Barriers to health appeals

Posted on July 18, 2015 by Priscilla

This is my summary/translation of the article Abwehrreaktionen auf Gesundheitsappelle: Forschungsstand und Praxisempfehlungen by Hastall, 2012.

Against threatening or disturbing messages we have defensive processes, in order not to get thrown into a (unhealthy) state of frenzy every time we encounter one. These defensive processes are understood as motivated reactions, responses to health-appeals that take up resources when three criteria are met (Hastall, 2012).

  1. The response follows directly after contact with the message
  2. The response is based on defensive measures; it is meant to reflect an anticipated threat (e.g. threats to feelings of self-worth or emotional well-being)
  3. The response is aimed directly or indirectly at avoiding the message or attacking the content of the message

We can distinguish four different groups of defensive responses that might inhibit effective health marketing/communication:

  1. Avoiding or minimising contact with threatening messages
  2. General psychological ego-defence mechanisms
  3. Attacking the content of the message or the messenger
  4. Increased health-damaging behaviour

Modern man has developed advanced avoidance strategies for online marketing messages of any kind to such a degree that we completely miss the advertisements on a website (a concept known as banner-blindness) and we install ad-blocking software, spam filters and the like to assist us in avoiding unsolicited content. Modern psychoanalysis and clinical psychology defines defence mechanismsas unconscious processes meant to protect an individual from fear and recognition of internal or external burdens and threats. A defence mechanism does this by regulating the response of the individual to emotional conflict and external burdens (Wittchen/Hoyer, 2011). Over 40 such processes have been discerned and are commonly and continually applied by individuals in their daily lives (Cramer, 2008). The mechanisms of denial, repression and rationalisation seem especially important in the health domain (Hastall, 2012).  For example; illusory superiority bias describes the constant overestimation of our positive aspects and the subsequent underestimation of our negative aspects. Combining this bias with unrealistic optimism and false consensus bias leaves many well intended health messages unattended to, because they are deemed ‘not relevant’ to us.

Table: Health marketing defence mechanisms (Hastall, 2012)
Avoiding or minimising contact with threatening messages
Selective message avoidance Complete avoidance of messages or turning away the attention after brief/short and unconscious contact
Banner blindness Selective advertisement avoidance specific to websites. While visually scanning the site, the anticipated  advertisements are visually faded out
Technical defence Using technical solutions to avoid contact with unwanted messages, such as AdBlock or a spam filter
Legal defence Prohibiting advertisements or joining a revocation list e.g. Robinson-list
General psychological ego-defence mechanisms
Denial Not considering or denial of aspects in reality that threaten ones’ existence, such as health risks
Repression Displacing threatening aspects of reality in ones’ subconscious
Rationalisation Inventing seemingly reasonable explanations to justify threatening thoughts, feelings or behaviours
Illusory superiority effect Overestimating ones’ positive qualities in comparison to others, while simultaneously underestimating ones’ negative qualities
Unrealistic optimism Believing that one will be affected less by negative occurrences and more by positive occurrences than other people
False consensus effect Overestimating the proportion of people that share ones’ viewpoint on a certain topic
Attacking the content of the message or the messenger
Selective interpretation Reinterpreting the content of the message in such a way that it harmonises with ones’ views and beliefs
Counter arguments Generating arguments that counter the propositions of a message and the recommendations made e.g. by looking for information stating the opposite
Source devaluation Devaluating the source of a message e.g. by insinuations of incompetence or unreasonable intentions
Aggression Verbal or physical  attacks on the messenger, the message or the medium carrying the message e.g. tearing down health related placards
Advantageous social comparison Comparing oneself to person who are worse off or are behaving worse than you in order to feel better about oneself and to diminish the necessity of a behaviour or attitude change
Social validation Looking for persons with similar attitudes and behaviours and emphasizing the high number of corresponding people
Heightened attractiveness of critical aspects Health damaging behaviours are seen as more attractive after contact with the message than before contact with the message
Increased health-damaging behaviour
Boomerang effect Message provokes the opposite of the intended goal e.g. smoking more after contact with a anti-smoking message
Taking psycho-active substances Taking alcohol, nicotine, drugs or medication after contact with the message in order to pacify oneself or shift thoughts

Should a possibly threatening message get through the first line of defence mechanisms and manage to get itself consciously considered, attack strategies might come into play. Findings that confirm this course of thought and action are aggregated from research into cognitive dissonance (Festinger, 1957), psychological reactance (Brehm, 1966; Dillard & Shen, 2005) and resistance (Jacks & Cameron, 2003).

