Anger in Health and Risk Messaging
Anger in Health and Risk Messaging
- Claude H. MillerClaude H. MillerDepartment of Communication, The University of Oklahoma
- and Reinaldo Cortes QuantipReinaldo Cortes QuantipDepartment of Communication, The University of Oklahoma
Within a range of health communication contexts, anger can be either a detriment to the receptivity of health promotion messages when poorly controlled, or a benefit to information processing when appropriately directed. In the former case, anger can disrupt cognitive processing, leading to a range of negative outcomes, including emotional turbulence and a preoccupation with anger-eliciting events that can severely limit the receptivity of health promotion and risk prevention messages. However, when properly directed and elicited in moderation, anger can motivate greater purpose and resolve in response to health threats, stimulate more active processing of health warnings, sharpen focus on argument quality, and direct greater attention to coping-relevant information concerning harmful health risks.
- Communication Theory
- Health and Risk Communication
- Interpersonal Communication
Although people commonly tend to think of anger as a troublesome, negative emotion, Aristotle wisely noted how: “Anyone can get angry—that is easy; however, to be angry at the right person, to the proper extent, at the proper moment, with the right motive, and in the right way, that is not so easy” (350 bce/1925). The motivation for all human action, according to Aristotle, can be assigned to one of seven causes: chance, nature, compulsion, habit, reasoning, anger, and appetite. Anger he referred to as an expression of passion and pain, for which humans have both an appetite and a fear. In this view, anger is not simply a negative emotion to be shunned and avoided, it is also a source of passion that may be concentrated and directed toward the pursuit of important goals.
In a similar sense, anger can play a duel role within the process of social influence in general, and persuasive message design in particular. As it concerns health communication, anger may be either a curse or a blessing—either an obstacle to be avoided, or a vehicle to be driven and finessed. In the pages that follow, the functions and consequences of this powerful emotion are reviewed with a mind toward identifying the direct and indirect roles anger can play in motivation, decision making, judgment, choice, and behavior. The goal is to explore how anger may be employed as a message feature with application across a broad range of health communication contexts.
As it concerns health message design, anger may be usefully focused upon the harmful effects of disease, substance abuse, health risks in general, and the companies profiting through products harmful to public health. On the other hand, anger may be unintentionally generated and misdirected toward policymakers and health campaigns perceived as unjustly limiting hedonically relevant personal freedoms (Miller, 2016). In either case, the effects of message-generated anger on pertinent health behaviors can be quite powerful, whether directed against risky and harmful outcomes, or rebounding in resistance to well-intentioned health promotion campaigns.
Anger may be defined as a primary, event-related negative emotion (Ortony, Clore, & Collins, 1988), and although it need not be directed at an agent in the same sense as an attribution-related emotion, such as resentment, contempt, or indignation, anger can be particularly intense in response to negative outcomes associated with the agency and actions of other people. Within a social–emotional context, anger is expressed and experienced as an interpersonal event that may often damage relationships by reducing intimacy, spawning discord, intensifying negative feelings, and escalating mutual hostility (Fehr & Baldwin, 1996). Conversely, anger may also lead to a number of positive outcomes, including the redress of grievances, shared understanding, emotional closeness, and the reduction of tension and anxiety through emotional ventilation and catharsis (Tavris, 1984).
In general, the subjective experience of anger is negatively valenced and aversively arousing, although some people may find it less aversive than others (Harmon-Jones, 2004). Because of anger’s potential for intense arousal, some individuals may experience a reinforcing, self-stimulation effect felt to be energizing and invigorating, although conducive to aggression (Berkowitz, 1970; Bushman, Baumeister, Stack, & Kruglanski, 1999). At input, the elicitation of anger depends on perceptions of goal-relevant, situational disruptions (Ortony et al., 1988); whereas at output, anger affects cognitive processing strategies (Nabi, 2002; Schwarz, 1990), risk assessment (Lerner & Keltner, 2000), and judgments bearing on goal-directed behavior (Clore, Ortony, Dienes, & Fujita, 1993; Schwarz & Clore, 1983). Though the occurrence of anger can be cognitively disruptive and affectively unpleasant, it can also have powerful effects on concentration, determination, and focus (Nabi, 2002, 2003), particularly when aimed at approaching, engaging, and removing goal-hindering obstructions.
Relative to sad or neutral emotion states, anger may also cause people to be more influenced by heuristic cues, especially source-relevant information. Bodenhausen, Sheppard, and Kramer (1994) argued that anger may induce a lack of analytic processing resulting in greater source derogation due to reduced motivation to actively analyze judgment-relevant information. According to Bodenhausen and colleagues, anger may reduce people’s ability to engage in thoughtful analysis. It seems likely that the high levels of physiological arousal that often accompany anger serve to reduce cognitive capacity and discourage analytical thinking. Regardless of cause, an increased reliance on heuristic cues is likely a result of limited information processing, and most anger theorists agree that angry people generally do not process information systematically (Moons & Mackie, 2007).
Anger can be extremely consuming, limiting the effectiveness of cognitive processing. Even when people make deliberate decisions to manage their anger, emotional turbulence and preoccupation with anger-eliciting objects and events can nonetheless result in a number of disconcerting states, including fear, negativism, defensiveness, projection (Schaef, 1987); self-face concern, competing conflict style (Zhang, Ting-Toomey, & Oetzel, 2014); emotional flooding (Gottman, 1994); aggression (Bushman, 2002); rage (Retzinger, 1991); tunnel vision and cognitive deficits (Zillmann, 1988, 1990). However, anger may also be associated with independent self-construal (Zhang et al., 2014), greater determination, more careful information processing, greater focus on argument quality (Schwarz, 1990), and greater attention to coping-relevant information, thereby enhancing active message processing (Nabi, 2002, 2003).
