David L Vogel

Iowa State University | ISU · Department of Psychology

The self-stigma (i.e., shame) associated with psychotherapy is a prominent barrier to seeking psychological help, but less is known about its effects after treatment begins. Evidence suggests that self-stigma may interfere with the formation of the therapeutic alliance, but no studies have examined this throughout the course of psychotherapy. Self-...

The present study examined the measurement invariance and latent mean differences of three versions of the Self-Stigma of Seeking Help scale among demographic profiles of men. Results revealed strong invariance for the three scales across all demographic groups. Differences in strict invariance and latent mean differences were identified. Public si...

This chapter provides an overview and delineation of the four major stigmas related to mental illness and seeking psychological help: public stigma of mental illness, public stigma of seeking help, self-stigma of mental illness, and self-stigma of seeking help. It begins with discussion of a theoretical model that distinguishes these four stigmas,...

Public attitudes toward mental illness create a cultural reality, defining what it means to deal with mental illness in a given place at a particular time. Time-trend studies show how the cultural conception of mental illness is changing, guiding our efforts to reduce the stigma of mental illness. Over the past decades, similar trends have emerged...

This chapter reviews the theoretical and research literature on self-, public, and structural stigma and stigma’s impact on mental health for the largest ethnic minority groups in the United States: African Americans, Latinx, Asian Americans, and Native Americans. None of these ethnic minority groups receives mental health treatment commensurate wi...

Albeit the UN Convention of the Rights of Persons with Disabilities advocates for the right to full and active participation is society, it is well known that individuals with intellectual disabilities face great disadvantages in most domains of life. Stigma and discrimination are at the roots of the limited life opportunities available to this gro...

Research on the measurement of mental illness stigma and discrimination has grown rapidly in the past 15 years with a large number of measures developed. This chapter first defines mental illness stigma and discrimination and highlights the importance of using an appropriately targeted measurement strategy including consideration of key measurement...

Stigma is a powerful force that is not easily dismantled. The goal of the Handbook of Stigma and Mental Health is to assist with policy changes, interventions, and movement toward social justice by presenting the breadth and depth of the work on mental health stigma. The authors of the Handbook have provided a deep and more complete picture of what...

Older adults are the least likely age group to seek mental health services and stigma is frequently cited as a key explanation. Guided by the internalized stigma of help-seeking model, the first objective of this chapter is to review research examining age differences in public stigmas, self-stigmas, help-seeking attitudes, and intentions to seek h...

This chapter focuses on the interventions designed to reduce the stigma and discrimination against people with mental illness at the person-level for individuals and small groups. The current evidence for anti-stigma interventions using social contact and educational strategies will be presented with a focus on interventions for specific target gro...

The present chapter provides a review and analysis of research on mental health stigma among military personnel. Given expectations of psychological resilience for military personnel, a large amount of research has been conducted to examine the antecedents and consequences of mental health stigma in this population. The chapter first provides an an...

Self-affirmation theory provides a sophisticated framework to understand individual differences in receptivity to health-risk communication. Health messages are often ineffective because reminders of health risks can create dissonanc, which causes people to react negatively against the perceived threat of the information. Self-affirmation intervent...

The persistence of stigma of mental illness and seeking therapy perpetuates suffering and keeps people from getting the help they need and deserve. This volume, analysing the most up-to-date research on this process and ways to intervene, is designed to give those who are working to overcome stigma a strong, research-based foundation for their work...

Help seeking for mental health problems is a multifaceted and dynamic process involving both formal and informal networks that has many associated barriers. One of the prominent barriers is help-seeking stigma, which is stigma associated with asking for or receiving help. This stigma can emerge even during very early stages of the development of a...

Members of the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) population have a unique relationship with stigma, as this community experiences both stigma associated with identifying within the LGBTQ+ spectrum and may also navigate the unique stigmas associated with mental illness and seeking help. It is important for researchers and pract...

The case for population-level approaches to reduce the stigma associated with mental illness is based on the need for cultural change, whether the culture is within organizations, communities, or families. As such, stigma is a multi-level phenomenon requiring intervention at these many levels. In this chapter we present the case for stigma reductio...

