Stigma and Other Barriers to Seeking Therapy: Publications


Skopp, N. A., Bush, N., Vogel, D. L., Wade, N. G., Sirotin, A., McCann, R., & Metzger-Abamukong, M. (in press). Development and initial testing of a measure of public and self-stigma in the military. Journal of Clinical Psychology.

Abstract

This research developed and conducted initial testing of the Military Stigma Scale (MSS), a 26-item scale, designed to measure public and self-stigma, two theorized core components of mental health stigma. The sample consisted of 1,038 active duty soldiers recruited from a large Army installation. The sample was randomly split into a scale development group (n = 520) and a confirmatory group (n = 518). Factor analysis conducted with the scale development group resulted in the adoption of two factors, named public and self-stigma, accounting for 52.13% of the variance. The public and self-stigma scales demonstrated good internal consistency (α = .94 and .89, respectively). Confirmatory factor analysis conducted with the confirmatory group indicated that the data fit the two-factor model; the fit for the two-factor model was superior to the fit for the one-factor model. The public and self-stigma scales for the confirmatory sample also demonstrated good internal consistency (α = .95 and .87, respectively). Additional support for the uniqueness of public and self-stigma was found in gender differences in levels of public and self-stigma, consistent with theory and earlier empirical findings. Also consistent with theory and empirical data, soldiers who had seen a mental health provider in the past scored lower on self-stigma but not public stigma than did soldiers who had not.


Hammer, J., Vogel, D. L., & Heimerdinger-Edwards (in press). Men’s help seeking: Examination of differences across community size, education, and income. Psychology of Men and Masculinity.

Abstract

The present study examined the relationships between traditional Western masculine norms, self-stigma and attitudes toward counseling across 4,748 men from differing community sizes, and education and income levels.  Structural equation modeling (SEM) analyses suggest that masculine norms were linked to self-stigma and, in turn, attitudes towards counseling across all male sub-groups.  However, several clear differences in the strengths of the relationships between model variables were found, including a relationship between masculine norms and self-stigma that was twice as strong for rural men than for other men.  The importance of attending to the varying relationships among masculine norm conformity, self-stigma, and help-seeking attitudes for men from these diverse demographic backgrounds in the context of clinical practice, prevention, and future research is discussed.


Kaplan, S., Vogel, D. L., Gentile, D., Wade, N. G. (in press). Increasing Positive Perceptions of Counseling: The Importance of Repeated Exposures. The Counseling Psychologist.

Abstract

This study assesses the effectiveness of repeated exposures to a video inter- vention based on the Elaboration Likelihood Model. The video was designed to increase help-seeking attitudes and perceptions of peer norms and to decrease the stigma associated with seeking counseling. Participants were 290 undergraduates who were randomly assigned to a repeated-exposure video intervention, a single-exposure video intervention, or a control video condition. Participants completed measures pre- and post-intervention and at a 3-week follow-up. Those in the repeated-exposure intervention improved significantly more than the single-exposure and control groups on help-seeking attitudes and perception of peer norms but not for stigma. The effect of repeated exposures on attitudes and peer norms showed both immediate and longer term effects. Effective, empirically supported interven- tions capable of reaching large numbers of people are necessary to improve utilization rates of counseling services. This study offers support for the use of repeated video interventions in changing attitudes and perceptions of counseling.


Vogel, D. L., Heimerdinger-Edwards, S. R., Hammer, J. H., & Hubbard, A. (2011). ‘Boys don’t cry’: Examination of the links between masculine norms and help-seeking attitudes for men from diverse cultural backgrounds. Journal of Counseling Psychology, 58, 368-382.

Abstract

The role of conformity to dominant U.S. masculine norms as an antecedent to help-seeking attitudes in men has been established using convenience samples made up largely of college-age and European American males. However, the role of conformity to masculine norms on help-seeking attitudes for noncollege-age men or for men from diverse backgrounds is not well understood. To fill this gap in the literature, the present study examined the cross-cultural relevance of a mediational model of the relationships between conformity to dominant U.S. masculine norms and attitudes toward counseling through the mediator of self-stigma of seeking counseling for 4,773 men from both majority and nonmajority populations (race/ethnicity and sexual orientation). Structural equation modeling results showed that the model established using college males from majority groups (European American, heterosexual) may be applicable to a community sample of males from differing racial/ethnic groups and sexual orientations. However, some important differences in the presence and strengths of the relation- ships between conformity to dominant masculine norms and the other variables in the model were present across different minority groups and sexual orientations. These findings suggest the need to pay specific theoretical and clinical attention to how conformity to dominant masculine norms and self-stigma are linked to unfavorable attitudes toward help seeking for these men, in order to encourage underserved men’s help-seeking behavior.