In this latter sense, anger can provide a powerful utility for health message designs advocating against harmful behaviors, such as the Truth Initiative’s anti-smoking campaign employing a defiant, confrontational tone focused on the marketing and profit of big tobacco companies. Anger has also been utilized within anti-substance use messages, although not always in effective ways, as demonstrated by dubious outcomes associated with the Partnership for a Drug-Free America’s “Brain on Drugs” campaign (Wakefield, Loken, & Hornik, 2010). However, the Partnership’s later “Brain on Heroin” PSA spot was likely more effective at directing anger at the problem—heroin use—rather than the message or its source (Buchanan & Wallack, 1998).
Theoretical Approaches Relevant to Health Communication
Cognitive Functional Model
Nabi’s (1999) cognitive functional model (CFM) associates emotions with unique person–environment relationships similar to the appraisal theory notion of core relational themes (Lazarus, 1991; Lerner & Keltner, 2000), and thus sees emotions as attendant upon different goals and action tendencies directed at attaining those goals. In this view, anger simply arises from the blockage of a salient goal, thereby motivating a contentious reaction designed to remove the obstruction.
The CFM is primarily concerned with the effects of discrete negative emotions—such as anger, fear, guilt, shame, and disgust—on information processing, persuasion, and attitude change. According to Nabi, a discrete emotional response motivates two simultaneous reactions: determined attention, which involves approach or avoidance behaviors; and motivated processing, which involves the drive to attain emotion-relevant information goals.
Consistent with dual process models of information processing such as the heuristic systematic model (HSM; Chaiken, 1980), the CFM posits that motivated attention directs the extent to which one engages and processes the content of a message. In both the CFM and the HSM, information processing is goal driven; however, whereas accuracy motivation forms the basis for the HSM, it is the motivation to alleviate aversive emotional states that drives information processing within the CFM. Nevertheless, Nabi notes how the CFM follows the HSM in allowing for both systematic and heuristic processing simultaneously.
In the case of anger, a baseline attention level is set so as to facilitate approach behaviors and information processing aimed at goal-relevant action. Beyond an initial approach response to anger-evoking stimuli, the CFM posits that message recipients will be motivated to resolve problematic situations by processing relevant efficacy information along with pertinent corrective and/or retributive material useful in putting things right (Nabi, 2002). Information processing depth is determined by expectations concerning the usefulness of subsequent message information, or what Nabi refers to as an “expectation of reassurance,” which ultimately determines whether message recipients will attend primarily to perceived argument quality via systematic processing, or to peripheral message features via heuristic processing.
Nabi asserts that expectations of reassurance may stem from three distinct sources: (1) message cues and content signaling the message’s usefulness (e.g., headlines, hooks, and news teasers); (2) previous experience recipients may have had with similar messages (providing the tools necessary for decoding them); and (3) message recipients’ individual personality traits (e.g., skepticism, cynicism, zeal, eagerness, vehemence). For example, if one views the front end of a PSA emphasizing how some people with sexually transmitted diseases continue to engage in unprotected sex, such perceived recklessness and disregard for others’ health could evoke anger and the desire for retribution and justice. Recipients would then be expected to assess whether the remainder of the message offers retributive information—similar to what the extended parallel process model of fear appeals (EPPM; Witte, 1992) would term “response efficacy.”
The CFM offers two important hypotheses concerning the effects of anger on the processing and influence of persuasive messages. First, anger is expected to promote more careful message processing with persuasive outcome directed toward and dependent upon argument quality. Second, the importance of argument quality within an anger appeal should apply regardless of reassurance certainty or uncertainty. To date, only the first of these two hypotheses has received strong support (Nabi, 2002, 2010).
Lerner and Keltner’s (2000) appraisal-tendency approach to affect and judgment (referred to as the appraisal-tendency framework, or ATF; Han, Lerner, & Keltner, 2007; Lerner & Tiedens, 2006) posits that anger motivates changes in cognitive and physiological states involved in coping behaviors that can often persist beyond the initial anger-eliciting events. Once initiated, such action tendencies and coping processes may persist in guiding subsequent behavior and cognition unrelated to the original eliciting events in otherwise anger-relevant, goal-directed ways. In sum, ATF holds that the appraisal tendencies associated with anger and other emotions are goal-directed processes outside an individual’s awareness affecting future judgments and choices by shaping perceptions used in interpreting future situations (Lerner & Tiedens, 2006).
Like other appraisal theorists (e.g., Lazarus, 1991; Han et al., 2007; Nabi, 1999; Ortony et al., 1988), Lerner and Keltner (2001) associate anger with specific appraisals reflecting the core meaning of anger-relevant eliciting events. They hypothesize anger as having a unique influence on social judgment differing from other negative emotions along multiple appraisal dimensions. For example, fear and anger differ along the dimensions of certainty and control, with fear characterized by uncertainty and an external, situational locus of control, whereas anger is represented by certainty, and an internal, individual locus of control. Similar appraisal differences are found even when emotion-evoking stimuli are presented suboptimally; for example, Yang, Tong, and Phelps (2010) found participants exposed to subliminal sad faces to be more likely to attribute negative events to situational factors, whereas those exposed to subliminal angry faces were more likely to attribute the same events to the agency and actions of individuals.
