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date: 06 December 2023

Fear Arousal and Health and Risk Messagingfree

Fear Arousal and Health and Risk Messagingfree

  • Jessica Gall MyrickJessica Gall MyrickCollege of Communications, Pennsylvania State University
  •  and Robin L. NabiRobin L. NabiDepartment of Communication, University of California, Santa Barbara


Fear is a negatively valenced discrete emotional state that is an inherent part of the human experience. With strong evolutionary roots, fear serves important functions, including alerting people to present threats and motivating action to avoid future threats. As such, fear is an emotion that frequently attracts the attention of scholars and message designers who hope to persuade audiences to change their behavior in light of potential threats to well-being and public safety. Several theories have aimed to describe the effects of fear-based appeals on audiences, focusing largely on the cognitive correlates of fear (i.e., severity and susceptibility) and their subsequent impacts on persuasive outcomes. However, more recent theorizing has returned to a focus on the influence that the emotion of fear itself has on attitude and behavior change. Given that many health-oriented fear appeals have been shown to evoke multiple emotions, including anger, disgust, and sadness, current theorizing has taken a mixed-emotions or emotional flow perspective to provide a deeper understanding of fear appeal effects. Further, individual differences have been considered to determine who is most likely to experience fear during and after message consumption.

In addition to fear appeals that purposefully aim to scare audiences to motivate attitude and behavior change, recent work suggests that fear can be generated by other forms of messages (e.g., news accounts, social media posts, interpersonal conversations) that may influence receivers’ approaches to health issues. Moreover, research also suggests that fear may motivate social sharing of messages, which can in turn allow for more widespread influence of fear-based messages.


  • Communication Theory
  • Health and Risk Communication
  • Mass Communication

As a universally relatable experience, fear is frequently incorporated into the design of messages related to health and risk that aim to motivate people to change their behaviors. Since the 1950s, researchers have addressed strategic fear appeal effects, continually refining answers to the questions of when, why, and for whom they are persuasive. Additionally, researchers have investigated the effects of fear in other message contexts, from news media to user-generated digital content. An overview of the scholarly work on the emotion of fear, fear appeal theories, and fear as a variable that impacts post-message attitudes and behaviors can provide insights as to what is currently known, as well as what remains to be learned about how fear can be incorporated into persuasive messages and to what effect.

What Is Fear?

The emotion of fear—a negatively valenced response to a threat—is an innate experience, and one that likely evolved from mammalian defense systems (Öhman, 2008). When people are aware of a threat, the aversive state of fear quickly follows. Fear, in turn, motivates protective behavior and a strong desire to escape the threat.

The physical experience of fear is generated by an extensive network of fear-related neural structures in the brain, particularly the amygdala (Lang, Davis, & Öhman, 2000; Öhman, 2008). Once evoked, fear manifests itself physically in multiple ways, including changes in facial expressions (e.g., wide-open eyes and raised eyelids) and the body (e.g., increased heart rate) (Öhman, 2008). The physical expression of fear not only represents the body’s readiness to protect itself, but it also serves a social function by warning others of nearby threats and alerting them that help may be needed. Cognitively, fear is associated with uncertainty over the likely outcome and one’s ability to cope with the current threat, which contributes to the motivation for avoidance and protection (Lazarus, 1991).

Of note, though the terms fear and anxiety are often used interchangeably in everyday language, they each represent unique affective states with, theoretically, different implications in persuasion contexts. Whereas fear is typically the result of an imminent and identifiable threat, anxiety stems from anticipating a potential threat, sometimes of unclear origin (Öhman, 2008). Thus anxiety is typically a more diffuse emotional experience with a less clearly defined action tendency or behavioral target than fear. Although the distinction between the two has not been studied empirically, and the word “anxious” is frequently included among the emotion words used to assess fear responses to persuasive appeals, it is useful to recognize that the experience of fear and anxiety are distinguishable, with fear carrying the potential for more adaptive action. Empirical work is needed, however, to test if and how differences between fear and anxiety manifest themselves across multiple persuasion contexts.

Fear As Mental State Versus Message Component

In discussions of fear appeals and fear appeal effects, it is important to draw the distinction between a message component—something inherent to the message—that may result in a fear response, and the experience of fear itself by the message receiver. If fear appeal messages are defined or identified based primarily on their ability to elicit fear, message design elements and message response become conflated, which interferes with gaining insight into the message components responsible for generating the desired fear response (O’Keefe, 2003). A fear appeal, then, can be defined as a message that intends to evoke fear in audiences by demonstrating the existence of a threat and then detailing ways to avoid that threat (Witte, 1994). As such, message components of fear appeals include threat and efficacy. The term “fear” is reserved for referencing the emotion experienced by audiences in response to fear appeal messages.

Theories of Fear’s Influence on Risk Perceptions, Attitudes, and Behavior

Since the 1950s, social scientists have studied the potential effects of fear-arousing messages on audiences. These efforts have resulted in a number of theoretical perspectives that still inform modern-day work on the persuasive power of fear and its implications for message design. Although these are presented in chronological order here, it is important to note that the evolution of fear appeal theorizing reflects a combination of attempts to build on previous theory alongside overarching changes in psychological research that shifted from motivation-based approaches to more cognitively oriented approaches starting in the 1970s (for a review, see Nabi, 2007). As such, each theory or model does not always present a direct response to its immediate predecessor.

