SUMMARY OF LITERATURE REVIEW

The literature review was designed to inform and provide context for the expert panel discussion (all panelists were sent a copy of the literature review to read prior to the meeting). Relevant articles, chapters, and other information for the review were selected based on the following criteria:

• Any theoretical or clinical literature on anxiety, risk perception, and fatalism in response to safety threats;
  
  
• Any theoretical or clinical literature on converting defensive mechanisms to coping reactions, particularly in response to risks;
  
  
• Any theoretical or clinical literature on adopting appropriate coping actions to ameliorate the consequences of risky events;
  
  
• Any theoretical or clinical literature that addresses the key question: How do you change defensive behaviors to coping mechanisms and apply them to the world of safety belt usage? Ideally, case studies of successful campaigns at a societal level were desired; or,
  
  
• Any theoretical or clinical literature that addresses the key question: How does behavior change happen for unconscious behaviors? Ideally, case studies of successful campaigns at a societal level were desired.

Articles were located via searches in various academic databases (e.g., ProQuest, PsychArticles, Sociology Abstracts, and Medline), as well as in specific academic journals (e.g., Risk Analysis and Cognitive Psychology). Additionally, relevant literature was identified through personal communication with experts in this field, and through Internet searches. In total, about 60 citations were reviewed. The Project Director prepared the literature review; a subcontractor served as a reviewer.

The literature review briefly examined seven main areas:
(1) Models of behavior change;
(2) The formation of risk perceptions in response to safety threats;
(3) Precursors to message resistance;
(4) How threat messages are resisted;
(5) How to convert defensive reactions to coping reactions;
(6) Relevant case studies; and,
(7) A summary of existing research on part-time users of safety belts.

Of most interest here, the literature review identified several techniques that might be useful in overcoming unconscious motivators. These included:

• Increased mindfulness (i.e., encourage cognition): Mindfulness draws attention to unconscious motivators, thus reducing their influence.
  
  
• Enhanced efficacy (i.e., promote individual capability): Efficacy is the sense that individuals are capable of changing their behaviors; thus, enhanced efficacy frequently enables behavior change.
  
  
• Increasing the social desirability of compliance: Social norms are a powerful motivator to induce behavior change.
  
  
• Disrupting resistance (i.e., interfere with the natural desire to resist a request via distraction or some other technique): Disrupting resistance is a way to interfere with unconscious defense mechanisms before they take root.
  
  
• Encouraging anticipatory regret (i.e., ask people to think about the regret they would feel if they did not engage in a protective behavior): This technique increases mindfulness in addition to drawing attention to the benefits of engaging in protective behaviors.

As noted, the complete literature review appears as Appendix C to this report.