Reducing stigma toward seeking mental health treatment among adolescents.

PURPOSE: This study examined the effectiveness of an intervention to reduce explicit and implicit stigma-relevant attitudes toward mental illness and treatment-seeking and behavioural indicators of willingness to seek treatment. METHODS: Adolescents were randomly assigned to the experimental (education about mental illness and treatment involving psychoeducation and contact (via DVD) with an affected individual) or control intervention (education about tobacco). RESULTS: Findings suggest the stigma intervention was effective at reducing explicit but not implicit stigma-relevant attitudes. As hypothesized, participants receiving the experimental intervention reported less explicit stigma toward treatment and greater openness to personally seek treatment if they had also reported prior mental health treatment. CONCLUSIONS AND IMPLICATIONS: These findings support the potential for a brief educational intervention among adolescents to reduce negative attitudes toward mental health treatment, but raise questions about how to effectively address implicit stigma as well as the importance of translating stigma reduction into behavior changes.

Implicit anti-fat bias among health professionals: is anyone immune?

OBJECTIVE: To investigate whether negative implicit attitudes and beliefs toward overweight persons exist among health professionals who specialize in obesity treatment, and to compare these findings to the implicit anti-fat bias evident in the general population. DESIGN: Health care professionals completed a series of implicit and explicit attitude and belief measures. Results were compared to measures obtained from a general population sample. SUBJECTS: A total of 84 health professionals who treat obesity (71% male, mean age 48 y, mean body mass index (BMI) 25.39). MEASUREMENTS: Participants completed an attitude- and a belief-based lmplicit Association Test. This reaction time measure of automatic memory-based associations asked participants to classify words into the following target category pair. 'fat people' vs 'thin people'. Simultaneously, the tasks required categorization of words into one of the following descriptor category pairs: good vs bad (attitude measure) or motivated vs lazy (stereotype measure). Participants also reported explicit attitudes and beliefs about fat and thin persons. RESULTS: Clear evidence for implicit anti-fat bias was found for both the attitude and stereotype measures. As expected, this bias was strong but was lower than bias in the general population. Also as predicted, only minimal evidence for an explicit anti-fat bias was found. Implicit and explicit measures of the lazy stereotype were positively related although the attitude measures were not. CONCLUSION: Even health care specialists have strong negative associations toward obese persons, indicating the pervasiveness of the stigma toward obesity. Notwithstanding, there appears to be a buffering factor, perhaps related to their experience in caring for obese patients, which reduces the bias.

The Claustrophobia Questionnaire.

The content and psychometric properties of the Claustrophobia Questionnaire (CLQ) are described. An earlier version of the CLQ was developed to test the hypothesis that claustrophobia is comprised of two distinct but related fears--the fear of suffocation and the fear of restriction [J. Anxiety Disord. 7 (1993) 281.]. The scale was used to assess patients undergoing the magnetic resonance imaging (MRI) procedure [J. Behav. Med. 21 (1998) 255.] and in participants with panic disorder [J. Abnorm. Psychol. 105 (1996) 146; Taylor, S., Rachman, S., & Radomsky, A. S. (1996). The prediction of panic: a comparison of suffocation false alarm and cognitive theories. Unpublished data.]. On the basis of these studies, we decided to revise and shorten the CLQ, collect normative data, and provide information on the scale's predictive and discriminant validity as well as its internal consistency and test-retest reliability. This was done through a set of four interconnected studies that included psychometric analyses of undergraduate and community adult questionnaire responses and behavioural testing. Results indicate that the CLQ has good predictive and discriminant validity as well as good internal consistency and test-retest reliability. The CLQ appears to be a reliable and sensitive measure of claustrophobia and its component fears. We encourage the use of the CLQ in a variety of clinical and research applications. The scale is provided in this paper for public use.

Implicit associations for fear-relevant stimuli among individuals with snake and spider fears.

This study investigated an implicit measure of cognitive processing, the Implicit Association Test (IAT; A. G. Greenwald, D. E. McGhee, & J. L. K. Schwartz, 1998), as a measure of fear-related automatic associations. Sixty-seven students with snake or spider fears completed 4 IAT tasks in which they classified pictures of snakes and spiders along with descriptive words indicating valence, fear, danger, or disgust. Results indicated that all 4 tasks discriminated between fear groups in terms of their implicit associations, and fear-specific effects were significant even after controlling for the impact of valence evaluation. Findings are discussed in terms of applications of the IAT methodology to examine cognitive processing and schemata in anxiety and potential uses for assessing anxiety disorders.

A cognitive distortion associated with eating disorders: thought-shape fusion.

OBJECTIVES: The primary objective of this study was to describe and investigate a cognitive distortion associated with eating psychopathology. This distortion, termed 'thought-shape fusion', is said to occur when merely thinking about eating a forbidden food increases the person's estimate of their shape or weight, elicits a perception of moral wrongdoing and makes the person feel fat. DESIGN: Two studies were conducted. The first was a psychometric study and the second utilized a within-participants experimental design. METHODS: In Study 1, thought-shape fusion was assessed in a sample of 119 undergraduate students using a questionnaire. In Study 2, 30 students with high thought-shape fusion scores participated in an experiment designed to elicit the distortion. RESULTS: Thought-shape fusion was found to be significantly associated with measures of eating disorder psychopathology. The questionnaire used to measure thought-shape fusion had high internal consistency, a good factor structure accounting for 46.2% of the variance and predictive validity. The results from Study 2 indicated that the distortion can be elicited under experimental conditions, produces negative emotional reactions and prompts the urge to engage in corrective behaviour (e.g. neutralizing/checking). This corrective behaviour promptly reduces the negative reactions. CONCLUSION: The results of the two studies indicate that the concept of thought-shape fusion is coherent, unifactorial and measurable. It is associated with eating disturbance and elicits negative emotional and behavioural responses.

Why do episodes of panic stop?

Episodes of panic are self-limiting--they all come to an end. However, it has not been explained how and why they end. Neither the cognitive nor the biological theory of panic deals with this phenomenon. As a first step toward an understanding of what stops a panic, we collected evidence about the self-limiting nature of these episodes. A semistructured interview was developed and conducted with 25 participants who had received a diagnosis of panic disorder. Participants reported a variety of triggers of panic, signs that a panic was ending, and strategies used to terminate panic episodes. A substantial proportion of participants indicated that there was a refractory period following panic episodes. The theoretical and therapeutic significance of this self-limiting feature of panic episodes is considered, as is the probable occurrence of a postpanic refractory period.