精神病康復者認同和內化公眾對他們的污名思維會經驗自我污名的想法。然而，自我污名思維本身並不一定會導致慢性心理困擾。只有當自我污名經常和自動地出現，成為心理習慣，才會產生恆定的精神困擾。自我污名的心理過程應該區別於心理內容，獨立評估，和不被假定相同於所有康復者。本論文基於心理習慣範式概念化自我污名的過程。 / 研究一開發一項名為自我污名的自動化和重複程度的測量工具，並於95位康復者建立這工具與其短版的效度。共有百分之四十二點一的參加者報告自我污名習慣。較負面的自我污名內容、較強的負面經驗避免和較低的靜觀跟自我污名習慣有關。這習慣和較差的自尊、主觀生活質量和復元亦有關。 / 研究二測量自我污名相關概念的自動聯想模式。具有較強（人數 = 46）和較弱（人數 = 45）自我污名習慣的康復者接受一系列簡短內隱聯想測驗，評估內隱自我污名的三個部分：康復者身份對自我的內隱中心性，對精神病的內隱態度和內隱自尊。較強的身份中心性與自我污名習慣有關。內隱身份中心性也會通過自我污名習慣降低自尊和主觀生活質量。 / 研究三測量對自我污名相關概念的自動注意力。具有較強（人數 = 46）和較弱（人數 = 45）自我污名習慣的康復者接受一項情緒斯特魯普任務，評估他們為自我污名、自信與非情感的刺激命名顏色的反應潛伏期。強組對自我污名刺激的反應較快，反映他們對那些信息的情感含義有較少的自動注意力，因此對顏色命名任務有較少的干擾。 / 自我污名習慣的概念為自我污名的理論、評估和干預提供了新的觀點。由於自我污名對心理健康的影響是雙重由於負面內容和其慣性的出現，如只基於傳統、以內容為本的工具測量自我污名，其對康復者的影響有可能被低估。現有的干預計劃亦應加強針對與自我污名習慣有關的不良應對機制（負面經驗避免和缺乏靜觀）和偏頗信息處理（自動聯想和注意力偏見）。以靜觀和接納為本的心理治療提升康復者對目前時刻的意識與對自我污名思維的不加批判驗收，可減輕自我污名習慣。 / 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. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Ka Shing Kevin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 119-149). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes in Chinese. / Abstract --- p.i / Acknowledgements --- p.iv / Table of Contents --- p.vii / List of Tables --- p.xi / List of Figures --- p.xii / Abbreviations --- p.xiii / Chapter Chapter 1. --- Self-Stigmatizing Thinking as Mental Habit --- p.1 / Chapter 1.1. --- Theoretical Conceptualizations of Habit --- p.1 / Chapter 1.2. --- Theoretical Conceptualizations of Mental Habit --- p.3 / Chapter Chapter 2. --- Self-Stigma in People with Mental Illness --- p.4 / Chapter 2.1. --- The Consequences of Self-Stigma for Mental Health of People with Mental Illness --- p.5 / Chapter 2.2. --- The Roots of Self-Stigma in People with Mental Illness --- p.5 / Chapter 2.3. --- Self-Stigma Interventions for People with Mental Illness --- p.7 / Chapter 2.3.1. --- Cognitive Content-Oriented Interventions for Self-Stigma --- p.7 / Chapter 2.3.2. --- Cognitive Process-Oriented Interventions for Self-Stigma --- p.10 / Chapter 2.4. --- Gaps in Research on Self-Stigma in People with Mental Illness --- p.12 / Chapter Chapter 3. --- Theoretical Conceptualizations of Self-Stigmatizing Thinking Habit --- p.15 / Chapter 3.1. --- The Mental Content of Self-Stigmatizing Thinking --- p.15 / Chapter 3.2. --- The Mental Process of Self-Stigmatizing Thinking --- p.16 / Chapter 3.2.1. --- The Frequency of Self-Stigmatizing Thinking --- p.16 / Chapter 3.2.2. --- The Automaticity of Self-Stigmatizing Thinking --- p.18 / Chapter 3.3. --- The Consequences of Self-Stigmatizing Thinking Habit for Mental Health of People with Mental Illness --- p.19 / Chapter 3.4. --- Interventions for Self-Stigmatizing Thinking Habit in People with Mental Illness --- p.20 / Chapter Chapter 4. --- Empirical Assessment of Self-Stigmatizing Thinking Habit --- p.24 / Chapter 4.1. --- The Self-stigmatizing Thinking‘s Automaticity and Repetition (STAR) Scale --- p.24 / Chapter 4.2. --- Implicit Association Test --- p.27 / Chapter 4.3. --- Emotional Stroop Task --- p.29 / Chapter Chapter 5. --- Overview of the Studies --- p.34 / Chapter 5.1. --- Objectives --- p.34 / Chapter 5.2. --- Long-Term Impact --- p.35 / Chapter Chapter 6. --- Study 1 Assessing Self-stigmatizing Thinking Habit Using a Self-Reported Questionnaire: A Validation Study of the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) Scale in People with Mental Illness --- p.38 / Chapter 6.1. --- Introduction --- p.38 / Chapter 6.2. --- Method --- p.39 / Chapter 