Barriers to health appeals

This is my summary/translation of the article Abwehrreaktionen auf Gesundheitsappelle: Forschungsstand und Praxisempfehlungen by Hastall, 2012.

Against threatening or disturbing messages we have defensive processes, in order not to get thrown into a (unhealthy) state of frenzy every time we encounter one. These defensive processes are understood as motivated reactions, responses to health-appeals that take up resources when three criteria are met (Hastall, 2012).

  1. The response follows directly after contact with the message
  2. The response is based on defensive measures; it is meant to reflect an anticipated threat (e.g. threats to feelings of self-worth or emotional well-being)
  3. The response is aimed directly or indirectly at avoiding the message or attacking the content of the message

We can distinguish four different groups of defensive responses that might inhibit effective health marketing/communication:

  1. Avoiding or minimising contact with threatening messages
  2. General psychological ego-defence mechanisms
  3. Attacking the content of the message or the messenger
  4. Increased health-damaging behaviour

Modern man has developed advanced avoidance strategies for online marketing messages of any kind to such a degree that we completely miss the advertisements on a website (a concept known as banner-blindness) and we install ad-blocking software, spam filters and the like to assist us in avoiding unsolicited content. Modern psychoanalysis and clinical psychology defines defence mechanismsas unconscious processes meant to protect an individual from fear and recognition of internal or external burdens and threats. A defence mechanism does this by regulating the response of the individual to emotional conflict and external burdens (Wittchen/Hoyer, 2011). Over 40 such processes have been discerned and are commonly and continually applied by individuals in their daily lives (Cramer, 2008). The mechanisms of denial, repression and rationalisation seem especially important in the health domain (Hastall, 2012).  For example; illusory superiority bias describes the constant overestimation of our positive aspects and the subsequent underestimation of our negative aspects. Combining this bias with unrealistic optimism and false consensus bias leaves many well intended health messages unattended to, because they are deemed ‘not relevant’ to us.

Table: Health marketing defence mechanisms (Hastall, 2012)

Avoiding or minimising contact with threatening messages
Selective message avoidance Complete avoidance of messages or turning away the attention after brief/short and unconscious contact
Banner blindness Selective advertisement avoidance specific to websites. While visually scanning the site, the anticipated  advertisements are visually faded out
Technical defence Using technical solutions to avoid contact with unwanted messages, such as AdBlock or a spam filter
Legal defence Prohibiting advertisements or joining a revocation list e.g. Robinson-list
General psychological ego-defence mechanisms
Denial Not considering or denial of aspects in reality that threaten ones’ existence, such as health risks
Repression Displacing threatening aspects of reality in ones’ subconscious
Rationalisation Inventing seemingly reasonable explanations to justify threatening thoughts, feelings or behaviours
Illusory superiority effect Overestimating ones’ positive qualities in comparison to others, while simultaneously underestimating ones’ negative qualities
Unrealistic optimism Believing that one will be affected less by negative occurrences and more by positive occurrences than other people
False consensus effect Overestimating the proportion of people that share ones’ viewpoint on a certain topic
Attacking the content of the message or the messenger
Selective interpretation Reinterpreting the content of the message in such a way that it harmonises with ones’ views and beliefs
Counter arguments Generating arguments that counter the propositions of a message and the recommendations made e.g. by looking for information stating the opposite
Source devaluation Devaluating the source of a message e.g. by insinuations of incompetence or unreasonable intentions
Aggression Verbal or physical  attacks on the messenger, the message or the medium carrying the message e.g. tearing down health related placards
Advantageous social comparison Comparing oneself to person who are worse off or are behaving worse than you in order to feel better about oneself and to diminish the necessity of a behaviour or attitude change
Social validation Looking for persons with similar attitudes and behaviours and emphasizing the high number of corresponding people
Heightened attractiveness of critical aspects Health damaging behaviours are seen as more attractive after contact with the message than before contact with the message
Increased health-damaging behaviour
Boomerang effect Message provokes the opposite of the intended goal e.g. smoking more after contact with a anti-smoking message
Taking psycho-active substances Taking alcohol, nicotine, drugs or medication after contact with the message in order to pacify oneself or shift thoughts

Should a possibly threatening message get through the first line of defence mechanisms and manage to get itself consciously considered, attack strategies might come into play. Findings that confirm this course of thought and action are aggregated from research into cognitive dissonance (Festinger, 1957), psychological reactance (Brehm, 1966; Dillard & Shen, 2005) and resistance (Jacks & Cameron, 2003).