Lerner and Keltner’s (2001) ATF posits anger can activate a tendency to appraise future events in line with the central appraisal dimensions initially triggering that anger, in a process referred to as an “appraisal tendency.” Just as anger motivates action tendencies predisposing individuals to cope in specific ways, it is hypothesized to similarly predispose anger-relevant appraisals in specific ways in response to anger-eliciting events, with attendant effects on judgment and choice domains relating to the appraisal themes of anger (Keltner, Ellsworth, & Edwards, 1993).
As anger is marked by the appraisal themes of certainty and control, both are expected to influence judgments of risk, whether in terms of “unknown risks” involving hazards judged to be uncertain, or “dread risks” involving threats perceived to be outside an individual’s control (Lerner & Keltner, 2000). Relative to the pessimistic risk assessments fearful people make, anger emboldens people to form more optimistic risk assessments and thereby encourages them to approach and engage potential threats before they can increase in intensity (Lerner, Gonzalez, Small, & Fischhoff, 2003; Lerner & Keltner, 2001). Thus, placing anger-inducing material at the beginning of a health message may help motivate message recipients to, for example, overcome their reluctance to visit a doctor or get tested, even if doing so could mean hearing something they would rather not hear.
On the other hand, anger’s effect on the formation of more optimistic risk assessments could backfire by leading message recipients to avoid the prospect of visiting a doctor or getting tested altogether. If anger can activate an appraisal tendency causing future events to be judged in line with the central appraisal dimensions triggered by the anger-inducing content (Han et al., 2007), then in a sense, placing anger-inducing content within a health message is not unlike playing with fire: If one is not careful with all the subtle aspects of message design, one could easily get burned by message rejection, source derogation, and/or boomerang effects (e.g., see Wolburg, 2006).
Anger Activism Model
The anger activism model (AAM; Turner, 2007) posits that message-relevant anger can facilitate attitude and behavior change when used with pro-attitudinal messages containing self-efficacy and/or response efficacy components to enhance one’s perceived ability to deal with an anger-inducing obstruction. According to the AAM, whether individuals will process an anger appeal depends on the intensity of the anger evoked, and the presence of perceptions of efficacy regarding the risks involved in dealing with it.
The model predicts that anger will only facilitate the processing of pro-attitudinal messages and that it will hinder the effectiveness of counterattitudinal messages. The AAM posits an inverted U-shaped function regarding anger arousal and constructive message processing: At low levels of arousal, its effects should be minimal, whereas at moderate levels, anger is expected to result in relatively more constructive responses; however, at greater levels of intensity, the increased anger arousal is expected to motivate impulsiveness and aggression, hindering constructive message processing.
The AAM, like the CFM, emphasizes the value of utilitarian anger over destructive anger, noting how moderate levels of anger can help focus attention and lead to more careful message processing—as long as the anger appeal also provides some form of response efficacy useful in ameliorating a negative outcome. However, lacking a sufficient element of response efficacy to improve upon an anger-provoking situation, the AAM predicts the effectiveness of anger will be minimal if not counterproductive.
Anger and Resistance to Influence
Brehm’s theory of psychological reactance (PRT; Brehm, 1966; Brehm & Brehm, 1981) posits that any persuasive message—especially those prohibiting important, hedonically relevant behaviors (Grandpre, Alvaro, Burgoon, Miller, & Hall, 2003)—may result in powerful threats to perceived freedoms. Reactance is characterized by anger and negative cognitions (Dillard & Shen, 2005; Rains & Turner, 2007) that lead to a number of undesirable outcomes, including more negative attitudes toward persuasive messages and their sources, as well as less positive behavioral intentions, and more positive evaluations of contra-advocated behaviors (Miller, Lane, Deatrick, Young, & Potts, 2007). Because it is experienced as aversively arousing—both psychologically and physiologically—the resulting anger and negative affect provide a powerful motivational force behind attempts at restoring the threatened freedoms through message rejection and source derogation.
Research has shown reactance to be positively correlated with self-esteem, effectance motivation (Brockner & Elkind, 1985; Wicklund & Brehm, 1968), and concerns for justice and fairness, and negatively correlated with concerns for warmth, affiliation, and social harmony (Buboltz et al., 2003). When subjectively important and/or hedonically relevant free behaviors are threatened with proscriptive messages (prohibiting behaviors) or prescriptive messages (requiring behaviors), high levels of reactance may result (Miller, 2015), especially when individuals feel a sense of self-efficacy associated with their ability to engage in the threatened freedom at that moment, or sometime in the near future (Brehm, 1966).
As it concerns health message design, psychological reactance reduces message effectiveness, particularly when hedonically relevant perceived freedoms associated with valuation and reward seeking (Critchfield & Kollins, 2001) and intertemporal choice bias (Ferrer, Klein, Lerner, Reyna, & Keltner, 2016) are aroused. For example, when individuals succumb to intertemporal choice bias by seeking immediate gratification at the expense of more substantial delayed benefits, then explicit, commanding directives using controlling language targeting such health-related behaviors as smoking, consuming junk food, practicing risky sex, and engaging in substance abuse may generate substantially high levels of anger. Moreover, such intense anger can be especially forceful, disruptive, and counterproductive in response to health-risk messages appealing to adolescent populations (Grandpre et al., 2003; Miller, 2015; Miller & Quick, 2010). More specifically, controlling language and the use of imperative terms such as “must,” “should,” and “ought” tend to cause greater levels of anger resulting in more negative assessments of message fairness, and more critical cognitions focused on the message source, along with more negative attitudes toward the topic of the message, less topic-relevant behavioral intentions, and greater source derogation (Miller et al., 2007).
