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Overview
This chapter will seek to explore fear appeal including its history, successes, limitations and the developing physiological theories that have expanded our use and understanding of this motivator. Furthermore, this chapter will address the controversies and contradicting theories regarding fear appeal and the varied results of multiple studies.

What is Fear Appeal?
Fear appeals are widely used in health communication and marketing. Fear appeal in psychology is defined as a persuasive message designed to evoke fear by illustrating the severity of an external threat, and the receiver’s vulnerability to that threat. Fear appeal seeks to alleviate the receiver’s fear by describing a coping response that are both effective and easily performed by the receiver. The intrinsic belief is that the use of fear appeal is the supposition that when emotional tension is evoked, the viewer will become more motivated to accept the recommendations advocated by the communicator (Janis & Feshbach, 1953).

Fear appeal is comprised of two components. The first is the threat factor – this is the identification of danger that exists in the receiver’s environment that is severe and likely to strike. The second component is efficacy (response effectiveness), which identifies a response to counter the threat, that is easy to perform (self-efficacy) (Roberto et al., 2018).

A Bried History of Theoretical Approaches to Fear Appeal
During the early 1950’s, a collective of US Public Health Services began to undertake research into health promotion and disease prevention. This approach developed due to an expansive ineffectiveness to accept disease preventatives and screening tests for early detection and a lack of compliance with medical regimes (Rosenstock, 1974). This led to an increase in research into health beliefs and attitudes, giving rise to cognitive health behaviour theories. Cognitive health behaviour theories assert that a diminutive number of beliefs and attitudes are conducive to the implementation of precautionary health behaviours (Clark et al., 2020). Several theoretical frameworks have contributed to the study of fear appeals. However, according to Witte (1992), there are the major categories that contributed to three separate time periods in the development of fear appeal theories: (a) the drive models (Hovland et al., 1953; Janis, 1967), (b) the parallel response model (Leventhal, 1970), and (c) the value expectancy theories (Rogers, 1975, Sutton, 1982).

The Drive Model(s)
The earliest research of fear appeals integrated variations of drive theories in an effort to provide scientific explanations for fear appeals (Witte & Allen, 2000). Hovland et al., (1953) proposed in the fear-as-acquired drive model that fear is parallel to hunger, therein, when individuals experience something as aversive, they are motivated to decrease it. In addition, the removal of an unpleasant stimulus is rewarding and in turn, reinforces that behaviour (Meczkowski et al., 2016). Janis (1967), argued that some fear arousal was necessary to elicit motivation, but too much fear would culminate in maladaptive outcomes, such as defensive avoidance (Witte, 1992). Drive theories predominantly suggest an inverted U-shape relationship between fear and message adoption, and generally suggest a moderate amount of fear would produce the most attitude change. However, both models have since been rejected as research has been unable to support the claim that message acceptance occurs when fear is decreased. (Witte & Allen, 2000).

Protection Motivation Theory
Protection Motivation Theory (PMT; Rogers 1975, 1983), is the most applied scientific model for the research in fear appeals (Ruiter et al., 2014). PMT is a value-expectancy theory that centres on Leventhal’s (1970) danger control process (i.e., perspectives on danger and threat and how to prevent it), however, it does not discuss fear control processes. In PMT, there are four message components that are proposed to motivate corresponding cognitive mediation processes. The first is the depiction of the probability of a perceived threat occurring which leads to perceived susceptibility. The second is severity, that is the seriousness of the threat that is depicted in the appeal. The third is the description of the effectiveness of the recommended response which results in perceived response efficacy. The last component refers to the belief of an individual’s ability to perform the recommended response which produces perceived self-efficacy. These cognitive mediation processes are said to generate protection motivation, in order to determine danger control actions. Rogers (1975) proposed that when all four components are met at a high level, the maximum protection motivation results in message acceptance. Rogers later (1983), extended the model to distinguish between maladaptive threat appraisal and adaptive coping appraisal processes (Witte, 1992). However, research testing PMT generally found at least one threat variable interacted with another efficacy variable to persuade message acceptance. PMT is generally considered to do well in explaining when and why fear appeals work, but fails to illustrate when and how fear appeals fail (Witte, 2000).