The literature on the internalized stigma (or self-stigma) of mental illness has been expanding rapidly. We review the key findings of two meta-analyses of the correlates and consequences that occurred a decade apart (Livingston & Boyd, 2010, Del Rosal et al., 2020), showing that internalized stigma is related to less self-esteem, quality of life,...

The persistence of stigma of mental illness and seeking therapy perpetuates suffering and keeps people from getting the help they need and deserve. This volume, analysing the most up-to-date research on this process and ways to intervene, is designed to give those who are working to overcome stigma a strong, research-based foundation for their work...

Individuals with mental illness can experience stigma and discrimination, which can cause adverse consequences (Zerger et al., 2014). Mental illness stigma and discrimination can also intersect with other marginalized social identities that individuals may possess, resulting in unique outcomes for individuals. Unfortunately, the research in this ar...

Mental health stigma has proven to be resilient against many intervention approaches. For example, previous interventions incorporating strategies like psychoeducation, cognitive restructuring, and motivational interviewing have shown inconsistent results (Mittal et al., 2012), prompting researchers and clinicians to search for novel approaches to...

Stigma serves as the mechanism through which an individual is disqualified from full social acceptance because they exhibit an attitude, a behavior, or a characteristic that is regarded as socially unacceptable. For men, this is most often experienced when they violate the socialized male gender role, often in the form of appearing feminine, weak,...

Stigma is a socially constructed phenomenon that occurs on multiple levels and has broad implications for both individuals with mental illness and society as a whole. Theoretical orientations provide a framework for organizing and advancing research on the stigma of mental illness. This chapter describes theoretical perspectives on types of mental...

The persistence of stigma of mental illness and seeking therapy perpetuates suffering and keeps people from getting the help they need and deserve. This volume, analysing the most up-to-date research on this process and ways to intervene, is designed to give those who are working to overcome stigma a strong, research-based foundation for their work...

Stigma can maintain discrimination and oppression and reduce compassion and understanding. In the area of mental illness and psychological help seeking, stigma acts as a considerable barrier to recovery and adds additional burdens to be managed. This reality has led many different research groups to explore the workings of stigma and ways to interv...

Theoretical conceptualizations of stigma distinguish three dimensions of stigma: public, perceived, and self-stigma, which encompass unconscious biases, stereotyping, negative attitudes, prejudice. and discrimination. These attitudes and behaviors may have negative effects for people who have suicidal thoughts, suicide attempts, or suicide bereavem...

PurposeTo determine the impact of a telemedicine-delivered intervention aimed at identifying unmet needs and cancer-related distress (CRD) following the end of active treatment on supportive care referral patterns.Methods We used a quasi-experimental design to compare supportive care referral patterns between a group of rural cancer survivors recei...

Background: Even when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. Fewer than one-third of participants in a telemedicine intervention for identifying rural survivors with high distress and connecting them with care accepted psychosocial referral. Obje...

The study evaluated the psychometrics of a newly developed scale that measures the perceived familial stigma of LGBQ-sexuality. Exploratory, confirmatory, bifactor, and omega reliability analyses were conducted on a set of items and suggest these scores reliably measure the intended construct, with specific factors of homonegativity, discretion, an...

The current study assessed the measurement invariance of the Self-stigma of Mental Illness scale (SSOMI) across Chinese and US samples and assessed whether the SSOMI differentially relates to distress levels across Chinese and US participants. We included 487 participants in China and 550 in the US (mean age was 19.52 in China and 19.29 in the US)....

US service members are at elevated risk for distress and suicidal behavior, compared to the general US population. However, despite the availability of evidence-based treatments, only 40% of Service members in need of mental health care seek help. One potential reason for the lower use of services is that service members experience stigma or concer...

Military suicide rates are near all-time highs. To help clinicians and researchers study suicide risk factors in military samples, the Military Suicide Research Consortium (MSRC) developed a set of brief suicide-risk screening measures. While previous research has examined the reliability of these screening measures, it remains unclear if measureme...

BACKGROUND Even when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. During our telemedicine-delivered intervention aimed at identifying rural survivors with high distress and connecting them with psychosocial care, fewer than 1/3 of those with high distres...

Objectives Even when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. During our telemedicine-delivered intervention aimed at identifying rural survivors with high distress and connecting them with psychosocial care, fewer than 1/3 of those with high distres...