On the other hand, Miller and colleagues (2007) have demonstrated how low-controlling, autonomy-supportive language using qualifiers such as “perhaps,” “possibly,” and “maybe” in the form of questions and suggestions (e.g., “it may be a good idea …” or “you might want to consider …”), as opposed to commands and imperatives, can lead to reduced levels of anger, decreased reactance, greater perceptions of fairness, and more favorable judgments of source credibility. Although Brehm primarily emphasized the importance of perceived freedoms, Miller and colleagues have demonstrated how the hedonic relevance of a threatened freedom can produce particularly high levels of reactance, especially in response to proscriptive messages targeting adolescent and emerging adult tobacco, drug, and alcohol use, and risky sexual behaviors (Miller, Burgoon, Grandpre, & Alvaro, 2006; Miller & Quick, 2010). The increased motivation to restore threatened freedoms resulting from hedonically relevant proscriptive messages generates especially high levels of anger, leading to more elevated and focused counterarguing activity (Pfau et al., 2009). Moreover, intensified anger increases risk-related restoration behaviors, resulting in boomerang effects, and vicarious engagement with the threatened behavior (Miller et al., 2007; Quick & Stephenson, 2007), as well as having behaviors associated with threatened freedoms become more attractive than they otherwise would be in the absence of explicit proscriptions (Brehm, 1966, 1972; Chandler, 1990).
From a health communication perspective, the various forms of restoration of freedom described above—message rejection, boomerang effects, increased interest in the contra-advocated position, and hostility aimed at the message source—are all manifestly undesirable outcomes. However, PRT also posits a means for less detrimental forms of restoration via autonomy-supportive alternatives, which can thereby minimize the anger and negative cognitions normally motivated by psychological reactance.
Brehm (1966) originally posited various forms of restoration of freedom (i.e., various means for reestablishing one’s threatened sense of autonomy) as useful in moderating the effects of psychological reactance. Unfortunately, as mentioned, most forms of restoration are harmful to message reception. However, research has demonstrated how less deleterious forms of restoration may be accomplished in relatively simple straightforward ways (Grandpre et al., 2003; Miller et al., 2007). One such method involves following a persuasive message with a postscript emphasizing the recipients’ freedom to choose for themselves. If given a chance to restore their threatened freedom in this way, message recipients may feel less need to perform one of the more detrimental restoration methods described above. Such an approach involves simply offering the message recipient a choice. For example, following an explicit proscriptive message, a postscript might suggest, “regardless of what anyone else says, the choice is yours,” or, “of course, you’re free to choose for yourself, it’s your decision” (Miller et al., 2007).
Following health risk-related messages using explicit, controlling language, restoration postscripts may be effective at reducing message rejection by decreasing the potential for anger and negative cognitions motivating a reactant response (Miller et al., 2007), or by increasing behavioral intentions to adopt the advocated behavior (Bessarabova & Miller, in press). Because even messages using low-controlling language may nevertheless be perceived as deliberately persuasive—especially when targeting adolescent audiences—restoration postscripts can be effective in reducing reactance even when following implicitly stated suggestions (e.g., “You might want to cut down on sweets, but it’s your choice.”). However, relative to high-threat messages, restoration postscripts may not always be effective following low-threat messages, presumably because, in some cases, they may act to alert receivers to the persuasive intent of the message (Bessarabova, Fink, & Turner, 2013). In any event, by emphasizing a message recipient’s basic choice options, even an explicit message can be made to generate less reactance than an implicit message—should the former be followed by an effective restoration postscript. Such an approach would allow for clear, straightforward, unambiguous statements that nevertheless may reduce the potential for angry, reactant responses.
Inoculation theory extends the medical analogy of immunization against disease into the domain of resistance to social influence (Pfau, 1997). Given that the practice of health communication often seeks to discourage and prevent risky and unhealthy behaviors such as alcohol and substance abuse, cigarette smoking, and unprotected sex, the ability of inoculation to confer resistance to social influence messages encouraging such behaviors is invaluable. McGuire (1964) demonstrated how inoculated attitudes and beliefs can be protected against counterattitudinal persuasive attack messages via two essential mechanisms: (a) the forewarning of a threat against a held attitude, and (b) the refutational preemption of prospective arguments supporting such a threat. As it concerns the potential generation of anger, the threat component of an inoculation message is of particular interest.
For the most part, McGuire left threat undefined as a primitive term in his theorizing. However, Pfau and colleagues (2009) identified threat as the key motivational stimulus for resistance to influence in virtue of its forewarning of impending challenges to one’s held attitudes or beliefs. In the late 1980s, inoculation researchers began testing levels of message-elicited threat (Pfau & Burgoon, 1988; Pfau, Kenski, Nitz, & Sorenson, 1990) finding them to be marginal at best, and rarely coming close to the midpoints of the various threat measures used (Compton & Pfau, 2005). Unfortunately, the relative weakness of threat manipulations within inoculation research has been reflected in the correspondingly small effect sizes found to date.
Because most traditional inoculation manipulations appear to be insufficient for generating significant levels of threat (Compton & Pfau, 2005), a number of studies have attempted to augment its potency with the aim of increasing the force and efficacy of inoculation treatments. A central feature within many of these studies has been the use of anger as a motivational device. Pfau and colleagues (2001) first demonstrated how inoculation treatments can enhance anger following exposure to counterattitudinal attacks, wherein the anger functions as a coping mechanism for threats to held attitudes, thereby increasing resistance to influence.
