This thesis explored how psychosis stigma affects the psychological wellbeing of young people at risk of psychosis and people with psychosis. The efficacy of psychosocial methods to reduce stigma in young people were explored. Multiple methods were used including qualitative, cross sectional, longitudinal and a randomsied controlled trial. Chapter 1 included a comprehensive review of the literature on stigma. Chapter 2 provided a review of the methodology used throughout the thesis. Study 1 (Chapter 3) examined the subjective experience of psychosis using Interpretative Phenomenological Analysis. Three super ordinate themes of judgment, disclosure and psychological distress were identified. Analysis of the data suggested a directional relationship between the themes with societal judgments, affecting issues of disclosure and judgment and disclosure issues increasing psychological distress. Possible exits from distress were suggested. Study 2 (Chapter 4) explored relationships between internalised stereotypes (IS) of psychosis and emotional dysfunction in people at risk of developing psychosis. Correlational analyses indicated significant relationships between IS, depression, social anxiety, and distress. Multiple regression analyses indicated that baseline IS predicted depression at follow up. Results suggested that IS may increase psychological distress and in particular depression in young people at risk of psychosis. Study 3 (Chapter 5) explored relationships between IS and emotional dysfunction in people with psychosis not taking antipsychotic medication. The findings revealed significant positive relationships between IS, depression and social anxiety. Multiple regression analysis suggested that baseline IS predicted depression at follow-up but this did not remain significant when controlling for baseline depression. These results replicate the findings of previous research carried out in other psychosis populations. Study 4 (Chapter 6) explored differences in the level of IS and the strength of relationship between IS and emotional dysfunction, between those at risk of psychosis and those with psychosis. Results of the cross sectional analysis indicated no significant differences between the groups on level of IS or on the strength of correlation between IS and emotional dysfunction. This interesting find suggests that young people at risk of psychosis may be internalising stereotypes early and before official diagnostic labels are applied. Study 5 (Chapter 7) examined the efficacy of internet based anti-stigma interventions for young people. Results indicated a non-significant trend towards reduction in stigma, immediately post intervention for the contact and psychosocial educational conditions, however superiority over control was not demonstrated. Findings indicated that internet based interventions for this group should be brief and ensure maximum engagement. This thesis has demonstrated that stigma affects the wellbeing of people whose experiences exist along the psychosis continuum. Research is required to better understand the feasibility and efficacy of clinical and mass media interventions to reduce the negative effects of stigma in people with psychosis and the public.

Includes bibliographical references (leaves 286-297). / In the communities of the Cape Flats, it is expected that all women will bear children and become mothers. Motherhood serves as a social and cultural indicator of femininity and enables women to access social and economic networks that knit them into community. The social and cultural valorization of motherhood in these communities has informed the powerful stigmatization of infertility (or the involuntary nonconformance to motherhood). The stigma associated with infertility affects women in particular, because the inability to bear children is commonly perceived to be a woman's problem. This study explores the cultural constructions of infertility. It examines in particular, the diverse cultural meanings and the stigma associated with infertility. The examination of these cultural meanings challenges the notion that infertility should only be examined in the biomedical realm. My research was conducted over a seven month period with six infertile women and with women who have borne children from different areas on the Cape Flats. The infertile women were the primary informants. Other informants included the mothers with whom the focus group was conducted and specialist informants who were healthcare professionals. The participants were recruited through the primary health care clinic in Manenberg, the network of community newspapers, The Daily Voice and through my own social network. Qualitative research methods were used. The study also used participatory research methods involved because the participants played an active role in the construction of the research process and interview schedules. The primary information used was obtained from in-depth interviews and journals kept by the infertile women. For comparative purposes, a focus group was conducted with a group of mothers. The study illustrates that on the Cape Flats, infertility is constructed as a major cultural and social problem for women. The stigma attached to infertility draws its power from the social and cultural meanings associated with inability of infertile women to live up to the expectation that every adult woman will become a mother. The effects of the social stigma of infertility are especially profound. As I show, bio-medicine does offer some solution, but only to the few who can afford it.

