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Changing Minds to Save Them

The year 2019 saw an explosion of e-cigarette popularity among high- and middle-school-aged children, with surveyed usage rates rising up to twenty-eight percent according to a government report. The report, in which researchers called the high usage rates among minors an “epidemic”, fueled a firestorm of public outcry towards e-cigarette makers, culminating in a February 2020 FDA Ban

Meanwhile, approximately ten percent of college students meet the criteria for an Alcohol Use Disorder. 1,800+ are killed annually from alcohol-related incidents. About 1 in 4 students reported academic problems, such as missing class or performing poorly, due to alcohol use (source). This problem can’t be capped off in the same manner that the FDA addressed the vaping issue, either; a Harvard College study found that schools with such bans only saw a 30% decrease in the rates of binge drinking. 

Dr. Angelo M. DiBello, Assistant Professor in the Department of Psychology at CUNY Brooklyn College & Graduate Center, says liquor bans aren’t the answer. He believes the best way to decrease alcohol consumption is to change the individual’s attitudes about drinking behavior. This would keep them from drinking heavily without keeping the drinks from them.

But if you know anything about politics, public speaking or marketing, you know that influencing another’s opinion is no easy task. So how does DiBello plan to pull it off?

The answer: Social Psychology, theory, and the scientific process DiBello revealed during his digital Social Psychology talk on May 29th, 2020. He outlined the process that went into the development of a novel intervention strategy called Counter-Attitudinal Advocacy (CAA). This strategy is the centerpoint of both an ongoing project and this digital talk. 

CAA relies on the social psychology Theory of Cognitive Dissonance, which revolves around the mental discomfort felt by an individual when experiencing conflicting beliefs and behaviors. For example… 

An individual who drinks heavily may experience cognitive dissonance when recounting what they have learned about the negative outcomes of long-term heavy alcohol use. According to the theory, they will reduce or eliminate this mental discomfort by either changing their attitudes or their behaviors to better resolve this disparity. 

In the best case scenario, if they were to change their behaviors, they might reduce or attempt to stop drinking heavily. If they were to change their attitudes, they might come to view heavy drinking less favorably. Conversely, students could formulate an excuse as to why their heavy drinking habit isn’t so severe as to result in these negative outcomes, for example.

CAA works through “evoking cognitive dissonance to change attitudes”, explained Dr. DiBello. He outlined the steps as follows:

1. Students are provided a writing prompt instructing them to advocate for a behavior contrary to their own
2. Students are given ~15 minutes to complete the prompt via self-directed writing
3. Students orally summarize their statements out loud.

To test this theory, DiBello gathered groups of students who met criteria for heavy drinking and had experienced two or more alcohol related problems. The two-question CAA prompt read as follows:


We are asking you to place yourself in the position of a student who is trying to avoid alcohol-related problems and do the following two (2) things.

1. List reasons why avoiding alcohol-related problems can be a positive approach to drinking
2. Describe how (or ways) students like you could avoid such alcohol-related problems in their own lives


This prompt is intended to evoke cognitive dissonance without making students aware that this is the intention of the activity. As DiBello explained in the talk, this prompt was designed and modified based on extensive student feedback to ensure that the students felt three things about the prompt: [that their] statements are self-generated, (…) [that] they have a choice in how to respond, [and that] the task is personally relevant.” Furthermore, DiBello explained that this low threshold approach to intervention empowers students to articulate behavioral strategies that can be used to reduce heavy alcohol consumption without demanding students abstain from drinking altogether. 

Continuing to explain these theoretical principles in more detail, he clarified that students would only experience the desired dissonance if they believed they had encountered the disparity between their beliefs and behaviors on their own. 

And although CAA trials are still ongoing, the results generated from this trial seem to indicate that students did feel the task was personally relevant.

DiBello provided the following graph in his presentation:

This graph compares the averaged number of words written by the control group to the average written by the experimental CAA group. DiBello theorized that the ~100 word difference between the control and CAA groups indicates that the CAA group was more engaged.

DiBello, in partnership with Drs. Kate Carey and Clayton Neighbors, plans to continue testing and improving on the Counter-Attitudinal Advocacy intervention in the future. Two NIH funded trials are ongoing with one at the University of Houston and Brown University, and another at Brooklyn College. The 5- and 3-year projects began in 2018 and are set to conclude in 2023 and 2021. By the conclusion of the two studies, long- and short-term follow ups will give researchers a better idea of CAA’s effectiveness.