Wade, N. G., Post, B., Cornish, M., Vogel, D. L., & Tucker, J. (2011). Predictors of the change in self-stigma following a single session of group counseling. Journal of Counseling Psychology, 58, 170-182.

Abstract

One of the major obstacles to seeking psychological help is the stigma associated with counseling and therapy. Self-stigma, the fear of losing self-respect or self-esteem as a result of seeking help, is an important factor in the help-seeking process. In the present study, college students meeting a clinical cutoff for psychological symptoms participated in 1 session of group counseling that either contained therapist self-disclosure or did not. In general, participants reported significantly less self-stigma following the session. Working alliance–bond and session depth significantly predicted the change in self-stigma. Furthermore, self-stigma (as well as bond, depth, psychological symptoms, and being female) predicted the intention to seek help following the session. Self-stigma and session depth also predicted interest in continuing with counseling. The therapist self-disclosure condition, however, had no effect on the change in self-stigma, intentions to seek help, or interest in continuing with group counseling.


Hackler, A. H., Vogel, D. L., & Wade, N. G. (2010). Attitudes toward seeking professional help for an eating disorder. Journal of Counseling and Development, 88, 424-431.

Abstract

The perceived stigma and anticipated outcomes of counseling may deter those experiencing disordered eating attitudes and behaviors from seeking the help they need. This study was conducted to examine the relationship between self-stigma, anticipated risks and benefits associated with seeking counseling, and attitudes toward seeking counseling among college students with disordered eating attitudes and behaviors. The results of hierarchical regression analyses demonstrated that self-stigma and the anticipated risks and benefits of counseling significantly predicted attitudes towards seeking counseling for people with disordered eating. In addition, self-stigma had a stronger relationship with men’s attitudes towards seeking counseling than women’s and anticipated benefits had a stronger relationship with women’s attitudes than men’s.


Hammer, J. H., & Vogel, D. L. (2010). Men’s help seeking for depression: Efficacy of a male-sensitive brochure about counseling. The Counseling Psychologist, 38, 296-313.

Abstract

Although depression among men is becoming better understood, men still underuse counseling services. Hence, there is an important need for improved ways to reach out to depressed men.This study examined the efficacy of a male-sensitive brochure aimed toward improving attitudes about seeking counseling and reducing the self-stigma of seeking counseling among 1,397 depressed men who had not previously sought help for their depression. Results indicate that the male-sensitive brochure, which incorporated current knowledge from the psychology of men and masculinity and mental health marketing, improved participants’ attitudes and reduced their self- stigma toward counseling. Furthermore, the new brochure improved attitudes and reduced stigma to a greater degree than previously developed brochures. Implications for mental health marketing, practice, and research are discussed.


Shechtman, Z., Vogel, D. L., & Mamen, N. (2010). Seeking psychological help: A comparison of individual and group treatment. Psychotherapy Research, 20, 30-36.

Abstract

The study examined public and self-stigma and their association with attitudes and intentions to seek psychological help in regard to both individual and group treatment as well as to various subgroups, including gender, ethnicity, educational, orientation, level of religion, and age. Undergraduate students (N=307) in three universities in Israel participated in the study. Results partly confirmed the model for both individual and group therapy: Self-stigma was related to attitudes and intentions to seek help. However, public stigma was not related to self-stigma. Importantly, some differences were also found among the various subgroups, and the model, which takes into account the different subgroups, looks somewhat different for individual and group therapy.


Vogel, D. L. & Armstrong, P. I. (2010). Self-concealment and willingness to seek counseling for academic, career-related, and psychological issues. Journal of Counseling and Development, 88, 387-396.

Abstract

Cramer’s (1999) model of self-concealment and willingness to seek counseling was extended to examine the role of both positive and negative social experiences in a sample of college students who reported experiencing a psychological, academic, or career issue. The tendency to conceal personal information was found to predict willingness to seek counseling through the specific mediators of positive and negative social experiences and psychological distress. Structural equation modeling of data from 235 college students indicated that self-concealment contributed to both positive and negative social experiences. Negative social experiences then influenced psychological distress, which mediated willingness to seek counseling. Furthermore, 48% of the variance in psychological distress and 6% of the variance in willingness to seek counseling was accounted for in the proposed model.