Drive Theory

The fear-as-acquired drive model (often referred to as the drive model) argues that stimuli that evoke fear result in a drive to avoid the unpleasant emotional state (Hovland, Janis, & Kelly, 1953). Under this model, any behavior that effectively alleviates fear will then become automatically associated with relief from the aversive state, and that behavior will become a habitual response to threatening stimuli. Hovland, Janis, and Kelly noted that habituated behaviors can be adaptive in that they target the threat itself and aim to reduce or eliminate it. These behaviors can also, however, be maladaptive if they do not result in behavioral change but instead involve avoiding the topic or becoming defensive toward the message source.

In an early test of this model, Janis and Feshbach (1953) examined the connection between fear arousal and the persuasiveness of dental-hygiene messages. In their experiment, participants who saw the most graphic and frightening images of tooth decay and poor oral hygiene rated the material as the most worrisome and interesting compared to those in other conditions who saw less disturbing images or just heard a lecture about cavities. However, the participants in this high-fear condition were actually less likely than those who saw milder images about tooth decay to improve their brushing and flossing habits in a post-test one week after exposure to the initial fear appeal.

In light of findings like these, Janis (1967) later argued that the relationship between the elicitation of fear and adoption of the target behavior would be an inverted U-shaped curve. That is, too little fear or too much fear would push individuals toward maladaptive behaviors that quickly reduce the aversive state, such as problem minimization or source derogation, without offering true protection from the threat. However, a moderate amount of fear could be just enough to motivate more adaptive actions to neutralize the threat. Empirical research, however, did not readily support the predicted curvilinear relationship between fear arousal and influence.

Parallel Process Model (PPM)

When a growing body of empirical evidence found a positive linear relationship between fear and persuasion (that is, the more frightened participants were, the more persuasive the message, generally speaking), the drive model no longer seemed a plausible explanation for why fear appeals affect audiences (Beck & Frankel, 1981; Giesen & Hendrick, 1974; Mewborn & Rogers, 1979). As the drive model lost favor, researchers began exploring alternative explanations for why stronger fear appeal messages could lead to greater adaptive responses, while still accounting for the evidence that sometimes, fear appeals lead to maladaptive responses. Most notably, Leventhal (1970, 1971) argued that fear appeals evoked two separate but simultaneous processes: an emotional fear control reaction and a primarily cognitive danger-control reaction. In his parallel process model (PPM), Leventhal argues that one of two responses to a fear appeal is likely. If a person focuses on managing the threat they perceive in the environment, Leventhal argues that danger-control processes are engaged to manage the threat. As such, adaptive outcomes are likely. However, if a person focuses on controlling the emotion of fear, fear control processes are engaged, which ultimately result in maladaptive outcomes, such as avoidance, denial, and reactance. Though conceptually appealing, the PPM did not specify when individuals were more likely to rely on fear-control or danger-control processes. Thus, the model proved unhelpful for both predicting responses to fear appeals as well as to fear appeal message design.

Protection Motivation Theory (PMT)

Given that theories of motivation were losing favor to those that focused on cognition in the field of psychology in the 1970s, it is unsurprising that the next major advance in fear appeal theorizing focused on the cognitive elements associated with fear appeal effectiveness. The protection motivation theory (Maddux & Rogers, 1983; Rogers, 1975) elaborated on the danger-control branch of the PPM, explicating four different cognitive reactions to fear appeals. These included two perceptions related to the potential threat: severity of the threat and susceptibility to it. The other two perceptions related to the target behavior: the effectiveness of the target behavior for avoiding the threat (response efficacy) and the ability of the individual to enact the target behavior (self-efficacy). Maddux and Rogers (1983) argued that individuals who were high in both threat and efficacy perceptions would be motivated to protect themselves from the threat at hand and therefore the most likely to engage in adaptive, danger-control behaviors. Though the four cognitions identified in the PMT proved important to persuasive outcomes in response to fear appeals, the specific relationships among them as asserted by the theory were not fully supported by empirical evidence. Despite accumulating evidence that fear appeals could be persuasive, the field remained without a good explanation for the mechanisms of these message effects.

Extended Parallel Process Model (EPPM)

In light of the limitations of previous theorizing, and coinciding with an increased interest in affect and emotion in the psychology literature (Lazarus, 1991), Witte (1992) proposed the extended parallel process model (EPPM). The EPPM represented a merger of the PPM and the PMT, but it also recognized the importance of the emotion of fear itself in understanding message effects. Broadly, the EPPM posits that message-relevant fear arises in response to threat appraisals. More specifically, the EPPM argues that if a message contains information on threat severity and susceptibility, fear will be aroused. Although fear may predispose audiences to engage in defensive motivations, it also prompts consideration of efficacy potential. If the threat appraisals are more dominant than the efficacy appraisals, individuals will seek to diminish their aroused fear through maladaptive behaviors, such as denigrating the message source or rationalizing their unhealthy behaviors. However, if efficacy appraisals are strong enough to dominate threat appraisals, the EPPM predicts that individuals will feel capable of addressing the threat and will then enact adaptive, danger-control behaviors.

