Preach What You Plan To Practice
Tuesday, January 6, 2009
One thing is true about New Year's health resolutions:
Year after year we resolve to lose weight. Quit smoking. Exercise. And year after year we don't do it.
This failure has a large cost. We pay not only in terms of our own health, but also as taxpayers and citizens. The federal government spends billions each year looking for cures for diabetes, AIDS and lung cancer, diseases whose origins largely lie in our inability to do what we know we ought to do. If people would just quit junk food and smoking, wear seat belts and use condoms, a good chunk of the medical industry would find itself out of work.
Over several decades, doctors have tried to frighten people into healthy behavior by showing them pictures of lung tumors, accident victims with ghastly injuries and skeletal AIDS patients. Parents, teachers, advice columnists, talk-show hosts have joined in: ordering, begging, bribing.
Nothing really works -- not for long, at least -- because the central impediment is not that people do not know what they ought to do, but that their minds refuse to commit to change.
As a new year's gift this year, introduce your mind to Elliot Aronson. This California psychologist has spent a lifetime studying how to get your mind's machinery to cooperate with your health resolutions.
His central finding is surprising: The most effective way to get people to change their behavior revolves around the clever use of . . . hypocrisy. When people feel not only that they are failing themselves but also that are failing to live up to what they tell other people to do, they change their behavior -- and stick to it.
But we're getting ahead of our story.
Buckle up. Parents, fair warning: Aronson's journey of discovery involved a sojourn into the world of pornography.
A quarter-century ago, the University of California at Santa Cruz found itself dealing with a public health crisis. An exotic and fearful disease called AIDS was spreading, and students were at risk. What was frustrating to officials was that the means to stop AIDS was simple and obvious: Students needed to either abstain from sex or, if they did have sex, use condoms.
Aronson, then a faculty member and now a professor emeritus at the university, decided to help out. Educating students was the obvious first step: Aronson and university officials put up advertisements on campus about the horrors of AIDS. They handed out pamphlets. They held conferences about the risks of unsafe sex.
"We tried to scare . . . them about why AIDS was such a terrible disease," Aronson said. "In the early '80s, it was a death sentence."
Unlike many educators, Aronson wanted more than a good feeling about what he was doing; he wanted evidence that the education was working. He conducted surveys before and after the outreach efforts. Before the messages went out, about 17 percent of sexually active students were using condoms regularly. After all the scary messages, that number went up -- to 19 percent.
The psychologist tried another tack. Some of the most effective persuaders in the world are not doctors, but marketers. If seductive marketing can get people to plunk down good money for baubles, surely it could get people to do something to save their own necks.
Aronson resolved to try to make condom use sexy. Students reported they were not using condoms because they saw it as an interruption to love-making: It was bathroom talk in the bedroom. Men declared that condoms interfered with their satisfaction. Aronson started looking for movies that depicted condom use in another light: prophylaxis as wild fun.
The psychologist scoured the adult movies available in Santa Cruz. Knowing glances followed the professor doing "research" in the backrooms of video stores.
Aronson wanted a five-to-six-minute clip of a normal-looking couple having sex with condoms, and enjoying it. But few pornographic movies fit the bill. They invariably veered into exotic scenarios: the guy wearing a Royal Canadian Mounted Police uniform, the midget and the obese woman.
"I spent the better part of a week watching the movies," he said. "They were boring as hell. One porno film is a turn-on. Fifty porno films is hell."
In frustration, Aronson decided to make his own sex movie. The Santa Cruz Shakespeare festival was featuring "Romeo and Juliet" that year, and the lead roles were being played by two gorgeous actors. Aronson told them about his project, and they agreed to help.
Aronson directed the movie in a single day. A young man and a woman are talking, and one thing leads to another. Most of the action takes place under a silk sheet; it's what Aronson called R-rated rather than X-rated.
"She would say, 'Do you have the stuff?' and he would bring out a beautiful box with condoms," Aronson recalled. "She opened a condom with her teeth -- ripped it off -- looking very sexy."
"The main thing was to make the use of condoms seem sexy and attractive rather than something you interrupt the sex with. It was now part of foreplay."
The results delighted the psychologist. After the movie was shown around campus, condom use soared to 60 percent. It was great news, except that the next survey, taken after two months, showed condom use back down at 20 percent.
Aronson recognized the problem: Marketers usually want you to make just a single purchase (a camera or a hot tub), whereas fighting AIDS required a long-term behavior change.
"Condoms are not fun to use, and we were trying to sell them something under false pretenses," he said. "Most of the students gave it a shot and then stopped. I was stupid to think they would never catch on. You cannot make something fun that isn't fun."
Aronson put aside his camera and went back to what he knew best: psychology. He had studied under Leon Festinger, who had discovered a now well-known phenomenon, cognitive dissonance. The theory suggests that when people do things against their better judgment, they experience internal discomfort, much like hunger or thirst.
