Health, Coping, and Well-being

Perspectives From Social Comparison Theory

Bram P. Buunk,Frederick X. Gibbons,A. Buunk

• Publisher: Psychology Press
• Year: 2013
• ISBN:
  9781134793174
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Over the past decades, the field of health psychology has witnessed a tremendous growth, and social psychologists have contributed substantially to the theoretical foundation of this field. Their research has focused on a wide variety of health-relevant topics such as how individuals decide to respond to threats to their health and well-being, how and why they change their behavior to avoid such threats, and especially, how they adjust to or cope with the risk of threatening disease and with the diseases themselves. As diverse as this literature may be, however, there does appear to be a common theme throughout much of it--the observation that comparison of oneself and one's health status and coping efforts with others is an integral part of the coping process. Consequently, social comparison theory is increasingly becoming recognized as a fruitful framework for illuminating health related issues. A still expanding literature is exploring the role of social comparisons with respect to coping with a wide range of health problems, including cancer, physical decline among the aged, rheumatoid arthritis, AIDS, stress at work and occupational burnout, and eating disorders. Social comparison theory has augmented knowledge about the ways in which people cope with stressful events, and thus has contributed significantly to it. At a more basic level, research in this applied context has made significant contributions to the development of social comparison theory itself. The present volume presents an overview of the various ways in which social comparison theory has been applied to issues related to health, coping, and well-being, and also points out how these applications have contributed to our insight into the way humans employ social comparison information. Given the attention paid to theoretical and applied issues, this volume will appeal to a wide audience, including social and health psychologists, as well as therapists, physicians, clinicians, medical sociologists, nurses, and those involved in the growing field of nursing research.

Chapter 1

Social Comparison in Health and Illness: A Historical Overview

Bram P. Buunk

University of Groningen

Frederick X. Gibbons

Monica Reis-Bergan

Iowa State University

As the rapid growth of health psychology over the past few decades indicates, issues of health and disease have become major topics in contemprary psychological research (Adler & Matthews, 1994). Health psychology has been described as “devoted to understanding psychological influences on how people stay healthy, why they become ill, and how they respond when they do get ill” (Taylor, 1991, p. 6). According to some authors, health psychology is largely applied social psychology (Stroebe & Stroebe, 1995; cf. Salovey, Rothman, & Rodin, in press), or, more specifically, applied social cognition (Clark, 1994). Indeed, a number of social psychological theories have been applied productively to a wide range of health-related issues. Social-cognitive theories have been utilized to enhance our understanding of the coping process (see Clark, 1993); the theory of reasoned action has been used to understand behaviors aimed at weight loss and weight control (e.g., Sejwacz, Ajzen, & Fishbein, 1980); social learning theory has been invoked to understand the adoption of disease-prevention behaviors, such as exercise, cessation of cigarette smoking, and seat belt use (e.g., McAlister, 1987); behavioral decision theory has been applied to the perception of health risks (Slovic, Fischhoff, & Lichtenstein, 1987); self-identification theory has been used to illuminate the nature of stress (Schlenker, 1987); and attribution theory has been employed as a framework for understanding responses to victimization (e.g., Janoff-Bulman & Wortman, 1977).

It has become increasingly clear that among these many different social psychological approaches, social comparison theory is one of the most fruitful and most important for application to health-related cognitions and behaviors. As Clark (1994), among others, has “research on social comparison has shown a recent resurgence in the context of health psychology” (p. 242). Providing an overview of current research in this area, the present volume testifies to the significance of this resurgence. The research discussed in the book illustrates the myriad issues related to physical as well as mental health that, in one way or another, involve social comparison processes. In particular, there are studies that focus on smoking and AIDS risk behaviors; responses to one’s own physical symptoms as related to the decision to seek medical help; adapting to serious diseases such as cancer; managing anxiety when facing surgery; coping with chronic pain disorders; and mental health and well-being, including depression and occupational burnout. This chapter offers a historical perspective of social comparison theory and outlines the theoretical and empirical developments that have stimulated and informed the research described in the book’s subsequent chapters.

