Seeking help despite the stigma: Experiential avoidance as a moderated mediator.

Abstract

The help-seeking literature identifies a model wherein public stigma of seeking help is internalized as self-stigma of seeking help, which, in turn, decreases help-seeking outcomes. The current study considered whether experiential avoidance, or a tendency to avoid painful thoughts or emotions, moderates how strongly these stigmata relate to help-seeking intentions among university students. Specifically, this study tested whether experiential avoidance moderates (a) the direct relationship between self-stigma of seeking psychological help and help-seeking intentions and (b) the indirect relationship between public stigma and help-seeking intentions. Conditional process modeling in a university student sample (N = 235) supported these hypotheses. The direct relationship between self-stigma and help-seeking intentions was nonsignificant and weaker for those who reported low experiential avoidance than for those who reported high experiential avoidance. Results also demonstrated a moderated indirect effect wherein the relationship between self-stigma and intentions was nonsignificant among those reporting low levels of experiential avoidance. This suggests that self-stigma may predict help-seeking intentions when avoidance of therapy functions as a means for avoiding unpleasant emotions. These findings suggest that interventions designed to decrease experiential avoidance by increasing openness to unpleasant emotions may offer a novel avenue to attenuate the impact of self-stigma on help-seeking intentions without requiring the difficult task of reducing stigma altogether.

Using Item Response Theory to Develop Revised (SSOSH-7) and Ultra-Brief (SSOSH-3) Self-Stigma of Seeking Help Scales

“…This subscale has demonstrated positive associations with attitudes toward seeking psychotherapy and previous help seeking (Vogel et al, 2006). Scores have demonstrated internal consistency in college student samples (α = .89; Brenner et al, 2020), similar to the current study (α = .84).…”

“…Based on psychometric literature (e.g., Dalal & Carter, 2015;DeVellis, 2016), we hypothesized that the reversescored items will yield the least information and, therefore, be more likely removed as part of the development of the new versions of the scale (Hypothesis 1). Consistent with the extant help-seeking literature (e.g., Brenner et al, 2020;Tucker et al, 2013), we hypothesized that the new versions of the SSOSH would demonstrate positive correlations with public stigma and negative correlations with attitudes toward seeking help and intention to seek help (Hypothesis 2).…”

“…The SSOSH includes items such as "I would feel inadequate if I went to a therapist for help," (Vogel et al, 2006, p. 328) as well as reversed-scored items such as "My self-confidence would NOT be threatened if I sought professional help," (Vogel et al, 2006, p. 328). Previous studies indicate positive correlations of the SSOSH scores with other forms of stigma (e.g., societal stigma, self-stigma of mental illness; Tucker et al, 2013) and negative correlations with help-seeking attitudes (Tucker et al, 2013), intentions (Brenner et al, 2020), and behavior (Lannin et al, 2016). SSOSH scores demonstrate internal consistency among community (α = .92) samples and college (α = .90) samples (Tucker et al, 2013), as well as 2-month test-retest reliability (.72) among college students (Vogel et al, 2006).…”

“…Consistent with helpseeking research (e.g., Brenner et al, 2020), the 10-item Psychological and Interpersonal Concerns subscale of the 17-item Intentions to Seek Counseling Inventory (Cepeda-Benito & Short, 1998) was used to capture intentions to seek psychotherapy. Participants rate the likelihood that they would seek help if they were experiencing each problem (e.g., loneliness, depression) on a 4-point scale from 1 (very unlikely) to 4 (very likely).…”

“…A major psychological barrier that prevents individuals from seeking treatment is self-stigma of seeking psychological help, or the negative stereotypes/ shame one would feel toward themselves for seeking psychological help (Vogel et al, 2006). Self-stigma has been linked to worse help-seeking attitudes (Vogel et al, 2017), lower intention to seek counseling (e.g., Brenner et al, 2020;Pattyn et al, 2014), lower rates of accessing online information about mental health and counseling services (Lannin et al, 2016), and lesser use of services over a 2-year period (Seidman, Wade, et al, 2019). As such, researchers increasingly use self-report measures of self-stigma to identify factors that contribute to its development (e.g., Pederson…”