Psychol Stud DOI 10.1007/s12646-012-0173-7
RESEARCH IN PROGRESS
Using Message Framing to Promote Social Support in Depression: When Misery Makes Better Company Jerusha B. Detweiler-Bedell & Brian Detweiler-Bedell & Amy Baugher & Melanie Cohen & Julie Robertson
Received: 17 August 2012 / Accepted: 17 November 2012 # National Academy of Psychology (NAOP) India 2012
Abstract A depressed person may have particular difficulty obtaining social support unless, as previous research indicates, members of the person’s support network believe that their interactions with the depressed person will be rewarding. Continuing this line of research, two studies investigated how message framing influences perceptions of providing social support to someone diagnosed with depression. In Study 1, participants first evaluated a website created by the research team, which emphasized either the rewards of volunteering to help individuals suffering from depression (gain-framed) or the drawbacks of not volunteering (loss-framed). One week later, participants read a vignette about a friend suffering from depression. Participants initially exposed to the gain-framed website indicated that the friend was in greater need of help, and they expressed stronger intentions to help and maintain supportive contact with the friend. The first phase of Study 2 was identical to the first phase of Study 1. However, a week after evaluating the framed website, participants interacted via instant messaging with a confederate posing as a prospective undergraduate student, who disclosed during the conversation that she had been diagnosed with depression. Participants
The first and second authors contributed equally to this project. Support for this research was provided by the National Science Foundation’s Course, Curriculum, and Laboratory Improvement program (0737399). Additional support was provided by Lewis & Clark College’s John S. Rogers Science Research Program. We would like to thank Kelsey Chapple, Nicolia Eldred-Skemp, Clare Montgomery-Butler, Corinne Innes, Dmitri Alvarado, Claire Beatus, Azalea Lewis, Lauren Tracy, Laurel Anderson, and the other members of the Behavioral Health and Social Psychology Laboratory for their invaluable contributions to this research. J. B. Detweiler-Bedell (*) : B. Detweiler-Bedell : A. Baugher : M. Cohen : J. Robertson Department of Psychology, Lewis & Clark College, Campus Box 16, 0615 SW Palatine Hill Road, Portland, OR 97219, USA e-mail:
[email protected]
initially exposed to the gain-framed website indicated greater comfort interacting with the prospective student and greater willingness to engage in follow-up interactions with the student (e.g., exchange emails, talk on the phone) compared to participants initially exposed to the loss-framed website. The implications of these findings for increasing the provision of social support to individuals with depression are discussed. Keywords Message framing . Depression . Social support . Persuasion . Mental health Psychologists have been engaged in a long-standing effort to identify the most effective methods of persuading people to adopt health recommendations. Research in this field initially focused on the effectiveness of using fear in persuasive health appeals (Leventhal 1970). More recently, researchers have turned their attention to the effectiveness of framed health messages, which typically emphasize the gains associated with performing recommended health behaviors or, alternatively, the losses associated with failing to perform these behaviors (Rothman et al. 2006; Rothman and Salovey 1997). The effectiveness of framed messages such as these has been investigated in contexts as wide-ranging as promoting breast self-exams (Meyerowitz and Chaiken 1987), flu vaccinations (McCaul et al. 2002), sunscreen use (Detweiler et al. 1999), and better dental hygiene (Mann et al. 2004). Although the message framing literature is quite extensive, it has focused predominantly on physical health behaviors, and little attention has been paid to the impact of health frames on the promotion of mental health behaviors. Yet as conditions such as major depressive disorder have become major public health problems (Mathers and Loncar 2006; McKenna et al. 2005), recuperation from these conditions has become a central concern. In one study bringing together health message framing and recuperation from depressive symptoms, Detweiler-Bedell and Salovey (2003) found that individuals
Psychol Stud
with mild to moderate symptoms of depression responded to treatment recommendations differently depending on both the frame used to describe the treatment and the individual’s perception of the importance of the recommended behavior. Participants who believed the recommended behavior to be important were significantly more likely to perform it if they had been exposed to an approach-framed message (e.g., “Doing pleasant activities will help you to feel happier”) as compared to an avoidance-framed message (e.g., “Doing pleasant activities will help you to feel less sad”). In contrast, participants who viewed the recommended behavior as less important were more likely to carry out the behavior if they had been exposed to avoidance-framed messages. In this paper, we further investigate the use of message framing to promote recuperative mental health behaviors. Specifically, we examine the influence of loss- versus gain-framed appeals on a depressed individual’s social support network. Individuals with depression are sensitive to the support network’s responsiveness to their underlying psychological needs (Ibarra-Rovillard and Kuiper 2011), and they report that a perceived lack of support complicates their recovery from depressive episodes (Gladstone et al. 2007). Higher perceived support, especially from family and friends, is associated with significantly lower levels of depressive symptomatology (Clara et al. 2003), shorter durations of depressive episodes, and fewer depressive episodes in one’s lifetime (Gladstone et al. 2007). However, past research suggests that the perceived reward of interacting with or helping a depressed individual moderates a person’s intentions to provide social support. Specifically, higher perceived reward is associated with greater intentions to help a depressed individual and less concern about the social costs of long-term helping as compared to lower perceived reward (Detweiler-Bedell et al. 2008). In the current research, we aim to influence potential caregivers’ perceptions of and likelihood of supporting a depressed individual using message framing.