Within the general domain of social comparison, a number of theoretical traditions have had an especially strong impact on current research on health, coping, and well-being. Most noteworthy are four such traditions:

1. Early work on reference groups–much of it sociological–and, of course, Festinger’s original theorizing and research.
2. Schachter’s (1959) pioneering work on affiliation under stress, as well as his later work on emotional contagion (Schachter & Singer, 1962).
3. Downward comparison theory, including the early studies on downward comparison choices under threat (e.g., Hakmiller, 1966), as well as the very influential papers by Brickman and Bulman (1977) and Wills (1981), and the seminal work of Taylor, Wood, and Lichtman (1983) with cancer patients.
4. Work in social cognition, including research showing false consensus for undesirable attributes (e.g., Suls, Choi, & Sand ers, 1988), and research on health risks, especially the research begun by Weinstein (1980) on unrealistic optimism.

In this chapter we outline these developments in social comparison theory briefly, and describe their relevance for the study of health-related issues. Throughout, we refer to research programs described in the book’s other chapters so as to place them in some historical perspective.

Early Work on Reference Groups and Social Comparison

Reference Groups

Although it was Festinger (1954) who used the term social comparison for the first time, the notion that comparisons with others play an important role in evaluating and constructing reality goes back to Sherif (1936). In a series of classic experiments, Sherif demonstrated that two individuals who face the same unstable situation together develop, in a process of mutual social influence, a single characteristic reference point. Sherif showed that individuals faced with the autokinetic effect (a stable point of light in a dark room is perceived as moving) develop a unique reference point to which each successive experienced movement is compared. However, when an individual faces this situation together with another individual, they appear to develop a joint reference point that is peculiar to the dyad. Comparison processes were also highlighted in the sociological research on reference groups that was prompted by the work of Hyman (1942). In his classic paper, Hyman argued that the assessment of one’s own status on such dimensions as financial position, intellectual capability, and physical attractiveness depends on the group with whom one compares oneself. In the same decade, the American Soldier studies (Stouffer, Suchman, DeVinney, Star, & Williams, 1949) provided evidence for what later was interpreted as the importance of social comparisons for satisfaction, or what we now would call subjective well-being. For example, African American soldiers in that study who were from northern states reported less satisfaction with their situations than did their counterparts from the south, supposedly because both compared themselves with Blacks outside the Army, a reference group that was, at the time, considerably worse off in the south. In subsequent work, particularly in sociology, the influence of reference groups on behavior continued to be an important issue (e.g., Singer, 1980).

In the current volume, the influence of this early work is most apparent in the chapter by Diener and Fujita on subjective well-being (chapter 11) and the chapter by Misovich, Fisher, and Fisher (chapter 4) on social comparison and AIDS preventive behavior. Misovich et al. make a strong case for the role of reference groups in influencing not only initial levels of AIDS awareness but attitudes and norms regarding AIDS risk perceptions and AIDS prevention. These investigators also show that interventions using social comparison, either in real life or on videotape, have a number of favorable effects. For example, because they enhance normative support for AIDS preventive behaviors, increase perceived vulnerability, and improve behavioral skills, they can be quite effective in reducing AIDS risk. On the other hand, Diener and Fujita find little evidence that social comparisons affect well-being directly. According to these authors, early empirical evidence of this impact was typically of a post hoc nature.

Social Comparison Theory

Mettee and Smith (1977) provided one of the more useful definitions of social comparison theory; they suggest that it is a theory about “our quest to know ourselves, about the search for self-relevant information and how people gain self-knowledge and discover reality about them-selves” (pp. 69–70). The theory states that individuals are driven by a desire for self-evaluation, a motivation to establish that their opinions are correct and to know precisely what they are capable of doing. According to Festinger (1954), individuals prefer objective information when evaluating their standing on a given attribute, but will, when such information is not available, turn to others for social information. In fact, the research described in this volume suggests that, if anything, Festinger may have underestimated both the strength of this motive to acquire social information and the impact such information can have on those who seek it.

