Trait and State Disgust: An Experimental Investigation of Disgust and Avoidance in Colorectal Cancer Decision Scenarios Lisa M. Reynolds, Sarah A. McCambridge, Ian P. Bissett, and Nathan S. Consedine The University of Auckland Objective: To evaluate whether trait and experimentally manipulated state disgust independently and/or interactively predict immediate and anticipated avoidance in decision scenarios related to colorectal cancer (CRC). Method: Eighty participants, aged 18 to 66 years, completed questionnaires assessing trait disgust prior to a laboratory session. Participants were gender block randomized to disgust or control conditions before completing tasks assessing immediate avoidance of a CRC disgust elicitor (stoma bag) and anticipated avoidance in hypothetical CRC scenarios. Results: Manipulation checks confirmed the elicitation of disgust in the experimental condition. Persons in the experimental condition were more likely to exhibit immediate avoidance behaviors in response to a commonly used bowel disease device (stoma bag), and trait disgust predicted time to touch the device. Trait disgust also moderated the influence of state disgust on anticipated avoidance, namely delay in help seeking for bowel symptoms and predicted rating disgusting side effects as more deterring to adherence. Conclusions: The current report suggests the importance of examining disgust in CRC contexts and provides the first empirical demonstration that state and trait aspects of disgust may interactively operate to deter certain types of decisions. It thus furthers understanding of emotions and avoidance in a health context that has had surprisingly little focus to date. Keywords: disgust, avoidance, emotion, decision making, colorectal cancer Contemporary medical systems are placing an increasing em- phasis on open communication and patient-led decision making. Although medical decisions can involve relatively simple choices about whether to seek care for symptoms or participate in screen- ing, they can also reflect multifaceted treatment options with uncertain outcomes. Patients are increasingly asked to make deci- sions in personal health contexts where the stakes are enormous. Emerging research indicates a role for emotions in health-related decisions (Anderson, 2003; Broadstock & Michie, 2000) with studies suggesting that aversive emotions predict avoidance of recommended screenings and treatments (Consedine, Ladwig, Reddig, & Broadbent, 2011; Consedine, Magai, Krivoshekova, Ryzewicz, & Neugut, 2004). Anticipated pain or embarrassment can promote avoidance of screening tests (Magai, Consedine, Neugut, & Hershman, 2007) and fear of aversive side effects can influence the decision to forego recommended cancer treatment (Carey & Burish, 1988). The colorectal cancer (CRC) context generates numerous aversive stimuli; decisions in response to these can have serious implications, and as such, generate partic- ular challenges to patient decision making. Disgust and Decision Making The literature examining emotions in health decision making has primarily focused on fear and embarrassment (Consedine & Moscowitz, 2007), and essentially overlooked other health- relevant emotions such as disgust. This oversight is surprising given disgust’s particular relevance to health (Curtis, Aunger, & Rabie, 2004). In theory, disgust functions to minimize or prevent exposure to health risks, such as those posed by violations of the body, exposure to bodily products (e.g., feces), and contamination threats (Leshner, Bolls, & Thomas, 2009). Several qualitative and cross-sectional studies implicate disgust as a barrier to decisions to attend cancer screening (Chapple, Ziebland, Hewitson, & McPher- son, 2008; Deutekom et al., 2010; O’Sullivan & Orbell, 2004; Worthley et al., 2006), and a retrospective analysis of case notes reported “repugnance” as a barrier to opting for stoma surgery (Akute, 2000). Although a single study has shown that state disgust predicts greater intention to use condoms (Tybur, Bryan, Magnan, & Caldwell Hooper, 2011), experimental studies inves- tigating disgust and decision making in health contexts are scant. To advance previous research, the current report makes three specific contributions: examining disgust in the context of CRC decisions, considering both immediate and anticipated avoidance, and evaluating the roles of both trait disgust and state disgust. First, the current report evaluates the causal impact of disgust on decisions in a new health domain (CRC) in which the emotion is highly relevant (Reynolds, Consedine, Pizarro, & Bissett, 2013). Multiple disgust elicitors are found in the CRC trajectory including screening tests requiring the self-collection of stool samples, ex- aminations involving the insertion of instruments into the anus, symptoms such as constipation or diarrhea, aversive treatment This article was published Online First January 20, 2014. Lisa M. Reynolds and Sarah A. McCambridge, Department of Psycho- logical Medicine, The University of Auckland, Auckland, New Zealand; Ian P. Bissett, Department of Surgery, The University of Auckland; Nathan S. Consedine, Department of Psychological Medicine, The University of Auckland. Correspondence concerning this article should be addressed to Lisa M. Reynolds, Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand. E-mail: lisa.reynolds22@gmail.com This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Health Psychology © 2014 American Psychological Association 2014, Vol. 33, No. 12, 1495–1506 0278-6133/14/$12.00 http://dx.doi.org/10.1037/hea0000023 1495