Stigma and Barriers to Seeking Therapy: Current Research


Cornish, M., Wade, N. G., Vogel, D. L., & Till, A. (in progress). Help-seeking stigma in the military: Insights from military personnel.

Abstract

Mental health concerns such as depression and posttraumatic stress disorder may be present in 19% to 26% of US service members after deployment (Hoge et al., 2004). In addition, suicide among US service members has reached an all-time high (Kuehn, 2009). These figures highlight the importance of access to mental health services. Unfortunately, stigma associated with receiving mental health care can significantly discourage seeking needed care (Greene-Shortridge, Britt, & Castro, 2007). In fact, stigma appears to be a significant barrier to care in the military among those who report higher levels of mental health symptoms (Greene-Shortridge et al., 2007), hence those in most need of care. Therefore, to better understand the types of interventions that could be most helpful in reducing stigma we conducted 7 focus groups with OEF/OIF veterans (N = 30). Results indicated that veterans experience barriers to seeking mental health care including mistrusting that information shared would be handled confidentially, uncertainty about whether civilian clinicians can understand their concerns and experiences, and public and self-stigma. In particular, participants voiced a concern that others would view them as weak, a failure, and/or incapable of performing their military duties if they were to seek mental health treatment. Participants’ comments also revealed internalized, or self-stigma; for example, some participants stated they have avoided seeking help because they did not want to acknowledge that they had a “problem” they could not handle on their own. Participants also, specifically, identified several factors that would lead to more successful interventions to reduce help-seeking stigma including psycho-education about confidentiality, personal stories from those who have sought help, support from the chain of command, and easily accessible information on how to seek help. The format preferred by the most participants was an in-person, small group format with an opportunity for interaction.


Hammer, J. H., & Vogel, D. L. (in progress). Assessing the utility of the willingness/prototype model in predicting help-seeking behavior.

Abstract

Research on the prediction of professional psychological help-seeking has solely relied on “rational choice” models, such as Azjen’s (1985) Theory of Planned Behavior.  However, research on the dual-process Prototype/Willingness Model (WP; Gerrard et al., 2005) finds that people often use heuristic, image-and-affect-based processing in addition to analytic processing when making health behavior decisions.  This study is assessing whether accounting for this heuristic processing path adds to the power of the Theory of Planned Behavior’s analytic processing path in predicting professional psychological help-seeking behavior.


Maier, J. A., Gentile, D. A., Vogel, D. L., & Kaplan, S. A. (under review). Person perception and media influences on self-stigma of seeking help.

Abstract

Self-stigma of seeking help has been identified as an important roadblock to seeking psychological help (Corrigan, 2004). Perceptions of therapists, people going to therapy, and people experiencing a mental illness were examined. Study 1 found that both perceptions of therapists and perceptions of people going to therapy uniquely predicted self-stigma, and but perceptions of the mentally ill indirectly influenced self-stigma through perceptions of clients. Study 2 looked at the role of the media as an informational source shaping these perceptions. Results supported that the portrayals of characters who are therapists, who are going to therapy, or who are suffering from a mental illness did influence the corresponding real-life perceptions. A model of media portrayal influencing perceptions of real life figures which then influence self-stigma was supported in study 2.


Tate, J., & Vogel, D. L. (in progress). Stigma, re-entry, and help-seeking behaviors among black american parolee populations.

Abstract

A limited number of studies have examined the attitudes or opinions that Black men on parole have with regard to seeking counseling.  The specific aims of this study are to better understand the (a) difficulties parolees experience after being released from prison, (b) the various forms of stigmatization (i.e. self-stigma, public stigma, double stigma) current parolees may be experiencing, and (c) the major themes that may aid in the implementation of new resources and counseling methods to assist with successfully re-entry. Participants attended a 90-minute focus group with questions assessing their beliefs and attitudes (e.g., “What are some personal difficulties you faced when you were released from prison or jail?”; “Have you experienced stigma attached to being a parolee?”; “If so, what experiences have you had with stigma since you were released?”). Initial findings suggest that Black males on parole are not always aware of what resources are available in the community to treat psychological disorders or help with the reintegration process upon re-entry into society.  Findings also suggest that several different types of stigma (i.e., public, self, and double stigma) may be particularly important factors in parolees successful reintegrating into society as well as their decisions about whether to use professional services such as counseling when they are experiencing problems reintegrating. In particular, the stigmatization surrounding both being a Black male and having a felony on the permanent record inhibited these individuals from having a smooth transition into society upon re-entry.  Furthermore, as a result of this double stigmatization, the participant’s experienced tremendous difficulties finding employment, stable housing, and meeting their personal needs to live successfully. Increasing our knowledge about Black males on parole and the double stigma attached to these individuals may assist help seeking professionals implement new methods of counseling and resources for successful reintegration.  The current study opens various doors for further research in areas advocating for meeting the needs of ethnic minorities on parole.