Borrowing from vested interest theory (Crano & Prislin, 1995; Sivacek & Crano, 1982), Pfau and colleagues (2010) attempted to enhance the threat component within an inoculation pretreatment by modifying traditional forewarnings to emphasize the greater certainty, immediacy, relevance, and seriousness of potential counterattitudinal attacks on held attitudes. However, with one exception—an increase in attitude certainty—their efforts did not significantly increase measured levels of perceived threat or corresponding inoculation effect sizes.
Beyond stimulating fear, threat can also function to elicit anger—whether in its own right, or as a coping behavior for fear. Either way, anger can be used in an inoculation treatment to increase motivation to protect one’s attitudes against attack. Moreover, a number of inoculation studies have used anger as a key motivational element (e.g., Ivanov, Pfau, & Parker, 2009; Lee & Pfau, 1998; Pfau et al., 2001). Further, anger may be more effective than fear to focus attention on protecting held attitudes, especially if the consequences of those attitudes are perceived as hedonically relevant (Miller, 2016). Thus, as Pfau and associates (2009) assert, a heightened state of anger can be instrumental in motivating more active, focused, and effective counterarguing, which in turn is critical for enhancing resistance to influence.
As mentioned, elicited anger enhances active message processing (Nabi, 1999, 2003), and can stimulate counterarguing and source derogation aimed at an offending agent (Cameron, Jacks, & O’Brien, 2002). However, just as rejection can lead to anger (Leary, Twenge, & Quinlivan, 2006), anger often leads to rejection in general, and message rejection in particular (Dillard & Shen, 2005; Rains & Turner, 2007).
Because anger motivates people to gain and maintain control of a threatening situations (Pfau et al., 2001), inoculation treatments designed to enhance anger aimed at a potential counterattitudinal attack tempting risky health behaviors can lead to greater counterarguing, thereby enhancing resistance to such harmful forms of social influence (Pfau et al., 2001).
Inoculation Theory and Reactant Anger
Within the health communication domain, reactance theory has traditionally—and almost exclusively—been used to model what should be done to prevent reactance, and thereby reduce resistance to health promotion and risk prevention messages (e.g., Burgoon et al., 2002; Dillard & Shen, 2005; Grandpre et al., 2003; Miller et al., 2007; Miller, Burgoon, Grandpre, & Alvaro, 2006). However, by provoking reactant anger and negative cognitions in opposition to freedom-threatening attack messages targeting risky health behaviors, Miller and colleagues (2013) have recently examined how reactance may be used to cultivate rather than prevent resistance.
As a means of enhancing the threat and refutational preemption components of an inoculation treatment, Miller and colleagues (2013) deliberately induced psychological reactance in both the forewarning and attack message phases of inoculation treatments targeting health attitudes held by an emerging adult population. Findings from their multisite experiment demonstrated how reactance can be used during the initial phase of an inoculation pretreatment to sensitize message receivers and thereby improve key resistance outcomes, including: exciting initial attitudinal threat; inciting anticipated threat to freedom; directing anticipated anger at the attack message source; and heightening anticipated attack message source derogation. Such reactance-induced anger during the initial forewarning and refutational preemption phase of the inoculation process is intended to provoke and presensitize receivers, making them more likely to respond forcefully to any potential reactance-eliciting counterattitudinal attack messages they may encounter in the future.
During the attack-message phase of their experiment (10 days on average beyond the initial inoculation pretreatments), Miller and associates (2013) found significant effects for the use of explicit, controlling language on perceived threat to freedom, negative cognitions, negative affect, anger at the attack message, attack-message source derogation, counterarguing, and resistance to persuasion. By aiming reactance-enhanced anger at the source of attack messages targeting hedonically relevant health behaviors, as Pfau and colleagues theorized (Ivanov et al., 2009; Pfau et al., 2009), the heightened state of motivation afforded by reactance-enhanced inoculation treatments can generate more focused counterarguing activity, thereby enhancing resistance (Miller et al., 2013).
Not only was this reactance-inducing method effective at “turbocharging” the threat component of an inoculation pretreatment, it also demonstrated how reactance can be successfully used to presensitize a target audience days in advance of a counterattitudinal persuasive message. Because reactance is a coping behavior for restoring threatened perceived freedoms, reactance research involving health communication has almost exclusively examined the effects of state and trait reactance immediately following the presentation of persuasive health messages. Whether freedoms are threatened by prescriptive or proscriptive messages, the anger and negative cognitions immediately following such persuasion attempts act to swiftly restore the threatened freedoms. Thus, as it is quickly satiated, the motivational force driving the restoration of those freedoms is necessarily short lived. If, on the other hand, reactance can be successfully used to presensitize a target audience days or weeks in advance of harmful persuasive messages advocating risky health behaviors, the effects of anticipated reactance (i.e., anticipated anger and negative cognitions) can be extended beyond an immediate post-message response to affect resistance to subsequent attack messages days or weeks into the future.
Costs and the Benefits
The overarching theme of this article has been the double-edged nature of anger. Within certain health communication contexts, anger can be either a boon when properly directed in moderation, or a bane when poorly controlled and excessive. In the latter case, anger can severely limit the effectiveness of cognitive processing, resulting in emotional turbulence and a preoccupation with anger-eliciting events. On the down side, as it concerns health communication message design, anger—particularly intense anger—can result in a number of distressing states detrimental to message processing, including cognitive impairment, fear, pessimism, defensiveness, psychological projection, emotional flooding, tunnel vision, hostility, and aggression.
