Most of us know that it’s in our interest to get regular checkups, do recommended screenings and be forthcoming with doctors. Nonetheless, it’s common for patients to delay medical care to shield themselves against negative health information. Data from a national survey suggests that about one-third of adults avoid doctor’s appointments they deem necessary, according to a 2014 study.
A psychological habit called self-affirmation, however, appears to be associated with a more proactive approach to healthcare. Self-affirmation is the act of focusing on personal values (i.e., things you like about yourself) during difficult situations. People who flake on doctor’s appointments to avoid hearing bad news or negative feedback, Kent State University social psychologist Jennifer Taber has found, might be more open to facing those dreaded unknowns if they self-affirm.
“A student who is worried about their performance on a history exam, for example, might remind themselves that they’re really good at soccer,” said Taber, who studies health behaviors.
In particular, Taber focuses on how people interact with information about disease risk. She took up the issue of healthcare avoidance in a 2015 study. Access barriers, such as cost, lack of insurance and time constraints, emerged as the most common reasons for shirking doctor’s appointments. But study participants cited other reasons as well, including not wanting to learn unsettling information or be reprimanded for unhealthy habits.
“I think that generally it helps people to see the big picture and look beyond themselves in sort of a self-transcendent manner.”
In a number of other psych studies, self-affirmation has similarly emerged as a psychological strategy to help people confront important but unpleasant information. In one 2007 study, smokers who self-affirmed before viewing graphic anti-smoking advertisements were more likely than non-self-affirmers to take the messaging to heart. In another study, smokers were more likely to pick up anti-smoking leaflets following self-affirmation exercises.
For her study, Taber analyzed the relationship between spontaneous self-affirmation and the pursuit of health information using data from a national survey called HINTS. Self-affirmation is considered spontaneous when people do it naturally, without being prompted. HINTS measures the habit by asking respondents to evaluate two statements: 1. “When I feel threatened or anxious, I find myself thinking about my strengths.” 2. “When I feel threatened or anxious, I find myself thinking about my values.”
Spontaneously self-affirming patients, Taber found, were not only more likely to pursue information about their health, they also reported engaging in more open communication with providers and having more positive healthcare experiences. Taber says her findings, published in 2016, support other work on self-affirmation, collectively suggesting that people could use self-affirmation to embrace a knowledge-is-power mentality toward their health and interact more candidly with doctors.
Based on her own work, Taber can’t say exactly how or when patients should self-affirm. This is partly because she doesn’t have data directly comparing spontaneous and induced self-affirmations. Research in other domains, however, points to the benefits of self-affirming before you confront a nerve-wracking situation, such as entering a doctor’s office, rather than during or after the experience.
Self-affirmations should also focus on values unrelated to the scary information at hand, as psychologists from Stanford University and the University of California, Santa Barbara, explained in a 2014 review paper. So, if you’re mustering the courage to call your doctor about the results of blood work, concentrate on a core value that has nothing to do with your health: Think about how well you take care of your kids or your dog or your plants. Or reflect on the pride you felt after finishing your dissertation, or getting through all the ’90s sitcoms in your Netflix queue.
It’s still not entirely clear why self-affirmation helps information-shy patients face their fears. In other words, how does reflecting on a positive characteristic affect your attitude or thought process in a way that makes you more accepting of potentially distressing news? “I think that generally it helps people to see the big picture and look beyond themselves in sort of a self-transcendent manner,” said Taber. “But we really need more research exploring this.”
Other researchers have proposed similar explanations. In the same 2014 review paper, the authors wrote, “When people remind themselves of their attributes, they’re able to assess negative information in the context of an expansive view of the self.”
The science of self-affirmation is preliminary, leaving Taber and others with plenty of questions to tackle in the future. For instance, is spontaneous self-affirmation truly distinct from optimism, another psychological characteristic associated with positive patient outcomes? After all, someone with a history of serious illness may very well feel pessimistic about their health — would self-affirming still make them more likely to get a checkup?
“Optimism is generally considered to be a pretty stable individual difference,” Taber said, “whereas we think of spontaneous self-affirmation as something that might be more malleable. Theoretically, I think that someone could engage in self-affirmation whether or not they feel optimistic, but this is something that would be worth empirically testing.”
While Taber says it’s too early to understand exactly how self-affirmation works in real-world situations, she still loosely applies her findings in her own life. “My research and scientific knowledge overwhelmingly seem to suggest that being defensive, with respect to one’s health, one’s relationships and many other domains, is often harmful,” Taber said. “So I try to be aware of this, and I see self-affirmation as one way to be less defensive.”