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Can Intergroup Contact in Virtual Reality (VR) Reduce Stigmatization Against People with Schizophrenia?

  • Weizenbaum Institute

Abstract and Figures

People with mental disorders such as schizophrenia do not only suffer from the symptoms of their disorders but also from the stigma attached to it. Although direct intergroup contact is an effective tool to reduce stigmatization, it is rare in real life and costly to be established in interventions, and the success of traditional media campaigns is debatable. We propose Virtual Reality (VR) as a low-threshold alternative for establishing contact since it involves less barriers for affected and unaffected persons. In a 2 + 1 experiment (n = 114), we compared the effects of encounters with a person with schizophrenia through a VR video with contact through a regular video and no contact at all on anxiety, empathy, social proximity, and benevolence towards people with schizophrenia. We found that contact via VR reduced stigmatization only for participants who liked the person encountered. Our data suggest that it is crucial how participants evaluate the person that they encounter and that stronger perception of spatial presence during reception plays an important role, too. Therefore, we discuss various boundary conditions that need to be considered in VR interventions and future research on destigmatization towards mental disorders, especially schizophrenia.
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Journal of
Clinical Medicine
Can Intergroup Contact in Virtual Reality (VR) Reduce
Stigmatization Against People with Schizophrenia?
Daniela Stelzmann 1,* , Roland Toth 2and David Schieferdecker 2
Citation: Stelzmann, D.; Toth, R.;
Schieferdecker, D. Can Intergroup
Contact in Virtual Reality Reduce
Stigmatization Against People with
Schizophrenia? J. Clin. Med. 2021,10,
Academic Editors: Andreas Reif,
Blazej Misiak and Jerzy Samochowiec
Received: 29 May 2021
Accepted: 26 June 2021
Published: 30 June 2021
Publisher’s Note: MDPI stays neutral
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1Institute of Computer Science, Freie Universität Berlin, 14195 Berlin, Germany,
2Institute for Media and Communication Studies, Freie Universität Berlin, 14195 Berlin, Germany; (R.T.); (D.S.)
People with mental disorders such as schizophrenia do not only suffer from the symptoms
of their disorders but also from the stigma attached to it. Although direct intergroup contact is an
effective tool to reduce stigmatization, it is rare in real life and costly to be established in interventions,
and the success of traditional media campaigns is debatable. We propose Virtual Reality (VR) as
a low-threshold alternative for establishing contact since it involves less barriers for affected and
unaffected persons. In a 2 + 1 experiment (n= 114), we compared the effects of encounters with a
person with schizophrenia through a VR video with contact through a regular video and no contact
at all on anxiety, empathy, social proximity, and benevolence towards people with schizophrenia.
We found that contact via VR reduced stigmatization only for participants who liked the person
encountered. Our data suggest that it is crucial how participants evaluate the person that they
encounter and that stronger perception of spatial presence during reception plays an important role,
too. Therefore, we discussvarious boundary conditions that need to be considered in VR interventions
and future research on destigmatization towards mental disorders, especially schizophrenia.
Keywords: stigma; schizophrenia; mental disorders; virtual reality (VR); intergroup contact
1. Introduction
In 2017, approximately 792 million people suffered from mental disorders world-
wide [
]. Affected persons do not only suffer from the symptoms of their mental disorder,
but also from the stigma attached to it [
]. The consequences of such stigmatization
are tremendous: It lowers affected persons’ self-esteem and their likeliness of seeking
professional help [
]. Accordingly, the World Health Organization (WHO) has made
stigma reduction one of its top priorities [8].
One approach to reducing stigmatization is to establish meaningful encounters be-
tween those who are affected by a mental disorder and those who are not [
]. Although
direct intergroup contact is an effective tool for reducing stigmatization in the realm of
mental disorders, it only infrequently happens in real life and can be costly to establish
in the context of stigmatization campaigns and educational programs. Seeking alterna-
tive forms of contact, mass media campaigns yielded non-satisfying results [
], but first
studies showed that computer-mediated intergroup contact can be an auspicious tool for
decreasing stigmatization [11,12].
We set out to test the potential of a digital technology that has not yet been in focus
regarding stigmatization towards people with mental disorders: Virtual Reality (VR).
The high sensual richness and involvement make VR a promising tool for intergroup
contact [
]. In the context of mental disorders, VR technology has mainly been studied
in the domain of cognitive behavioral therapy [
]. We are not aware of any study that
investigates intergroup contact via VR in the context of mental disorders [
]. To close
this gap, we conducted an experiment that tested the effects of VR/360
-3D videos on
J. Clin. Med. 2021,10, 2961.
J. Clin. Med. 2021,10, 2961 2 of 11
stigmatization towards people with schizophrenia, one of the most stigmatized mental
disorders [16].
1.1. Stigma Towards People with Mental Disorders and Their Consequences
According to Goffman, a stigma is a deeply discrediting attribute attached to a person
or group [
]. Individuals who suffer from mental disorders are affected by various forms
of stigmatization [
]. The symptoms of the mental disorders are often cited as the
main cause of stigma since they can lead to deviant behavior and are sometimes hard to
comprehend for bystanders [
]. Particularly mental disorders that can induce psychotic
episodes—like schizophrenia—are commonly associated with danger, crime, and unpre-
dictability [
]. These beliefs neglect the fact that mental disorders such as schizophrenia
are neither a necessary, nor a sufficient precondition for violent behavior
Yet, these
stereotypes largely persist because media coverage is perpetuating images of violent “mad
men”, serial killers, and psychopaths and involves people with mental disorders like
schizophrenia primarily in the context of violence [2427].
The stigma around mental disorders such as schizophrenia has real consequences for
affected persons. The unaffected majority feels more anxious, less empathic, more socially
distant towards affected persons, and is less supportive of policies that benefit people with
mental disorders [
]. As a result, it can become even harder for affected individuals
to engage in positive contact with others—they feel socially isolated and disconnected
from society and suffer from low self-esteem [
]. Moreover, people with strongly
stigmatized mental disorders such as schizophrenia take longer to seek therapy and engage
in treatments [
] which may exacerbate existing symptoms [
]. Even when they do engage
in therapy, they are often faced with discrimination in the health care system [34].
1.2. Reducing Stigma Towards People with Mental Disorders
For a long time, scholars have studied ways to reduce stigmatization towards peo-
ple with mental disorders [
]. Among others, direct intergroup contact—face-to-face
encounters with affected persons—has emerged as an effective tool for improving attitudes
towards people with mental disorders in general [
] and schizophrenia in particular [
Having said this, opportunities for direct contact are scarce in real life because the lifetime
prevalence of mental disorders such as schizophrenia is low at approximately 0.5% [
Moreover, affected individuals either avoid contact, are being avoided, or will not reveal
their condition at all due to fear of stigmatization [38].
