Psychological Reactance and Doctor-Patient Communication: The Influence of Threatening Uncertainty

Recent literature reviews (e.g., Harrington, Noble, & Newman, 2004) have indicated that effective communication between healthcare providers and patients has implications for a range of outcomes, including patient satisfaction, medication adherence, and compliance with medical advice. However, The Institute of Medicine’s (Committee on Quality of Health Care in America, 2001) move toward patient-centered care has revealed that there are conflicting data in the literature on the most effective approaches for communicating with patients. One body of scholarship holds that giving patients choice and including them in decision-making results in the highest satisfaction, adherence, and compliance rates (e.g., Janssen & Lagro-Janssen, 2012). Other research suggests that at least for some populations, directive communication approaches are more effective (e.g., Arnow et al., 2003). Based on social psychological theorizing (e.g., Brehm, 1966) and classic philosophy (e.g., Fromm, 1941), we proposed a possibility for reconciling these two literatures—namely, that patients’ emotional or motivational state interacts with providers’ communication style to influence patient outcomes (e.g., Dillard & Seo, 2014).

We conducted three studies to assess whether directive messages are less noxious to people when in a state of threatening uncertainty (vs. certainty/safety). Prior to looking at this phenomenon in the applied realm (Studies 2 and 3), we designed a study to examine it on a theoretical level. Study 1 revealed that participants primed to feel threatening uncertainty perceived uncertainty as more noxious, and in turn reported a greater preference for order than participants primed to feel certain and secure. In Study 2, we again primed participants with threatening uncertainty or certainty and safety, and asked them to choose between a doctor who provided choices and one who dictated a treatment regimen. Results indicated that participants primed to feel threatening uncertainty were twice as likely as those who felt certain and secure to choose a controlling (vs. autonomy-supportive) doctor. Study 3 assessed whether controlling health messages (e.g., espousing the benefits of daily flossing) are less aversive for people in a state of threatening uncertainty (vs. certainty/safety). Findings indicated a boomerang effect for participants primed to feel certain and secure, who were more reactant to a controlling (vs. autonomy-supportive) message (i.e., reported intentions counter the message). Conversely, for participants primed to feel threatening uncertainty, health intentions did not vary based on the controlling nature of the message.

The results of the current research effort challenge a common assumption in prevention science, that indirect communication that offers people choice is a universally useful communication tactic. Indeed, these data indicate that rather that a one size fits most communication approach, to maximize effectiveness, healthcare practitioners and campaign designers should consider people’s state of mind. Based on the present findings, knowing the uncertainty and certainty level of the receivers of a given message could be critical when determining how to communicate with them.