Self-Stigmatizing Thinking as Mental Habit in People with Mental Illness

People with mental illness (PMI) may endorse and internalize public stigma directed against them and at times experience self-stigmatizing thinking. However, having self-stigmatizing thoughts per se does not necessarily lead to chronic psychological distress. Only when such thinking occurs frequently and automatically as a mental habit, this creates constant mental negotiation within the individuals, which may have deleterious effects on their mental health and recovery. Of note, the mental process should be distinguished from the mental content of self-stigmatizing thinking, assessed independently, and not be assumed to be homogeneous across all PMI. In a series of three studies, I conceptualized process aspects of self-stigmatizing thinking based on the mental habit paradigm.;Study 1 applied the construct of self-stigmatizing thinking habit in developing a new assessment tool, the Self-stigmatizing Thinking's Automaticity and Repetition (STAR), and validated the STAR and its short form in a community sample of 95 PMI. Almost half (42.1%) of the participants reported habitual self-stigmatizing thinking. More negative cognitive content of self-stigmatizing thinking, greater experiential avoidance, and lower mindfulness contributed to stronger self-stigmatizing thinking habit. The adverse effects of the mental habit included lower self-esteem, decreased subjective quality of life, and poorer recovery.;Study 2 investigated the possibility of a pattern of more automatic self-stigma-relevant associations among habitual self-stigmatizing thinkers. A set of Brief Implicit Association Tests was administered to PMI with strong (n=44) and weak (n=50) self-stigmatizing thinking habit to assess the three components of implicit self-stigma: implicit centrality of the mental illness identity to the self, implicit attitudes toward mental illness, and implicit self-esteem. Greater implicit identity centrality, but not negative implicit attitudes toward mental illness and low implicit self-esteem, was predictive of stronger self-stigmatizing thinking habit. Implicit identity centrality also contributed to lower self-esteem and decreased subjective quality of life through self-stigmatizing thinking habit.;Study 3 examined the potential automatic attentional biases for self-stigmatizing information among habitual self-stigmatizing thinkers. An Emotional Stroop Task was administered to PMI with strong (n=46) and weak (n=45) self-stigmatizing thinking habit to assess response latencies in color-naming self-stigmatizing versus self-assurance versus non-affective words. The strong habit group was characterized by faster responses to the self-stigmatizing stimuli, reflecting their automatic attentional bias away from the emotional meaning of self-stigmatizing information and hence less interference effects on the color-naming task.;The construct of self-stigmatizing thinking habit offers new perspectives on self-stigma's theory, assessment, and intervention. As the deleterious effects of self-stigma on mental health are due doubly to the negative content and habitual manifestation of self-stigmatizing thoughts, the impact of self-stigma on PMI may be underestimated if it is based solely on traditional content-oriented measures. Existing self-stigma intervention programmes, which are cognitive content-oriented, should be improved by additionally targeting the dysfunctional coping mechanisms (i.e., experiential avoidance and the lack of mindfulness) and information-processing biases (i.e., automatic evaluation and attentional biases) involved in the mental habit. In mitigating self-stigmatizing thinking habit, practitioners may apply psychotherapies based on mindfulness and acceptance in order to enhance present-moment awareness and nonjudgmental acceptance of self-stigmatizing thoughts.;Keywords: automatic, experiential avoidance, Emotional Stroop, implicit, mindfulness, stigma.