Two established but disparate lines of research exist: studies examining the self-stigma associated with mental illness and studies examining the self-stigma associated with seeking psychological help. Whereas some researchers have implicitly treated these 2 constructs as synonymous, others have made the argument that they are theoretically and empirically distinct. To help clarify this debate, we examined in the present investigation the overlap and uniqueness of the self-stigmas associated with mental illness and with seeking psychological help. Data were collected from a sample of college undergraduates experiencing clinical levels of psychological distress (N = 217) and a second sample of community members with a self-reported history of mental illness (N = 324). Confirmatory factor analyses provide strong evidence for the factorial independence of the 2 types of self-stigma. Additionally, results of regression analyses in both samples suggest that the 2 self-stigmas uniquely predict variations in stigma-related constructs (i.e., shame, self-blame, and social inadequacy) and attitudes and intentions to seek help. Implications for researchers and clinicians interested in understanding stigma and enhancing mental health service utilization are discussed.

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.

This investigation introduced the Internalized Stigma Model to test the mechanisms by which the stigma of mental illness and of seeking psychological help affect self-esteem and intentions to seek counseling. We hypothesized that both stigmas would predict decreased self-esteem, but only stigma of seeking psychological help would predict decreased intentions to seek counseling. Furthermore, we predicted that these links follow a process wherein people's perceptions of societal stigma are fully mediated by internalization of that stigma. Public stigmas predict their respective self-stigmas, which subsequently predict self-esteem and intentions. Using structural equation modeling, we tested the hypothesized relationships in a sample of undergraduates (N = 448). Results supported the hypotheses. Selfstigma mediated the relationship between public stigma and both outcomes; both self-stigma of mental illness and self-stigma of seeking psychological help predicted decreased self-esteem, but only self-stigma of seeking psychological help predicted decreased intentions to seek counseling.

Forgiveness-based group treatments to address interpersonal hurts have been shown to be efficacious across a range of therapy models (Wade, Hoyt, Kidwell, & Worthington, 2014). However, little is known about how treatment and individual characteristics may interact in predicting outcomes. The present study examined a sample of 162 community adults randomly assigned to three treatment conditions; an 8-week REACH Forgiveness intervention (Worthington, 2006), an 8-week process group, and a waitlist control. Hierarchical linear modeling (HLM) indicated that the forgiveness-based treatment was more effective than the waitlist control across a range of forgiveness-related constructs but no more effective than the process condition. Furthermore, attachment avoidance and anxiety interacted with treatment type to predict certain outcomes, indicating that the REACH Forgiveness model may be more helpful for promoting forgiveness with insecurely attached individuals. (PsycINFO Database Record

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