Vogel, D. L., Shechtman, Z., & Wade, N. G. (2010). The role of public and self-stigma in predicting attitudes toward group counseling. The Counseling Psychologist, 38, 904-922.

Abstract

Public and self-stigmas have been implicated as factors in the underutilization of individual counseling. However, group counseling is also underutilized, and yet scholars know very little about the role of different types of stigma on attitudes toward seeking group counseling. Therefore, the current study examined the relationships between public and self-stigma and attitudes toward group counseling among a sample of 491 U.S. college students. Results of structural equation modeling analyses indicated that public stigma is internalized as self-stigma and self-stigma is then negatively related to attitudes toward group counseling. Furthermore, public stigma and self- stigma explained 52% of the variance in attitudes toward seeking help.


Ludwikowski, W., Vogel, D. L., & Armstrong, P. I. (2009). Attitudes towards career counseling: The role of public and self-stigma. Journal of Counseling Psychology, 56, 408-416. [article reprinted in Italian in 2010 in GIPO Giornale Italiano Di Psicologia Dell'Orientamento, 11, 47-59.]

Abstract

Although many students struggle with career-related issues in college, comparatively few seek help for their difficulties. In addition, there is little research on the factors influencing students’ decisions to engage in counseling services for career-related issues. The present study examines the role of the stigma associated with help seeking as a barrier to engaging in career counseling. Structural equation modeling of data from 509 college students indicated that the public stigma of career counseling was related to attitudes toward career counseling through self-stigma associated with career counseling. These results will help develop interventions to decrease negative attitudes about career counseling and help individuals feel comfortable seeking assistance for their career-related problems.


Vogel, D. L., Michaels, M., & Gruss, N. J. (2009). Parental attitudes and college students’ willingness to seek counseling. Journal of Social and Clinical Psychology, 28, 689-713.

Abstract

This study examined the relationship between parents’ attitudes toward therapy and college students’ intentions to seek therapy through the mediator of college students’ attitudes toward therapy. Structural equation modeling of data from 196 parent-student pairs indicated that parents’ attitudes was linked to students’ attitudes, which in turn influenced students’ intentions to seek therapy for psychological and interpersonal concerns. Fifty-seven percent of the variance in attitudes and 48% of the variance in intentions was accounted for in the model. Furthermore, significant group differences in the relationship between parents’ attitudes and children’s attitudes were found between students with high attachment to their parents (b = .54) and those with low attachment (b = -.08). Implications for mental health care providers are discussed.


Vogel, D. L., Wade, N. G., & Ascheman, P. (2009). Measuring the public stigma associated with seeking psychological help. Journal of Counseling Psychology, 56, 301-308.

Abstract

Fear of being stigmatized is the most cited reason why individuals avoid psychotherapy. Conceptually, this fear should be strongest when an individual considers the reactions of those they interact with. Across 5 samples, we developed the Perceptions of Stigmatization by Others for Seeking Help (PSOSH) scale. In Sample 1 (N = 985), the 5-items of the PSOSH were selected (α = .91). In Sample 2 (N = 842), the factor structure of the scale was examined across a diverse sample. In Sample 3 (N = 506), concurrent validity was supported through correlations with related variables. In Sample 4 (N = 144), test-retest reliability across a three-week period was calculated (.82). Finally, in Sample 5 (N = 130), reliability and validity were explored with a sample experiencing symptoms of psychological distress.


Vogel, D. L., Gentile, D., & Kaplan, S. (2008). The influence of television on willingness to seek therapy. Journal of Clinical Psychology, 63, 1-20.

Abstract

Media portrayals of contemporary psychologists may be contributing to a misinformed, unfavorable public perception of counseling services. The present study (N = 369) used Structural Equation Modeling to examine the relationship between exposure to television programs depicting psychologists and mental health care services, perceptions of counseling (i.e., perceived self-stigma, anticipated risks and benefits, and attitudes towards services), and willingness to seek counseling. The results demonstrated that (a) the relationship between television portrayals and attitudes was fully mediated by self-stigma and anticipated benefits and (b) the relationship between television portrayals and willingness to seek counseling was fully mediated by attitudes, self-stigma and anticipated benefits. Furthermore, 54% of the variance in attitudes and 47% of the variance in willingness was accounted for by the variables in the model.