However, on the upside, when properly directed in moderation, anger can prompt greater purpose and resolve in response to health threats, more careful information processing, and sharper focus on argument quality in response to health warnings and prevention messages. In this way, anger can lead to greater attention to coping-relevant information and more active processing of health messages advocating against harmful behaviors.
- del Barrio, V., Aluja, A., & Spielberger, C. (2004). Anger assessment with the STAXI-CA: Psychometric properties of a new instrument for children and adolescents. Personality and Individual Differences, 37, 227–244.
- DeSteno, D., Petty, R. E., Rucker, D. D., Wegener, D. T., & Braverman, J. (2004). Discrete emotions and persuasion: The role of emotion-induced expectancies. Journal of Personality and Social Psychology, 86, 43–56.
- Dillard, J. P., & Shen, L. (2005). On the nature of reactance and its role in persuasive health communication. Communication Monographs, 72, 144–168.
- Ferrer, R., Klein, W., Lerner, J. S., Reyna, V. F., & Keltner, D. (2016). Emotions and health decision-making: Extending the appraisal tendency framework to improve health and healthcare. In C. Roberto & I. Kawachi (Eds.), Behavioral economics and public health. (pp. 101–131) Cambridge, MA: Harvard University Press.
- Fischer, A. H., & Evers, C. (2010). Anger in the context of gender. In M. Potegal, G. Stemmler, & C. Spielberger (Eds.), International handbook of anger: Constituent and concomitant biological, psychological, and social processes (pp. 349–360). New York: Springer.
- Gerend, M. A., & Maner, J. K. (2011). Fear, anger, fruits, and veggies: Interactive effects of emotion and message framing on health behaviors. Health Psychology, 30, 420–423.
- Myrick, J. G. (2015). The role of emotions in preventative health communication. New York: Lexington Books.
- Spielberger, C. D., & Reheiser, E. C. (2010). The nature and measurement of anger. In M. Potegal, G. Stemmler, & C. D. Spielberger (Eds.), International handbook of anger: Constituent and concomitant biological, psychological, and social processes. (pp. 403–412). New York: Springer.
- Aristotle. (350 BCE). Nicomachean Ethics. Translated with introduction by D. Ross (1925). Oxford: Oxford University Press. Retrieved March 30, 2016, from the Internet Classics Archive website http://classics.mit.edu/Aristotle/nicomachaen.html.
- Berkowitz, L. (1970). Experimental investigations of hostility catharsis. Journal of Consulting and Clinical Psychology, 35, 1–7.
- Bessarabova, E., Fink, E. L., & Turner, M. (2013). Reactance, restoration, and cognitive structure: Comparative statics. Human Communication Research, 39, 339–364.
- Bessarabova, E., & Miller, C. H. (in press). A further exploration of the effects of restoration postscripts on reactance. Western Journal of Communication.
- Bodenhausen, G. V., Sheppard, L. A., & Kramer, G. P. (1994). Negative affect and social judgment: The differential impact of anger and sadness. European Journal of Social Psychology, 24, 45–62.
- Brehm, J. W. (1966). A theory of psychological reactance. New York: Academic.
- Brehm, S. (1972). Responses to loss of freedom. A theory of psychological reactance. Morristown, NJ: General Learning Press.
- Brehm, S. S., & Brehm, J. W. (1981). Psychological reactance: A theory of freedom and control. New York: Academic Press.
- Brockner, J., & Elkind, M. (1985). Self-esteem and reactance: Further evidence of attitudinal and motivational consequences. Journal of Experimental Social Psychology, 21, 346–361.
- Buboltz, W., Thomas, A., Williams, D., Seemann, E., Soper, B., & Woller, K. (2003). Psychological reactance: Expanding the nomological net. Personality and Individual Differences, 34, 1167–1177.
- Buchanan, D. R., & Wallack, L. (1998). This is the Partnership for a Drug-Free America: Any questions? Journal of Drug Issues, 28, 329–356.
- Burgoon, M., Alvaro, E. M., Broneck, K., Miller, C., Grandpre, J. R., Hall, J. R., & Frank, C. A. (2002). Using interactive media tools to test substance abuse prevention messages. In W. D. Crano & M. Burgoon (Eds.), Mass media and drug prevention: Classic and contemporary theories and research (pp. 67–87). Mahwah, NJ: Lawrence Erlbaum Associates.
- Bushman, B., Baumeister, R., Stack, A., & Kruglanski, A. W. (1999). Catharsis, aggression, and persuasive influence: Self-fulfilling or self-defeating prophecies? Journal of Personality and Social Psychology, 76, 367–376.
- Bushman, B. J. (2002). Does venting anger feed or extinguish the flame? Catharsis, rumination, distraction, anger, and aggressive responding. Personality and Social Psychology Bulletin, 28, 724–731.
- Cameron, K. A., Jacks, J. Z., & O’Brien, M. E. (2002). An experimental examination of strategies for resisting persuasion. Current Research in Social Psychology, 7, 205–224.
- Chaiken, S. (1980). Heuristic versus systematic information processing and the use of source versus message cues in persuasion. Journal of Personality and Social Psychology, 39, 752–766.
- Chandler, T. A. (1990). Why discipline strategies are bound to fail. Clearing House, 64, 124–127.
- Clore, G. L., Ortony, A., Dienes, B., & Fujita, F. (1993). Where does anger dwell? In R. W. Wyer & T. K. Srull (Eds.), Perspectives on anger and emotion (Vol. 6, pp. 57–88). Hillsdale, NJ: Lawrence Erlbaum Associates.