The Parallel Response Model and Extended Parallel Process Model
Leventhal’s (1970) parallel response or process model proposes that fear appeals yield two distinct processes. These processes include danger control processes (efforts to control the threat or danger) and fear control processes (efforts to control fear about a danger or threat) (Witte, 2000). While the model itself was criticised for lack of specificity and being untestable, the extended parallel process model (EPPM; Witte 1992) does use Leventhal’s (1970) model as the overall outline to distinguish between two processes, threat/danger control and fear control. Threat is defined by Witte (1992), as an external stimulus variable (e.g., an environmental or message cue), that exists whether or not an individual is aware of it. However, fear is defined as a negative emotion, accompanied by a level of physiological arousal, elicited by a threat perceived to be substantial and personally pertinent (Easterling & Leventhal, 1989). In addition, the EPPM integrates the original explanation of danger control processes from PMT (PMT; Rogers 1975), which lead to message acceptance, and elaborates on the fear control processes which can lead to message rejection. There are three central constructs in fear appeals: fear, threat and efficacy.

The EPPM suggests that the detection of a threat stimulates message processing which consists of two appraisals. First, the individual will examine the potential danger of the threat. If the evaluation of the threat is perceived to be moderate or high, then fear is triggered. Once the fear is elicited, it is followed by a second appraisal, perceived efficacy (self-efficacy, response efficacy). When a fear appeal triggers both perceived threat and perceived efficacy, danger control processes are undertaken. When the response to a threat appears feasible and effective, individuals are motivated to control the danger. By contrast, when perceived threat is high, but perceived efficacy is low, fear control processes begin. When this occurs, fear becomes intensified leading to an inability to effectively deter the threat. Consequently, the individuals become motivated to cope with their fear via maladaptive responses (e.g., denial). However, if perceptions of threat are low, people may lose motivation to continue message processing, as the threat is viewed as irrelevant or trivial. In essence, perceived threat influences the intensity of the reaction to the message, while perceived efficacy impacts the nature of the reaction (Witte, 1992).

Application of Research
Fear appeals are commonly used in health communication. This is best demonstrated in the use of health warnings on cigarette packages, upon which textual and graphic warnings are clearly displayed. Health warnings displayed on cigarette packages were introduced in 2002 in Europe, and quickly spread worldwide (Ruiter et al., 2014). Other examples of fear appeal include the Australian Grim Reaper campaign from 1987, which was intended to inform the public on the dangers of HIV/AIDS (hyperlink Wikipedia). As well as the well-known US campaign “this is your brain on drugs” to prevent substance abuse (hyperlink Wikipedia).

Contemporary Meta-Analysis
The use of fear appeals is a dividing issue. Although there are many practitioners who are adamant that fear appeals persuade audiences, there are just as many who believe they are ineffective and even damaging (Ruiter et al., 2014, Janis & Feshbach, 1953). Nonetheless, in the present research, there was a comprehensive meta-analysis investigation conducted into the largest database of fear appeals. This meta-analysis explored the effectiveness of fear appeals for changing attitudes, intentions, and behaviours, and tested predictions made by a large selection of influential fear appeal theories. The meta-analysis concluded that fear appeals are in fact effective and successful at influencing attitudes, intentions and behaviours across virtually all conditions that were analysed. Given the wide range of theories that specify conditions under which fear appeals should be ineffectual (Janis & Feshbach, 1953), it is surprising how many studies produced favourable results towards fear appeals. Through the meta-analysis, the researchers were also able to determine varying factors that can improve their effectiveness. By way of illustration, the fear appeals were more effective when the message depicted a relatively high degree of fear and included an efficacy message. The fear appeals that were more effective were also the ones that stressed susceptibility as well as the severity of the threat. Fear appeals were also more persuasive when they recommended one-time only behaviours. Nevertheless, there were limitations within the meta-analysis, namely, there was only a comparison between groups who were exposed to additional, or less fear-inducing content. There was no comparison between those who were unafraid and those who are. Another limitation is the meta-analysis solely focused on experimental studies, the researchers of the meta-analysis recommend further research into whether or not these results can be generalised to naturalistic settings (Tannenbaum et al., 2015).

Summary
Since the inception of fear appeal, a general consensus that higher levels of fear arousal produced greater persuasiveness of communication has been challenged by some earlier research. In fact, research has suggested there is a negative relationship between fear arousal and persuasiveness, and that a lower level of fear arousal is ideal (Janis and Fleshbach, 1953). However, despite over fifty years of research on fear appeal and the use of fear-based publicity campaigns, an unequivocal answer concerning effectiveness has not been confirmed (Tay & Watson, 2002). Indeed, meta-analysis studies have indicated that higher amounts of fear may be more effective when utilising fear appeal, especially when combined with heightened severity and susceptibility. Regardless, the prevailing consensus within the current literature on fear appeal is that expanding upon efficacy is fundamental to message acceptance.