6.2.1. --- Participants --- p.39 / Chapter 6.2.2. --- Procedure --- p.39 / Chapter 6.2.3. --- Measures --- p.40 / Chapter 6.2.3.1. --- Sociodemographic, clinical, and social contact characteristics --- p.40 / Chapter 6.2.3.2. --- Self-stigmatizing thinking habit --- p.40 / Chapter 6.2.3.3. --- Self-stigmatizing cognitive content --- p.40 / Chapter 6.2.3.4. --- Self-esteem --- p.41 / Chapter 6.2.3.5. --- Self-identity --- p.41 / Chapter 6.2.3.6. --- Experiential avoidance --- p.41 / Chapter 6.2.3.7. --- Mindfulness --- p.42 / Chapter 6.2.3.8. --- Subjective quality of life --- p.42 / Chapter 6.2.3.9. --- Recovery --- p.42 / Chapter 6.2.4. --- Data Analyses --- p.43 / Chapter 6.3. --- Power Calculation --- p.44 / Chapter 6.4. --- Results --- p.45 / Chapter 6.4.1. --- Participant characteristics --- p.45 / Chapter 6.4.2. --- Score distribution on the STAR --- p.46 / Chapter 6.4.3. --- Factor analyses on the STAR and STAR-S --- p.46 / Chapter 6.4.4. --- STAR-S reliability and validity --- p.48 / Chapter 6.4.5. --- Prevalence of self-stigmatizing thinking habit --- p.51 / Chapter 6.4.6. --- Predictors of self-stigmatizing thinking habit --- p.51 / Chapter 6.4.7. --- Impact of self-stigmatizing thinking habit on self-esteem when self-stigmatizing cognitive content was taken into consideration --- p.52 / Chapter 6.4.8. --- Impact of self-stigmatizing thinking habit on subjective quality of life when selfstigmatizing cognitive content was taken into consideration --- p.53 / Chapter 6.4.9. --- Impact of self-stigmatizing thinking habit on recovery when self-stigmatizing cognitive content was taken into consideration --- p.54 / Chapter 6.5. --- Discussion --- p.54 / Chapter 6.6. --- Implications for the Next Study --- p.58 / Chapter Chapter 7. --- Study 2 Automatic Self-Stigma-Relevant Associations in Self-Stigmatizing Thinking Habit: Evidence from the Brief Implicit Association Tests --- p.59 / Chapter 7.1. --- Introduction --- p.59 / Chapter 7.2. --- Method --- p.61 / Chapter 7.2.1. --- Participants --- p.61 / Chapter 7.2.2. --- Procedure --- p.61 / Chapter 7.2.3. --- Measures --- p.61 / Chapter 7.2.3.1. --- Self-stigmatizing thinking habit --- p.61 / Chapter 7.2.3.2. --- Explicit self-stigma --- p.62 / Chapter 7.2.3.3. --- Implicit attitudes toward mental illness --- p.62 / Chapter 7.2.3.4. --- Implicit identity centrality --- p.64 / Chapter 7.2.3.5. --- Implicit self-esteem --- p.64 / Chapter 7.2.3.6. --- Explicit self-esteem --- p.65 / Chapter 7.2.3.7. --- Subjective quality of life --- p.65 / Chapter 7.2.4. --- Data Analyses --- p.66 / Chapter 7.3. --- Power Calculation --- p.68 / Chapter 7.4. --- Results --- p.69 / Chapter 7.4.1. --- Participant characteristics --- p.69 / Chapter 7.4.2. --- Confirmation of the interrelated two-factor structure --- p.71 / Chapter 7.4.3. --- Confirmation of the second-order hierarchical structure --- p.71 / Chapter 7.4.4. --- Characteristics of participants in the strong and weak habit groups --- p.72 / Chapter 7.4.5. --- BIAT performance by participants in the strong and weak habit groups --- p.73 / Chapter 7.4.6. --- Predictors of self-stigmatizing thinking habit --- p.74 / Chapter 7.4.7. --- The mediating role of self-stigmatizing thinking habit on explicit self-esteem --- p.75 / Chapter 7.4.8. --- The mediating role of self-stigmatizing thinking habit on subjective quality of life . --- p.76 / Chapter 7.5. --- Discussion --- p.77 / Chapter 7.6. --- Implications for the Next