- Compton, J. A., & Pfau, M. (2005). Inoculation theory of resistance to influence at maturity: Recent progress in theory development and application and suggestions for future research. In Communication Yearbook 29 (pp. 97–145). Mahwah, NJ: Lawrence Erlbaum Associates.
- Crano, W. D. & Prislin, R. (1995). Components of vested interest and attitude-behavior consistency. Basic and Applied Social Psychology, 17, 1–21.
- Critchfield, T. S., & Kollins, S. H. (2001). Temporal discounting: Basic research and the analysis of socially important behavior. Journal of Applied Behavior Analysis, 34, 101–122.
- Dillard, J. P., & Shen, L. (2005). On the nature of reactance and its role in persuasive health communication. Communication Monographs, 72, 144–168.
- Fehr, B., & Baldwin, M. W. (1996). Prototype and script analyses of laypeople’s knowledge of anger. In J. Fitness & G. Fletcher (Eds.), Knowledge structures and interaction in close relations: A social psychological approach (pp. 219–245). Hillsdale, NJ: Lawrence Erlbaum Associates.
- Ferrer, R., Klein, W., Lerner, J. S., Reyna, V. F., & Keltner, D. (2016). Emotions and health decision-making: Extending the appraisal tendency framework to improve health and healthcare. In C. Roberto & I. Kawachi (Eds.), Behavioral economics and public health. (pp. 101–131). Cambridge, MA: Harvard University Press.
- Gottman, J. M. (1994). What predicts divorce? The relationship between marital processes and marital outcomes. Hillsdale, NJ: Lawrence Erlbaum Associates.
- Grandpre, J., Alvaro, E. M., Burgoon, M., Miller, C. H., & Hall, J. R. (2003). Adolescent reactance and anti-smoking campaigns: A theoretical approach. Health Communication, 15, 349–366.
- Han, S., Lerner, J. S., & Keltner, D. (2007). Feelings and consumer decision making: The Appraisal-Tendency Framework. Journal of Consumer Psychology, 17, 158–168.
- Harmon-Jones, E. (2004). On the relationship of anterior brain activity and anger: Examining the role of attitude toward anger. Cognition and Emotion, 18, 337–361.
- Ivanov, B., Pfau, M., & Parker, K. (2009). The attitude base as a moderator of the effectiveness of inoculation strategy. Communication Monographs, 76, 47–72.
- Keltner, D., Ellsworth, P. C., & Edwards, K. (1993). Beyond simple pessimism: Effects of sadness and anger on social perception. Journal of Personality and Social Psychology, 64, 740–752.
- Lazarus, R. S. (1991). Cognition and motivation in emotion. American Psychologist, 46, 352–67.
- Leary, M. R., Twenge, J. M., & Quinlivan, E. (2006). Interpersonal rejection as a determinant of anger and aggression. Personality and Social Psychology Review, 10, 111–132.
- Lee, W., & Pfau, M. (1998). The effectiveness of cognitive and affective inoculation appeals in conferring resistance against cognitive and affective attacks. Paper presented at the annual conference of the International Communication Association, Jerusalem, Israel.
- Lerner, J. S., Gonzalez, R. M., Small, D. A., & Fischhoff, B. (2003). Effects of fear and anger on perceived risks of terrorism: A national field experiment. Psychological Science, 14, 144–150.
- Lerner, J. S., & Keltner, D. (2000). Beyond valence: Toward a model of emotion-specific influences on judgment and choice. Cognition & Emotion, 14, 473–493.
- Lerner, J. S., & Keltner, D. (2001). Fear, anger, and risk. Journal of Personality and Social Psychology, 81, 146–159.
- Lerner, J. S., & Tiedens, L. Z. (2006). Portrait of the angry decision maker: How appraisal tendencies shape anger’s influence on cognition. Journal of Behavioral Decision Making, 19, 115–137.
- Leary, M. R., Twenge, J. M., & Quinlivan, E. (2006). Interpersonal rejection as a determinant of anger and aggression. Personality and Social Psychology Review, 10, 111–132.
- McGuire, W. J. (1964). Inducing resistance to persuasion. Some contemporary approaches. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 1, pp. 191–229). New York: Academic Press.
- Miller, C. H., (2015). Persuasion and psychological reactance: The effects of explicit, high-controlling language. In R. Shulze & H. Pishwa (Eds.), The exercise of power in communication: Devices, reception and reaction (pp. 269–286). London: Palgrave Macmillan.
- Miller, C. H., (2016). Hedonic relevance and outcome relevant involvement. In D. K. Kim & J. Dearing (Eds.), Health communication measures (pp. 99–106). New York: Peter Lang.
- Miller, C. H., Burgoon, M., Grandpre, J., & Alvaro, E. (2006). Identifying principal risk factors for the initiation of adolescent smoking behaviors: The significance of psychological reactance. Health Communication, 19, 241–252.
- Miller, C. H., Ivanov, B, Compton, J., Averbeck, J. Robertson, K.J., Sims, J.D., Parker, K. A., & Parker, J.L. (2013). Boosting the potency of resistance: Combining the motivational forces of inoculation and psychological reactance. Human Communication Research, 39, 127–155.
- Miller, C. H., Lane, L. T., Deatrick, L. M., Young, A. M., & Potts, K. A. (2007). Psychological reactance and promotional health messages: The effects of controlling language, lexical concreteness, and the restoration of freedom. Human Communication Research, 33, 219–240.
- Miller, C. H., & Quick, B. (2010) Sensation seeking and psychological reactance as health risk predictors for an emerging adult population. Health Communication, 25, 266–275.
