, N. H., & Scherer, K. R. (1994). Culture and emotion. In P. Dasen & T. S. Saraswathi (Eds.), Handbook of cross-cultural psychology: Basic processes and human development (Vol. 2, pp. 255–297). Boston: Allyn & Bacon.Find this resource:

        Mitchell, M. M., Brown, K. M., Morris-Villagran, M., & Villagran, P. D. (2001). The effects of anger, sadness, and happiness on persuasive message processing: A test of the negative state relief model. Communication Monographs, 68(4), 347–359.Find this resource:

          Moyer-Gusé, E. (2008). Toward a theory of entertainment persuasion: Explaining the persuasive effects of entertainment-education messages. Communication Theory, 18(3), 407–425.Find this resource:

            Mukherjee, A., & Dubé, L. (2012). Mixing emotions: The use of humor in fear advertising. Journal of Consumer Behaviour, 11(2), 147–161.Find this resource:

              Nabi, R. L. (2015). Emotional flow in persuasive health messages. Health Communication, 30(2), 114–124.Find this resource:

                Nabi, R. L., & Green, M. C. (2015). The role of a narrative's emotional flow in promoting persuasive outcomes. Media Psychology, 18(2), 137–162.Find this resource:

                  Oliver, M. B., Hartmann, T., & Woolley, J. K. (2012). Elevation in response to entertainment portrayals of moral virtue. Human Communication Research, 38(3), 360–378.Find this resource:

                    Scherer, K. R. (2005). What are emotions? And how can they be measured? Social Science Information, 44(4), 695–729.Find this resource:

                      Slater, M., & Rouner, D. (2002). Entertainment—education and elaboration likelihood: Understanding the processing of narrative persuasion. Communication Theory, 12(2), 173–191.Find this resource:

                        Turner, M. M. (2007). Using emotion in risk communication: The anger activism model. Public Relations Review, 33, 114–119.Find this resource:

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