Although the predicted interaction between threat and efficacy appraisals lies at the heart of the EPPM, the full model includes 12 propositions detailing numerous intricate relationships between the different types of cognitions, fear, and message effectiveness (Witte, 1992). Visually, the EPPM is represented as a path model whereby the four message components in the external stimuli (i.e., self-efficacy, response efficacy, susceptibility, and severity) predict their related cognitive perceptions. Next, these cognitive perceptions form a feedback loop with fear, as well as interact with each other to either predict protection motivation (which then predicts message acceptance) or defensive motivation (which then predicts message rejection). From a message-design standpoint, the EPPM suggests that fear-arousing messages should include both threat and efficacy information if they are to persuade audiences to take adaptive actions. That is because threat perceptions are necessary to elicit fear but efficacy perceptions are necessary to promote protection motivation.

As with previous models, though EPPM offers an appealing explanation for when fear appeals may be more or less persuasive, research has not supported all of the EPPM’s key predictions. That is, though significant relationships between fear and persuasion have been identified, meta-analyses have found mixed support for the threat by efficacy interactions predicted by the EPPM (de Hoog, Stroebe, & de Wit, 2007; Witte & Allen, 2000). Further, many of the 12 propositions originally articulated within the EPPM have not been consistently tested. Indeed, in a systematic review of the EPPM literature, Popova (2012) found that two of Witte’s (1992) propositions, (a) when perceived efficacy is at a moderate level, perceived threat will have an inverted-U-shaped effect on message acceptance, and (b) when perceived efficacy is at a high level, there is a reciprocal relationship between perceived threat and fear, have yet to be empirically tested. In order to fully support or reject tenets the original EPPM, additional research is needed.

Cognitive Functional Model (CFM)

Although no new models of fear appeals have specifically been advanced since the EPPM, theorists have considered how a range of emotions, including fear, might generate persuasive effect. For example, Nabi (1999) proposed the cognitive-functional model (CFM) to advance the literature on negative emotional appeals generally, including specific predictions regarding the role of fear in mediated persuasion. Combining aspects of cognitive-response theories of persuasion with the appraisal-based perspectives on emotion, the CFM focuses on the role of three concepts: motivated attention, motivated processing, and message expectations. Motivated attention refers to the degree of approach or avoidance response to the message based on the receiver’s initial emotional response; motivated processing refers to how motivated the message receiver is to process the message carefully; and message expectations pertain to the audience’s degree of certainty that the message will offer reassurance or not.

The CFM predicts that because fear’s action tendency motivates individuals to avoid threatening situations, message-related fear should predispose audiences to want to avoid giving further attention to the message. Yet fear’s associated motivation for protection from the threat may still lead to message processing, depending on the audience’s expectations regarding the remainder of the message content. Specifically, the CFM predicts that an individual experiencing message-relevant fear who is also uncertain as to whether the rest of the message will contain reassuring information (i.e., it may help alleviate fear, but full exposure is necessary to know for sure) would be most likely to carefully process the message. This deeper processing in the face of uncertainty occurs, according to the CFM, because the audience member is trying to find some piece of information that might satisfy the fear-induced goal of protection. In an initial test of the model, the predictions that fear promotes less careful message processing relative to anger and uncertainty of message reassurance results in more careful processing that certainty of reassurance were supported. However, the prediction that fear, but not anger, would be associated with less careful information processing when expectation of reassurance was high was not supported. Still, the CFM introduces the notion that the emotion of fear influences how carefully persuasive messages are processed, which in turn has implications for the direction and endurance of persuasive effect.

Emotions as Frames Model (EFM)

A second more general approach to considering the influence of discrete emotions, including fear, on persuasive outcome is the emotions-as-frames perspective, which argues that an audience member’s emotional state provides a lens through which individuals pay attention to and process message information (Nabi, 2003). Rooted in appraisal theories of emotions (e.g., Lazarus, 1991), the EFM argues that when a message contains information that is relevant to an emotion’s core relational theme, or the essential perception that underlies an emotional experience, that particular emotion is aroused. For example, the core relational theme of fear is imminent threat. So, if an audience member appraises a message as representing an imminent threat to her own well-being, she will likely experience fear. The EFM then predicts that once an emotion is experienced, emotion-consistent information will be made accessible from memory. Additionally, audiences will be motivated to attend to message information that is consistent with the goals of the aroused emotion (e.g., protection, in the case of fear). Finally, given the expectation that emotional experience directs information processing and information accessibility, the EFM predicts that decision-making and action will be heavily influenced by these emotion-driven processes. In short, message consumers’ emotional states frame how they respond to the rest of the message, which in turn results in emotion-consistent decision-making and action.

