Self-Stigma and PTSD: Conceptualization and Implications for Research and Treatment

Benfer, Natasha; Howell, Mary Katherine; Lucksted, Alicia; Romero, Erin G.; Drapalski, Amy L.

doi:10.1176/appi.ps.20220397

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…The second goal of this study was to examine whether perceived stigma was dependent upon whether a participant decided to opt out of a treatment arm. Mental health stigma is defined as the process of internalizing negative societal sentiments regarding mental illness and the treatment of psychological distress (Benfer et al., 2023). Moreover, Watson et al.…”

Section: Figurementioning

confidence: 99%

“…(2007) detail that stigma is a process that includes an awareness of negative stereotypes, the agreement of these attitudes, and the application of these negative beliefs toward oneself. Benfer and colleagues (2023) explain that stigma, as it relates specifically to PTSD, has been largely overlooked as a potential factor in preventing treatment engagement.…”

Section: Figurementioning

confidence: 99%

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The interactions between patient preferences, expectancies, and stigma contribute to posttraumatic stress disorder treatment outcomes

Moring,

Peterson,

Straud

et al. 2023

Journal of Traumatic Stress

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Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD); however, some patients do not improve to the same extent as others. It is important to understand potential factors that can be modified for better patient outcomes. This clinical trial implemented a three‐arm, equipoise‐stratified randomization design to allow for the accommodation of patient preference before randomization to one of three CPT treatment modalities: in‐home, in‐office, or telehealth. This study examined whether satisfaction with the modality, perceived stigma, expectations of therapy, and credibility of the therapist differed between modalities and whether these factors impacted treatment outcomes. We hypothesized that the contributions of these variables would depend upon whether participants opted out of any treatment arms and that these factors would predict treatment outcomes. Participants who endorsed less perceived stigma demonstrated larger reductions in PTSD symptom severity than those with similar levels of perceived stigma in the telehealth and in‐office conditions, η2 = .12–.18. Participants who endorsed lower satisfaction with their treatment modality and were assigned to the in‐home condition experienced larger PTSD symptom reductions than those with similar dissatisfaction in the telehealth and in‐office conditions, η2 = .20. The results show the robustness of evidence‐based therapies for PTSD given that dissatisfaction did not impede treatment success. In addition, they demonstrate that it is important for clinicians to address stigma before initiating evidence‐based therapies for PTSD. Strategies to address these factors are discussed.

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

The interactions between patient preferences, expectancies, and stigma contribute to posttraumatic stress disorder treatment outcomes

Moring,

Peterson,

Straud

et al. 2023

Journal of Traumatic Stress

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show abstract

“…While there is extensive research on self-stigma in people with serious mental illness (SMI), which refers to ‘mental, behavioral, or emotional disorder resulting in serious functional impairment’ (National Institute of Mental Health, 2023 , March), much less is known about stigma in people with trauma-related disorders (Bonfils et al, 2018 ). In a recent paper, Benfer et al ( 2023 ) have already pointed out that, although research on self-stigma in people with trauma-related disorders is nascent and limited, self-stigma is associated with greater symptom burden in people with post-traumatic stress disorder (PTSD) and it may be a significant barrier to help seeking too. In addition, post-traumatic psychopathology and self-stigma share common cognitive and affective features, including negative appraisal or beliefs about oneself, and therefore more research on self-stigma in trauma survivors is needed so as to understand how it may potentially affect treatment adherence and clinical outcomes (Benfer et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

“…In a recent paper, Benfer et al ( 2023 ) have already pointed out that, although research on self-stigma in people with trauma-related disorders is nascent and limited, self-stigma is associated with greater symptom burden in people with post-traumatic stress disorder (PTSD) and it may be a significant barrier to help seeking too. In addition, post-traumatic psychopathology and self-stigma share common cognitive and affective features, including negative appraisal or beliefs about oneself, and therefore more research on self-stigma in trauma survivors is needed so as to understand how it may potentially affect treatment adherence and clinical outcomes (Benfer et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: a preliminary investigation

