Emotion, health decision making, and health behaviour

Efforts aimed at understanding and changing health decisions and behaviour have relied on theoretical frameworks or models comprised of social-cognitive determinants, such as knowledge, risk perception, attitudes, social norms, and self-efficacy (Conner & Norman, 1996, 2017; Noar & Zimmerman, 2005). These frameworks, and the interventions based upon them, largely do not take affective states into account. However, converging evidence suggests that emotion, stress, motivation and other affective states are essential to decision making and behaviour (e.g. Damasio, 1994; Lerner & Keltner, 2000, 2001; Loewenstein & Lerner, 2003). Moreover, health decisions and behaviour often take place in emotionally-laden contexts. For example, decisions about cancer treatment involve managing fears of cancer, treatment side effects, and the burden and fears of close others who must manage the emotional consequences of the diagnosis (Ellis & Ferrer, 2017; Ferrer, Green, & Barrett, 2015). Decisions about sexual risk and prevention take place in the context of arousal and lust (Ariely & Loewenstein, 2006; George et al., 2009). Healthpromoting behaviour, like healthy eating and exercise, are compromised when stress is high, uncontrollable, and chronic, or when emotion regulation is poor (e.g. Ferrer, Green, Oh, Hennessy, & Dwyer, 2017; Schnohr, Kristensen, Prescott, & Scharling, 2005; Tomiyama, Dallman, & Epel, 2011). Thus, the relative dearth of research focused on how affective states contribute to and influence health decision making and behaviour is an important gap in the literature. It is critical to cultivate research to fill this gap to inform effective intervention development and implementation efforts. To date, the affective state most likely to be examined in a health context is stress. Stress research largely focuses on associations among stressors (i.e. social or environmental demands for which an individuals’ coping resources are absent or exceeded) and biobehavioural responses to stressors, including health biomarkers and outcomes. Responses include, but are broader than, negative affect and behaviour, also encompassing cognitive responses, physical symptoms, and physiological changes (e.g. Kemeny, 2009; Lazarus & Folkman, 1984). Stress research often links to biological health outcomes, although some research examines stress as a predictor of decision making (e.g. Jamieson, Koslov, Nock, & Mendes, 2013; Kassam, Koslov, & Mendes, 2009; Lighthall, Mather, & Gorlick, 2009), including health behaviour (e.g. Adam & Epel, 2007).