1. Do interventions based on
cognitive dissonance promote
health behaviour change?
A systematic review
Tanya Freijy and Emily Kothe

2. 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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3. 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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4. 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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5. Existing evidence
So, dissonance-based interventions are strong in the
clinical literature, but what about non-clinical?
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6. 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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7. 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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8. 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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9. 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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10. 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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11. 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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12. 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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13. 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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14. Limitations
› Publication bias.
› Search restricted to
English-language papers.
› Analysis relied upon statistical
p-values.
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15. 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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16. 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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17. 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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18. 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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19. References
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Journal of Public Health, 81(12), 1636-1638.
Aronson, E., & Mills, J. (1959). The effect of severity of initiation on liking for a group. The Journal of Abnormal and Social Psychology, 59(2), 177.
Becker, C. B., Wilson, C., Williams, A., Kelly, M., McDaniel, L., & Elmquist, J. (2010). Peer-facilitated cognitive dissonance versus healthy weight eating
disorders prevention: A randomized comparison. Body Image, 7(4), 280-288.
Brehm, J. W. (1956). Postdecision changes in the desirability of alternatives. The Journal of Abnormal and Social Psychology, 52(3), 384.
Dickerson, C. A., Thibodeau, R., Aronson, E., & Miller, D. (1992). Using cognitive dissonance to encourage water conservation. Journal of Applied Social
Psychology, 22(11), 841-854.
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Festinger, L., Riecken, H. W., & Schachter, S. (1956). When prophecy fails. New York: Harper-Torchbooks.
Fointiat, V. (2004). "I know what I have to do, but..." When hypocrisy leads to behavioral change. Social Behavior and Personality, 32(8), 741-746.
Kantola, S., Syme, G., & Campbell, N. (1984). Cognitive dissonance and energy conservation. Journal of Applied Psychology, 69(3), 416.
McKimmie, B. M., Terry, D. J., Hogg, M. A., Manstead, A. S. R., Spears, R., & Doosje, B. (2003). I'm a hypocrite, but so is everyone else: Group support and
the reduction of cognitive dissonance. Group Dynamics: Theory, Research, and Practice, 7(3), 214-224.
Pallak, M., Cook, D., & Sullivan, J. (1980). Commitment and energy conservation. In L. Bickman (Ed.), Applied social psychology annual (Vol. 1, pp. 235-
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Simmons, V. N., & Brandon, T. H. (2007). Secondary smoking prevention in a university setting: A randomized comparison of an experiential, theory-based
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Simmons, V. N., Webb, M. S., & Brandon, T. H. (2004). College-student smoking: An initial test of an experiential dissonance-enhancing intervention.
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Son Hing, L. S., Li, W., & Zanna, M. P. (2002). Inducing hypocrisy to reduce prejudicial responses among aversive racists. Journal of Experimental Social
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Stice, E., Shaw, H., Becker, C. B., & Rohde, P. (2008). Dissonance-based interventions for the prevention of eating disorders: Using persuasion principles to
promote health. Prevention Science, 9(2), 114-128.
Stone, J., Aronson, E., Crain, A., Winslow, M. P., & Fried, C. B. (1994). Inducing hypocrisy as a means of encouraging young adults to use condoms.
Personality and Social Psychology Bulletin, 20(1), 116-128.
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