Multiple studies have supported the predictive power of the emotions-as-frames perspective, demonstrating not only that different emotion frames lead to different ways of viewing problems and preferred solutions but also that emotion is an important mediator of that process (e.g., Kühne & Schemer, 2015). Although it is applied more in the context of news than persuasion, the EFM has the potential to assist in understanding how fear-based messages might generate persuasive influence by emphasizing how emotion-relevant information is more likely to be attended to later in the message and how post-message behaviors are likely to be consistent with emotional motivations.

Emotional Flow

Throughout the history of the study of fear appeals, any message that evoked negative emotion would often be categorized as a fear appeal. More recently, scholars have adopted a more nuanced approach, noting that messages that include both threat components and efficacy components, and thus are well-categorized as fear appeals, can evoke other emotions in addition to fear and that these other emotions have unique influence on persuasive outcomes. The recently advanced emotional flow perspective (Nabi, 2015; Nabi & Green, 2015) builds on this recognition by arguing that messages, including fear appeals, evoke multiple emotions in sequence as the contents of the messages unfold. It further asserts that the ordering or shifts in emotional states in response to changing message content may be critical to understanding persuasive outcomes. For example, fear appeals begin with threat information followed by efficacy information. The emotional flow perspective suggests that the threat information results in fear arousal, and the efficacy information is associated with feelings of hope. As such, the emotional flow perspective suggests that the emotional shift from fear to hope may help to explain the conditions under which fear appeals are more likely to be effective. Although as yet untested, the emotional flow perspective is unique in highlighting that emotional states like fear can be fleeting and rapidly evolve into other states, and this sequencing could be useful in persuasive message design.

Meta-analyses of Fear Appeal Effects

Despite multiple theoretical perspectives advanced in the literature, no single model decisively captures the conditions of fear appeal effectiveness. Still, meta-analyses across a range of fear- appeal studies have helped clarify the direction and magnitude of fear’s influence on persuasive outcomes and associated cognitions. Although these meta-analyses focus on different variables used across different fear-appeal theories, together they provide helpful evidence for any theory that utilizes the variables each meta-analysis addressed.

Mongeau’s (1998) meta-analysis examined the influence of fear appeals on perceived fear, attitudes, and behaviors. He found that fear appeal manipulations resulted in a moderate relationship with perceived fear (r = .34), attitudes (r = .20), and behavior (r = .17). Two years later, in their meta-analysis of 98 studies, Witte and Allen (2000) likewise found a moderately positive relationship between fear appeals and experienced fear (r = .30). Additionally, they found that the fear aroused by messages that included a message-based fear or threat manipulation was associated with attitudes (r = .15), intentions (r = .13), and behavior change (r = .16). With a smaller set of studies (between 17 and 33), the authors also analyzed the relationship between fear appeal manipulations in the message content and cognitions. They found positive relationships with severity (r = .44), susceptibility (r = .30), response efficacy (r = .36), and self-efficacy (r = .36). Importantly, Witte and Allen (2000) did not find support for the EPPM’s predicted threat by efficacy interaction.

Fifteen years later, Tannenbaum, Hepler, Zimmerman, Saul, Jacobs, Wilson et al. (2015) conducted a meta-analysis based on 248 independent samples from studies that contained a treatment group exposed to a fear appeal; a comparison group (described by the authors as a group that was either not exposed to a message or exposed to a message specifically designed to not evoke fear, or exposed to a message meant to induce less fear than the treatment group’s message); a manipulation of depicted fear; and a measure of attitudes, intentions, or behaviors. The results replicated previous meta-analyses, demonstrating a significant positive relationship between fear appeal manipulations and attitudes, intentions, and behaviors (average weighted d = .29). For the 71 studies in their sample that reported perceived fear, the meta-analysis revealed that treatment groups reported greater perceived fear than comparison groups, d = 1.00. Tannenbaum et al. (2015) also found that studies with messages that included efficacy statements had larger effects (d = .43) than did those that did not include efficacy statements (d = .21), with the outcome being an average weighted effect size encompassing attitudes, intentions, and behaviors. In a similar analysis, messages that included severity (d = .23) or susceptibility (d = .43) or both (d = .39) had stronger effects on outcomes than messages that did not include these threat components (d = .12). The meta-analysis did not, however, directly address interactions between the threat and efficacy elements.

Additionally, Tannenbaum et al. (2015) calculated an average weighted effect size comparing groups exposed to moderate fear versus those exposed to high depicted fear. If the linear fear-persuasion hypothesis supported by the Mongeau (1998) and Witte and Allen (2000) meta-analyses, were the superior model of fear appeal effects, this value would be positive and significant. However, if the curvilinear hypothesis suggested by the drive model were the best model of fear appeal effects, this value would be negative and significant. It was d = −.05 with a 95% confidence interval that crossed 0 [−.34, 0.24], suggesting that neither the linear nor curvilinear hypotheses were fully supported by the body of existing fear appeal research. Although these meta-analyses seem to converge on a small but significant relationship between fear and persuasion-related outcomes, the mechanisms of fear appeal effects are still not entirely clear.