Fung,

Černis,

Shum

2023

European Journal of Psychotraumatology

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Background: Previous studies showed that self-stigma is associated with poor clinical outcomes in people with serious mental illness, and is associated with post-traumatic stress disorder (PTSD). However, less is known about self-stigma in people with dissociative symptoms, which are often related to psychological trauma. This study examined whether baseline self-stigma would be associated with dissociative, PTSD and depressive symptoms at post-intervention, after controlling for treatment usage and baseline symptom severity, in a sample of traumatized Chinese adults undertaking a psychoeducation intervention for dissociative symptoms. Methods: We conducted a secondary analysis of data from a 60-day web-based psychoeducation programme. A total of 58 participants who provided data before and after the intervention were included for analysis. Hierarchical regression analyses were conducted. Results: In this highly traumatized, dissociative, and symptomatic help-seeking sample, baseline self-stigma was associated with PTSD (β = .203, p = .032) and depressive (β = .264, p = .025) symptoms at post-intervention, even after controlling for baseline symptom severity, age, location, number of sessions attended in the web-based psychoeducation programme, and use of psychological treatments for PTSD/dissociative symptoms. However, self-stigma was not associated with dissociative symptoms ( p = .108). Conclusions: This is the first study showing that self-stigma is a significant predictor of comorbid symptoms (i.e. PTSD and depressive symptoms) in people seeking interventions for dissociative symptoms. The findings that post-traumatic and dissociative symptoms have different relationships to self-stigma also highlight the possibility dissociation might be an independent psychological construct closely associated with trauma, but not merely a PTSD symptom, although further studies are necessary. The preliminary findings call for more efforts to understand, prevent, and address self-stigma in people with trauma-related mental health issues such as dissociative symptoms.

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“…However, as the authors contend, it is possible that negative public attitudes towards refugees as a socially devalued group may have contributed to limiting adolescents' help-seeking behavior, independently from and likely in interaction with self-stigma associated with psychological support. Importantly, stigmatizing attitudes towards refugees may affect domains beyond healthcare, further constraining adolescents' chances to take full advantage of wider opportunities for personal advancement in society, be it seeking an education, a career, or engaging in civic participation.Another reason why a deeper understanding of stigma and its effects on refugee adjustment and well-being is warranted concerns the fact that when internalized, (self) stigma may share cognitive, affective, and behavioral characteristics with post-traumatic stress symptoms (Benfer, Howell, Lucksted, Romero, & Drapalski, 2023). Negative beliefs about oneself, selfblame, and feelings of shame and worthlessness which lead to avoidance of social contact are similar and may explain the high prevalence of self-stigma amongst people with PTSD.…”

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confidence: 99%

On the importance of understanding and addressing stigmatization experiences in refugees

Fino

2024

Psychol. Med.

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In a recent article Özaslan, Yildirim, Guney, İlhan, and Vostanis (2024) examined the stigma associated with seeking psychological support as a barrier to health-seeking behavior in Syrian adolescent refugees experiencing distress. The issue is relevant and points to the importance of understanding and addressing stigmatization experiences in young refugees, as they strive to adjust in their new homes. While the number of forcibly displaced people due to war, poverty, and natural disasters is increasing, supporting their endeavors to adapt and succeed in new societies is a prominent challenge of our times. Yet societal stigma remains a complex and often underestimated barrier constraining people's attempts to capitalize on the resources and opportunities that new environments can offer. Negative attitudes towards refugees are on the rise in Europe and are often based on contradictory stereotypes, depicting them as threatening to take away jobs and vital resources, while at the same time having no/low specialized skills or literacy levels (Bauer, Boemelburg, & Walton, 2021;Webber, Molinario, Jasko, Gelfand, & Kruglanski, 2023). Such stigmatizing narratives limit their chances of inclusion and integration in new societies and extend beyond individuals with anti-refugee sentiments (Graf et al., 2023). Well-intentioned actors, including aid organizations and the research community, often accentuate vulnerabilities that may encompass experiences of victimization and trauma, while overlooking the resourcefulness of this community (Sims & Pooley, 2016). Often moved by genuine concern and intention to help, an exclusive focus on vulnerability may leverage dated notions of charity, whereby refugees are to be helped out of pity, whereas they seek parity and opportunities everyone deserves (Corrigan, 2017).Although refugees represent a highly heterogenous, resilient, and resourceful population, widespread stigmatizing attitudes may shape experiences of vulnerability in unique ways and act as a barrier to accessing essential resources and opportunities in new societies (Bauer et al., 2021;Webber et al., 2023). Social stigma signifies a process of social devaluation that reduces the target in the eyes of others from a whole person to a discounted one (Goffman, 1963) making them easy targets of stereotypes, prejudice, and discrimination. While refugees may be aware of others' stigmatizing attitudes towards them ( public stigma) and may experience stigmatization in everyday encounters (enacted stigma), they may also anticipate discrimination from others (anticipated stigma) in the absence of direct contact, and further, internalize these unfavorable beliefs about themselves (self-stigma). Whether enacted, perceived, anticipated, or internalized, stigma impinges on a person's self-esteem and self-efficacy, it tarnishes relationships with others and institutions, restricting access to resources, and opportunities for growth and social integration. Hence, the importance of a nuanced understanding of the stigmatization experiences ...

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Self-Stigma and PTSD: Conceptualization and Implications for Research and Treatment

Cited by 7 publications

References 11 publications

The interactions between patient preferences, expectancies, and stigma contribute to posttraumatic stress disorder treatment outcomes

The interactions between patient preferences, expectancies, and stigma contribute to posttraumatic stress disorder treatment outcomes

Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: a preliminary investigation

On the importance of understanding and addressing stigmatization experiences in refugees

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