Although research on the stigma associated with mental health care has grown substantially in the last decade, most of this work focuses on outpatient treatment; recent research on the stigma associated with inpatient treatment is strikingly absent. In this study, we examined the stigma of seeking professional psychological help from outpatient and...

The current research developed ultra-brief (SSOSH-3) and revised (SSOSH-7) versions of the Self-Stigma of Seeking Help scale. Item response theory was used to examine the amount of information each item provided across the latent variable scale and test whether items functioned differently across women and men. In a sample of 857 community adults,...

Objective: This study utilized best-worst scaling and latent class analysis to assess mental health treatment preferences and identify subgroups of college student help seekers. Method: College students (N = 504; age: M = 20.3, 79.2% female) completed assessments of mental health treatment preferences, self-stigma, and distress. Results: Stude...

This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale–21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States ( N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four diff...

The extent to which individuals prioritize different personal values may be conceptually linked to the perceptions of societal stigma associated with seeking psychological help (public stigma), as well as the extent to which they apply that stigma to themselves (self-stigma). We examined how personal values predicted public stigma and self-stigma o...

Objective: Stigma is commonly identified as a key reason that older adults are especially unlikely to seek mental health services, although few studies have tested this assumption. Our objectives were to: (a) examine age differences in public and self-stigma of seeking help, and attitudes toward seeking help, and (b) see whether age moderates an i...

Theory: Despite high rates of psychiatric illnesses, medical students and medical professionals often avoid psychological help. Stigma may prevent medical students from seeking psychological help when experiencing distress, which may hinder their job performance and mental health. Compassionate values-preferred principles that guide attitudes and...

Testing self-affirmation writing against well-established alternatives is an important step in validating self-affirmation writing as an empirically informed clinical exercise. Therefore, this multi-wave study examined the effects of two theoretically distinct writing exercises: self-affirmation and emotionally expressive writing. It was hypothesiz...

The current study (N = 404) used a moderated moderation model to examine how gender, religious commitment, and self-stigma toward seeking psychological help may interact in the prediction of help-seeking attitudes. Bivariate zero-order correlations indicated that help-seeking attitudes was negatively associated with self-stigma of seeking help (r =...

This study assessed the relationship between the stigma of seeking psychological help and use of outpatient behavioral health services over a 2-year period among active duty military service members initially referred for neuropsychological evaluation secondary to their histories of mild traumatic brain injury. Although research has examined how st...

This research was an examination of the effects of two types of self-affirmation interventions in reducing threat responses associated with receiving help-seeking information. Help-seeking information can be threatening to one’s positive self-perceptions and people may avoid seeking such information to protect themselves. There is evidence that ref...

Help-seeking stigma predicts more negative attitudes towards seeking psychological help, yet it remains unclear how distress levels might impact this relationship. Increased distress could diminish the relationship between stigma and help-seeking attitudes, as the potential benefits of seeking psychological help might outweigh the potential risks....

In this study, we examined exposure to stereotypical movie portrayals of American Indians, motivations to respond without prejudice, and awareness of White privilege on racist attitudes. European American participants (N = 232) were randomly assigned to watch stereotypical representations of American Indians or control videos. Hierarchical regressi...

Student veterans experiencing mental health concerns could benefit from seeking counseling (Rudd, Goulding, & Bryan, 2011), though they often avoid these services. Self-affirmation interventions have been developed to increase openness to health-related behaviors (Sherman & Cohen, 2006), and may also help promote psychological help-seeking intentio...

As an individual takes concrete steps toward psychotherapy (e.g., attending an intake) and the salience of becoming a help seeker increases, he or she may experience heightened levels of self-stigma and view self-disclosing personal information to a counselor as a risk. There is evidence that eliciting self-affirmation, a psychological process that...

Contemplating seeking therapy may evoke threats to self-integrity that lead to avoidance of treatment, but eliciting self-affirmation, a psychological process that temporarily bolsters self-integrity, may forestall those threats. The present study utilized a randomized experimental design to test the effectiveness of contemplating seeking therapy a...