Limitations of Fear Appeal Research

Despite the wealth of research on the effects of fear-based messages, numerous limitations have been pointed out in the existing literature. Most crucially, and from a practical standpoint, the controlled laboratory settings and forced message exposure used in many fear appeal studies may not translate to real-world settings. For instance, there is little work to confirm that people actually stay attuned to an entire fear appeal encountered in their daily lives or change the channel to avoid the unpleasant information (Witte & Allen, 2000). This is a critical because if audiences stop paying attention to a fear appeal after the presentation of the threat, they may miss out on the efficacy information that is critical to a fear-based message’s success.

At a methodological level, many studies of fear appeals fail to measure the emotion of fear itself as an outcome, instead analyzing only threat and efficacy cognitions. Indeed, the Tannenbaum et al. (2015) meta-analysis did not examine the relationship between the amount of fear aroused and fear-appeal effects on persuasive outcomes. Thus, the influence of the emotional arousal versus its related cognitions is often blurred. As O’Keefe (2003) argues, it is important to differentiate between message features and message effects, and if researchers are to gain a deeper understanding of the mechanisms behind fear appeal effects and the specific role that the emotion of fear plays in this process, they need to clearly distinguish not only message features from their psychological effects but also emotional responses from cognitive ones.

Further, of the studies that do measure fear, they tend to do so in very limited ways, typically self-report of emotional arousal in response to the message generally. However, this approach offers a limited understanding of the experience of fear throughout message exposure. Indeed, though meta-analyses support a linear relationship between fear arousal and persuasive outcomes, recent methodologies suggest that shifts in experienced fear across a fear appeal, an inverted-U pattern of fear responses specifically, may also be a valid predictor of the persuasiveness of a fear appeal (Meczkowski, Dillard, & Shen, 2016). Using a within-subjects design and asking participants about their fear responses before, during, and after viewing a message about colorectal cancer screening using, Dillard et al. found that this dynamic approach offered evidence in support of a curvilinear relationship between fear and persuasion. Such curvilinear patterns likely result from minimal fear in response to the beginning of a message, stronger fear when an individual sees the threat component of the message, and resolving fear after seeing the efficacy component. As this study suggests, more nuanced methodological approaches are needed to better understand how individuals experience fear appeals over the course of message exposure.

Finally, though fear appeals may generally be persuasive at an individual level (although, as discussed above, the mechanisms of these effects remain murky, and they may at times backfire), we know far less about the influence of exposure to multiple fear appeals over time. Repeated exposure could possibly promote complacency among those who see frightening messages but are not directly targeted or do not perceive themselves to be in the target audience. Conversely, the frequent use of fear appeals across a range of issues could possibly result in a chronic sense of heightened anxiety. Longitudinal work on fear appeal exposure and responses, as well as research on the influence of more prevalent use of fear appeals versus other message strategies, could help confirm or dismiss these possibilities.

Individual Differences in Fear Arousal

While meta-analyses support the claim that on the aggregate, fear-based messages are persuasive, researchers are still working to explain why fear appeals work and for whom they work best and under what conditions. There has been sporadic attention in the literature to the individual differences that may determine the types of audiences who will be more or less persuaded by a fear appeal. It is to this literature we now turn.


Evidence from a meta-analysis of fear appeals found that appeals targeting female-dominated audiences are more effective than those targeting male audiences, likely because women tend to be more prevention focused in that they are more sensitive to avoiding negative outcomes than to seeking positive outcomes (Tannenbaum et al., 2015). A review of the literature on more general gender differences in fear may also help explain potential gender differences in responses to fear appeals. This body of work suggests that, in general, women report being afraid of more items or events and having more severe fear reactions to frightening items or events than men. However, these gender differences are likely moderated by gender-role socialization processes such that expressions of fear are typically looked down on for men but not women, resulting in a cycle whereby fearful reactions by women are both tolerated and expected by other members of society (McLean & Anderson, 2009). This raises the question of how gender-role socialization may influence how men, in particular, respond to fear appeals in terms of experienced fear versus reported fear, and the implications for both message design and application.


The use of fear to motivate behavior change is well-documented across the lifespan. While some work suggests age is not a moderator of fear-appeal effects (Witte & Allen, 2000), the role of developmental stages in the processing of and behavioral reactions to fear appeals has yet to be thoroughly or rigorously tested. Indeed, with developmental stages in mind, there is reason to believe that different message structures would be more appropriate for different age groups.

Beginning with the very young, testing the influence of fear-based messages on children is a difficult area of empirical inquiry given the ethical implications of potential psychological trauma. However, cautionary tales, which tell the stories of people who ignore the dangers of a forbidden act and suffer as a result, have frequently been used to encourage compliant behavior in children (P. J. Miller & Moore, 1989). As such, it is evident that fear is used to persuade even very young audiences. Although not specifically documented, the pervasiveness and endurance of cautionary tales in children’s literature suggest that such narratives are believed to be influential; and in light of the growing evidence of the persuasive influence of narratives on adults (Green, 2006; Green & Brock, 2000), there is reason to believe such stories do, indeed, have the desired influence on children. Thus, it is reasonable to imagine that fear-evoking narratives—whether in the media or told by parents—are effective vehicles for persuading children, perhaps even more so than didactic fear-based messages. Further, at a more general level, fear-based messages that alert children to the importance of making self-protective decisions while they are still developing their schemas for health-related behaviors, such as regular teeth brushing or healthy eating, may result in the creation of sustainable habits that eventually result in improved health across the lifespan.