Vogel, D. L., Wade, N. G., & Hackler, A. H. (2008). Emotional expression and the decision to seek therapy: The mediating role of the anticipated benefits and risks. Journal of Social and Clinical Psychology, 27, 254-279.

Abstract

Fears about expressing unpleasant emotions can be a barrier to seeking counseling. This investigation (N = 295) used Structural Equation Modeling to examine anticipated risks and benefits of disclosing emotions to a counselor as mediators of the relationship between the tendency to express emotions and participants’ (a) attitudes towards seeking counseling and (b) willingness to seek counseling. The results demonstrated that (a) the relationship between emotional expression and attitudes was fully mediated by anticipated risks and benefits and (b) the relationship between emotional expression and willingness was fully mediated by attitudes and anticipated risks and benefits. Furthermore, 53% of the variance in attitudes and 41% of the variance in intent was accounted for by the variables in the model.


Pederson, E. L., & Vogel, D. L. (2007). Men’s gender role conflict and their willingness to seek counseling: A mediation model. Journal of Counseling Psychology, 54, 373-384.

Abstract

Men who experience negative consequences of their socialized gender roles—i.e., are higher in gender role conflict—report less positive attitudes and willingness toward seeking counseling. Using structural equation modeling with data from 575 undergraduate men, this study examined three mediators (self-stigma associated with seeking counseling, tendency to disclose distressing information, and attitudes toward seeking counseling) regarding the link between gender role conflict and willingness to seek counseling for psychological and interpersonal concerns. Results indicated that this link was partially mediated by these three factors. Men experiencing higher gender role conflict were more likely to self-stigmatize and less likely to self-disclose. High self-stigma and less disclosure then led to less positive attitudes and subsequently less willingness to seek counseling.


Vogel, D. L., Wester, S. R., & Larson, L. M. (2007). Avoidance of counseling: Psychological factors that inhibit seeking help. Journal of Counseling and Development, 85, 410-422.

Abstract

How do counselors reach out to individuals reluctant to seek psychological services? To answer this question this paper examines the research on the psychological help-seeking barriers from counseling, clinical, and social psychology as well as social work and psychiatry. First, the specific avoidance factors that have been identified in the therapy literature are examined. Next, important variations in the setting, problem-type, and individual and cultural characteristics that can influence the degree to which avoidance factors affect help-seeking decisions are presented. Finally, suggestions for overcoming these avoidance factors are discussed in order to assist practitioners who are attempting to reach out to those who are in need of professional help yet hesitant to obtain the help.


Vogel, D. L., Wade, N. G., Wester, S. R., Larson, L. M., & Hackler, A. H. (2007). Seeking help from a counselor: The influence of one’s social network. Journal of Clinical Psychology, 63, 233-245.

Abstract

Two studies examined the role of those close to an individual on intentions to seek mental health services. In Study 1, being prompted to seek help and knowing someone who had sought help were related to positive expectations about mental health services and about what friends and family would think about making use of those services. In Study 2, being prompted and knowing someone also were related to attitudes toward seeking mental health services and knowing someone was related to intentions to seek mental health services. Across studies (N = 780, N = 746), of those who sought professional help, 74 and 78% had someone directly suggest that they seek help and 92 and 95% knew someone else who had sought help, respectively.


Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes towards counseling. Journal of Counseling Psychology, 54, 40-50.

Abstract

This study examined the mediating effects of the self-stigma associated with seeking counseling and attitudes towards seeking counseling on the link between public stigma and willingness to seek counseling for psychological and interpersonal concerns. Structural equation modeling of data from 676 undergraduates indicated that the link between public stigma and willingness to seek counseling was fully mediated by self-stigma and attitudes. Perceptions of public stigma contributed to the experience of self-stigma, which in turn influenced help-seeking attitudes and eventually help-seeking willingness. Furthermore, 57% of the variance in attitudes towards counseling and 34% of the variance in willingness to seek counseling for psychological and interpersonal concerns was accounted for in the proposed model.


Shaffer, P., Vogel, D. L., & Wei, M. (2006). The mediating roles of anticipated risks, anticipated benefits, and attitudes on the decision to seek professional help: An attachment perspective. Journal of Counseling Psychology, 53, 442-452.

