Do interventions based on

cognitive dissonance promote

health behaviour change? A systematic review

Tanya Freijy and Emily Kothe

What is cognitive dissonance?

› Cognitive dissonance: A state of psychological discomfort

that arises from conflicting attitudes or beliefs

(Festinger, 1957).

› Reduce dissonance via

adaptation of cognitions

or behaviour.

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How is dissonance induced?

Interventions based on cognitive dissonance usually follow one of

several experimental paradigms:

› Induced compliance paradigm (Festinger & Carlsmith, 1959)

› Hypocrisy paradigm (Aronson, Fried, & Stone, 1991)

› Belief-disconfirmation paradigm (Festinger, Riecken, &

Schachter, 1956)

› Free choice paradigm (Brehm, 1956)

› Effort justification paradigm (Aronson & Mills, 1959)

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Existing evidence

Dissonance-based interventions have targeted:

› Water conservation (Dickerson et al., 1992)

› Energy conservation (Pallak, Cook, & Sullivan, 1980)

› Smoking (Simmons et al., 2004)

› Racism (Son Hing, Li, & Zanna, 2002)

› Generosity (McKimmie et al., 2003)

› Eating disorder (ED) prevention (Stice et al., 2008; Becker

et al., 2010)

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Existing evidence

So, dissonance-based interventions are strong in the

clinical literature, but what about non-clinical?

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Aims

The current review aimed to:

1. Determine whether dissonance-based interventions are

effective in changing participants’ health behaviour, attitude, or

intention.

2. Assess the risk of bias associated with such interventions.

3. Explore whether some health

behaviours are more amenable

to change than others.

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Search strategy

› PsychINFO, Medline, Web of Science, Embase, and CINAHL

from database inception to March 2012.

› Search terms included dissonance, hypocrisy, cognitive

dissonance, health, behavio(u)r, lifestyle and prevention.

› Included: All pre/post studies described as dissonance-based

that measured one or more of attitude, intention, or behaviour.

› Excluded: clinical behaviours e.g., ED prevention studies.

› Records after duplicates removed n = 1420;

after title screen n = 670;

after abstract screen n = 42;

after full-text screen n = 18 (20 studies)

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Results

Intervention effects

› In 15 of 20 studies changes were achieved in one or more

measures of participants’ behaviour, attitude or intention.

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Results

Intervention effects

› In 15 of 20 studies changes were achieved in one or more

measures of participants’ behaviour, attitude or intention.

› Intervention effects were not influenced by type of health

behaviour, but were influenced by experimental paradigm.

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Results

Intervention effects

› In 15 of 20 studies changes were achieved in one or more

measures of participants’ behaviour, attitude or intention.

› Intervention effects were not influenced by type of health

behaviour, but were influenced by experimental paradigm.

› Hypocrisy appears to be most reliable (+ve effects on all

measures in 10 of 14 studies) rather than induced compliance (null

or mixed results in all 4 studies).

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Results

Intervention effects

› In 15 of 20 studies changes were achieved in one or more

measures of participants’ behaviour, attitude or intention.

› Intervention effects were not influenced by type of health

behaviour, but were influenced by experimental paradigm.

› Hypocrisy appears to be most reliable (+ve effects on all

measures in 10 of 14 studies) rather than induced compliance (null

or mixed results in all 4 studies).

› Long-term effects difficult to determine.

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Results

Intervention effects

› In 15 of 20 studies changes were achieved in one or more

measures of participants’ behaviour, attitude or intention.

› Intervention effects were not influenced by type of health

behaviour, but were influenced by experimental paradigm.

› Hypocrisy appears to be most reliable (+ve effects on all

measures in 10 of 14 studies) rather than induced compliance (null

or mixed results in all 4 studies).

› Long-term effects difficult to determine.

› Self-esteem and gender emerged as potential moderators.

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Results

Assessment of risk of bias

› Majority of studies had inadequate

randomisation and concealment of

allocation.

› Reporting bias high in 5 studies – data

withheld or provided graphically only.

› Self-report data social desirability bias.

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Limitations

› Publication bias.

› Search restricted to

English-language papers.

› Analysis relied upon statistical

p-values.

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Future directions

› Hypocrisy should be used when targeting non-clinical

health behaviours. Induced compliance paradigm has the

potential to be strengthened.

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Future directions

› Hypocrisy should be used when targeting non-clinical

health behaviours. Induced compliance paradigm has the

potential to be strengthened.

› Minimise bias via adequate selection & randomisation, full

reporting of data, demographic variables, social desirability

scale.

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Future directions

› Hypocrisy should be used when targeting non-clinical

health behaviours. Induced compliance paradigm has the

potential to be strengthened.

› Minimise bias via adequate selection & randomisation, full

reporting of data, demographic variables, social desirability

scale.

› Explore moderators: - self-esteem & gender

- readiness for change?

- ethnicity?

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Thank you

tfre6453@uni.sydney.edu.au

emily.kothe@deakin.edu.au

Freijy, T., & Kothe, E. J. (in press). Dissonance-based interventions for health behaviour

change: A systematic review. British Journal of Health Psychology (accepted 19/01/13).

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References

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