The use of fear appeals to discourage adolescents from engaging in risky health behaviors, such as smoking and drug use, is well-documented and unsurprising, given that adolescents are often assumed to perceive themselves as less vulnerable to risk. However, some evidence suggests a more nuanced picture. That is, adolescents may not perceive themselves to be less vulnerable to risk as much as they actually perceive a range of health-threatening behaviors as less risky than they actually are, compared to their adult counterparts. Moreover, they may perceive themselves to be less able to avoid the harms associated with risky health behaviors (Cohn, Macfarlane, Yanez, & Imai, 1995). Thus, highlighting both actual risk of health-threatening behavior, especially occasional ones, to enhance perceived severity, as well as boosting self-efficacy to protect oneself from harm, may be particularly important message goals to match the psychological profile of adolescents. Further, there is evidence that campaigns targeting adolescents’ risky health behaviors are at high risk for failure due to the likelihood of reactance, or resistance to having behavioral choices controlled by others. Given that fear-based messages, which may be perceived as a more manipulative message style, carry a higher likelihood of defensive processing and reactance, fear appeals may be a risky message strategy to use for this age group. As such, careful attention to both the contexts in which fear appeals are most appropriate for adolescent audiences and how such messages are structured is warranted.

At the other end of the age spectrum, there is reason to believe that the elderly may also have unique reactions to fear-evoking messages compared to younger people. Socioemotional selectivity theory argues that the elderly and the terminally ill are more likely to pay attention to positive information than to negative information (Carstensen, Fung, & Charles, 2003). This is because present-oriented goals are more important than future-oriented, protection-related goals when one perceives her timeline to be limited. This theoretical perspective also argues that older individuals have better memory for positive information than for negative information, suggesting that the threat component of fear appeals may not be as memorable as the efficacy component for this particular audience. Thus, it may be that fear appeals that emphasize efficacy over threat may be more successful for this demographic, though future research is needed to address this question directly.

Based on the literature and existing theory spanning from children to the elderly, we suggest that though fear-based messages may be useful to address health issues across the lifespan, there are unique challenges to consider for each age group. From children and adolescents to young adults, middle-aged individuals, and finally the elderly, using diverse samples with wide age ranges or investing in long-term cohort and longitudinal studies may help reveal potential differences in fear-arousal and fear appeal effects across developmental stage. Such research would, in turn, help determine what message structures would be best suited for which age groups and within what health contexts.

Personality Traits

Although little attention has been given to how specific personality traits impact reactions to fear appeals, there are good reasons to believe that they matter and should be looked at more carefully in the future. Given personality traits influence perceptions of events, and given emotions are based on such perceptions, personality traits could influence whether or not a fear appeal is likely to evoke fear, to what degree, and toward what end. In essence, different types of audiences with different predispositions are likely to respond differently to fear appeals.

One trait variable that has been studied for its contribution to fear arousal is trait anxiety, or the dispositional tendency toward experiencing anxiety and worry across situations. However, there is mixed evidence as to trait anxiety’s impact on fear appeal effects. Witte and Allen (2000), in their meta-analysis, did not find a significant relationship between trait anxiety and post-message attitudes, intentions, or behaviors. However, trait anxiety has been linked to other outcomes of fear appeals. For example, in a study of fear appeals about condom use and AIDS prevention, Witte and Morrison (2000) found that whereas trait anxiety was not related to threat perceptions, efficacy perceptions, or behavior, participants low in trait anxiety reported greater defensive avoidance than did those high in trait anxiety. This relationship could indicate that individuals who are already in an anxious state of mind when presented with a fear appeal may be more accepting of the message than those who come to a message with less anxiety.

Another individual difference that may influence reactions to fear appeals is monitoring versus blunting responses to information (S. M. Miller, 1987). People cope with potentially threatening information in different ways. Some individuals, known as monitors, tend to experience more anxiety and prefer more, rather than less, information about health threats; whereas blunters instead avoid information related to threats. As such, monitors and blunters may respond differently to fear appeal messages. Although little research speaks to this issue, Williams-Piehota, Pizarro, Schneider, Mowad, and Salovey (2005) found that participants classified as blunters responded with less negative affect to mammography messages that were simple and direct versus lengthy and detailed in their presentation of threat and efficacy information. Further, blunters were significantly more likely to actually obtain a mammogram in response to the more direct messages. Monitors, however, responded to both message types similarly. Thus, it may be that blunters may respond better to shorter, more direct fear appeals whereas monitors may be more willing to engage with longer or more detailed fear-inducing messages. However, far more research is needed to confirm this finding and to explore other ways in which monitoring and blunting, and indeed other individual differences, suggest implications for fear-based messaging.