abstract: Human Immunodeficiency Virus (HIV) remains a persistent problem around the world, even though antiretroviral therapy has shown to be effective in reducing viral load and limiting transmission of the virus. Due to HIV’s infectious nature, visibility, the populations at risk, and its connections to race, class, and sexuality, it is more stigmatized than any other illness. HIV stigma has been associated with increased depression, social isolation, and poor psychological adjustment. HIV stigma can influence disclosure and care-seeking behavior. Internet-based interventions have shown to be effective in increasing knowledge on STIs and HIV, however, researchers have tested strategies that include educating participants on HIV to reduce stigma and have found that informational approaches alone are not effective. There is evidence that emotional intelligence and empathy are associated with prosocial behavior and influence attitudes towards stigmatized groups. Thus, this thesis aims to test an online intervention using an informational video from the Center for Disease Control and Prevention (CDC) in combination with an empathy-generating component to reduce stigma. It was hypothesized that the online intervention would increase HIV knowledge scores (H1), but stigma will only be reduced in the group introduced to the empathy-inducing component (H2) and those with high emotional intelligence would show the greatest reduction in stigmatizing attitudes (H3). Results did not support these hypotheses, suggesting that the CDC’s video does not significantly increase HIV knowledge in the general public. Further, the video intended to generate empathy and reduce stigma was also ineffective. These findings stress the need for further research and questions the effectiveness of empathy-generating interventions (e.g., FACES OF HIV, HIV Justice Network) to increase knowledge and reduce stigma. Future researchers should test the effectiveness of personalized interventions to reduce HIV-related stigma. / Dissertation/Thesis / Masters Thesis Psychology 2020

ABSTRACT Tattoos are to many perhaps a seemingly new fashion and their presence can be felt throughoutour modern-day society in great volumes. Although it might seem like tattoos are a newfashion, the case is pretty far from it. Tattoos have a long motley history that can be traced backto around 5000 years ago. Today, our capital Stockholm is considered to be one of the densestplaces in the world concerning tattoos. However, if we turn back the clock to around 100 yearsago, we can see a different situation, where tattoos only were to be found on sailors, railwayworkers, soldiers, criminals and prostitutes according to contemporary researchers. A type ofstigma that still can be felt today, even though tattoos are worn by all types of people. Eventhough the contemporary researchers are probably to be believed, there is no statisticalevidence that the fact is actually so. With this essay, we will bring forth such statistical evidencethrough a study based on a register of released prisoners that can be found in the NationalArchives. The aim of the study is to find out how many of the released prisoners that actuallywere tattooed, what tattoos they wore, where they lived and what their profession was.

Indiana University-Purdue University Indianapolis (IUPUI) / An increasing number of working age adults are choosing to delay or forego parenthood entirely, but little research has explored how voluntarily childfree adults are perceived and treated in the workplace. While a large body of research has examined the impacts of motherhood on working women, little work has been done to understand the experiences of voluntarily childfree women. This study explored perceptions of working women based on their reproductive choices and whether these perceptions relate to differences in promotion decisions. Based on social backlash theory, I hypothesized that voluntarily childfree (VCF) women would be penalized in promotion decisions, and that perceptions of agentic-dominance and communality would explain this relationship. Using a sample of 220 participants recruited through Amazon Mechanical Turk, I tested my proposed mediation model and found no support for my hypotheses. Counter to expectations, no evidence of the motherhood penalty emerged either. Despite the lack of significant findings in this study, future work should consider assessing the relationships proposed with different experimental design.

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: The Attribution Model of mental illness stigma posits that attributions about the causes and controllability of mental illness contribute to prejudicial emotional reactions, which in turn may lead to discriminatory behaviors towards people with mental illnesses. Given that people make different assumptions about different mental illnesses, if this model is correct, it suggests that specific diagnoses would elicit different types of stigma. Another important, but unexamined, predictor is extrinsic religious orientation, which correlates positively with other types of prejudice and may predict higher levels of mental illness stigma. The purpose of this study was to test the Attribution Model of stigma and examine the relationships between diagnosis, religious orientation, and stigma. Methods: Participants (n = 334) were recruited via Amazon Mechanical Turk, randomized to read one of three vignettes about a person with a mental illness (i.e., schizophrenia, anorexia nervosa, depression), and completed measures of mental illness stigma, religious orientation and affiliation, familiarity with mental illness, and authoritarianism. Using latent variable path analysis, analysis of covariance, and multiple regression analyses, relationships in the Attribution Model of mental illness stigma were assessed, as well as the impact of diagnosis and extrinsic religiosity on specific aspects of stigma as measured by the Attribution Questionnare-27 subscales (i.e., blame, anger, pity, danger/fear, avoidance, segregation, and coercion). Results: Assessment of the Attribution Model indicated moderate overall model fit after respecification. Path coefficients indicated strong relationships between variables that were generally consistent with paths predicted by the model. One notable exception was that feelings of pity were not associated with greater helping behaviors. Analysis of covariance suggested that diagnosis was a key predictor of stigma, and that schizophrenia was the most stigmatized. Multiple regression analyses revealed that extrinsic religiosity was also an important predictor of stigma; extrinsic religiosity appeared to increase certain types of stigma, and moderate the relationship between diagnosis and stigma overall. Discussion: Although the respecified Attribution Model fit the data fairly well, the findings suggest that either the scale or the model would benefit from further refinement. Results support prior evidence that severe mental illnesses like schizophrenia are more stigmatized than other diagnoses. Extrinsic religiosity was also predictive of increased stigma, both directly and indirectly. As a moderator, extrinsic religiosity may decrease the impact of diagnosis on stigma, raising stigma for diagnoses perceived as more “controllable” (i.e., anorexia nervosa, depression) such that levels were similar to schizophrenia. Limitations and suggestions for future research are discussed.