Strategies to lessen the resistance

There are two neurological systems working in parallel: BIS and BAS (e.g. Carver et al. 2000; Gray, 1982). The Behavioural Inhibition System; looking for potential threats and possible dealing with them through various defence mechanisms – and the Behavioural Activation System; looking for cues for potential positive experiences. BIS concerns itself with (our protection from) negative emotions. Any message that intends to trigger certain health behaviours would do well to address both systems, simultaneously trying to minimize BIS while maximizing BAS (Knowles & Linn, 2004) Minimizing the threat– All health related sciences tend to take the perspective of the ‘Natural model’ of health vs. disease and mainly focus their efforts on the physical. However, a health related message can be perceived as threatening on more levels than just as it relates to our physical manifestation. All the possible levels of threat must be discerned if they are to be minimized.

Table: Threats by health marketing (Hastall, 2012)
Target of threat Anticipated health relevant conditions
Reading messages on health risks Anxiety of health risks Execution of the recommended protective behaviour
Body Physical discomfort when reading the message Pain, reduced capabilities, death Physical strain; side effects
Cognition Worry about the likelihood of the disease Worry about the likelihood of healing Worry about the effectiveness of the protective behaviour
Emotion Fear or dread at reading the message Sorrow about those concerned; fear Feelings of shame or uncertainty
Self-worth “Manipulation” by marketing messages Dependent on outside help; passive layman Self-perception as vulnerable or overanxious
Social status Non-compatible role expectations Loneliness; Blaming others as accomplices Being ridiculed or rejected by others
Resources Time or expenses looking for more information Time or expenses for necessary treatment Time or expenses for protective behaviour

References

Brehm, J. W. (1966): A Theory of Psychological Reactance, New York: Academic Press. Carver, C. S., Sutton, S. K., & Scheier, M. F. (2000). Action, emotion, and personality: Emerging conceptual integration. Personality and social psychology bulletin, 26(6), 741-751.
Cramer, P. (2008): Seven Pillars of Defense Mechanism Theory, in: Social and Personality Psychology Compass, 2, 5, S. 1963-1981
Dillard, J. P./Shen, L. (2005): On the Nature of Reactance and Its Role in Persuasive Health Communication, in: Communication Monographs, 72, 2, S. 144-168.
Festinger, L. (1957): A Theory of Cognitive Dissonance, Stanford: Stanford University Press.
Gray, J. A. (1982). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. New York: Oxford University Press.
Hastall, M. R. (2012). Abwehrreaktionen auf Gesundheits-appelle: Forschungsstand und Praxisempfehlungen. In S. Hoffmann, U. Schwarz & R. Mai (Eds.), Angewandtes Gesundheitsmarketing (pp. 281-296): Springer Fachmedien Wiesbaden. Jacks, J. Z.
Cameron, K. A. (2003): Strategies for Resisting Persuasion, in: Basic & Applied Social Psychology, 25, 2, S. 145-161 Knowles, E. S.
Linn, J. A. (2004): Approach-Avoidance Model of Persuasion: Alpha and Omega Strategies for Change, in: Knowles, E. S./Linn, J. A. (Hrsg.): Resistance and Persuasion, Mahwah: Psychology Press, S. 117-148.
Wittchen, H.-U./Hoyer, J. (2011): Klinische Psychologie & Psychotherapie, Berlin: Springer.

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Perceived realism in media & gaming

Posted on June 10, 2015 by Priscilla

Research at the turn of the century indicated that people can make judgements about the reality of a media experience on a moment-to-moment basis and that this judgement depends highly on the typicality of the experience (Shapiro, 2003). If it is typical of what is known and expected we are more likely to perceive it as real. Any media experience is compared to personal experience, and the experiences of the people that one is familiar with (Eikelenboom, 2006). “Beyond one’s own direct experiences of the world, humans rely on communication to form impressions about the rest of reality” (Kosciki, 2008). The observed behaviour is assessed, personal risk is also assessed and an interpretation of the media is made. Then a judgement is made on the realism of the media experience. The more typical we judge story elements of the media experience, the more likely we are to judge the whole thing as real.