Strategies to lessen the resistance

There are two neurological systems working in parallel: BIS and BAS (e.g. Carver et al. 2000; Gray, 1982). The Behavioural Inhibition System; looking for potential threats and possible dealing with them through various defence mechanisms – and the Behavioural Activation System; looking for cues for potential positive experiences. BIS concerns itself with (our protection from) negative emotions. Any message that intends to trigger certain health behaviours would do well to address both systems, simultaneously trying to minimize BIS while maximizing BAS (Knowles & Linn, 2004) Minimizing the threat– All health related sciences tend to take the perspective of the ‘Natural model’ of health vs. disease and mainly focus their efforts on the physical. However, a health related message can be perceived as threatening on more levels than just as it relates to our physical manifestation. All the possible levels of threat must be discerned if they are to be minimized.

Table: Threats by health marketing (Hastall, 2012)
Target of threat Anticipated health relevant conditions
Reading messages on health risks Anxiety of health risks Execution of the recommended protective behaviour
Body Physical discomfort when reading the message Pain, reduced capabilities, death Physical strain; side effects
Cognition Worry about the likelihood of the disease Worry about the likelihood of healing Worry about the effectiveness of the protective behaviour
Emotion Fear or dread at reading the message Sorrow about those concerned; fear Feelings of shame or uncertainty
Self-worth “Manipulation” by marketing messages Dependent on outside help; passive layman Self-perception as vulnerable or overanxious
Social status Non-compatible role expectations Loneliness; Blaming others as accomplices Being ridiculed or rejected by others
Resources Time or expenses looking for more information Time or expenses for necessary treatment Time or expenses for protective behaviour


Brehm, J. W. (1966): A Theory of Psychological Reactance, New York: Academic Press. Carver, C. S., Sutton, S. K., & Scheier, M. F. (2000). Action, emotion, and personality: Emerging conceptual integration. Personality and social psychology bulletin26(6), 741-751.
Cramer, P. (2008): Seven Pillars of Defense Mechanism Theory, in: Social and Personality Psychology Compass, 2, 5, S. 1963-1981
Dillard, J. P./Shen, L. (2005): On the Nature of Reactance and Its Role in Persuasive Health Communication, in: Communication Monographs, 72, 2, S. 144-168.
Festinger, L. (1957): A Theory of Cognitive Dissonance, Stanford: Stanford University Press.
Gray, J. A. (1982). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. New York: Oxford University Press.
Hastall, M. R. (2012). Abwehrreaktionen auf Gesundheits-appelle: Forschungsstand und Praxisempfehlungen. In S. Hoffmann, U. Schwarz & R. Mai (Eds.), Angewandtes Gesundheitsmarketing (pp. 281-296): Springer Fachmedien Wiesbaden. Jacks, J. Z.
Cameron, K. A. (2003): Strategies for Resisting Persuasion, in: Basic & Applied Social Psychology, 25, 2, S. 145-161 Knowles, E. S.
Linn, J. A. (2004): Approach-Avoidance Model of Persuasion: Alpha and Omega Strategies for Change, in: Knowles, E. S./Linn, J. A. (Hrsg.): Resistance and Persuasion, Mahwah: Psychology Press, S. 117-148.
Wittchen, H.-U./Hoyer, J. (2011): Klinische Psychologie & Psychotherapie, Berlin: Springer.

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