A smoker who reads about how smoking causes cancer experiences cognitive dissonance if she continues to smoke: She is knowingly doing something that will harm her. There are two ways to relieve herself of the discomfort. The first is to quit smoking. But that is difficult, so most smokers convince themselves that the links between smoking and lung cancer are not quite as strong as doctors assert.
"I convince myself the scientific data is not really all that good or my uncle Hymie smoked for 87 years and he is 95 now [or] the filter tip does trap all the cancer-producing agents," Aronson said. "I find a way to sleep at night even though I am doing something incredibly stupid."
The students at Santa Cruz were doing the same thing by engaging in unsafe sex: They were rationalizing away the risks. But what if there were a way to keep them from doing so? What if the students placed themselves in a position where they vociferously and publicly advocated to others the utility of condoms? If Aronson could make them spokespeople for AIDS prevention, he theorized, it would be very difficult for them to then act as if condoms didn't really do much to stop AIDS or they were not really at risk. They would feel like hypocrites.
Aronson realized he had gotten things backward: Instead of his selling condom use to students, what he really needed was for them to sell AIDS prevention to him.
Aronson found a bunch of students at the health center. He said he needed them to make a video aimed at high school seniors about the risks of AIDS and the importance of using condoms. If they did a good job, they could save lives. After the students made up their own speeches and shot the videos, Aronson paid them $5 and asked them about their own condom use.
"We increased their awareness that they were not practicing what they were preaching," he said. "Their nose is being rubbed in the fact that they are a hypocrite."
At the same time, Aronson paid $5 to some students who had been given educational messages about safe sex.
As both groups of students headed out the door after being paid, Aronson arranged for them to pass a woman in a nurse's uniform who was selling heavily subsidized condoms. He measured how much of their newfound $5 the volunteers spent buying condoms. He found that the video-making but hypocritical volunteers spent far more on condoms than those who had merely been given educational messages. Some of the students made to feel like hypocrites spent their entire $5 on condoms.
But did the effect last? Months later, Aronson arranged for the students in his experiment to be cold-called by a person taking a survey. The survey made no mention of the health center incident. Both three and six months after his intervention, Aronson found, 65 to 70 percent of students who had made videos about condom use and then had their faces gently rubbed in their own hypocrisy were using condoms every time they had sex.
"You can get better results from using hypocrisy than any other technique I know," Aronson said. "You are never going to get 100 percent change, but the condom stuff is so powerful because we went from 17 percent to 70 percent for at least six months. It is not a magic bullet, but it is more magical than any other bullets we have in our arsenal."
Over time Aronson and others showed that hypocrisy could be used to change a wide range of health behaviors.
Renée Bator, a social psychologist at the State University of New York at Plattsburgh, recently corralled students who were on their way to a fitness center. She asked them to sign pledges that they would work out at least four times a week and give each workout their best effort. She also asked them to sign fliers that declared, "If I can do it, so can you!"
Then she asked these students about their exercise habits -- queries that triggered feelings of hypocrisy.
Unlike Aronson's study, which relied on people's reporting about their condom use, Bator's used a more dependable measure: She tracked how often the students' fitness center cards were used subsequently.
Students who had made public pledges about how often they worked out and had exhorted others to do the same -- but were then reminded that they were not living up to their own preaching -- used the fitness center far more regularly thereafter than students who had not been made to feel hypocritical.
At the University of Arizona in Tucson, psychologist Jeff Stone has found hypocrisy useful in prompting people to use sunscreen to fight skin cancer. All the educational messages in the world seem far less effective than getting people to preach the importance of sunscreen to others and then reminding them that they are not living up to their own exhortations.
What these techniques have in common is their reliance on the fact that humans care intensely about how they are perceived. When we make public pledges and then are reminded that we are not living up to those pledges, we effectively turn the people around us into our enforcers: We feel that the eyes of our friends and colleagues are on us and that they are disparaging us.
"When it comes to making those New Year's resolutions, I can think of several reasons people do not follow through," Stone said. "If it is something you believe in, you should be made mindful of the fact you do not do it. . . . We use hypocrisy to create a teachable moment."
There are two important caveats to the technique: The first is that it works when people are convinced about the importance of the issue. If people don't really think exercise is crucial, they won't feel very hypocritical when they fail to exercise. The second is that it is essential to alert people to their hypocrisy in a subtle and supportive manner. If people feel publicly humiliated, they may respond by pooh-poohing the importance of the health intervention.
Among the ways people can use these findings, the psychologists said, is to make public pledges about what they want to do. Teachers can have students break into teams and take turns trying to persuade one another to pursue healthy behaviors -- and then be subtly reminded about their own inconsistencies.
Asked whether she had applied her research to her own life, Bator hesitated and laughed.
"I just bought a new piece of exercise equipment," she said, "and I was going to tell my husband I am going to work out Tuesdays and Thursdays" as a way to trigger feelings of hypocrisy in herself if she failed to live up to her goal. "And then I said, 'Maybe not. If I tell him, I am probably going to do it, so I am just going to make the commitment to myself.' "