Perception might also be viewed as categorization. As Shrum states “…people are always ready to perceive (categorize), and they may do so by choosing among a number of categorization possibilities” (Shrum, 2006, p. 57). Combined with Shapiro’s research (2003) this means that people place what they perceive in categories they are familiar with. To make reality-judgements on situations that go beyond actual knowledge, like a dragon filled-fantasy world, imagination is needed (Valkenburg & Peter, 2006). People imagine what the situation would be like IF it were to happen and then judge the realness of the media content based on their expectations (Shapiro, Pena-Herborn, & Hancock, 2006).
Zillmann (2006) questioned whether we need to suspend reality in order to experience the emotion or if we could just believe in the fiction. Research among ARG players reveals that although players believe in the game reality, this is a choice that they are aware of; they play the believe in the game reality (McGonical, 2003). “Simply put, when a person is immersed in pleasurable game play, the mind has no motivation whatsoever to disbelieve any of the information it is receiving” (Castronova, 2007).

The perceived realism of video games depends heavily on the inferential and imaginative elements that the game incorporates as well as the sensory information (Shapiro et.al., 2006). Current video game design focuses on making it look real instead of making the player think it is real. More effort is focussed on the sensory stimulation to enhance realness then to the more abstract and conceptual elements. These conceptual elements are typicality, character type, character judgement and emotion. There are two types of characters in video games; avatars, controlled by humans, and Non Playing Characters (NPC) or bots, controlled by the game system. The interaction with the avatar gives greater meaning and a higher sense of realism then the interaction with a NPC. Although dialogue-protocols are very advanced, an experienced player can easily tell the difference between an avatar and a NPC. Emotions in the game enhance perceived realism if the emotions shown are in line with the expectations of the player (Shapiro et.al., 2006). An avatar is inherently better at showing the correct expected emotion than a NPC, creating a heightened sense of realism.

In several studies of video games (e.g. Anderson and Dill, 2000; Ballard and West, 1996: Calvert and Tan, 1994; Dill and Dill, 1998) evidence is found that the level of perceived reality determines the psychological effects of the game play. The more real it is perceived, the stronger the effects are.

References
Castronova, E. (2007). Exodus to the Virtual World: How Online Fun Is Changing Reality: St Martins Press.
Eikelenboom, T. (2006). VR en AR. Confrontaties met de nieuwe realiteiten. small paper orientation new media. [VR and AR. Confrontations with new realities.] Universiteit van Amsterdam.
Kosicki, G. (2008). Perceived reality as a communication process. In W. Donsbach (Ed.), The international encyclopaedia of communication (pp. 3550-3552): Blackwell Publishing, 2008.
McGonical, J. (2003). A real little game: The performance of belief in pervasive play. Paper presented at the Digital Games Research Associaton (DiGRA) “Level Up”, Utrecht.
Shapiro, M. A., & Makana Chock, T. (2003). Psychological processes in perceiving reality. Media psychology, 5(2), 163-198.
Shapiro, M. A., Pena-Herborn, J., & Hancock, J. T. (2006). Realism, imagination and narrative video games. In P. Vorderer & J. Bryant (Eds.), Playing video games; Motives, responses and consequences (pp. 275-290). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Shrum, L. J. (2006). Perception. In J. Bryant & P. Vorderer (Eds.), Psychology of Entertainment (pp. 36-55). Mahway, New Jersey: Lawrence Erlbaum Associated.
Valkenburg, P., & Peter, J. (2006). Fantasy and imagination. In P. Vorderer & J. Bryant (Eds.), Psychology of Entertainment (pp. 105-118). Mahway, New Jersey: Lawrence Erlbaum Associated.
Zillmann, D. (2006). Dramaturgy for emotions from fictional characters. In J. Bryant & P. Vorderer (Eds.), Psychology of entertainment (pp. 151-182). Nahwah NJ: Lawrence Erlbaum Associates, Inc.

– this is an excerpt from my MSc-thesis How Alternate Reality Gaming changes reality

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Reality is socially made

Posted on June 1, 2015 by Priscilla

One way to define reality is to approach it as a construct that is built within a social context. Social comparison theory, social proof and shared mental models are three different perspectives that all treat the perception of reality as a social process:

The social comparison perspective looks at the determination of reality on the basis of a social consensus. By checking individual experiences and their interpretations against the perception of similar others a consensus is established, then every event or opinion can be correctly interpreted based on this consensus (Festinger, 1954 as cited in Van Swol, 2008).