Study --- p.81 / Chapter Chapter 8. --- Study 3 Attentional Bias for Self-Stigmatizing Stimuli in Self-Stigmatizing Thinking Habit: Evidence from the Emotional Stroop Task --- p.82 / Chapter 8.1. --- Introduction --- p.82 / Chapter 8.2. --- Method --- p.83 / Chapter 8.2.1. --- Participants --- p.83 / Chapter 8.2.2. --- Procedure --- p.83 / Chapter 8.2.3. --- Measures --- p.83 / Chapter 8.2.3.1. --- Self-stigmatizing thinking habit --- p.83 / Chapter 8.2.3.2. --- Self-stigmatizing cognitive content --- p.84 / Chapter 8.2.3.3. --- Experiential avoidance --- p.84 / Chapter 8.2.3.4. --- Self-esteem --- p.84 / Chapter 8.2.3.5. --- Subjective quality of life --- p.84 / Chapter 8.2.3.6. --- Depression --- p.84 / Chapter 8.2.3.7. --- Emotional Stroop effects --- p.85 / Chapter 8.2.3.8. --- Cognitive Stroop effects --- p.87 / Chapter 8.2.4. --- Data analyses --- p.87 / Chapter 8.3. --- Power Calculation --- p.89 / Chapter 8.4. --- Results --- p.90 / Chapter 8.4.1. --- Participant characteristics --- p.90 / Chapter 8.4.2. --- Characteristics of participants in the strong and weak habit groups --- p.91 / Chapter 8.4.3. --- Emotional Stroop effects --- p.93 / Chapter 8.4.3.1. --- Response errors on the Emotional Stroop trials --- p.93 / Chapter 8.4.3.2. --- Response latencies on the Emotional Stroop trials --- p.93 / Chapter 8.4.4. --- Cognitive Stroop effects --- p.95 / Chapter 8.4.4.1. --- Response errors on the Cognitive Stroop trials --- p.95 / Chapter 8.4.4.2. --- Response latencies on the Cognitive Stroop trials --- p.95 / Chapter 8.4.5. --- Predictors of self-stigmatizing thinking habit --- p.96 / Chapter 8.4.6. --- The Mediating role of self-stigmatizing thinking habit on self-esteem and subjective quality of life --- p.97 / Chapter 8.5. --- Discussion --- p.97 / Chapter Chapter 9. --- General Discussion --- p.102 / Chapter 9.1. --- Theoretical Implications --- p.102 / Chapter 9.2. --- Clinical Implications --- p.104 / Chapter 9.3. --- Limitations and Call for Future Research --- p.106 / Chapter Chapter 10. --- Concluding Remarks --- p.109 / Appendix 1 --- p.110 / Appendix 2 --- p.111 / Appendix 3 --- p.118 / References --- p.119

Prior research has indicated that public stigma towards individuals diagnosed with mental illness may be reduced by exposing individuals to the truths about mental illness and by exposing individuals to a mentally ill person who by society's standards is a productive functioning adult. This study detemined whether the conditions shown to be effective for the public may, in turn, decrease the extent to which individuals diagnosed with mental illness stigmatizes themselves. Four conditions (education alone, contact alone, education-contact, control) were used to determine which method was more effective in reducing the effects of stigma. Stigma was measured using the Internalized Stigma of Mental Illness total and subscale scores and Devaluation-Discrimination Scale which were administered before the treatment session (pre), at the end of the treatment session (post), and at a 2-week follow-up. Conducting 4 (condition) X 3 (time) ANOVAs showed no significant results for any measure. Due to low power from poor participation-in-the-2--week-follow-up, 4 x 2 mixed_factorial ANOVA's were conducted without the follow-up data. The ISMI and Devaluation-Discrimination scores for each condition differed significantly for pre/post scores but not for conditions, with no significant interactions.