In response to the lack of direct contact, researchers investigated indirect forms of con-
tact, among others via media [
]. Contact via media can come as unidirectional, one-sided
exposure to one or more out-group member(s) (e.g., an affected person who recounts their
medical history). Theoretically, such encounters should be less anxiety-provoking, more
scalable for interventions and should protect people with mental disorders from stressful
experiences of unsupervised interactions in non-therapeutic settings. Since findings about
contact through traditional media are inconsistent and provide no clear effect patterns [
scholars began exploring contact in digital, computer-mediated settings [
]. For in-
stance, Maunder et al.
found a reduction of fear, anger, and stereotyping towards
people with schizophrenia after computer-mediated interaction.
One technology that has received little attention as a means for intergroup contact and
destigmatization, is VR. VR allows recipients to freely adjust their view in a 360
video or a
computer-animated space using a headset. Moreover, it enables rendering the perceived
scene in 3D as both eyes are provided separate screens. As such, VR allows for high levels
of perceived realism and immersion during media reception [14,41].
In the context of mental disorders, VR has been primarily studied in the context of
cognitive behavioral therapy for inducing attitudinal and behavioral change in patients
with mental disorders, for example, by exposing them to virtual situations that elicited
their fears, such as public speaking or spiders [
]. With regards to destigmatization,
first research indicates that first-hand experiences of the perceptions of an affected person
J. Clin. Med. 2021,10, 2961 3 of 11
(e.g., psychotic symptoms such as hearing noises) in a simulated VR environment can
increase empathy and positive attitudes towards persons with schizophrenia—at least
when the intervention is accompanied with additional empathy-inducing information [
Outside the realm of mental disorders, VR was also used to induce empathy by taking
virtual first-person perspectives of racialized minorities [
], women experiencing partner
violence [45], and elderly help-seeking people [46].
Empirical studies that assess the effects of contact with an out-group member in VR
are scarce [
]—and with regards to mental disorder such as schizophrenia, to the best of
our knowledge, non-existent. This is a serious shortcoming, since exposure in VR—defined
here as one-sided exposure to an affected person—should combine the advantages of
direct contact with those of mediated contact. VR should offer levels of sensual richness
and involvement—two core dimensions used to categorize different forms of intergroup
contact [
]—that are much higher than in other forms of media exposure, even if they lack
the interactive quality of direct contact [
]. At the same time, VR contact should not be
burdened by the anxiety that is often evoked by face-to-face contact and spares affected
people negative experiences, since their physical presence is not required. We therefore ask
the following explorative research question:
To what extent can contact with a person with schizophrenia through VR reduce stigma
associated with the mental disorder in comparison to no contact at all and a regular video?
2. Materials and Methods
We employed a 2 + 1 experimental design with two experimental groups that watched
either a VR video or a regular video and a control group.
2.1. Stimulus Material
We recorded a video of an actor portraying a young man with schizophrenia using a
-3D camera with multiple lenses (Insta360 Pro). As we expected our participants to be
fairly young, we chose a young actor to increase the likelihood that recipients relate and
identify with him due to their age. In line with this, we chose a male actor since males are
usually diagnosed with schizophrenia at a younger age compared to females [
]. Sitting
on a bench outdoors, the young man spoke of his life with the schizophrenic disorder. In his
monologue, he recounted the appearance of first symptoms and his medical history, gave
an account of his daily routines, and explained how his loved ones were trying to cope with
the situation. Although fictitious, the monologue merged various real-life histories and
applied principles of narrative medicine [
] in order to make the person more relatable
and to allow for an empathetic response.
We rendered two videos from the recording. The first video was a 360
-3D video
that could be watched on a VR device. The option to freely look around the scene and the
perception of depth and distance ought to ensure maximum involvement and engagement
in the scene. The second video was a regular video with a fixed perspective, centering on
the actor. Apart from the rendering modes, the videos were identical.
2.2. Participants
Assuming a small effect size,
= 0.15 [
] and allowing for
errors of 0.05 each,
a priori power analysis suggested a desirable sample size of 120 participants. We recruited
114 participants (n
= 31, n
= 45, n
= 38) via advertisements at a German public
university in June 2019. The mean age was M= 24 years (SD = 6.6 years), 58% of participants
were female and 63% had a high-school diploma. These demographics suggest that our
pool of participants consisted of majority, but not solely, students.
2.3. Procedure
After arriving at the laboratory, participants were seated in front of a laptop and
randomly assigned to one of the three groups. They were informed about the study
procedure and their right to stop participation anytime. All participants were informed
J. Clin. Med. 2021,10, 2961 4 of 11
that they were about to answer questions regarding their perceptions of persons with
schizophrenia. Participants in the VR group and in the regular video group were addi-
tionally informed that they were about to watch a video of a person who suffered from
schizophrenia talking about their experiences, and—in the case of the VR video—that this
may cause slight dizziness.
In the VR group, the assistant then revealed the VR headset (Zeiss VR One with
aSamsung Galaxy S8) that was hidden in a drawer and helped the respondent mount
it. Participants were then given about 90 seconds to become acquainted with the virtual
surroundings. The assistant then started the video on the phone. In the regular video group,
the assistant started the video on the laptop. In the control group, no video was shown.
All participants then filled out a questionnaire on the laptop. At the end, participants
were comprehensibly debriefed and handed over a fact sheet about schizophrenia. For the
debriefing document, see the online supplementary material (OSM) .
2.4. Measures
Since scholars have not agreed upon one unified measure of stigmatization, we used
four related constructs as outcome variables: anxiety, social proximity, empathy, and
benevolence. Knowing that intergroup contact is a powerful instrument for altering out-
group attitudes [
], we controlled for past exposure to people with schizophrenia (i.e.,
quantity of prior out-group contact). In addition, we controlled for two qualities of the
reception experience that are crucial in the context of contact, especially in VR settings: the
perceived attraction of the encountered person (i.e., evaluation of the out-group member)
and the immersion in the contact situation (i.e., feeling of spatial presence). Finally, we
controlled for gender and age as core demographic indicators.
We assessed all measures but contact frequency with a Likert-type scale ranging
from 1 (do not agree at all) to 7 (totally agree). Where applicable, we applied Confirmatory
Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) for uncovering underlying
dimensions within the scales. For all items and the analysis code, see the OSM.
2.4.1. Anxiety
We measured how anxious a participant would feel meeting a person with schizophre-
nia using items from intergroup anxiety scales [
]. Items included, for example, feeling
“nervous” or “alarmed”. The one-dimensional measure consisted of four items (ω= 0.85).
2.4.2. Social Proximity
We measured social proximity to persons with schizophrenia by inverting a scale
previously used by Angermeyer and Matschinger
and Röhm
. Items included, for
example, “I would accept a schizophrenic person as a coworker”. The one-dimensional
measure contained six items (ω= 0.86).
