Public Health Briefs Overcoming Denial and Increasing the Intention to Use Condoms through the Induction of Hypocrisy Elliot Aronson, Came Fried, and Jeff Stone Introducion Now that the acquired immunodeficiency syndrome (AIDS) epidemic is making significant inroads into the heterosexual, nonintravenous drug-using, young adult population,I it is vital that we convince this group to practice safer sex. The intervention of choice, thus far, has primarily been information campaigns that rely heavily on fear. Unfortunately, social psychological research has shown that fear does not always lead people toward rational behavior; it may instead trigger denial. Indeed, recent surveys have shown that, although most young adults believe that AIDS is a serious problem, they have trouble believing it is their problem. We have found that denial is caused by fear of AIDS coupled with a prejudice against using condoms; young people believe condoms are a nuisance that diminishes the romance and spontaneity of sexual encounters. Unless this denial can be overcome, it seems doubtful that we can convince this population to practice safer sex. If they have convinced themselves that they are not at risk, why should they change their behavior? What kind of intervention might obviate this denial and induce young adults to realize their vulnerability and increase their resolution to practice safer sex? Imagine you are a college student and your younger brother, who is in high school, confides to you that he has become sexually active. How might you respond? You would probably urge him to use condoms. But suppose further that you were then reminded that you, yourself, do not always use condoms. How might this affect you? Recent theorizing2 suggests that being confronted with the fact that you are not practicing what you preach induces feelings of hypocrisy, which is a form of cognitive dissonance.3 Cognitive dissonance has been shown to produce “self persuasion,” a powerful and relatively permanent form of persuasion.4 We propose that inducing people to realize they are not practicing what they are preaching cuts off the easy route of denial and forces them to make a more realistic assessment of the risk of AIDS and, ultimately, to take adequate precautions. Method To test this hypothesis, it was necessary to manipulate the degree to which subjects were made aware of their own insufficient condom use and the degree to which they took an active role in preaching to others. In a two-by-two laboratory experiment, 40 female and 40 male sexually active young adults were randomly assigned to condition, counterbalanced by gender. Upon entering the lab, all subjects were told they would be helping to develop an AIDS prevention program. Half the subjects (high mindful) were asked to describe fully the situations in their recent past when they failed to use condoms; half of this subgroup then went on to the preach condition. The other half of the subjects (low mindful) simply went directly to the preach condition without any reference to their own sexual behavior. The authors are all with the University of California at Santa Cruz. Requests for reprints should be sent to Elliot Aronson, Kerr Hall, University of California at Santa Cruz, Santa Cruz, CA 95064. This paper was submitted to the journal August 30, 1990, and accepted with revisions June 24, 1991. December 1991, Vol. 81, No. 12 Public Health Briefs In the preach condition, half the high mindful and half the low mindful subjects were induced to compose a short speech (from a menu of facts) advocating condom use and to deliver it in front of a television camera. They were told this tape would be shown to high school students as part of an AIDS prevention program. The other half of the subjects (no preach) used the same menu of facts to compose a speech; these subjects rehearsed their speeches silently and were not videotaped. Thus, all subjects were exposed to the same information, but only those in the preach condition believed they were actively persuading others. All subjects then answered questions about the frequency of their condom use in the past, as well as about their intentions to use condoms in the future. The difference between the two questions can be seen as a measure of how much an individual intends to improve his or her condom use in relation to past behaviors. Results The results showed support for the effectiveness of hypocrisy and are summarized in Figure 1. On the first measure, subjects in the hypocrisy condition were more likely to admit to their failure to use condoms enough in the past. This indicates that our procedure enabled subjects to overcome denial. Although a ceiling effect prevented us from documenting any possible differences on the future intentions measure, the difference between responses on the two questions indicates that the hypocrisy condition yielded a better index of improvement than any of the other conditions. In addition to the immediate measures, we contacted subjects after 3 