Tucker, J., Hammer, J., Vogel, D. L., & Wade, N. G.  (in progress). Disentangling the self-stigma of mental illness and the self-stigma of seeking psychological help.

Abstract

Two disparate and long-standing lines of research exist: studies of the self-stigma of mental illness (SSOMI) and studies of the self-stigma of seeking psychological help (SSOSH).  While some researchers implicitly treat these two constructs as synonymous, others make the argument that these constructs are theoretically and empirically distinct. To help clarify this debate, the present investigation examines measures of both constructs among 699 undergraduate students at a large Midwestern University.  Results indicate that 1) while a there is a moderate correlation between the two types of stigma, principal axis factoring results show the clear existence of two distinct factors; 2) the SSOMI  and the SSOSH are differentially predicted by demographic and psychological variables; 3) the SSOSH is a more accurate predictor of attitudes toward counseling, intentions to seek counseling, and self-esteem than the SSOMI for those with clinical levels of psychological distress; and 4) the SSOSH is a more accurate predictor of psychological distress than the SSOMI. These findings have clear implications for researchers interested in better understanding stigma as it relates to mental health and clinicians interested in improving interventions to increase those who seek needed psychological treatment. Specifically, if there are cumulative negative effects of both types of self-stigma in numerous domains, it may be beneficial for psychologists to develop interventions to reduce stigma of both mental illness and help seeking in order to best help people decrease mental health concerns and seek help for those concerns.


Tucker, J., Wade, N. G., & Vogel, D. L. (in progress). The change in self-stigma following a single session of group counseling: A comparison to a focus group session.

Abstract

Evidence suggests that group counseling is effective in reducing the levels of self-stigma related to seeking psychological help.  Still, there is a lack of understanding into how the self-stigma of seeking psychological help behaves before, after, and in the absence of group counseling.  The proposed study uses an experimental design to examine the effects of a single group counseling session on levels of the self-stigma of seeking psychological help.  The four primary hypotheses are 1) that a single session of group process therapy will lead to significantly greater reductions in the self-stigma of seeking help than either a focus group on student stress or a no treatment condition, 2) that these reductions will remain significant at two week follow-up, 3) that four group therapy variables—working alliance—bond with the counselor, session depth, level of group engagement, and identification with other group members—will predict reductions in self-stigma, and 4) that the self-stigma of seeking help, session depth, and group identification will be significant predictors of interest in continuing with counseling.


Vogel, D. L., Armstrong, P. I., Tsai, P.-C., Wade, N. G., Hammer, J. H., Shechtman, Z., Liao, H.-Y., Kouvaraki, E., Efstathiou, G., Topkaya, N., & Holtham, E. (in preparation). Cross-cultural validation of self-stigma of seeking help (SSOSH) scale.

Abstract

Researchers have identified several different aspects of the stigma associated with seeking therapy that can inhibit the use of psychological services. In particular, self-stigma (i.e., the fear of losing self-respect or esteem as a result of seeking help) has been found to be an important factor in the help-seeking process. As such, scales such as the Self-Stigma of Seeking Help scale (SSOSH; Vogel, Wade & Haake, 2006) have been gaining popularity. However, most of the research on self-stigma has been conducted in the United States. This is a limitation of the current research as the role of self-stigma in the help-seeking process may vary across cultural groups. To develop culturally valid and relevant scales, researchers must examine their measures with diverse samples to determine which aspects of the scales have universal utility and which are applicable only to certain groups. Therefore, this study examined scale validity and reliability of the SSOSH across samples from six different countries, including the England, Greece, Israel, Taiwan, Turkey, and the United States. Specifically, we used a confirmatory factor analysis (CFA) framework to conduct invariance analysis of model fit and factor loadings to examine the SSOSH across samples from the different countries. The results show the samples from the Mideast were significantly different from the samples in the United States and Taiwan. The two Mideast samples as well as the samples from the United States and Taiwan did not differ from each other. The results suggest that the SSOSH might be used to explore cultural differences in the way that self-stigma relates to help-seeking behavior.