Although Festinger (1954) did not relate social comparison to issues of health and disease, his theory would seem directly relevant to many health-related concerns because such concerns usually imply a strong need for self-evaluation. For instance, following Festinger’s argument, one would expect that if people were interested in evaluating their chances of contracting a certain disease, they would compare themselves and their risk with other people they thought similar to themselves, that is, people of the same age and gender, and people with similar physical characteristics and risk behaviors. In a similiar vein, Suls, Martin, and Leventhal (see chapter 7) apply some of Festinger’s original ideas to a discussion of how individuals may employ social comparison information when they are experiencing physical symptoms that are ambiguous or difficult to interpret, asking themselves such questions as, “Am I sick?” and “Should I go to a doctor?” According to Suls et al., the advice of social comparison others-the so-called lay referral network–can either inhibit or promote medical referral. This may account in part for the fact that many people visit their physicians when they are not ill, whereas others who are suffering from potentially serious symptoms fail to seek appropriate health care.

Stress, Affiliation, and the Need for Social Comparison

The second theoretical tradition in social comparison theory that has relevance for health and coping was the pioneering work of Schachter (1959) on stress and affiliation. Indeed, despite the potential importance of the early work on social comparison and reference groups for health-related issues, the link between social comparison theory and health was not established explicitly until Schachter began investigating the ways in which social comparison is involved in the reaction to stress. Schachter’s work stemmed from the convergence of two somewhat different research interests: first, the social comparison of opinions, and second, the dramatic effects of sensory deprivation. Schachter wondered whether social deprivation would have effects similar to those of sensory deprivation. He decided that the importance of social deprivation could best be studied by confronting an individual with a novel situation and then examining the strength of his or her desire for affiliation, that is his or her need to be with other people (Jones & Gerard, 1967). In his experiments with women students, Schachter showed that fear caused by the prospect of having to undergo an electric shock evoked in most people the desire to wait with someone else, and preferably someone anticipating the same event rather than someone in a different situation. As Schachter (1959) concluded: “Misery doesn’t love just any kind of company, it loves only miserable company” (p. 24). Furthermore, Schachter argued and tried to demonstrate that social comparison was the main motive behind affiliation under stress, and in particular that this motive was more important than the desire for cognitive clarity about the nature of the threat. In line with the social comparison hypothesis, later studies have shown that fear of an electric shock leads to a desire for the company of others, especially when uncertainty about one’s responses is induced experimentally, for instance by providing false feedback suggesting that one has quite unstable emotional reactions (Gerard, 1963), or by not providing any information about the responses of others (Gerard & Rabbie, 1961; see also Mills & Mintz, 1972).

Health-Related Research

In retrospect, Schachter’s work, which emphasized the threat of impending distress, has clear relevance for issues in health psychology, and, in fact this paradigm has certainly influenced a number of research traditions in the health area. That impact is readily apparent in this book. For example, in chapter 13, Ahrens and Alloy point out that depressed people experience a more or less chronically high level of distress, and are more interested in and more open to social comparison information than are nondepressed people. Buunk and his colleagues have examined affiliative desires in relation to coping with various types of stress, including marital and occupational stress. These researchers have shown that uncertainty over one’s feelings and responses is associated with an enhanced desire for social comparison information and for affiliation with similar others (for a review, see Buunk, 1994; see also chapter 12, this volume). Furthermore, it must be noted that Schachter’s (1959) original research led eventually to his classic 1962 experiment with Jerome Singer, which showed that when the cause of arousal is ambiguous, comparison with similar others can influence the way people interpret that arousal and the emotional label they place on it. Following on these experiments, a large number of studies have examined the role that attributions of arousal play in emotional experience (for a review, see Reisenzein, 1984). As Suls (1977) noted, however, it is ironic that Schachter and Singer’s experiment is usually linked to attribution theory, when it really followed logically from Schachter’s theorizing on social comparison. An important general implication of the work of Schachter and Singer is that especially when individuals are uncertain about their internal states, they may be very susceptible to the way others respond. Indeed, in this book’s chapters by Suls et al. (chapter 7), and by Buunk and Ybema (chapter 12), the work of Schachter and Singer is related to situations in which individuals “adopt” the symptoms shown by others around them, such as occurs in the case of mass psychogenic illness.