The social proof perspective examines how the behaviours of others influence an individual’s social reality. A person may accept the behaviour of the majority proving its own justification. Since ‘everyone’ is behaving or believing in a certain way this must be the true and correct way to perceive reality (Sunstein, 2003 as cited in Van Swol, 2008).

The perspective of shared mental models approaches the co-creation of reality as a shared view of group processes, norms, and roles that helps coordination and performance. Trough communication a shared model of the situation is build along with how best to perceive it and how to behave accordingly (Roberson, 2006 as cited in Van Swol, 2008). Strong shared mental models have shown to improve task performance (Cannon-Bowers et al. 1993 as cited in Van Swol, 2008).

Truth is stranger than fiction, but it is because fiction is obliged to stick to possibilities; Truth isn’t.
(Mark Twain, 1897)

When we are born we know nothing and accept everything, quite literally anything is possible. When we grow up our view of the world changes from acceptance into expectancy; in our middle to late childhood what we define as real changes from everything that is possible into the things that are probable or plausible (Shapiro, & Makana Chock, 2003; Van Swol, 2008). Especially in a mediated context, whether or not we perceive things as real becomes more important.

Van Swol, L. (2008). Perceived reality as a social process. In W. Donsbach (Ed.), The international encyclopaedia of communication (pp. 3558-3559): Blackwell publishing.
Shapiro, M. A., & Makana Chock, T. (2003). Psychological processes in perceiving reality. Media psychology, 5(2), 163-198.

– this is an excerpt from my MSc-thesis How Alternate Reality Gaming changes reality

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Resources: Games for health and education

Posted on May 21, 2015 by Priscilla

The Center for Digital Games Research holds the searchable
Health Games Database where you can find “hundreds of Games, Publications, Resources, Organizations, and Events – all focused on the use of digital games for health and health care.” It looks to be US-only, though.

The Games for Change database – has 26 entries in the Health category and a 133 games overall.

The Center for Games and Impact has an interesting collection of “games that provoke a change in the player or the world – change stimulated in part because of the player’s experience with the particular game. We’ve provided resources to help you understand a game’s impact as we understand it (for example, try downloading a game’s Impact Guide to complement your play experience with one of the games listed here).”

The Game Classification database which “is a collaborative classification system suited to videogames, based on multiple criterias. The games are classified according to their gameplay, their purposes, their markets and target audience, alongside with user-contributed keywords.” Right now it has 39130 featured games.

The Extra Credit curated list of educational game

The MIT Game Lab list of Documentary Games “… we’ve decided to focus on the outliers — earnest, complex works that had to be included despite their marginal qualities. (We also prioritized games that would be easy to find, given the state of game publishing and platforms in 2015.) Take note at how different these games are from each other in format, treatment of sources, point of view, and player agency. By drawing your eyes to a few dots on the perimeter, we hope to illustrate a landscape of possibility.”

What I would love to see added to all of these lists/ databases is a link to the EVIDENCE that a certain serious game does what it aims to do..

With thanks to the Serious Games Research LinkedIn-group

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The play perspective of videogaming

Posted on May 15, 2015 by Priscilla

Play seems to be something unreal. At first it seems intuitively clear what is meant by play; it is obvious when one is playing and when one is in earnest. The distinction between real and play seems clear, but at closer inspection the concept of play reveals itself to be a complex one. Before a very specific type of game play can be discussed, a definition of play in general must be given.

Caillios (1957) defines play as an activity that is essentially free, separate, uncertain, unproductive, governed and make-believe. Meaning that we cannot be forced into play; it is something we undertake by our own choice. If we would be forced, the experience would cease to be play and become an assignment. Furthermore, play is separated from normal day-to-day living. Often this separation is physical; one chalks lines on the ground for hop-scotch to physically limit the playing field or plays a board game on a board and only on this board does the game exist.

Play is also separated in time: there is a start and a stop to the playing. Play also requires some level of uncertainty; will it work, will it be fun, will the audience laugh and of course who will win? If the outcome of the undertaking was certain play would turn into a task. It would be no more than a series of steps to achieve an outcome. The achievement of an outcome must also be absent; the product of play can only be play itself, otherwise it becomes merely a means to an end. To control all the things play must or must not be, play requires rules. Finally, play can never be real. Huizinga sums it up as
“a free act, that is consciously ‘not meant’ and outside of normal life, that still might completely absorb the player, to which no direct material interest is connected, or use is gained, that unfolds itself in a purposely set up limited time and space, which adheres to certain rules and order, and brings forth a sense of community, which gladly shrouds itself in secrets or is distinguished from the real world by use of disguise.“ (translated from p. 41, Huizinga, 1938).