2.4.3. Empathy
We measured empathy toward persons with schizophrenia using an indicator devel-
oped by Kinnebrock et al.
and used by Röhm
. The scale included items such as
“People underestimate the emotional burden caused by schizophrenia”. Since multiple EFA
did not lead to a satisfactory solution, we used the two highest-correlated items (r= 0.53)
and created a mean index (M= 5.54, SD = 1.06).
2.4.4. Benevolence
We measured benevolence toward persons with schizophrenia with the benevolence
dimension of the Community-Attitudes-Toward-the-Mentally-Ill Inventory (CAMI), trans-
lated to German by Angermeyer et al.
. We replaced the phrase “mentally ill” with
“persons with schizophrenia”. Items included, for example: “As a society, we need to adopt
a much more tolerant attitude towards persons with schizophrenia.” Since multiple EFA
J. Clin. Med. 2021,10, 2961 5 of 11
did not lead to a satisfactory solution, we used the two highest-correlated items (r= 0.48)
and created a mean index (M= 6.14, SD = 0.99).
2.4.5. Contact
We asked how much contact participants have had with persons with schizophrenia
within their “family, circle of friends or acquaintances within the past five years” on a scale
ranging from 0 (not at all)to5(a lot).
2.4.6. Spatial Presence
We measured feelings of spatial presence within the VR/regular video with the Spatial
Presence sub-scale from the MEC Spatial Presence Questionnaire [
]. It includes items
such as “I felt like I was actually there in the environment of the presentation”. The
one-dimensional measure included four items (ω= 0.93).
2.4.7. Evaluation
We measured the valence of participants’ evaluation of the person in the VR/regular
video with items from the General Evaluation Scale [
] and the intergroup anxiety
scale [
]. Attributes included, e.g., “likeable” or “natural”. The one-dimensional measure
contained four items (ω= 0.81).
2.5. Statistical Analysis
For data cleansing and analysis, we used R (Version 4.0.3; [
]) and the R-packages
lavaan (Version 0.6.8; [
]), and tidyverse (Version 1.3.1; [
]). Additional information, the
data, the analysis scripts, and a completely reproducible version of this manuscript can be
found in the OSM.
We ran various Structural Equation Models (SEM) to cover comparisons between our
experimental groups. We always used anxiety, social proximity, empathy, and benevolence
as outcome variables and controlled for the quantity of prior out-group contact, gender,
and age. For the comparison between the VR and regular video groups, we additionally
controlled for evaluation of the encountered group member and spatial presence during
reception. We focus on both statistical significance and effect sizes/directions and report
significance at p< 0.05.
3. Results
See Table 1for the results.
In Model 1, we compared the VR group with the control group and found that contact
in VR did not decrease stigmatization in comparison to not having any exposure at all
(RMSEA = 0.070, CFI = 0.921). None of the effects were significant, and in terms of mere
effect sizes, the VR video group showed more social proximity than the control group, but
also marginally more anxiety and marginally less empathy and benevolence.
In Model 2, we compared the VR group with the regular video group (RMSEA = 0.049,
CFI = 0.943). In this comparison, VR contact actually increased stigmatization. The VR
group showed significantly more anxiety, significantly less social proximity and empathy,
and less benevolence judging by the effect only. Contrasting VR with regular video contact
allowed us to account for context variables surrounding the reception experience. The
evaluation of the group member emerged as a crucial predictor: a more positive evaluation
of the encountered person significantly decreased anxiety and significantly increased social
proximity and benevolence, as well as empathy, judging by the effect only. Moreover, we
found that spatial presence during reception marginally decreased anxiety and increased
social proximity, empathy and benevolence—although only the effect on benevolence
was significant.
In Model 3, we compared the regular video group with the control group (
RMSEA = 0.082,
CFI = 0.873). In comparison to no exposure, the regular video decreased anxiety, increased
J. Clin. Med. 2021,10, 2961 6 of 11
empathy, social proximity, and marginally benevolence—although only the effect for social
proximity reached statistical significance.
Table 1.
SEM results for group difference, spatial presence, evaluation, contact, female gender, and age predicting anxiety,
social proximity, empathy, and benevolence.
Proximity Empathy Benevolence
Model 1 (VR vs. Control) (n= 60)
VR 0.009 0.943 0.133 0.281 0.144 0.234 0.038 0.750
Contact 0.426 0.000 0.365 0.003 0.235 0.048 0.214 0.023
Female 0.020 0.867 0.051 0.691 0.056 0.640 0.060 0.608
Age 0.166 0.131 0.405 0.000 0.050 0.739 0.373 0.000
Model 2 (VR vs. Regular video) (n= 69)
VR 0.508 0.032 0.506 0.039 0.507 0.046 0.328 0.196
Spatial presence 0.052 0.679 0.214 0.097 0.101 0.437 0.247 0.046
Evaluation 0.323 0.004 0.472 0.000 0.254 0.069 0.363 0.003
Contact 0.397 0.000 0.378 0.001 0.084 0.493 0.242 0.003
Female 0.080 0.482 0.032 0.756 0.003 0.981 0.118 0.232
Age 0.048 0.547 0.200 0.023 0.120 0.124 0.138 0.403
Model 3 (Regular video vs. Control) (n= 74)
Regular video 0.175 0.157 0.311 0.020 0.098 0.425 0.005 0.967
Contact 0.302 0.009 0.271 0.020 0.199 0.101 0.045 0.650
Female 0.014 0.904 0.029 0.794 0.113 0.310 0.024 0.833
Age 0.057 0.507 0.291 0.011 0.039 0.718 0.146 0.400
Model 4 (VR vs. Control, high evaluation) (n= 54)
VR 0.115 0.425 0.414 0.002 0.029 0.818 0.223 0.071
Contact 0.402 0.008 0.298 0.028 0.284 0.052 0.116 0.319
Female 0.016 0.907 0.084 0.549 0.180 0.182 0.243 0.054
Age 0.121 0.276 0.467 0.000 0.001 0.994 0.325 0.001
Note: Robust ML estimation, standardized coefficients
To corroborate the impression from Model 2, we re-ran the comparison between the
VR group and the control group just for participants who evaluated the group member
in the video in a positive way, i.e., who scored higher than the median value, in Model 4
(RMSEA = 0.102, CFI = 0.821). As a result, the effect of the VR video changed directions.
VR exposure significantly increased social proximity and—although not significantly—also
increased benevolence and decreased anxiety.
Finally, it is notable that more prior direct contact decreased stigmatization constantly
and mostly significantly in all models. Although gender had no significant effect, older
participants usually showed higher levels of stigmatization.
4. Discussion
This study aimed for contributing to the growing literature on destigmatization
of mental disorders via contact interventions by testing the potential of VR technology.
Specifically, we investigated whether intergroup contact with a person with schizophrenia
through VR technology can decrease stigmatization towards people with schizophrenia.