The current study examined a mediation model of help-seeking stigma towards group therapy in a community sample of clinical and nonclinical Arabs adults in Israel (n = 196). Path analyses indicated that public stigma demonstrated an indirect effect with intentions to seek group therapy through self-stigma, and self-stigma demonstrated a direct rela...

The Conformity to Masculine Norms Inventory-46 (CMNI-46) measures conformity to hegemonic masculine gender role norms. Research offers conflicting conclusions regarding the CMNI-46's dimensionality, with varying degrees of support for models that consist of 9 correlated factors and second-order or bifactor models that include a general Conformity t...

The current research tested a theoretical model of self-relating that examined the unique relationships of self-compassion and self-coldness with distress and well-being. Self-coldness has recently been identified as theoretically distinct from self-compassion, rather than part of a unitary self-compassion construct. As such, the incremental value...

Help-seeking stigma is considered a major barrier that keeps people from seeking out psychological help. Self-compassion, or the act of treating oneself with kindness and non-judgment, is a possible protective factor that could be associated with diminished stigma. However, this possibility has yet to be studied. The present research (N = 369) exam...

This study tested whether high counseling self-efficacy was associated with less physiologic stress for student helpers facing difficult helping situations. A total of 225 students completed a counseling self-efficacy measure before providing supportive help. During this time, participants’ blood pressure and heart rate were evaluated. Between the...

Stigma associated with seeking help has been found to be a key help-seeking barrier, however its role is less clear for: (a) adolescents, (b) groups outside the United States and (c) different types of therapy. This study addresses these omissions by examining the relationships between perceptions of public stigma of mental illness and the self-sti...

Social network stigma refers to the perceived negative views about seeking help for mental health problems that are held by those closest to an individual, such as family and friends. This form of stigma predicts help-seeking attitudes and intentions beyond other forms of stigma, and is predominantly measured using the Perceptions of Stigmatization...

The Self-Compassion Scale (SCS; Neff, 2003a) is the most widely used measure of self-compassion. Self-compassion, as measured by the SCS, is robustly linked to psychological health (Macbeth & Gumley, 2012; Zessin, Dickhaüser, & Garbade, 2015). The SCS is currently understood as exhibiting a higher-order structure comprised of 6 first-order factors...

Stigma is one of the most commonly cited barriers toward seeking mental health services for men in the military. Although factors like socialized masculine norms (i.e., restrictive emotionality) and levels of distress are associated with stigma in civilian samples, less is known about these factors for men in the military. This study examines how d...

This study builds on previous help-seeking research in the United States by examining the role of counseling stigma in Turkey. Undergraduate students in Turkey (N = 520) completed self-report measures of attitudes and intentions to seek counseling and 3 forms of help-seeking stigma. Results indicated that perceptions of public and social network s...

Stigma is an important barrier to seeking psychological services worldwide. Two types of stigma exist: public stigma and self-stigma. Scholars have argued that public stigma leads to self-stigma, and then self-stigma is the primary predictor of attitudes toward seeking psychological services. However, this assertion is largely limited to U.S. sampl...

This research developed and tested an online values-affirmation exercise to attenuate threat and enhance positive beliefs about counseling among individuals struggling with mental health concerns. There is evidence that reflecting on personal values (values-affirmation) is an effective approach to eliciting self-affirmation—a psychological process...

Less than 1/3 of college men seek psychological help per year when experiencing mental health concerns. Many believe this is because socialized masculine norms are incongruent with help-seeking decisions. In line with this, adherence to masculine norms, like emotional control and self-reliance, is consistently linked to factors associated with lowe...

The psychological help-seeking patterns of college students in the United Arab Emirates (UAE) have only recently begun to be examined. Initial suggestions indicate that the majority of Emirati students treat help seeking from counselors as a last resort, which may be linked to aspects of Emirati culture including feared loss of societal face, stigm...

Mental illness stigma is both prevalent in our society and has serious negative consequences for persons with mental illness. The current study examined whether an intervention involving indirect contact with friends and family of individuals with mental illness could reduce stigma toward mental illness, as measured by desired social distance from...

People’s mental image of a person who performs a behavior predicts their willingness to engage in that behavior. In particular, a negative mental image of an individual who seeks mental health services may be an important barrier to seeking help. Therefore, over the course of 5 studies, the authors developed and examined evidence for the reliabilit...