- Moons, W. G., & Mackie, D. M. (2007). Thinking straight while seeing red: The influence of anger on information processing. Personality and Social Psychology Bulletin, 33, 706–720.
- Nabi, R. L. (1999). A cognitive-functional model for the effects of discrete negative emotions on information processing, attitude change, and recall. Communication Theory, 9, 292–320.
- Nabi, R. L. (2002). Anger, fear, uncertainty, and attitudes: A test of the cognitive-functional model. Communication Monographs, 69, 204–216.
- Nabi, R. L. (2003). “Feeling” resistance: Exploring the role of emotionally evocative visuals in inducing inoculation. Media Psychology, 5, 199–223.
- Nabi, R. L. (2010). The case for emphasizing discrete emotions in communication research. Communication Monographs, 77, 153–159.
- Ortony, A., Clore, G. L. & Collins, A. (1988). The cognitive structure of emotions. New York: Cambridge University Press.
- Petty, R. E., & Cacioppo, J. T. (1986). The elaboration likelihood model of persuasion. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 19, pp. 123–205). New York: Academic Press.
- Pfau, M. (1997). The inoculation model of resistance to influence. In G. A. Barnett & F. J. Boster (Eds.), Progress in communication sciences: Advances in persuasion (Vol. 13, pp. 133–171). Greenwich, CT: Ablex.
- Pfau, M., Banas, J., Semmler, S. M., Deatrick, L., Lane, L., Mason, A., Craig, E., Nisbett, G., & Underhill, J. (2010). Role and impact of involvement and enhanced threat in resistance. Communication Quarterly, 58, 1–18.
- Pfau, M., & Burgoon, M. (1988). Inoculation in political campaign communication. Human Communication Research, 15, 91–111.
- Pfau, M., Kenski, H. C., Nitz, M., & Sorenson, J. (1990). Efficacy of inoculation strategies in promoting resistance to political attack messages: Application to direct mail. Communication Monographs, 57, l–12.
- Pfau, M., Semmler, S. M., Deatrick, L., Mason, A., Nisbett, G., Lane L., et al. (2009). Nuances about the role and impact of affect in inoculation. Communication Monographs, 76, 73–98.
- Pfau, M., Szabo, E. A., Anderson, J., Morrill, J., Zubric, J., & Wan, H.-H. (2001). The role and impact of affect in the process of resistance to persuasion. Human Communication Research, 27, 216–252.
- Quick, B. L., & Stephenson, M. T. (2007). Further evidence that psychological reactance can be modeled as a combination of anger and negative cognitions. Communication Research, 34, 255–276
- Rains, S. A., & Turner, M. (2007). Psychological reactance and persuasive health communication: A test and extension of the intertwined model. Human Communication Research, 33, 241–269.
- Retzinger, S. M. (1991). Violent emotions: Shame and rage in marital quarrels. Thousand Oaks, CA: SAGE.
- Schaef, A. W. (1987). When society becomes an addict. New York: Harper & Row.
- Schwarz, N. (1990). Feelings as information: Informational and motivational functions of affective states. In E. T. Higgins & R. Sorrentino (Eds.), Handbook of motivation and cognition: Foundations of social behavior (Vol. 2, pp. 527–561). New York: Guilford.
- Schwarz, N., & Clore, G. L. (1983). Mood, misattribution, and judgments of well-being: Informative and directive functions of affective states. Journal of Personality and Social Psychology, 45, 513–523.
- Sivacek, J., & Crano, W. D. (1982). Vested interest as a moderator of attitude-behavior consistency. Journal of Personality and Social Psychology, 43, 210–221.
- Tavris, C. (1984). Anger: The misunderstood emotion. New York: Simon & Schuster.
- Turner, M. M. (2007). Using emotion in risk communication: The anger activism model. Public Relations Review, 33, 114–119.
- Wakefield, M. A., Loken, B., & Hornik, R. C. (2010). Use of mass media campaigns to change health behaviour. The Lancet, 376, 1261–1271.
- Wicklund, R. A., & Brehm, J. W. (1968). Attitude change as a function of felt competence and threat to attitudinal freedom. Journal of Experimental Social Psychology, 4, 64–75.
- Witte, K. (1992). Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs, 59, 329–349.
- Wolburg, J. M. (2006). College students’ responses to antismoking messages: Denial, defiance, and other boomerang effects. Journal of Consumer Affairs, 40, 294–323.
- Yang, Z., Tong, E., & Phelps, E. A. (2010). The effects of subliminal anger and sadness primes on agency appraisals. Emotion, 10, 915–922.
- Zhang, Q., Ting-Toomey, S., & Oetzel, J. G. (2014). Linking emotion to the conflict face-negotiation theory: A U.S.–China investigation of the mediating effects of anger, compassion, and guilt in interpersonal conflict. Human Communication Research, 40, 373–395.
- Zillmann, D. (1988). Cognition-excitation interdependence in aggressive behavior. Aggressive Behavior, 14, 51–64.
- Zillmann, D. (1990). The interplay of cognition and excitation in aggravated conflict. In D. D. Cahn (Ed.), Intimacy in conflict: A communication perspective (pp. 187–208). Hillsdale, NJ: Lawrence Erlbaum Associates.
- Intercultural Conflict
- Transtheoretical Model and Stages of Change in Health and Risk Messaging
- Inoculation Theory Applied in Health and Risk Messaging
- Fear Arousal and Health and Risk Messaging
- Gender as a Consideration When Designing Health and Risk Messages
- Using Guilt to Motivate Individuals to Adopt Healthy Habits
- Spiral of Silence in Health and Risk Messaging