Iowa State University Capstones, Theses and Graduate Theses and Dissertations Dissertations 2020 The use of a self-affirmation intervention and group therapy to increase psychological help-seeking Andrew Seidman Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/etd Recommended Citation Seidman, Andrew, "The use of a self-affirmation intervention and group therapy to increase psychological help-seeking" (2020). Graduate Theses and Dissertations. 18224. https://lib.dr.iastate.edu/etd/18224 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. The use of a self-affirmation intervention and group therapy to increase psychological help- seeking by Andrew Jacob Seidman A dissertation submitted to the graduate faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Major: Psychology (Counseling Psychology) Program of Study Committee: Nathaniel Wade, Major Professor William Abraham Marcus Credé Susan Cross David Vogel Meifen Wei The student author, whose presentation of the scholarship herein was approved by the program of study committee, is solely responsible for the content of this dissertation. The Graduate College will ensure this dissertation is globally accessible and will not permit alterations after a degree is conferred. Iowa State University Ames, Iowa 2020 Copyright © Andrew Jacob Seidman, 2020. All rights reserved. ii TABLE OF CONTENTS ABSTRACT………………………………. ............................................................. iii ACKNOWLEDGEMENTS………………………………. ..................................... iv CHAPTER 1 INTRODUCTION .......................................................................... 1 CHAPTER 2 LITERATURE REVIEW ............................................................... 9 Understanding Stigma ......................................................................................... 11 Public stigma of mental illness and seeking help .......................................... 11 Self-stigma of mental illness and seeking help ............................................ 12 Psychotherapy and the Role of Group ................................................................. 15 What makes group work? .............................................................................. 17 Self-disclosure and the therapeutic relationship ........................................... 25 Self-stigma in the counseling room .............................................................. 27 Self-Affirmation Theory and Openness to Threat ............................................... 30 Self-affirmation and seeking help ................................................................ 37 The Need for Future Research ............................................................................. 39 The Present Study ................................................................................................ 40 Hypotheses ........................................................................................................ 40 CHAPTER 3 METHODS ..................................................................................... 43 Participants ........................................................................................................ 43 Measures ........................................................................................................ 45 Procedures ........................................................................................................ 51 CHAPTER 4 RESULTS ....................................................................................... 57 Descriptive Statistics .......................................................................................... 57 Analytic Strategy ................................................................................................. 58 Hypotheses & Analyses ....................................................................................... 58 CHAPTER 5 DISCUSSION ................................................................................. 72 Self-affirmation, Process, and Outcome .............................................................. 73 Group vs. No Group ............................................................................................ 75 Limitations and Future Directions ....................................................................... 76 Implications ........................................................................................................ 77 Conclusion ........................................................................................................ 78 REFERENCES .......................................................................................................... 80 APPENDIX A: IRB APPROVAL ............................................................................. 95 APPENDIX B: SELF-AFFIRMATION INTERVENTION ..................................... 96 APPENDIX C: PRE-GROUP ORIENTATION ....................................................... 97 APPENDIX D: MEASURES ................................................................................... 99 APPENDIX E: DEMOGRAPHIC QUESTIONNAIRE ........................................... 109 iii ABSTRACT The self-stigma of seeking help is a significant barrier to utilizing psychotherapy (Vogel, Wade, & Haake, 2006). Self-stigma may also impair therapeutic factors from emerging during the therapy process itself (Kendra, Mohr, & Pollard, 2014). In order to manage fears of negative reactions, clients may conceal painful emotions, interfering with therapeutic work (Corrigan & Rao, 2012). This may help explain why the majority of clients only attend one session (Center for Collegiate Mental Health, 2018). Research has provided evidence for the ability of a self- affirmation intervention to reduce self-stigma and, via an indirect effect, increase anticipated benefits and decrease anticipated risks of self-disclosure among clients about to meet for a psychotherapy intake (Seidman, Lannin, Heath, & Vogel, 2018). However, research is needed to examine if this intervention influences actual behaviors in a therapy session. In addition, there is no known research on its effect on post-session perceptions of therapy or openness to continued help-seeking. This study tested the utility of a self-affirmation intervention to improve group therapy process variables (e.g., cohesion) and increase openness to continued help-seeking (i.e., less public stigma, self-stigma, increased attitudes and intentions). This study also sought to replicate and extend upon findings from a previous study (Wade et al., 2011), which demonstrated that attending a single session of group therapy reduces self-stigma compared to a waitlist condition. Keywords: self-affirmation; group therapy; self-stigma; cohesion; help-seeking iv ACKNOWLEDGEMENTS Without the support from my family, this process would have felt much more lonely and much less meaningful in many ways. Thank you for all the support and pride you have taken in me pursuing this journey. I feel so lucky to have you in my life and I love you all. Thank you to Stefanie, Edwin, Sawyer, and George. The last three years with you have been everything I have hoped for and more. I love our crew. I would like to express my deep appreciation for my mentor Dr. Nathaniel Wade; you have mentored me in a variety of ways and have been an unconditional source of support for which I am forever grateful. I would also like to thank the members of my dissertation committee, whose input helped me think more critically about this study and what questions to ask next. I would like to extend a special thank you to Dr. William (Todd) Abraham and Johnie Allen for their statistical consulting. You helped me overcome major roadblocks. CHAPTER 1 INTRODUCTION One in six American adults (44.7 million) are currently living with a mental illness (National Institute of Mental Health, 2017). Surprisingly, only 43.1% of those afflicted seek professional psychological help - young adults (18-25 years old) utilize treatment at the lowest rates (~35%). A comprehensive review of the efficacy of psychotherapy has demonstrated its ability to treat a diverse set of mental health concerns (Wampold & Imel, 2015). In addition, psychotherapy services are becoming increasingly available on college campuses (Center for Collegiate Mental Health, 2018). This raises the question: what is stopping college students from seeking help? When considering professional help, people typically encounter numerous barriers, including, but not limited to: provider availability, insurance restrictions, and financial barriers (Kessler et al., 2001). People may also endorse low levels of positive attitudes towards professional help, viewing it as a waste of time and ineffective (Vogel, Wester, & Larson, 2007). However, research has consistently implicated one barrier as most prominent: the self-stigma of seeking help (e.g., Vogel, Wade, & Haake, 2006; Vogel et al., 2017). The self-stigma of seeking help, or the negative self-judgment that one feels for utilizing professional psychological services, is an internalization of the public stigma of seeking help (Lannin, Vogel, Brenner, & Tucker, 2015; Vogel,