Abstract

This study examined the mediating effects of anticipated risks, benefits, and attitudes towards seeking counseling on the link between adult attachment and help-seeking intentions for psychological and interpersonal concerns in a sample of 821 undergraduates. The structural equation modeling results indicated that the link between higher attachment avoidance and less intent to seek help was mediated by lower anticipated benefits, higher anticipated risks, and less positive attitudes towards seeking help. Conversely, the link between higher attachment anxiety and greater intent to seek help was mediated by higher anticipated benefits and risks and more positive attitudes towards seeking help. Thus, attachment contributed to perceptions of the benefits and risks of counseling, which in turn influenced help-seeking attitudes and eventually help-seeking intentions.


Vogel, D. L., Wade, N. G., & Haake, S. (2006). Measuring the Self-Stigma Associated With Seeking Psychological Help. Journal of Counseling Psychology, 53, 325-337.

Abstract

Self-stigma is an important factor in people’s decisions not to engage in therapy. To measure this construct, the authors developed the 10-item Self-Stigma of Seeking Help (SSOSH) scale. In Study 1 (n = 583), the SSOSH had a unidimensional factor structure and good reliability (.91) among participants. Study 2 (n = 470) confirmed the factor structure. Studies 2, 3 (n = 546), and 4 (n = 217) cross-validated the reliability (.86 to .90; test–retest, .72) and showed evidence of validity (construct, criterion, and predictive) across the study samples. The SSOSH uniquely predicted attitudes toward and intent to seek psychological help. Finally, in Study 5 (n = 655) the SSOSH differentiated those who sought psychological services from those who did not across a 2-month period.


Vogel, D. L., Wester, S. R., Larson, L. M., & Wade, N. G. (2006). Information processing and the decision to seek professional help. Professional Psychology: Research and Practice, 37, 398-406.

Abstract

Despite the presence of quality mental health care in many communities, people tend to avoid seeking help and wind up languishing in their problems unnecessarily. In order for the professional to better understand how to reach these individuals, an information-processing model is presented, which examines the effects of people’s interpretation of their environment and their symptoms on their decision to seek mental health services. Using the model as a guide, suggestions are provided for practitioners who wish to provide services to those who are in need of professional help yet are hesitant to obtain it.


Vogel, D. L., Wester, S. R., Wei, M., & Boysen, G. A. (2005). The role of outcome expectations and attitudes on decisions to seek professional help. Journal of Counseling Psychology, 52, 459-470.

Abstract

Two studies examined the predictors of seeking psychological services. Study 1 examined the role of attitudes in mediating the relationship between eleven psychological factors and intent to seek help for three psychological problems. The results demonstrated that: (a) the psychological factors and attitudes predicted 62% of the variance in intent to seek help for interpersonal problems and 18% of the variance for drug problems; and (b) attitudes towards counseling mediated most of the relationships between the different psychological factors and help-seeking intent. Study 2, in turn, demonstrated that: (a) anticipated outcomes of talking with a counselor were associated with the use of psychological services; and (b) anticipated risks of disclosing emotions were salient for those having experienced a distressing event.


Vogel, D. L., & Wei. M. (2005). Adult attachment and help-seeking intent: The mediating roles of psychological distress and social support. Journal of Counseling Psychology, 52, 347–357.

Abstract

This study examined the mediating roles of perceived social support and psychological distress on the relationship between adult attachment and help-seeking intentions. Participants were 355 college students at a large Midwest university. The structural equation model results indicated that individuals with attachment anxiety were more likely to acknowledge their distress and were more willing to seek help. Conversely, individuals with attachment avoidance denied their distress and were reluctant to seek help. However, both individuals with attachment anxiety and avoidance also perceived less social support, which negatively contributed to their experience of distress, and their distress then positively contributed to their help-seeking intention. Furthermore, attachment anxiety and avoidance, social support, and distress explained 17% of the variance in intent to seek help.


Vogel, D. L. & Wester (2003). To seek help or not to seek help: The risks of self-disclosure. Journal of Counseling Psychology, 50, 351-361.

Abstract

Investigations into the reasons why people seek counseling have, for the most part, focused on approach factors; those variables that are associated with a potential client’s increased likelihood of seeking psychological services. The purpose of this research, however, is to explore the role of avoidance factors; those factors that are associated with decreased likelihood of seeking services. Across two studies of primarily Caucasian college students (N = 209 and N = 268, respectively), the results of simultaneous multiple regression analyses demonstrated that avoidance factors predict negative attitudes toward counseling as well as decreased intentions to seek counseling. Overall, results demonstrate that avoidance factors account for at least as much help-seeking variance as traditionally studied approach factors.