An important first step in seeking counseling may involve obtaining information about mental health concerns and treatment options. Researchers have suggested that some people may avoid such information because it is too threatening due to self-stigma and negative attitudes, but the link to actual help-seeking decisions has not been tested. Therefo...

This study examined the relationship between public and self-stigma of seeking behavioral health services, and help-seeking attitudes and intent in a sample of active duty military personnel currently being assessed for traumatic brain injuries in a military health center. Although it has been suggested that many military personnel in need of care...

The end of a romantic relationship is a common and serious presenting concern among clients at university counseling centers. Researchers have highlighted the need to understand the nature of thoughts about an ex-relationship, because they may lead to unique clinical interventions. One aspect of thought that may be clinically relevant is content va...

This study experimentally investigated the influence of different norms regarding the acceptability of sexual coercion and overperception of sexual intentions in casual interactions with women, as well as an interaction of these factors on self-reported likelihood to engage in sexual assault by male college students. Results of a logistic regressio...

Given the dramatic rates of mental health concerns among military veterans, more needs to be done to connect wounded warriors to the resources available to them. Through focus groups with veterans of the Operation Enduring Freedom (OEF) and/or Operation Iraqi Freedom (OIF) conflicts (N = 30) we sought to understand the current post-deployment diffi...

Psychotherapy and mental illness are often depicted on screen for audiences’ entertainment. Although previous research has examined how portrayals of other professions, such as medical doctors, influence people’s attitudes toward these figures in real life, there is little research looking at the effects of portrayals of psychologists and issues of...

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...

This article explores the issues involved in addressing religion and spirituality (R/S) in nonthematic group psychotherapy through a case study of a process-oriented group for adults. The group, which occurred within a psychology-department-affiliated clinic, consisted of 7 community members, 2 coleaders, and 1 process observer. Videos from the fir...

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 emp...

Why do men tend to underutilize mental health services? One reason may be that men are less frequently referred to seek such services. Indeed, male friends and family members may be particularly unlikely to refer men to seek mental health services, as it means going against the traditional male gender role proscription of talking to other men about...

The current study examined the validity of Gender Role Conflict Scale-Short Form (GRCS-SF) among a sample of 256 Chinese heterosexual men and 250 Chinese gay men. Confirmatory factor analysis (CFA) supported the conclusion that a Chinese translated version of the GRCS-SF had acceptable structural validity. Specifically, the four-factor solution (i....

This research examined whether naturally-occurring self-fulfilling prophecies influenced adolescents' responsiveness to a substance use prevention program. The authors addressed this issue with a unique methodological approach that was designed to enhance the internal validity of research on naturally-occurring self-fulfilling prophecies by experim...

Psychotherapy may be underutilized because people experience self-stigma-the internalization of public stigma associated with seeking psychotherapy. The purpose of this study was to experimentally test whether the self-stigma associated with seeking psychotherapy could be reduced by a self-affirmation intervention wherein participants reflected on...

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 emp...

Researchers have found that the stigma associated with seeking therapy-particularly self-stigma-can inhibit the use of psychological services. Yet, most of the research on self-stigma has been conducted in the United States. This is a considerable limitation, as the role of self-stigma in the help-seeking process may vary across cultural groups. Ho...

Stigma is considered an important barrier to seeking mental health services. Two types of stigma exist: public stigma and self-stigma. Theoretically, it has been argued that public stigma leads to the development of self-stigma. However, the empirical support for this assertion is limited to cross-sectional data. Therefore, the goal of this researc...

Prior research on professional psychological help-seeking behavior has operated on the assumption that the decision to seek help is based on intentional and reasoned processes. However, research on the dual-process prototype/willingness model (PWM; Gerrard, Gibbons, Houlihan, Stock, & Pomery, 2008) suggests health-related decisions may also involve...

School participants offer a unique, yet often overlooked, perspective about the education of African American students. In the present study, 22 elementary and 21 high school students (aged 7–17 yrs) completed an open-ended questionnaire regarding African American students' perceptions of academic problems and solutions to these problems. Thematic...

This research developed and tested 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 comprised 1,038 active duty soldiers recruited from a large Army installation. Soldiers' mean age was 26.7 (standard deviation = 5.9) years, and 93.6% were...