Vogel, D. L., Wade, N. G., Hammer, J. H., Al-Darmaki, F. R., Liao, H.-Y., Gailbraith, V., Mackenzie, C., Mak, W. W. S., Nasvytienė, D., Pignattelli, A., Rubin, M., Tavakoli, S., Topkaya, N., & Tsai, P.-C. (in progress). Examining the role of self-stigma across 10 countries.

Abstract

While people’s perceptions of stigma towards mental illness and seeking help from a psychologist have been studied in the United States, less is known about how these attitudes and perceptions differ across various world cultures.  This study seeks to investigate how the nature of help-seeking attitudes and stigma differs between different world cultures. To examine the potential similarlies and differences, we are administering scales that assess different aspects of attitudes and stigma towards mental illness and seeking help and from a psychologist in samples collected in the U.S. and nine other countries. It is expected that understanding how people’s attitudes and stigma surrounding mental illness and towards seeking help from a psychologist vary across culture will help the research community determine whether models of help seeking and interventions designed to improve help-seeking attitudes can be worth extending to other cultures or if they need revision in order to be adapted properly.


Vogel, D. L., Bitman, R., Hammer, J., Wade, N. G. (in progress). The longitudinal impact of public stigma on self-stigma: Is societal stigma internalized?

Abstract

According to the National Institute for Mental Health, in any given year, a quarter of the American population is experiencing at least one diagnosable mental illness according to DSM-IV TR criteria (NIMH, 2005). However, approximately three fourths of Americans affected by mental illness do not seek treatment (NIMH, 2005).  The most noted reason for not seeking mental health treatment is stigma (Corrigan, 2004).  Stigma has been defined as a mark of shame or disgrace associated with a particular circumstance, quality or person (Blaine, 2000).  Two types of stigma exist: public stigma and self-stigma (Corrigan, 2004). Research examining the relationship between public and self-stigma has found that public stigma is positively associated with self-stigma and that people may internalize negative perceptions when dealing with mental health issues (Link & Phelan, 2001). However, the belief that public stigma is, in fact, internalized as self-stigma is not clear as past studies are largely cross-sectional in nature. Therefore, the goal of this research is to examine the cross lag relationships between public stigma and self-stigma over time. This research will provide more evidence regarding the causal directions and will provide essential information and guidance for designing interventions at the societal and individual level aimed at reducing stigma associated with mental illness and seeking help. Perceptions of public and self-stigma were measured at time 1 (T1) and then again three months later (T2).  Using Structural Equation Modeling (SEM) we conduced a cross lag analysis of the effects of public stigma on self-stigma. We found that public stigma at T1 predicted self-stigma at T2 (b = .15, p < .01) to greater degree than self-stigma at T1 predicted public stigma at T2 (b = .06, p > .05).  In fact, public stigma significantly predicted future self-stigma while self-stigma did not significantly predict future public stigma. Furthermore, the effect of public stigma on self-stigma was found over and above the effect of self-stigma. These findings are consistent with previous assertion regarding the role of public stigma on the development (i.e., internalization) of self-stigma. Overall, these results provide further evidence regarding the causal direction the role of public stigma on an individual’s internalized self-stigma and shed light on the importance of societal interventions aimed at reducing self-stigma.  While, public stigma is based on societal factors that can be difficult to change, this study highlights an alternate avenue for reducing the negative effects of stigma; the individual. Specifically, the focus on internal factors as opposed to external factors may provide a more direct way to combat the multifaceted and long-standing battle against the stigma of mental illness and help-seeking decisions.


Wester, S. R., Vogel, D. L., Hackler, A., Hammer, J., Downing-Matibag, T., & Geisinger, B. (in preparation). Gender role conflict, stigma, and talking about psychological issues.

Abstract

Men who experience greater gender role conflict often avoid talking to friends and family about their psychological needs given that doing so conflicts with the male socialized gender role of being tough, stoic, and in control. The stigmatization of those who seek counseling potentially increases this avoidance, such that experiences of gender role conflict may lead to increases in feelings of stigmatization about mental illness and subsequent decreased willingness to talk about psychological issues. Using Structural Equation Modeling (SEM) with data from 216 male collegians, we tested this possibility. Results indicated that men who endorse greater RABBM endorsed greater stigma which then led to a decreased willingness to talk about psychological issues. However, men who endorsed greater RE were only less likely to talk about seeking help. Implications of these findings and areas needing future research are discussed.