The Effects of Frightening News

Although the lion’s share of research on the persuasive influence of fear focuses on persuasive advertisements, other media messages may be considered as possible conduits of influence via fear arousal. Some recent studies have examined the structure of health news in ways that speak to the link between emotional arousal, most notably fear, and persuasive outcomes. Most directly relevant, Goodall, Sabo, Cline, and Egbert (2012) conducted a content analysis of print and electronic news coverage of the H1N1 virus from a fear appeal perspective, looking for the appearance of threat and efficacy information within the news coverage. Their results indicated that most stories (86%) referenced threat and of these, 94% did so in the first third of the story. Further, the threat coverage was frequently sensationalistic, with more than half of stories referring to “pandemic,” “outbreak,” or death in ways disproportionate to the actual threat. They also found that efficacy responses were included in 56% of the stories, but of these, only 23% made statements speaking to the effectiveness of such actions. Ultimately, only 2.5% of stories included all four components associated with fear appeals. If news stories are processed as fear appeals, this composition suggests concern that health stories are not reaching their potential to positively influence the health behaviors of audiences. However, this assumes news stories are processed as fear appeals, which is as yet an open question.

Indeed, Nabi and Prestin (2016) conducted experimental research to examine the influence of the structure of news stories that incorporated fear. Participants read news stories designed to evoke either fear or hope about the human papilloma virus (HPV) and with different levels of response efficacy information regarding the impending HPV vaccine. Results indicated no main effects for fear or hope or response efficacy, but a significant interaction suggested that emotionally consistent presentations (fear and low efficacy, hope and high efficacy) boosted intentions to engage in protective actions relative to emotionally inconsistent, sensationalized presentations (fear and high efficacy, hope and low efficacy). This research suggests that exposure to health news stories—fear-generating ones in particular—can influence audience health behaviors, but that the traditional fear appeal structure does not always translate to the news context. This may be because, unlike with public service announcements, audiences do not expect news stories to highlight a significant problem and then offer a clear and effective solution. Rather, news stories frequently highlight new health threats for which there are no clear solutions yet, leaving the audience to come up with their own ideas on how to best protect themselves. More research examining the influence of fear-based health news stories—with particular focus on the structure of such news stories and audience expectations, or schema, about the type of content in different types of messages—is necessary.

Fear Messages and Patient-Provider Communication

Fear-appeal research has focused almost exclusively on mediated messages. Yet fear-based messages may also be transmitted interpersonally, particularly in healthcare environments. However, despite anecdotal evidence that physicians’ communication may trigger fear in patients for the purpose of motivating behavior change or compliance, the intentional use of fear-based messages in the clinical context has not received attention in the academic literature. Rather, the research on provider communication has focused on how the use of empathic communication by physicians may help reduce existing anxiety in their patients. Thus, in this context, the emphasis is on how existing fear or anxiety may be minimized by the provider’s communication style rather than the provider’s communication being the stimulus for fear. Although this approach suggests that patient anxieties may be reduced through the presentation of efficacy-related information, which is consistent with fear-appeal messaging, there are large gaps in this area of research that would benefit from additional attention.

Fear-Based Messages and Social Sharing

One critique of the general study of fear-based persuasive appeals is that such research is typically studied in the lab rather than in real-world contexts in which message exposure and processing are not controlled and discussion of those messages with friends and family is possible. Yet, there is a growing body of literature on the social sharing of emotions that indicates that people have an instinctive need to disclose to others when they experience emotionally charged events, which has been widely documented across cultures, gender, and age groups (Rimé, 2009). Indeed, the more intense the emotional experience or the greater the emotional disruption, the more likely it is to be socially shared and shared repetitively over an extended period of time (Rimé, 2009). There are multiple explanations for this need to share, including the need to verbalize experiences to help make sense of them, to help validate the self or confirm that people are still themselves despite this event, and to allow groups to develop collective social knowledge of emotional experiences.

There is growing evidence in multiple media contexts, including health messages (e.g., Dunlop, Wakefield, & Kashima, 2010) that the emotionality of media messages, regardless of valence, is associated with their diffusing through social networks. Given that fear appeals are designed to evoke powerful emotional responses, it is reasonable to surmise that such messages may be the source of social sharing, both through interpersonal discussion and social media posting or commenting. Yet, little attention has been paid to this issue. Recent research, however, is beginning to more carefully consider how the emotions associated with health messages promote information-sharing behaviors. For example, Myrick and Oliver (2015) found that feeling fearful after watching a YouTube public-service announcement about skin cancer was a positive predictor of intentions to share the video with others.

Additionally, social media provide opportunities not only for social sharing but also for information requests from others, which in turn could improve health outcomes. For instance, Myrick, Holton, Himelboim, and Love (2016) content analyzed tweets about cancer that included the hashtag “#stupidcancer,” which is particularly popular with young-adult members of the online cancer community. The authors found that though fear was the least common of the emotional responses found, tweets that did exhibit fear were significantly more likely than those that did not to contain a link to outside information and to contain requests for information, as well as interactive health information sharing between users. Thus, as research on fear appeals moves forward, it is important to give greater consideration not only to how such messages are processed in situ but also how those messages are shared and discussed within social networks, both interpersonally and online.