The Current Research The two studies reported in this article investigated the impact of gain- versus loss-framed persuasive appeals on potential caregivers’ likelihood of volunteering social support to individuals with depression. We hypothesized that caregivers would be more likely to offer social support to a depressed individual if they had been presented with a gain-framed message about the upsides of volunteering support as compared to a loss-framed message about the downsides of failing to provide support. We predicted that gain-framed appeals would be most effective because they accentuate the rewards associated with helping a depressed person, which appears to be a key determinant of social support (Detweiler-Bedell et al. 2008).
Both studies exposed participants to framed information through a depression support center’s volunteer recruitment website (ostensibly genuine, but actually created by the research team). The second phase of each study took place approximately 1 week later, when participants were exposed to a vignette (Study 1) or an immersive laboratory-based social interaction (Study 2) enabling us to assess the impact of the framed messages on participants’ attitudes and behavioral intentions concerning helping a depressed individual. Many studies of message framing first present a framed appeal and then measure the effects of this appeal within what participants would clearly recognize as the same experiment. However, we separated the two phases of these studies in order to examine whether framing effects might be robust over time and in a somewhat unrelated context. Although participants undoubtedly recognized a superficial relationship between the two phases of our studies (e.g., both were conducted by researchers at the same institution, both addressed depression), no participants mentioned any substantive connections between the two phases when asked to describe the overall purpose of the research.
Study 1 Method Participants Fifty-two participants (54 % women, 46 % men) completed the study in its entirety. Participants were recruited from two college campuses in the United States of America and ranged in age from 18 to 55 years old (M025.6; SD09.0). Three participants were excluded a priori from the study’s analyses because they did not meet explicit inclusion criteria (i.e., one participant reported being under 18 years old, and two participants reported hearing about the study from a family member who had already participated). Both phases of the study were completed online. As compensation, participants received $4 for completing Phase 1 and $10 for completing Phase 2. Procedure Phase 1 Individuals who had previously expressed interest in participating in psychology studies were invited by email to complete an online study evaluating a website. Participants received a link to the online survey, and they were randomly assigned to either the gain-frame (N028) or loss-frame (N024) condition. All participants were told that this study was being conducted in collaboration with the “Mount Hood Center for Depression Support” and that the study involved the evaluation of the center’s new website for volunteers (see Fig. 1).
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Participants were asked to explore the website and to pay particular attention to the page entitled, “What Can Volunteers Expect?”, which was framed in terms of the “Upside of Volunteering” (gain frame) or the “Downside of Not Volunteering” (loss frame). This webpage comprised the study’s experimental manipulation. All other information was kept constant across conditions (see Table 1). After browsing the website for approximately 5 min, participants were given a short questionnaire to evaluate the website’s design and clarity. Next, participants were asked to recall as many pieces of information as they could from the “What Can Volunteers Expect?” page of the website, and they were asked to elaborate briefly on the “upsides of volunteering” (gain-framed condition) or the “downsides of not volunteering” (loss-framed condition). These openended questions were meant to confirm that participants had visited the framed webpage and to reinforce the experimental manipulation. After this, participants completed a short questionnaire concerning their impressions of volunteering and their own likelihood of volunteering. Finally, participants answered a few general demographic questions and reported on their previous experience and familiarity with depression. At the end of the survey, participants were thanked for their time, and within a few days they received $4 by mail as compensation for their participation. Phase 2 Approximately 1 week after completing Phase 1, participants were sent an invitation for a separate, ostensibly unrelated survey. In this phase of the study, participants read a brief scenario about a hypothetical friend (matched to participant sex) who recently had been diagnosed with depression, which was modeled after a similar scenario used by Detweiler-Bedell et al. (2008). After reading the vignette, participants completed a series of dependent measures. Following this, participants were debriefed concerning the study as a whole, and they were offered the opportunity to Fig. 1 Homepage of the “Mount Hood Center for Depression Support” website, which was used in Studies 1 and 2
visit online mental health resources if they had further questions concerning any of the symptoms of depression described in the study. A few days later, participants received $10 additional compensation by mail.
Measures Phase 1 Three sets of measures were used in Phase 1 of the study. Design and Clarity of Website Eight items assessed participants’ impressions of the depression support center website. These items were rated on five-point scales ranging from “poor” or “not at all” to “good” or “very” (depending on the question), and they were averaged to form a composite measure of the website’s design and clarity (Cronbach’s α0.79). Positive Attitude Toward Volunteering Ten items assessed participants’ perceptions of volunteering to help depressed individuals. These items were rated on seven-point scales ranging from “not at all” to “extremely,” and they were averaged to form a composite measure of the participant’s positive attitude toward volunteering (Cronbach’s α0.85). Demographics Participants were asked to report their sex and age. They also were asked if they had ever been diagnosed or treated for depression, and they rated their familiarity with depression on a seven-point scale ranging from “not at all familiar” to “very familiar.” These demographic measures were assessed in both Study 1 and Study 2, and a common methodology was adopted to evaluate whether any of these variables should serve as covariates in our primary analyses. Specifically, covariates were retained if their potential to account for error variance in the final model was appreciable (p.54 for all four Phase 2 measures). Phase 2 Approximately 1 week after being exposed to the framed volunteer recruitment website, participants completed a second study in which they read about a hypothetical friend who had been recently diagnosed with depression. After reading the vignette, participants previously exposed to the gainframed volunteer website rated the friend’s emotional state as being more negative (M06.16, SE0.12) compared to participants in the loss condition (M05.78, SE0.13; controlling for participant sex and prior diagnosis of depression), F(1, 48)04.61, p