The definitions of Caillios (1957) and Huizinga (1938) both define play as a domain that is within society yet different from it, a domain which has no merit beyond itself, in which chance is always of influence in a complex structure governing the fantasy of which the domain is created and a domain to which one must enter voluntarily. An important part of play is the interaction; with oneself but often in a social setting. “Playing is always communication” (Ohler, 2008, p. 3638), whether this is intra- or interpersonal communication. These definitions give a solid structure to hold the fuzzy concept of play.

The way we play might differ between cultures but there is not one culture in which play is absent (Huizinga, 1938). We engage in play to fulfil a number of basic human needs. Based on Self Determination Theory, Ryan and Deci (2000) attribute three fundamental needs to every human being; a need for competence, a need for autonomy and a need for relatedness. When these needs are met psychological well-being is heightened and self-motivation is increased. By playing these needs can be met. The need for competence is fulfilled by a task not too challenging but not too simple so one can feel competent, which relates to the concept of flow (Csikszentmihalyi, 1990). The need for autonomy is met by one of the ‘ground rules’ of play; that it is voluntarily. The player autonomously decides to play. The relatedness we find in the social aspects of play, most playing is done in a social interaction. Be it between several players, between a player and an audience or between a player and a mediated character.

“Play is a credible developmental and evolutionary antecedent to the more sophisticated forms of entertainment we engage in today” (Vorderer, Steen, & Chan, 2006, p. 13). One of the more sophisticated forms of play that we engage in today is interactive gaming. Gamers are a different type of media audience: Contrary to most audiences, they are active.

For the TV, radio or newspaper audience communication is mostly one-way and the users are passively on the receiving end of the medium (Katz, 1962). Games are a fixed part of the media landscape that we move in today; “…[games] are now considered main stream media, competing with newspapers, television, radio, and film for attention and dollars” (Williams, 2006, p. 199). Gamers and internet users search and demand content specific to their needs, interacting and possibly adapting it as they see fit. Creation of new content is also high among gamers. For example, almost a quarter of the popular MMORPG Everquest players had created their own artwork or fiction based on or around the game play (Griffiths, 2003).

Concepts such as curiosity, surprise and suspense work very different in interactive video games compared to other media entertainment and therefore most media enjoyment theories are not directly applicable to interactive gaming (Grodal, 2000). A likely more suitable perspective on the investigation of interactive media is a play-perspective. “The analysis of interactive media entertainment especially can be based on a play frame (Ohler, 2008, p. 3639)”.

References
Caillois, R. (1957). Le jeux et les Hommes [Man and play] (M. Barash, Trans.): University of Illinois press.
Csikszentmihalyi, M. (1990). Flow. New York: Harper and Row.
Griffiths, M., Davies, M., & Chappell, D. (2003). Breaking the stereotype: the case of online gaming. Cyberpsychology and behaviour, 6 (1), 81-91.
Grodal, T. (2000). Video games and the pleasures of control. In D. Zillmann & P. Vorderer (Eds.), Media entertainment: the psychology of its appeal (pp. 197-212). Mahwah NJ: Lawrence Erlbaum.
Huizinga, J. (1938). Homo ludens. Proeve eener bepaling van het spel-element der cultuur. In Verzamelde werken V. Cultuurgeschiedenis III (pp. 26-146).[Homo Ludens, Test of determination of the gaming-element of culture. In the Collected works of Cultural history III] Haarlem: H.D. Tjeenk Willink & Zoon N.V.
Katz, E., & Foulkes, D. (1962). On the use of the mas media as “escape”: clarification of a concept. Public opinion quarterly, 26, 377-388.
Ohler, P. (2008). Playing. In W. Donsbach (Ed.), The international encyclopaedia of communication (pp. 3638-3640): Blackwell publishing.
Ryan, R., & Deci, E. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist, 55(1), 68-78.
Vorderer, P., Steen, F., & Chan, E. (2006). Motivation. In J. Bryant & P. Vorderer (Eds.), Psychology of entertainment (pp. 3-18). Mahwah, New Jersey: Lawrence Erlbaum Association.
Williams, D. (2006). A brief social history of game play. In P. Vorderer & J. Bryant (Eds.)