Our study revealed that contact through VR is not a magic bullet for reducing stigma-
tization in the context of mental disorders. Encountering a person talking about their life
with schizophrenia in VR did not significantly decrease stigmatization. Judging by effect di-
rection only, contact via VR may even have negative effects and perpetuate existing stigma.
In comparison to watching the regular video, VR contact was associated with significantly
more stigmatization in three out of four outcomes. At the same time, participants who
J. Clin. Med. 2021,10, 2961 7 of 11
watched the regular video showed slightly less stigma than the control group. At first
glance, the negative effects of the VR video intervention are counter-intuitive, since the
sensual richness and personal involvement of VR promised to make it an effective form of
intergroup contact [
]. However, considering the effects of our covariates, we can offer a
first explanation for this finding.
In our study, evaluation of the encountered group member emerged as the most impor-
tant factor for a successful destigmatization via VR. A positive evaluation was negatively
associated with all indicators of stigmatization, regardless of the type of video. Moreover,
contact in VR did decrease stigmatization among respondents who evaluated our actor in
a positive way. It is therefore essential to establish in advance that the encountered person
appears likeable to the target audience . This may be particularly important for mental
disorders such as schizophrenia that are stereotypically associated with threat [19,20].
The evaluation of the encountered person was important in VR, but not in the regular
video which decreased stigmatization independently of it. Subjects were likely over-
whelmed by the VR experience and therefore processed the video in a peripheral, heuristic
manner [
]. Among participants in the VR condition, none were routine users of the tech-
nology; the majority had rarely tried it and one third reported they had never used it before.
For inexperienced users, the location shift and 3D perspective in a virtual environment
can be a strong sensual experience [
] — many participants in the VR group may have
been primarily concerned with adjusting to it. This probably led to restricted cognitive
capacity and paying attention specifically to information in the actor’s monologue that
was congruent with existing stereotypes and judging the actor by heuristic cues such as
attraction [
]. Moreover, participants may have felt as if they had no control or agency
in the contact situation: the setting was a 360
-3D video in which they could not adjust
location [
] and had to dismount the headset in order to interrupt the encounter. In such a
situation, the level of comfort likely depends more strongly on the likeability of the person
encountered. Appropriately, participants who felt higher spatial presence showed slightly
less stigma.
Based on our findings, future researchers do not only need to choose a likeable person
for VR contact, but simultaneously ensure high levels of immersion without making the
experience overwhelming, which is in line with previous research [
]. Several solutions
might be feasible. First, participants should be offered even more time to become used to
the VR condition, e.g., by showing them one or two unrelated videos in the beginning, and
therefore allowing them to later focus on the encounter itself rather than adjusting to the
situation [
]. Second, once likeable actors are identified, VR-based destigmatization
campaigns could repeatedly expose participants to them. Not only could participants grow
even more familiar with the technology such as this, but repeated, positive intergroup con-
tact such as friendships are known to be more effective than superficial once-off
contact [66]
Familiarity-based liking and decreased (anticipated) anxiety could work particularly well
for a group that is conceived as unpredictable. Third, recipients can be part of an immersive
setting, yet not actively involved, if the VR video presents a situation of so-called vicarious
contact [
], meaning that participants are exposed to an interaction between an out-group
and an in-group member rather than directly to the out-group member. Finally, health care
professionals—who represent trustworthy sources of health information [
]—could be
integrated in the contact setting to moderate, comment and contextualize the narrative
medical history.
Altogether, we only expect positive effects from VR encounters if the contact situation
is carefully calibrated. The assumed advantages of VR over other forms of mediated
contact may turn out to be disadvantages otherwise. Future research should investigate
the suggestions introduced above. While it was not in the focus of this article, our results
indicate the importance of direct intergroup contact as a means for reducing stigmatization,
as the mere quantity of prior contact was constantly associated with less stigmatization.
J. Clin. Med. 2021,10, 2961 8 of 11
5. Limitations
Our study is a first exploration of the potential of VR contact for reducing stigmatiza-
tion against persons with schizophrenia. As an explorative study, it is limited regarding
four ways. First, using a sample that predominantly consists of students can have advan-
tages for exploratory studies with limited sample size, since age and education are rather
homogeneous. However, a more heterogeneous sample would yield more generalizable
effects [
]. Second, different mental disorders are associated with different types of stigma.
VR interventions might be more effective in the context of mental disorders that are less
associated with threat, such as major depressive disorder or eating disorders [
Third, while we found several consistent effect patterns among our outcome variables,
some of the effects were not statistically significant. We already used a small expected
effect size (
= 0.15) in power analysis, so future researchers should use an even smaller
one. Finally, we presented participants with a natural setting in which they could not
engage in a real conversation with the encountered person, but rather in a para-social
form of contact [
]. Since prior studies demonstrated the effectiveness of interactive
computer-mediated contact [
], future studies should explore fully animated VR settings
that allow for interactions—although these may lack in realism and credibility.
6. Conclusions
In contrast to our expectations, contact through VR did not reduce stigmatization as
compared to no contact and led to more negative attitudes as compared to contact through
a regular video in our study. This effect shifted once we only considered individuals
who evaluated the encountered group member positively. Our findings offer first insights
into the conditions of successful destigmatization through contact in VR—namely how
it could be optimized to maximize positive effects and minimize undesirable outcomes.
We hope this study instills a greater engagement with the potential of new technologies
for generating pro-social attitudes towards people with mental disorders in general and
people with schizophrenia in particular and thus contributes to a better quality of life for
those affected.
Author Contributions:
Conceptualization, D.S. (Daniela Stelzmann), R.T. and D.S. (David Schiefer-
decker); Methodology, D.S. (Daniela Stelzmann), R.T. and D.S. (David Schieferdecker); Software,
R.T.; Analysis, R.T.; Writing—Original Draft Preparation, D.S. (Daniela Stelzmann), R.T. and D.S.
(David Schieferdecker); Writing—Review and Editing, D.S. (Daniela Stelzmann), R.T. and D.S. (David
Schieferdecker); All authors have read and agreed to the published version of the manuscript.
Funding: The publication of this article was funded by Freie Universität Berlin.
Institutional Review Board Statement:
This social science study was conducted according to the
norms of the Code of Ethics of the World Medical Association [
]. As is common in social science
studies, the ethical evaluation of the study was conducted within the department. Since no concerns
were expressed about the study and no patients were involved, an external ethical review was waived
for this study. Nevertheless, during recruitment, potential participants were informed about the
content of the study to assure that at the start of the experiment, all participants were fully aware
that mental disorders were addressed. All information acquired was anonymous.
Informed Consent Statement:
Written informed consent was obtained from all subjects involved in
the study.
Data Availability Statement:
All data and code to reproduce the analysis is available at https:
//, accessed 29 June 2021.
Conflicts of Interest: The authors declare no conflict of interest.