The research program of Kulik and his colleagues on stress and affiliation in hospital settings (e.g., Kulik & Mahler, 1987a; Kulik, Mahler, & Earnest, 1994; see also chapter 8) appears to be the most directly influenced by Schachter’s work. The research of these investigators focuses more on the informational value of affiliation, however, and as a result, they reach conclusions that differ from Schachter’s. Employing an impressive variety of methods, including both laboratory studies and field research, Kulik and Mahler’s research indicates that even though Schachter’s research is still influential (after more than 35 years), some of his original ideas do not seem to apply well to real-life settings, and that the evidence for a number of widely cited conclusions from Schachter’s research is scarce. For example, Schachter’s conclusions that people prefer to affiliate with others under similar stress, and that the desire for cognitive clarity is a relatively unimportant element of this preference has been challenged. Various studies discussed by Kulik and Mahler (chapter 8) indicate that individuals who are anticipating some stressful event (such as surgery) actually prefer to affiliate with people who have the most information about the threat the subjects face. Not surprisingly, these are often people who have already experienced the stressor (e.g., postoperative patients) rather than similar others who are awaiting the same stressful event.

The Support Group Phenomenon

Schachter’s work is directly relevant to the field of self-help and support groups. The proliferation of such groups over the last 15 to 20 years seems in itself clear evidence of the importance of affiliation with similar others for coping with stress. Surprisingly, however, the increase in lay interest in what is clearly a social-psychological phenomenon has not really been matched by an increase in empirical work by social psychologists. Indeed, the two major explanations proposed for why individuals facing some type of threat often decide to join support groups involve social comparison processes, and follow more or less directly from Schachter’s (1959) work on fear and affiliation (cf. Medvene, 1992). The first explanation is that contact with others who are facing similar problems reduces anxiety by means of a shared stress type of process (cf. Coates & Winston, 1983). As noted above, a major implication of the work of Schachter is that individuals under stress often prefer contact with others in a broadly similar situation. Although this implication needs to be qualified, there is indeed evidence that people with similar problems are most effective at providing social support, and that is particularly true with regard to health problems. For example, evidence of this comes fr...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• Preface
• 1. Social Comparison in Health and Illness: A Historical Overview
• 2. Social Comparison and Unrealistic Optimism About Personal Risk
• 3. Health Images and Their Effects on Health Behavior
• 4. Social Comparison Processes and AIDS Risk and AIDS Preventive Behavior
• 5. Future-Oriented Aspects of Social Comparisons: A Framework for Studying Health-Related Comparison Activity
• 6. Modes and Families of Coping: An Analysis of Social Comparison in the Structure of Other Cognitive and Behavioral Mechanisms
• 7. Social Comparison, Lay Referral, and the Decision to Seek Medical Care
• 8. Social Comparison, Affiliation, and Coping With Acute Medical Threats
• 9. Social Comparison as a Coping Process: A Critical Review and Application to Chronic Pain Disorders
• 10. Social Comparisons Among Cancer Patients: Under What Conditions Are Comparisons Upward and Downward?
• 11. Social Comparisons and Subjective Well-Being
• 12. Social Comparisons and Occupational Stress: The Identification-Contrast Model
• 13. Social Comparison Processes in Depression
• 14. Social Comparison and Health: A Process Model
• Author Index
• Subject Index