Concealable stigma such as sexual or gender identity or mental illness has been linked to numerous adverse outcomes. Additionally, stigma of mental illness and help seeking stigma has been associated with reduced treatment utilization for psychological problems. Research on internalized stigma of mental illness (ISMI) has largely focused on a) the stigma associated with serious mental illness (e.g., schizophrenia; psychosis spectrum; bipolar-spectrum disorders) and b) the impact of stigma on disparities in treatment access/utilization. However, there have been few studies that have examined the impact of ISMI on treatment outcome or mechanisms through which ISMI influences treatment outcome. The current study addresses these gaps in literature by focusing on ISMI in a diverse outpatient sample within the Psychological Services Center (PSC) at Temple University. In this study, we investigated how mental health self-stigma influences outcome; processes that account for the relationship between mental health self-stigma and outcome; and how self-stigma changes over the course of up to ten therapy sessions in an outpatient setting. Data were drawn from adults participating in individual therapy at the PSC. Participants included 50 individuals (54% female; 76% White, 6% African American, 8% Multiracial, 6% Hispanic, 2% Middle-Eastern and Asian-American) who completed self-report measures of internalized stigma, psychological distress, shame, self-efficacy, social isolation, and hope for up to ten therapy sessions. Multilevel models were used to identify the trajectories of change for the main outcomes (psychological distress) and other variables of interest (stigma, shame, self-efficacy, social isolation, hope) across treatment. Baseline assessment of stigma was used to predict changes in the primary outcome in a set of conditional multilevel models. Logistic regression was used to examine effect of baseline stigma on treatment dropout. Additionally, multilevel models with indirect effects were used to examine the mechanism of relationship between ISMI and treatment outcome. Gender, gender role conflict and demographic variables were considered as potential covariates. Psychological distress, social isolation, and shame significantly reduced over the course of treatment. We did not find significant changes in depression, self-efficacy or hope. Stigma did not significantly change over the course of treatment. Most notably, greater stigma at baseline and over time (at each time point) was significantly associated with greater psychological distress (i.e., poorer treatment outcome), and greater baseline stigma predicted a greater likelihood of treatment dropout. However, baseline stigma was not associated with rate of change in psychological distress. There were no significant indirect effects mediating the impact of stigma on treatment outcome. Findings suggest that greater ISMI impacts subjective report of psychological distress in the beginning stages of treatment and contributes to early treatment dropout. These findings suggest that clients' personal beliefs about mental health and stigma should be attended to throughout treatment to help clients achieve better treatment outcomes, not only in terms of symptom/distress reduction, but also functionally. / Psychology

In the communities of the Cape Flats, it is expected that all women will bear children and become mothers. Motherhood serves as a social and cultural indicator of femininity and enables women to access social and economic networks that knit them into community. The social and cultural valorization of motherhood in these communities has informed the powerful stigmatization of infertility ( or the involuntary nonconformance to motherhood). The stigma associated with infertility affects women in particular, because the inability to bear children is commonly perceived to be a woman's problem. This study explores the cultural constructions of infertility. It examines in particular, the diverse cultural meanings and the stigma associated with infertility. The examination of these cultural meanings challenges the notion that infertility should only be examined in the biomedical realm. My research was conducted over a seven month period with six infertile women and with women who have borne children from different areas on the Cape Flats. The infertile women were the primary informants. Other informants included the mothers with whom the focus group was conducted and specialist informants who were healthcare professionals. The participants were recruited through the primary health care clinic in Manenberg, the network of community newspapers, The Daily Voice and through my own social network. Qualitative research methods were used. The study also used participatory research methods involved because the participants played an active role in the construction of the research process and interview schedules. The primary information used was obtained from in-depth interviews and journals kept by the infertile women. For comparative purposes, a focus group was conducted with a group of mothers. The study illustrates that on the Cape Flats, infertility is constructed as a major cultural and social problem for women. The stigma attached to infertility draws its power from the social and cultural meanings associated with inability of infertile women to live up to the expectation that every adult woman will become a mother. The effects of the social stigma of infertility are especially profound. As I show, bio-medicine does offer some solution, but only to the few who can afford it.

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