Blind spots of psychotherapists? Implicit and explicit mental illness stigma in psychotherapists, psychology students, and laypersons

TL;DR

Psychotherapists show less explicit stigma toward mental illness than non-experts, but not less implicit stigma, which may affect treatment outcomes.

Contribution

This study compares explicit and implicit mental illness stigma in psychotherapists, psychology students, and laypersons using a novel implicit association task.

Findings

Psychotherapists had significantly lower explicit mental illness stigma than graduate academics.

No differences were found in implicit mental illness stigma between the groups.

Social desirability was linked to implicit, but not explicit, attitudes toward mental illness.

Abstract

While explicit mental illness stigma in mental health professionals is often lower compared to laypersons, implicit mental illness stigma is not. However, implicit mental illness stigma may negatively affect treatment processes and outcomes, for example, via over-diagnosis, yet few studies examine such attitudes held by psychotherapists/clinical psychologists. We explored whether psychotherapists differ from psychology students and laypersons in their explicit or implicit mental illness stigma.

We created a Single Category Implicit Association Task to measure implicit stigma. We tested it in a sample of 108 academic laypersons without a psychological background (students and graduates) and in 82 psychology students and psychotherapists. We also measured explicit mental illness stigma and, for example, social desirability via established self-report surveys.

Psychotherapists showed significantly lower explicit mental illness stigma than graduate academics with a medium sized effect. The groups did not differ in their implicit, negatively biased, mental illness stigma. Social desirability was connected to implicit, but not explicit attitudes.

The findings are in line with the Dual Attitude Model: explicit mental illness stigma in the psychotherapy subsample may reflect especially positive attitudes towards mental illness due to, for example, specific aspects of psychotherapeutic training or professional values, while implicit mental illness stigma may reflect negative attitudes deeply embedded in society that are resistant to change.