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• Response to Hastings & MacFadyen [Tobacco Control 11(1): 73]
  Mike Jones
  Published on: 15 May 2002

• Published on: 15 May 2002

  Response to Hastings & MacFadyen [Tobacco Control 11(1): 73]

  • Mike Jones, smoking cessation adviser & communications trainer

  Firstly, congratulations to Hastings & MacFadyen on highlighting the issues inherent in attempting to ‘negatively emote’ people into doing what we’d like them to do. I use the term ‘negatively emote’ to take into account the following journal article by Biener & Taylor [T C 11(1):75] - their point being that fear is not the only emotion involved. There are admittedly many attempts at ‘pushing’ people through the...

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  Firstly, congratulations to Hastings & MacFadyen on highlighting the issues inherent in attempting to ‘negatively emote’ people into doing what we’d like them to do. I use the term ‘negatively emote’ to take into account the following journal article by Biener & Taylor [T C 11(1):75] - their point being that fear is not the only emotion involved. There are admittedly many attempts at ‘pushing’ people through the Stages of Change (Prochaska & DiClemente) by means of perceptual triggers generating feelings of loss; sadness; guilt etc. This at first glance seems a viable approach – after all it works with some and we’re doing it for their own good! However, in my experience, life changes tend to be permanent most often when people experience acceptable emotional states during their progression through the stages.

  If a person enters the contemplation stage in high negative arousal (e.g. fear) there are two possible avenues of ‘escape’. The first avenue is to move on to the next stage - Planning (and then hopefully to Action). This happens more easily with ‘self-actuated’ individuals who have enough knowledge to know what to do and then enough confidence to implement that knowledge. What defines ‘self-actuated’ people is that fear or other negative emotions only remain transiently to be replaced by a resolve to avoid negative consequences by focusing on a set of positive outcomes with the associated positive emotions that they trigger. With this group ‘scare tactics’ may have a high chance of long-term success. The first avenue is also often taken by less self-actuated individuals who are pushed into moving on by their anxiety, fear or even panic. Yet their negative emotions are not dissipated in the same way as in the latter group. Smoking cessation advisers and health promotion message designers should aim to reduce negative emotions in the latter group of people, not enhance them.

  The second avenue is the one taken by those who feel unable to move on and involves one of two strategies – fight against the truth or personal relevance of the emotive tactic or withdraw by pushing the emotive information to the far reaches of their mind (often having a cigarette alongside the process in order to reduce the stress of it all!). This of course is the pathway to the precontemplation stage

  There are serious consequences relevant to the less self-actuated in either avenue. Those who move to stopping do so in an anxious state thus making the experience of not smoking a difficult one. Further, if they experience a lapse (highly probable) they fall back to a contemplation state that was originally anxious and now is doubly so – this often precludes another attempt at taking action. And those who avoided the issue by withdrawing attention or downplaying it? They have had a life strategy re-affirmed with perhaps underlying feelings of inadequacy. Thus, emotive tactics can in the end reinforce, in those groups, a perception that making significant life changes is beyond their reach. The relevance of this to current government targeting of certain populations of smokers is significant to say the least.

  Even the language of smoking cessation kicks the less self-actuated when they are already down. The logic and associated emotions are clear:

  1. Smoking always has a value in a smoker’s life (stress relief; pleasure; social acceptance etc). Emotionally a cigarette is often referred to as ‘my one and only – friend – standby – vice etc’ 2. The exhortations: quit it; cut it out; give it up; etc carry the message ‘remove this valuable thing from your life’. Emotionally, such messages push the listener into a state of deprivation with its associated response – ‘how can I live without my – friend – standby – vice?’ 3. When any human gets to feeling deprived enough, intelligence switches off and ‘fight or flight’ switches on. This is the moment the less self- actuated withdraw or the action takers lapse and smoke unthinkingly – but oh the relief from that deprived state! 4. Of course, once out of that state, the rational mind re-appears with the concomitant regret; guilt; anger; frustration – some will be back in contemplation in an emotionally aroused state ready to fall into making the journey again. This is the classic vicious circle.

  Biener & Taylor’s conclusion that people haven’t tired of repeated emotive messages because they report that the messages don’t exaggerate the dangers of smoking seems lacking in logic. I can assert that a TV ad does not exaggerate Mr Dunky’s claim to kitchen cleaning power. But I can do without seeing it now because the product brought me out in a rash. Just being true doesn’t make an assertion motivating or useful!

  So what is the solution to giving health messages such that we avoid the vicious circle outlined above. It seems clear that to avoid relapse one would have to ensure that a smoker felt comfortable in actuating each step of their journey. Ideally, for that to happen, smokers must either choose each step or be given advice they are comfortable in going along with. This would be a learning experience with the person acquiring self- actualisation skills. Other approaches can lead to people becoming reliant on external forces to fuel movement or to keep their life stable. An external force focus in smoking cessation can lead to the often heard – ‘I can’t stop, can’t you give me something’; ‘how can I survive without the stop smoking group’; ‘how will I cope when my NRT ends’ etc. Even the focus on the power of nicotine as an addictive substance undermines self- actualisation – ‘how can I do anything, they say nicotine’s as addictive as heroin’; ‘I’ve always smoked, it’s got me well and truly hooked’ etc

  As a smoking cessation adviser and a communications trainer I see my role as one of facilitating people in choosing to do for themselves that which will enhance their lives in important ways. As part of this I make it clear that the manner in which a smoker thinks about things will either help or hinder. To illustrate this point I use an analogy: imagine you buy a new TV set for £200. Would you sit in front of it thinking ‘I’ve lost £200 and it’s not coming back!’ or would you accept that you chose it, it’s new, it takes learning to live with it. Of course, both points of view are a true reflection. But the former way of thinking guarantees a miserable experience watching TV. The latter way of thinking seems more appropriate if the decision to spend your money was based on some good reasoning about what you wanted in your life. After relating this analogy, if someone becomes pessimistic at any stage, I say – ‘you’re in minus £200 mode! Remind yourself why you’re choosing to do this.’

  Negatively emoting messages can point out what is life depriving about smoking (or any health promotion issue) – that’s OK. But the aim is to have the smoker act, and this is where the less self-actuated need different messages that leave them in emotionally comfortable states conducive to moving to the next stage of change. The focus needs to be on the design of such messages for a wide audience. For example, with smokers I refrain from setting a ‘quit day’ – but suggest a ‘freedom day’. The former provokes emotional deprivation, the latter, a self-actuated choice to do something of personal benefit.

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  Conflict of Interest:
  None declared.

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