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... The number of participants ranged from 16 to 579 in each group and included undergraduates (11 of 16 studies, 68.8%), high school students, patients, caregivers and the public, including online community. Four studies were randomized controlled trials [36,[41][42][43]. Ten studies adopted quasi-experimental design. ...
... Some interventions (4 of 16 studies, 25%) also allowed the participants to experience perceptual or sensory disturbances such as auditory hallucinations [35,[46][47][48]. The other interventions (2 of 16 studies, 13%) allowed participants to view scenarios of characters suffering from mental illnesses [42,45]. Please see Appendix A for Cochrane's risk of bias rating for each study. ...
... Seven studies examined stigma towards people with dementia [50], psychotic illnesses [41,42,46], mixed anxiety and depression [43] or a range of mental illnesses [36,49]. Most studies (five out of seven studies) found reduction of stigma for both within [36,50] and between group comparisons [36,41,43] while two studies did not [42,46]. ...
Full-text available
Interventions adopting augmented and virtual reality (AR/VR) modalities allow participants to explore and experience realistic scenarios, making them useful psycho-educational tools for mental illnesses. This scoping review aims to evaluate the effectiveness of AR/VR interventions in improving (1) knowledge, (2) attitudes, (3) empathy and (4) stigma regarding people with mental illnesses. Literature on published studies in English up till April 2022 was searched within several databases. Sixteen articles were included. The majority of studies were conducted in the West (93.8%), within undergraduates (68.8%) but also amongst high school students, patients, caregivers, public including online community, and covered conditions including psychotic illnesses, dementia, anxiety and depression. A preponderance of these included studies which employed AR/VR based interventions observed improvements in knowledge (66.7%), attitudes (62.5%), empathy (100%) and reduction of stigma (71.4%) pertaining to people with mental illnesses. In the context of relatively limited studies, extant AR/VR based interventions could potentially improve knowledge, attitudes, empathy and decrease stigma regarding people with mental illness. Further research needs to be conducted in larger and more diverse samples to investigate the relatively beneficial effects of different AR/VR modalities and the durability of observed improvements of relevant outcomes of interests over time for different mental conditions.
... The same controversy appears when looking at the intervention studies carried out from a majority perspective, which mostly show a solid persistence of prejudice towards stigmatised minorities [51,55,[61][62][63][64][65][66][67][68][69] Two recent studies [70,71] even report increased prejudice towards the contacted outgroup using explicit measures. ...
... Interestingly, while de Silva et al. [91] show increased empathy towards schizophrenic patients following an augmented reality experience, Kalyanaraman et al. [84] suggest that such embodied experience may lead to a desire for keeping a greater distance towards them. Stelzmann et al. [70] also find stronger stigmatisation of people with schizophrenia after facing an outgroup member in a 3D video. Hadjipanayi and Michel-Grigoriou [83] reach similar conclusions following embodiment in people with Asperger syndrome. ...
... By contrast, sixteen studies enacting bias-reducing interventions exclusively used explicit measures. A considerable number of them found a decrease in prejudice following embodiment in an outgroup member [52,53,[76][77][78]80,92]. Two studies by Peña et al. [71] and Steltzmann et al. [70] conversely found increased levels of prejudice after engaging in virtual intergroup contact with an outgroup member, and Hadjipanayi and Michel-Grigoriou [83] and Kalyanaraman et al. [84] obtain similar results through embodiment of an outgroup member. ...
Full-text available
This systematic review provides an up-to-date analysis of existing literature about Virtual Reality (VR) and prejudice. How has VR been used in studying intergroup attitudes, bias and prejudice, are VR interventions effective at reducing prejudice, and what methodological advantages and limitations does VR provide compared to traditional methods are the questions we aim to answer. The included studies had to use VR to create an interaction with one or more avatars belonging to an outgroup, and/or embodiment in an outgroup member; furthermore, they had to be quantitative and peer-reviewed. The review of the 64 included studies shows the potential of VR contact to improve intergroup relations. Nevertheless, the results suggest that under certain circumstances VR contact can increase prejudice as well. We discuss these results in relation to the intergroup perspective (i.e., minority or majority) and target minority groups used in the studies. An analysis of potential mediators and moderators is also carried out. We then identify and address the most pressing theoretical and methodological issues concerning VR as a method to reduce prejudice.
... 19 Additionally, research in psychology has shown that "one approach to reducing stigmatization is to establish meaningful encounters between those who are affected by a mental disorder and those who are not". 20 Currently, there is a lack of experimental research in the realm of VR and mental illness stigma; however, preliminary research has been conducted and suggests that virtual environments can serve as effective proxies in battling implicit stereotypes. 21 Novel research in Europe has been performed to discover whether destigmatization of mental disorders, specifically, schizophrenia, could be enhanced through intergroup contact using VR. ...
... 21 Novel research in Europe has been performed to discover whether destigmatization of mental disorders, specifically, schizophrenia, could be enhanced through intergroup contact using VR. 20 Successful destigmatization was seen in a few conditions such as when "the encountered person appears likeable to the target audience". 20 Additionally, it was imperative that the contact was not "superficial once-off contact" 20 and that "repeated, positive intergroup contact such as friendships" 20 were stimulated, in order to decrease measures of stigmatization after the interaction. ...
... 20 Successful destigmatization was seen in a few conditions such as when "the encountered person appears likeable to the target audience". 20 Additionally, it was imperative that the contact was not "superficial once-off contact" 20 and that "repeated, positive intergroup contact such as friendships" 20 were stimulated, in order to decrease measures of stigmatization after the interaction. Ample research has shown that contact is an important strategy to decrease stereotypes and mental health stigma. ...
Full-text available
The objective of the following systematic literature review was to analyze the current stigma surrounding schizophrenia in North America, its implications, as well as to suggest potential interventions. The current societal climate reveals that many individuals lack an understanding of the etiology and symptoms of schizophrenia, leading to a general negative bias towards individuals with this disease. Additionally, many misperceptions such as enhanced violent tendencies surround patients with schizophrenia, exacerbating negative bias and actions such as avoidance. Suggestions to minimize stigma and its effects were made and include the renaming of schizophrenia, the use of virtual reality programs, the refinement of education programs, and an overall switch in how the media presents schizophrenia.
... VR has also increasingly been used in the field of mental health [24,25] to reduce anxiety, such as interaction with a virtual spider to help treat arachnophobia (fear of spiders) [26] and interaction with virtual humans to treat social anxiety disorder [27]. In addition, VR has been used to reduce the public stigma of schizophrenia [28][29][30]. ...
... None of the comments from the participants indicated a reduction in anxiety. A prior study using VR to reduce the stigma of schizophrenia showed a reduction in stigma only for participants who liked the person encountered, suggesting that a more positive evaluation of the virtual patient may lead to a reduction in anxiety [28]. However, because schizophrenia and depression have different symptoms, we did not measure the anxiety level of the participants. ...