months and asked them about their recent condom use (Table 1). Because a sizable proportion of the subjects could not be located, statistical testing was inappropriate. Nevertheless, the obvious difference in the size of the means suggests that hypocrisy might be the most effective route to long-term behavior change. These findings may have important implications for AIDS interventions that rely on the passive reception of communication. Specifically, when it comes to acknowledging personal risk of human immunodeficiency virus infection, simply learning about AIDS does not appear to motivate people to overcome denial and examine their risk objectively. Our December 1991, Vol. 81, No. 12 Corndfflons o . Low Mindful, No Preach * Preach Ony 1. Mindkig Only U* High Mlndful, Preach (Hypocilsy) 14 more Frequently Enough 1312 10 9- 8 Not LeSS Frequently 7 Enough 6 Intent for AIDS Specific Past Use Future Use FIGURE 1-mean responses to qusIons about past and future use of condoms. information-only condition, which most closely resembles passive information, was the least effective intervention. The people within this category remained in a state of denial and were unwilling or unable to admit that AIDS was a serious threat to them personally. Additionally, learning about AIDS even when the information is directly linked to personal behavior does not appear to motivate people to examine their risk objectively, nor does simply advocating safe sex. Our data suggest that making people aware of their past high-risk behaviors must be accompanied by an engaging activity such as a public advocacy if we want them to overcome denial and adopt safer sexual behavior. The hypocrisy technique can easily be applied to most secondary school classes on sex education or AIDS prevention. Based on our results, we suggest that lectures be supplemented by small group discussions in which each student is induced to make a public attempt to persuade others about the importance of safe sex and, subsequently, to acknowledge his or her past laxity. El Acknowledgments was presented at the Western Psychological Association Conference in Los Angeles, Calif, April 1990, in a paper titled “AIDS Prevention through Cognitive Dissonance: New Twist on an Old Theory.” The authors would like to thank Anthony R. Pratkanis, Judith C. Schwartz, Ruth Thi- This research American Journal of Public Health 1637 EPublc Health Briefs bodeau, and the rest of the SIRF committee for helpful comments on the design. We also thank Kyra Kissam, Jennifer Hearst, and Bruce Fraser for their help in collecting the data. References 1. Weisse CS, Nesselhof-Kendall S, FleckKandath C, Baum A. Psychosocial aspects z.f,Ssn:-N^B.fa>;8S.,sSO:-A>;:B^izFYR2Msex ………………………………………………^}- :-fsf :f!. Sfa:}}2 ;2 X .:fSS>.R N.:>>::.:>i>i:..a>aX.>i^..R.:f-ff.fs-..sa->:af _ -M M. S: _ _.1- Z_} SkUR _..:>;3 xSxfs: ……..~~~~………. s………..a sb fss s e> S.::.zwx3.S=S .:…… s::B :S sE. :::s^ r Knowledge about HJV and Behavioral Risks of Foreign-Born Boston Public School Students Intdudion V..yh::’i S.o >f.v nance. Stanford, Calif: Stanford University Press; 1957. 4. Aronson E. Self-persuasion via selfjustification: large commitments for small rewards. In: Festinger L, ed. Retrospection on Social Psychology. New York, NY: Oxford University Press; 1980. Ralph W. Hingson, ScD, Lee Stnir* PhD, Michael Grady, MD, Nancy StwunI RN, MS, Robert Carr, MS, Beth BerMW MS, and Donald E. Craven, MD .*:S}..S. …. >, .F!>M.._._W.. ………………:.. ZR« X!-:g: :}} IBM..2~EwEr_ …k:} of AIDS prevention among heterosexuals. In: Bickman L, ed.Applied Social Psychology AnnuaL Beverly Hills, Calif: Sage; 1990;10. 2. Aronson E. The return ofthe repressed: dissonance theory makes a comeback. Psychol Inquiy. In press. 3. Festinger L. A Theory of Cognitive Disso- e ‘S^:S>’ Sixteen million mainland US residents age 18 and older were bom elsewhere.’ Many are Blacks or Hispanics who moved to urban areas where the incidence of AIDS has been particularly high, e.g., New York City, Miami, and Los Angeles. Little is known about their knowledge of human immunodeficiency virus-i (HIV-1), drug use, and sexual behaviors. Studies of adolescents particularly are needed. One fifth of the 186 895 AIDS cases nationally as of September 1991 have been in the 16 to 29-year-old age group.2 Given the long incubation period of HIV-1, many persons in this age group probably became infected as teenagers. This study compares middle and high school students in the Boston public schools who were born outside the US mainland with students born in the US concermingknowledge about HIV-1 transmission; beliefs about the number of adolescents who engage in risky sexual practices and drug use; and intravenous (IV) drug use, sexual intercourse, and condom use. Metds In May 1990, 3049 students from a random sample of Boston public schools (13/19 middle schools and 9/15 high schools) completed a self-administered questionnaire about these topics in English (n = 2704), Spanish (n = 158), Chinese (n = 45), Vietnamese (n = 50), or French or Haitian Creole (n = 92). Trans- lation and independent back translation ensured accuracy of questionnaire wording. We attempted to survey all 8th and 10th grade students in selected schools. In response to an informational letter about the survey sent to parents of eligible students, 75 parents (1.5%) requested that their children not participate. On the day of the survey 11% of middle school students and 23% of high school students were absent. Among students in attendance, 81% (n = 1382) in middle schools and 73% (n = 1667) in high schools completed the questionnaires, (overall response rate = 77%). Most nonresponse resulted from teachers not scheduling time to administer the survey. The gender, racial, and ethnic distributions of surveyed students closely matched those enrolled in the 8th and 10th grades in the targeted schools and in the Boston school system (Table 1). The questionnaires were anonymous and were placed by students in Ralph W. Hingson, Lee Strunin, Beth Berlin, and Donald E. Craven are with Boston University Schools of Public Health and Medicine. Michael Grady and Nancy Strunk are with the Boston School Department. Robert Carr and Donald E. Craven are with the Boston Department of Health and Hospitals. Requests for reprints should be sent to Ralph Hingson, ScD, Boston University School of Public Health, Social and Behavioral Sciences Section, 85 East Newton Street, Boston, MA 02118. This paper was submitted to the journal October 30, 1990, and accepted with revisions April 2, 1991. Editores Note. See related Editorial by Hinnman on page 1557. December 1991. Vol. 81. No. 12 U.S. Copyright Law (title 17 of U.S. code) governs the reproduction and redistribution of copyrighted material. Downloading this document for the purpose of redistribution is prohibited. Eleventh Edition The Social Animal Elliot Aronson University of California, Santa Cruz with Joshua Aronson New York University WORTH PUBLISHERS To Vera, of course The Social Animal, Eleventh Edition Acquisitions Editor: Erik Gilg Marketing Manager: Jennifer Bilello Art Director: Babs Reingold Senior Designer: Kevin Kali Senior Project Editor: Laura McGinn Copy Editor: Maria Vlasak Production Manager: Sarah Segal Compositor: Northeastern Graphic, Inc. Printing and Binding: R. R. Donnelley Cover Drawing by Tom Durfee Library of Congress Control Number: 2007925852 ISBN-13: 978-1-4292-3341-5 ISBN-10:1-4292-3341-9 © 2012, 2008, 2004,1999 by Worth Publishers ©1995,1992,1988,1984,1980,1976,1972 by W. H. Freeman and Company Printed in the United States of America First printing 2011 Worth Publishers 41 Madison Avenue New York, NY 10010 www.worthpublishers.com Saul Steinberg, Untitled drawing, ink on paper. Originally published in The New Yorker, February 16, 1963. © T h e Saul Steinberg Foundation / Artists Rights Society (ARS), New York 5 Self-Justification Picture the following scene: A young man named Sam is being hypnotized. The hypnotist gives Sam a posthypnotic suggestion, telling him that, when the clock strikes 4:00, he will (1) go to the closet, get his raincoat and galoshes, and put them on; (2) grab an umbrella; (3) walk eight blocks to the supermarket and purchase six bottles of bourbon; and (4) return home. Sam is told that, as soon as he reenters his apartment, he will “snap out of it” and be himself again. When the clock strikes 4:00, Sam immediately heads for the closet, dons his raincoat and galoshes, grabs his umbrella, and trudges out the door on his quest for bourbon. There are a few strange things about this errand: (1) it is a clear, sunshiny day—there isn’t a cloud in the sky; (2) there is a liquor store half a block away that sells bourbon for the same price as the supermarket eight blocks away; and (3) Sam doesn’t drink. Sam arrives home, opens the door, reenters his apartment, snaps out of his “trance,” and discovers himself standing there in his raincoat and galoshes, with his umbrella in one hand and a huge sack of liquor bottles in the other. He looks momentarily confused. His friend, the hypnotist, says, “Hey, Sam, where have you been?” “Oh, just down to the store.” “What did you buy?” “Urn . . . um . . . it seems I bought this bourbon.” “But you don’t drink, do you?” 18 8 The Social An imal “No, but . . . um . . . um . . . I’m going to do a lot of entertaining during the next several weeks, and some of my friends do.” “How come you’re wearing all that rain gear on such a sunny day?” “Well . . . actually, the weather is quite changeable this time of year, and I didn’t want to take any chances.” “But there isn’t a cloud in the sky.” “Well, you never can tell.” “By the way, where did you buy the liquor?” “Oh, heh, heh. Well, um . . . down at the supermarket.” “How come you went that far?” “Well, um . .. um . . . it was such a nice day, I thought it might be fun to take a long walk.” People are motivated to justify their own actions, beliefs, and feelings. When they do something, they will try, if at all possible, to convince