Conclusion: Fear Appeals and Message Effects

The study of fear-based messages has a long and robust history. After decades of research, it is clear that fear can indeed motivate positive health behaviors and that exposure to information about threat susceptibility, severity, response efficacy, and self-efficacy is key to this process. However, the conditions under which the emotion of fear and the cognitive perceptions related to threat and efficacy information produce productive persuasive effect remain unclear. In addition, understanding how fear-based messages fit within the general context of other emotion-based messages—or how fear works with other emotions within the same message—is somewhat uncharted territory. Further, current understanding of the role of individual differences as well as fear’s impact in contexts beyond direct persuasive messages, like news, entertainment, patient-provider dynamics, and social media, is likewise limited. Thus, despite the sustained attention that fear-based messages have received in the past, many questions still remain for future research to address.


The social scientific study of fear in persuasive messages traces back to Carl Hovland’s research program in the 1950s, which incorporated the persuasive influence of fear among other questions of attitude change and message design. Given that persuasion research during this era was heavily influenced by motivational perspectives, it is not surprising that fear was conceptualized as an unpleasant, drive-like state, one that audiences were motivated to reduce. As the field of psychology shifted to emphasize cognition over motivation through the 1960s into the 1970s, the study of fear appeals followed suit, with the theories developed during this timeframe highlighting the cognitions associated with the experience of fear, as well as the link between those cognitions and attitude change. A balance between the two perspectives was struck in the 1990s with the introduction of the extended parallel process model (Witte, 1992) in which the evocation of fear from cognitive appraisals of message content was conceptualized as motivating consideration of both response and self-efficacy, the combination of which was predicted to influence attitudinal and behavioral response. Research has continued to rely heavily on the EPPM, and a special issue of the journal Health Communication in 2013 highlighted the contributions of this model to research over the past two decades.

In place of focusing solely on the persuasive effects of fear, theorizing since the 1990s has shifted to understanding the role of other emotions—whether evoked by messages designed to produce fear or designed to simply be emotional—on persuasive outcomes. Currently, scholars are considering how emotions in addition to fear influence the effect of fear appeals (e.g., emotional flow) and possible moderators of fear appeal effects. Further, additional perspectives, like the cognitive functional model, ask how messages that evoke emotions other than fear might influence persuasive outcome, with growing attention to the role of specific emotions, such as guilt, anger, and hope.

Primary Sources

A researcher searching for literature on fear, fear appeals, or the role of fear in message outcomes will likely find an astounding number books, journal articles, encyclopedia entries, and even essays to examine. These topics have generated great interest from scholars in multiple fields, ranging from communication and media studies to psychology, sociology, behavioral economics, and beyond. There has been so much written about fear and the role of fear in risk-related messages that one can get easily overwhelmed with the voluminous responses to search queries for the terms. However, the resources listed below are helpful places to start exploring these topics as they are addressed in the academic literature.

A student interested in the historical roots of fear appeal theorizing could start with seminal pieces from Carl Hovland’s Yale research group, including the 1953 book by Hovland, Janis, and Kelly titled Communication and Persuasion: Psychological Studies of Opinion Change, as well as later journal articles reporting empirical data related to fear appeals.

Two decades later, Howard Leventhal’s work provides helpful summaries of those who came before as well as his own conceptualization of the parallel process model. His 1971 theoretical article published in the American Journal of Public Health includes a discussion of previous works dating back to Darwin alongside a discussion of promising ways to persuade people to adopt preventative health behaviors. This journal article, as well as other journal articles, can be found in scholarly databases available via most university libraries. They can also sometimes be found through online scholarly search engines, such as Google Scholar, PubMed, or the American Psychological Association’s PsycNET website.

By the 1990s, Kim Witte’s extended parallel process model (EPPM) gained traction, and her 1992 piece in the journal Communication Monographs that first proposes the model is a good place to start understanding this perspective. It also provides a nice overview of the fear appeal theories that came before it (i.e., the drive model, the parallel process model, and protection motivation theory).

Multiple book chapters also provide nice overviews of the existing research on the emotion of fear. Arne Öhman’s chapter on fear and anxiety in the third edition of the Handbook of Emotions provides a helpful overview of the biological and psychological underpinnings of the study of fear and its influence on cognition and behavior. Moreover, Richard Lazarus’s discussion of fear in his 1991 book Emotion and Adaptation offers a useful overview of the emotion from the perspective of cognitive appraisal theory and social psychology more generally.

Book chapters that discuss fear’s role in communication and media processes and effects also provide helpful overviews of the state of the literature as well as suggestions for future research directions. Marco Yzer, Brian Southwell, and Michael Stephenson discuss the use of fear in public communication campaigns in their chapter in the fourth edition of Public Communication Campaigns. Paul Mongeau also addresses the history and current state of the fear appeal literature in his chapter of the second edition of The Sage Handbook of Persuasion: Developments in Theory and Practice.

Further Readings