– this is an excerpt from my MSc-thesis How Alternate Reality Gaming changes reality –

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So you think you can…

Posted on May 8, 2015 by Priscilla

Self-efficacy, health and reappraisal

Self-efficacy has proven to be an important concept in the chase of understanding and predicting what we do, and what we don’t. Bandura (1994, p.1) defines perceived self-efficacy as

“… people’s beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives. Self-efficacy beliefs determine how people feel, think, motivate themselves and behave. Such beliefs produce these diverse effects through four major processes. They include cognitive, motivational, affective and selection processes.” (Bandura, 1994)

Research has shown that self-efficacy is an important construct in many health behaviours, and it is widely seen as an important part of creating short- and long-term changes in health related behaviour. “Higher self-efficacy has been related to less addictive behaviors (Diclemente et al., 1995), lower physiological stress responses (O’Leary & Brown, 1995), and lower relapse rates of smoking cessation (Gulliver, Hughes, Solomon, & Dey, 1995). Additionally, greater self-efficacy is related to better adherence to a medical treatment regimen (Dennis & Goldberg, 1996; Rosenbaum & Smira, 1986).” (Maher, 2014)

Persons with high (trait) self-efficacy see the world as a place with challenges that they can learn to master, persons with low self-efficacy see the world as a possibly threatening place and experience setbacks as a personal failure from which they find it hard to recover. Belief in self-efficacy can be promoted in four ways (Bandura, 1994, 2004, 2006)
1) Mastery experience,
2) Social models,
3) Social persuasion and
4) Reappraisal of somatic and emotional state.

The experience of our own success builds up our perceived self-efficacy while experiencing failure lowers our perceived self-efficacy. However, if our successes are too easily achieved we do not learn any efficacy in the face of obstacles and our built up perceived self-efficacy collapses at the first unexpected setback. A robust sense of self-efficacy comes from the experience of overcoming obstacles; mastery is something that requires effort and leads to success.
Through the observed efforts and results of others we influence what effort we expect to lead to what results in our own behaviour. This social modelling depends highly on the perceived similarity between the social model and ourselves; the more similar we judge them to be to ourselves, the more our perceived self-efficacy shifts depending on the efforts and results of the model. We look for models that display the skills we desire and try to learn ways to achieve such skills from them, leading to a higher sense of perceived self-efficacy.
Persuading people that they are capable of mastery can heighten perceived self-efficacy in the sense that it can lead to a short-lived increase of effort and commitment, whereas people might have given up without such persuasion, resulting in a successful mastery experience. However, it is easier to undermine self-efficacy through social persuasion than it is to promote is. Psychological boosts are easily deflated by reality and do not provide any resilience over time. Social persuasion is more successful when it focuses on teaching people how to structure situations to maximize the chance of success and measuring success in terms of self-improvement instead of comparison to others.
We tend to interpret our physical responses and our mood-state as related to our capabilities, while this need not be the case. Persons with a high sense of self-efficacy can interpret a state of arousal as a motor to action whereas persons with a low sense of self-efficacy can interpret the same state as an obstacle to action, or even an indication to cease all efforts. Since these are the same states, it is not so much the occurrence but the interpretation that determines its’ influence on perceived self-efficacy. The interpretation of such physiological indicators  appears to be most important when it pertains to health functioning and physical activity.

One experiment that follows the line of Reappraisal of somatic and emotional state is the work of Alison Wood Brooks (2013) “Get Excited: Reappraising Pre-Performance Anxiety as Excitement”. She conducts several experiments in which participants are faced with tasks that make them anxious and are prompted beforehand – or prompt themselves – either with “I am calm” or with “I am excited”. The calm-prompt follows the usually taught response to being anxious, which is to try and calm down. In these experiments Brooks consistently found that the participants with the excited-prompt performed better on their tasks while remaining highly aroused, this was measured by raised heart rates throughout, as compared to the calm-prompt participants (Brooks, 2013).

References:
Bandura, A. (1994). Self‐efficacy: Wiley Online Library.
Bandura, A. (2004). Health promotion by social cognitive means. Health education & behavior, 31(2), 143-164.
Bandura, A. (2006). Toward a psychology of human agency. Perspectives on psychological science, 1(2), 164-180.
Brooks, A. W. (2013). Get Excited: Reappraising Pre-Performance Anxiety as Excitement.
Maher, K. (2014). The effect of youth diabetes self-efficacy on the relation among family conflict, disease care and glycemic control. (PhD Dissertation ), Virginia Commonwealth University.

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