Full-text available
Background: Public stigma against depression contributes to low employment rates among individuals with depression. Contact-based educational (CBE) interventions have been shown to reduce this public stigma. Objective: We investigated the ability of our Virtual Reality Antistigma (VRAS) app developed for CBE interventions to reduce the stigma of depression. Methods: Sixteen medical students were recruited and randomized 1:1 to the intervention group, who used the VRAS app (VRAS group), and the control group, who watched a video on depression. The depression stigma score was assessed using the Depression Stigma Scale (DSS) and Attitudinal Social Distance (ASD) questionnaire at pre- and postintervention. Feasibility was assessed in both groups and usability was assessed only in the VRAS group after the intervention. A qualitative study was performed on the acquisition of knowledge about stigma in both groups based on participants' answers to open-ended questions and interviews after the intervention. Results: The feasibility score was significantly higher in the VRAS group (mean 5.63, SD 0.74) than in the control group (mean 3.88, SD 1.73; P=.03). However, no significant differences were apparent between the VRAS and control groups for the DSS (VRAS: mean 35.13, SD 5.30; control: mean 35.38, SD 4.50; P=.92) or ASD (VRAS: mean 12.25, SD 3.33; control: mean 11.25, SD 1.91; P=.92). Stigma scores tended to decrease; however, the stigma-reducing effects of the VRAS app were not significant for the DSS (pre: mean 33.00, SD 4.44; post: mean 35.13, SD 5.30; P=.12) or ASD (pre: mean 13.25, SD 3.92; post: mean 12.25, SD 3.33; P=.12). Qualitative analysis suggested that the VRAS app facilitated perspective-taking and promoted empathy toward the patient. Conclusions: The CBE intervention using virtual reality technology (VRAS app) was as effective as the video intervention. The results of the qualitative study suggested that the virtual reality intervention was able to promote perspective-taking and empathy toward patients. Trial registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000043020;
... Few empirical studies have assessed the empathetic responses created by the exposure to an immersive (VR or 360-degree video) storytelling experience in comparison with other non-immersive media (normal 2D video or images). And none of these studies found significant positive results concerning the capabilities of VR to foster long-term empathy (Archer and Finger, 2018;Farmer, 2019;Stelzmann et al., 2021). It remains then unclear whether immersion experiences foster an empathic appreciation of the other. ...
Full-text available
This article looks through a critical media lens at mediated effects and ethical concerns of virtual reality (VR) applications that explore personal and social issues through embodiment and storytelling. In recent years, the press, immersive media practitioners and researchers have promoted the potential of virtual reality storytelling to foster empathy. This research offers an interdisciplinary narrative review, with an evidence-based approach to challenge the assumptions that VR films elicit empathy in the participant—what I refer to as the VR-empathy model. A review of literature from the fields of psychology, computer science, embodiment, medicine, and virtual reality was carried out to question and counter these claims through case studies of both fiction and non-fiction VR experiences. The results reveal that there is little empirical evidence of a correlation between VR exposure and an increase in empathy that motivates pro-social behavior, and a lack of research covering VR films exposure eliciting empathy. Furthermore, the results show an alarming lack of research into the long-term effects of VR films and other VR immersive experiences. This contribution aims to understand and demystify the current “empathy machine” rhetoric and calls for more rigorous, scientific research that can authenticate future claims and systemize ethical best practices.
... Ce type de contact virtuel a pu ainsi permettre de réduire la stigmatisation à l'égard de personnes vivant avec une schizophrénie, rencontrées par ce biais. 16 Néanmoins, Adu et coll. 7 soulignent que, pour que ces interventions directes ou médiatisées soient réellement efficaces dans la réduction de la stigmatisation de la maladie mentale, il faut qu'elles soient soutenues par une large adhésion sociale, impliquant non seulement l'enga gement des établissements liés à la santé, mais aussi des médias et des politiques publiques. ...
Full-text available
Stigmatization and self-stigmatization of people suffering from mental disorders have been denounced for several years, however they still impact treatment and identity construction. Education, social sharing, and institutional engagement are interventions that challenge public stigma. Interventions based on individual or group therapies that oppose self-stigma proved effective. Questions regarding the effects of media coverage or the intersectionality of stigmatized identities remain open. In this article, we made a summary of the current situation based on recent literature.
... Therefore, it seems essential for medical experts to proactively support journalists in addressing pedophilia and to ensure fact-based media coverage [42,120]. Previous scholars have suggested the use of low threshold offers such as fact boxes, guidelines [14,120] or (digital) contacted-based interventions [121][122][123] as a means to reach out to journalists as well as society. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. ...
Full-text available
The public stigma associated with pedophilia, the sexual attraction to prepubescent children, is tremendous. Previous research indicates that undifferentiated media coverage plays an essential role in perpetuating the public stigma by falsely equating pedophilia and child sexual abuse (CSA) and thus may stop persons suffering from a pedophilic disorder from seeking professional help. Until now, a comprehensive examination of positive as well as negative media effects on affected individuals is missing. Therefore, the present study explores if and how media coverage impacts the lives of help-seeking persons with pedophilia by conducting four qualitative focus group discussions with a clinical sample (N = 20) from the German Prevention Network “Kein Täter werden”. Present results demonstrate that media coverage of pedophilia was perceived as mostly undifferentiated, even though participants observed an increase in fact-based reporting over the years. Moreover, it seems that media coverage has strong emotional and behavioral consequences for patients (e.g., negative reporting reduced self-esteem). In sum, our results highlight that differentiated media coverage could play a key role in supporting help-seeking persons with pedophilic disorder, while the impact of undifferentiated media coverage appears to be mostly negative. Therefore, our results point to the need to reframe pedophilia using differentiated media coverage to help affected persons receive treatment efficiently and thereby prevent CSA.
... In addition, as 2 of the studies [32,33] reported their results through standardized regression, the β coefficients were entered into the comprehensive meta-analysis software (CMA) as correlation coefficient, according to the recommendations of Peterson and Brown [34]. ...
