Expanding the analysis of mechanisms of action in behavioral interventions: cognitive change versus cognitive activation

Objective To understand the mechanisms of action underlying behavioral interventions, researchers typically examine whether the treatment changes cognitions and whether changes in cognition predict behavior (cognitive change). This current research explores an alternative mechanism whereby the intervention increases the impact of pre-existing cognitions on behavior (cognitive activation). We tested whether cognitive change or cognitive activation explains the impact of cigarette pack messages on smoking restraint. Design The research comprised a validation experiment (N = 135) and a 4-week RCT (N = 719) with smokers. Main Outcome Measures At both baseline and follow-up of the RCT, smokers self-reported threat appraisals, coping appraisals, and smoking restraint. Results Intervention messages heightened the accessibility of threat appraisals compared to control messages (validation experiment). In the RCT, smoking restraint increased among intervention participants but not controls. Trial arm showed no corresponding change in threat or coping appraisals. However, trial arm interacted with baseline health cognitions such that synergies between threat appraisal components, and between threat appraisals and coping appraisals, predicted smoking restraint for intervention participants but not for controls. Conclusion Our findings support a cognitive activation process whereby health messages on cigarette packs increase the impact of pre-existing threat appraisals on smoking restraint.

Automated summary

This research examines the mechanism of cognitive activation, where interventions increase the impact of pre-existing cognitions on behavior. The study found that health messages on cigarette packs increased smokers' sensitivity to threat appraisals and led to an increase in smoking restraint.