themselves (and others) that it was a logical, reasonable thing to do. There was a good reason why Sam performed those silly actions—he was hypnotized. But because Sam didn’t know he had been hypnotized, and because it was difficult for him to accept the fact that he was capable of behaving in a nonsensical manner, he went to great lengths to convince himself (and his friend) that there was a method to his madness, that his actions were actually quite sensible. The experiment by Stanley Schachter and Jerry Singer discussed in Chapter 2 can also be understood in these terms. Recall that these investigators injected people with epinephrine. Those who were forewarned about the symptoms caused by this drug (palpitations of the heart, sweaty palms, and hand tremors) had a sensible explanation for the symptoms when they appeared. “Oh, yeah, that’s just the drug affecting me.” Those who were misled about the effects of the drug, however, had no such handy, logical explanation for their symptoms. But they couldn’t leave the symptoms unjustified; they tried to account for them by convincing themselves that they were either deliriously happy or angry, depending on the social stimuli in the environment. Self-Justification 179 The concept of self-justification can be applied more broadly still. Suppose you are in the midst of a great natural disaster, such as an earthquake. All around you, buildings are toppling and people are getting killed and injured. Needless to say, you are frightened. Is there any need to seek justification for this fear? Certainly not. The evidence is all around you; the injured people and the devastated buildings are ample justification for your fear. But suppose, instead, the earthquake occurred in a neighboring town. You can feel the tremors, and you hear stories of the damage done to the other town. You are terribly frightened, but you are not in the midst of the devastated area; neither you nor the people around you have been hurt, and no buildings in your town have been damaged. Would you need to justify this fear? Yes. Much like the people in the Schachter-Singer experiment experiencing strong physical reactions to epinephrine but not knowing why, and much like our hypnotized friend in the raincoat and galoshes, you would be inclined to justify your own actions or feelings. In this situation, you see nothing to be afraid of in the immediate vicinity, so you would be inclined to seek justification for the fact that you are scared out of your wits. This disaster situation is not a hypothetical example; it actually occurred in India. In the aftermath of an earthquake, investigators collected and analyzed the rumors being spread. What they discovered was rather startling: Jamuna Prasad,1 an Indian psychologist, found that when the disaster occurred in a neighboring village such that the residents in question could feel the tremors but were not in imminent danger, there was an abundance of rumors forecasting impending doom. Specifically, the residents of this village believed, and helped spread rumors to the effect that a flood was rushing toward them; February 26 would be a day of deluge and destruction; there would be another severe earthquake on the day of the lunar eclipse; there would be a cyclone within a few days; and unforeseeable calamities were on the horizon. Why in the world would people invent, believe, and communicate such stories? Were these people masochists? Were they paranoid? Certainly these rumors would not encourage the people to feel calm and secure. One rather compelling explanation is that the people were terribly frightened, and because there was not ample justification for this fear, they invented their own justification. Thus, they were not compelled to feel foolish. After all, if a cyclone is on the way, isn’t it 18 8 The Social An imal perfectly reasonable that I should be wild-eyed with fear? This explanation is bolstered by Durganand Sinha’s study of rumors.2 Sinha investigated the rumors being spread in an Indian village following a disaster of similar magnitude. The major difference between the situation in Prasad’s study and the one in Sinha’s study was that the people being investigated by Sinha had actually suffered the destruction and witnessed the damage. They were scared, but they had good reasons to be frightened; they had no need to seek additional justification for their fears. Thus, their rumors contained no prediction of impending disaster and no serious exaggeration. Indeed, if anything, the rumors were comforting. For example, one rumor predicted (falsely) that the water supply would be restored in a very short time. Leon Festinger organized this array of findings and used them as the basis for a powerful theory of human motivation that he called the theory of cognitive dissonance.3 It is a remarkably simple theory but, as we shall see, the range of its application is enormous. Basically, cognitive dissonance is a state of tension that

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