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Background: Stigma toward people with mental illness presents serious consequences for the impacted individuals, such as social exclusion and increased difficulties in the recovery process. Recently, several interventions have been developed to mitigate public stigma, based on the use of innovative technologies, such as virtual reality and video games. Objective: This review aims to systematically review, synthesize, measure, and critically discuss experimental studies that measure the effect of technological interventions on stigmatization levels. Methods: This systematic review and meta-analysis was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and included studies in English and Spanish published between 2016 and 2021. Searches were run in 5 different databases (ie, PubMed, PsycInfo, Scopus, Cochrane Library, and ScienceDirect). Only randomized controlled trials were included. Two independent reviewers determined the eligibility, extracted data, and rated methodological quality of the studies. Meta-analyses were performed using the Comprehensive Meta-Analysis software. Results: Based on the 1158 articles screened, 72 articles were evaluated as full text, of which 9 were included in the qualitative and quantitative syntheses. A diversity of interventions was observed, including video games, audiovisual simulation of hallucinations, virtual reality, and electronic contact with mental health services users. The meta-analysis (n=1832 participants) demonstrated that these interventions had a consistent medium effect on reducing the level of public stigma (d=–0.64; 95% CI 0.31-0.96; P<.001). Conclusions: Innovative interventions involving the use of technologies are an effective tool in stigma reduction, therefore new challenges are proposed and discussed for the demonstration of their adaptability to different contexts and countries, thus leading to their massification. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021261935;
360°-(3D-)Video-Projekte haben häufig einen anwendungsbezogenen Charakter, der es Nutzer*innen ermöglicht, auf einfache Art und Weise in eine aufgezeichnete, reale Umgebung einzutauchen. Durch die sinkenden Kosten dieser Technologie wird ihr Einsatz auch im universitären Kontext immer attraktiver – sowohl in der Forschung als auch in der Lehre. Über die Frage, wie sinnvoll die Implementierung dieser Technologie in forschungsorientierte Lehrprojekte ist, ist gegenwärtig allerdings noch wenig bekannt. Aus diesem Grund illustriert der vorliegende Beitrag anhand eines Fallbeispiels, wie sich 360°-(3D-)Videos in Lehrprojekten umsetzen lassen. Konkret basieren die beschriebenen Erfahrungen auf einem forschungsorientierten Lehrprojekt zum Thema „Psychische Störungen und mediale Stigmatisierung“, welches die Autor*innen im Jahr 2019 durchgeführt haben. Nachdem die Autor*innen ihre Motivation für das forschungsorientierte Lehrprojekt beschreiben, gehen sie detailliert auf dessen Umsetzung ein und leiten anhand dieses Fallbeispiels praktische Implikationen ab, die für zukünftige forschungsorientierte Lehrprojekte mit 360°-(3D-)Videos von Nutzen sein können. Insgesamt zeigt der Beitrag, dass auch in Kontexten, in denen keine umfassende technische Ausstattung vorhanden ist und finanzielle Mittel begrenzt sind, 360°(-3D-)Videos in forschungsorientierten Lehrprojekten erfolgreich eingesetzt werden können. Die Durchführung solcher Projekte ist jedoch noch immer mit einem verhältnismäßig hohen Aufwand verbunden.
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Background Understanding patients’ trust in health information sources is critical to designing work systems in healthcare. Patient-centered communication during the visit might be a major factor in shaping patients’ trust in information sources. Objective The purpose of this paper is to explore relationships between patient ratings of clinician communication during the visit and patient trust in health information sources. Methodology We conducted a secondary analysis of the nationally-representative Health Information National Trends Surveys; HINTS4 Cycle1 (2011), HINTS4 Cycle4 (2014), and HINTS5 Cycle1 (2017), and HINTS5 Cycle2 (2018). We created a composite score of patient-centered communication from five questions and dichotomized at the median. We created multivariable logistic regression models to see how patient-centered communication influenced trust in different information sources across cycles. Consecutively, we used hierarchical analysis for aggregated data. Results We analyzed data from 14,425 individuals. In the adjusted logistic models for each cycle and the hierarchical model, clinicians’ perceived patient-centered communication skills were significantly associated with increased trust in the clinicians as an information source. Conclusion Clinicians still represent an essential source of trustworthy information reinforced by patient-centered communication skills. Given that trust helps build healing relationships that lead to better healthcare outcomes, communication sets an essential foundation to establish necessary trust. Interpreting information from the internet sources for patients is likely to remain a vital clinician function.
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The fierce stigma associated with pedophilia may interfere with attempts to prevent sexual offending. Prior research on the effects of media reports about pedophilia mostly focused on their role in perpetuating stigma in the general population. In order to better understand potential benefits and risks of the media coverage on people with pedophilia and specialized prevention and treatment efforts, we conducted semi-structured qualitative interviews with 11 healthcare practitioners of the German Prevention Network “Don’t offend”. Healthcare practitioners described positive (e.g., raising awareness for prevention offers) as well as negative (e.g., perpetuating the existing public stigma) effects of the media coverage and estimated that only about one-third of media coverage portrays pedophilia realistically. To destigmatize pedophilia and benefit the prevention of child sexual abuse, a fact box for journalists was developed based on practitioners’ expert knowledge.
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As a result of persisting stigma, transgender people experience vastly higher rates of harassment, violence, and mental health issues compared to cisgender people. The current study experimentally evaluated a computer-mediated intergroup contact strategy, called E-contact, to reduce transgender stigma. E-contact is a synchronous, cooperative, goal-directed online interaction which is informed by Allport’s intergroup contact theory. In total, 114 cisgender, heterosexual, Australian undergraduates and community members (83 women, 31 men) were randomly allocated to E-contact with an online confederate who either disclosed that they were a transgender woman or a cisgender woman. Following the online interaction, participants then completed measures assessing prior transgender contact and transgender stigma. The findings revealed that transgender E-contact reduced stigma for cisgender men whereas it had no impact on women’s already lower levels of stigma. These novel findings have important implications for researchers, policymakers and counsellors interested in developing transgender stigma reduction interventions by (a) highlighting the importance of transgender contact for those individuals with low or poor prior contact and (b) targeting prejudice-prone populations, such as men, who stand to gain the most from such cooperative, goal-directed interventions.
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Immersive virtual reality is widely used for research and clinical purposes. Here we explored the impact of an immersive virtual scene of intimate partner violence experienced from the victim's perspective (first person), as opposed to witnessing it as an observer (third person). We are ultimately interested in the potential of this approach to rehabilitate batterers and in understanding the mechanisms underlying this process. For this, non-offender men experienced the scene either from the perspective of the victim's virtual body (a female avatar), which moved synchronously with the participants' real movements, or from the perspective of an observer, while we recorded their behavior and physiological responses. We also evaluated through questionnaires, interviews and implicit association tests their subjective impressions and potential pre/post changes in implicit gender bias following the experience. We found that in all participants, regardless of perspective, the magnitude of the physiological reactions to virtual threatening stimuli was related to how vulnerable they felt for being a woman, the sensation that they could be assaulted, how useful the scene could be for batterer rehabilitation, and how different it would have been to experience the scenario on TV. Furthermore, we found that their level of identification with the female avatar correlated with the decrease in prejudice against women. Although the first-person perspective (1PP) facilitated taking the scene personally, generated a sensation of fear, helplessness, and vulnerability, and tended to induce greater behavioral and physiological reactions, we show that the potential for batterer rehabilitation originates from presence and identification with the victim, which in turn is more easily, but not exclusively, achieved through 1PP. This study is relevant for the development of advanced virtual reality tools for clinical purposes.
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Objective: The project adopted technology that teaches medical and other health professions students to be empathetic with older adults, through virtual reality (VR) software that allows them to simulate being a patient with age-related diseases, and to familiarize medical students with information resources related to the health of older adults. Methods: The project uses an application that creates immersive VR experiences for training of the workforce for aging services. Users experience age-related conditions such as macular degeneration and high-frequency hearing loss from the patient's perspective. Librarians and faculty partner to integrate the experience into the curriculum, and students go to the library at their convenience to do the VR assignment. Results: The project successfully introduced an innovative new teaching modality to the medical, physician assistant, physical therapy, and nursing curricula. Results show that VR enhanced students' understanding of age-related health problems and increased their empathy for older adults with vision and hearing loss or Alzheimer's disease. Conclusion: VR immersion training is an effective teaching method to help medical and health professions students develop empathy and is a budding area for library partnerships. As the technology becomes more affordable and accessible, it is important to develop best practices for using VR in the library.
The stigma against persons with pedophilic interests (minor-attracted persons) leads to serious consequences for those affected, adds to the development of a sexual preference disorder (which is a sexual preference for children accompanied by psychological distress and/or risk for direct and indirect sexual behavior against children) and increases their risk of becoming offenders. One-sided media coverage maintains and reinforces the existing stigma by continuously and inadequately conflating minor-attracted persons with sexually abusive behavior against children. To destigmatize pedophilia and support non- offending minor-attracted persons, journalists have a great responsibility to portray pedophilia appropriately. Until now, nothing is known on the journalists’ knowledge and personal attitude of minor-attracted people. Therefore, this paper addresses the question of how journalists deal with the topic of pedophilia, in detail what they know about pedophilia, what attitudes and emotions are associated with the topic and what thoughts about prevention of child sexual abuse (CSA) journalists have. We conducted 11 qualitative interviews with journalists who had published at least one article on pedophilia or CSA within 2018. The transcripts were processed using qualitative content analysis. The results show that the interviewees largely defined pedophilia as consistent with scientific evidence but overestimated the risk for minor-attracted persons of becoming an offender. At the same time, many respondents were aware that persons who are not attracted to minors also abuse children sexually. Strong or negative feelings toward minor-attracted persons were reported only occasionally. Rather, the interviewees talked about sympathy as long as minor-attracted persons did not offend children. The interviewed journalists were generally open to a differentiated, evidence-based reporting, which could be a first step toward destigmatizing pedophilia, making supportive services known and, as a consequence, preventing CSA.
The prolific expansion of intergroup contact research has established that intergroup interactions are tightly linked to social integration. In this review, recent technological and statistical innovations with the potential to advance this body of research are presented. First, concerns over the validity of longitudinal models are discussed before innovative analytical techniques are introduced that explore change over time. Next, intensive repeated measure designs, such as experience sampling approaches, are introduced as opportunities to investigate the day‐to‐day lives of individuals. Virtual reality technology is then presented as another means to examine naturalistic contact experiences in the laboratory, offering researchers an unrivaled capacity to induce uncommon contact experiences. Finally, we propose that additional sources of contextual data, such as competing media messages, could extend these models in innovative ways by accounting for the time and place surrounding intergroup contact. Similarly, longitudinal social network analysis can provide additional contextual information by considering the broader network environment in which contact occurs. We describe these innovations with the intention of spurring future research that will advance our understanding of how intergroup contact can be used to improve our societies. Thus, we conclude with a discussion on how to bridge divides between researchers and practitioners.
Objective Stigma decreases healthcare seeking and treatment adherence and increases the duration of untreated psychosis among people with first-episode psychosis (FEP). This study evaluated the efficacy of a brief video-based intervention in reducing stigma among youth toward individuals with FEP and schizophrenia. We hypothesized that the social-contact-based video intervention group would reduce stigma more than written vignette and control groups, and the vignette more than the control group. Methods Using Amazon Mechanical Turk, we recruited and assigned 1203 individuals aged 18–30 to either (a) video intervention, (b) written description of the same content (“vignette”), or (c) nonintervention control arm. In the 90-second video intervention, an empowered young woman with schizophrenia described her FEP and the aspects of successful coping with her everyday life difficulties, exposing the viewer to schizophrenia in the context of her personal narrative. Web-based self-report questionnaires assessed stigma domains, including social distance, stereotyping, separateness, social restriction, and perceived recovery. Results A MANOVA showed a significant between-group effects for all 5 stigma-related subscales (P < .001). Post hoc pairwise tests showed significant differences between video and vignette vs control for all 5 stigma domains. Video and vignette groups differed significantly on social distance, stereotyping, and social restriction. Secondary analyses revealed gender differences across stigma domains in the video group only, with women reporting lower stigma. Conclusions A very brief social contact-based video intervention efficaciously reduced stigma toward individuals with FEP. This is the first study to demonstrate such an effect. Further research should examine its long-term sustainability.
News media plays an influential role in shaping society’s understanding of mental illness and can promote perspectives ranging from those that promote help-seeking behaviour to stigmatised associations with attributes such as danger and violence. Stigma has been found to have significant negative impacts on people with psychosis. No existing studies have explored how young people with psychosis are represented in newspapers. Targeting this gap, this study analysed news articles relating to youth psychosis to determine the types of discourses used. We searched the ProQuest Australia and New Zealand Newsstream database (2011-2016) for Australian newspaper articles related to young people and psychosis. Qualitative analysis was used to identify content and these were arranged into key themes. The recurring themes evident in the 27 articles linked youth psychosis to illicit drug use, violence and professional infighting about treatment options, and thus promoted significantly stigmatised perspectives of youth psychosis. Acknowledgement of these stigmatised discourses is important for encouraging responsible media reporting and for understanding the social messages impacting on treatment and help-seeking by young people. We discuss the conflicted role of journalists in presenting information about mental illness and recommend development of a more solutions-focused approach to reporting in this area.
Mental health stigma is a substantial problem all over the world. Although many interventions to reduce stigma exist, there is considerable methodological variability, making it difficult for decision-makers to determine what strategies are the most effective and what characteristics make them so. To this end, we conducted a meta-analysis on intergroup contact strategies and examined several potential moderators. We searched 5 databases for published and unpublished studies and retrieved 101 studies from 24 countries that could be included in the analyses. Ninety studies assessed outcomes immediately after the intervention (n = 15,826), 33 in the short-term (n = 3,697), and 7 in the medium-term (n = 842). The effect of contact was significant and small-to-medium in size at all three timepoints, d = −0.384, −0.334, and −0.526, respectively. Intervention effectiveness did not differ between contact with or without an educational component, different contact mediums, or the mental illness of the outgroup member. However, the effect of contact was stronger in non-Western countries and in university students and health professionals compared to community members. These results may inform policy-makers of the most effective and suitable stigma-reduction initiatives to invest in and can guide researchers towards important avenues for future research.