VA psychologists help Veterans overcome self-stigma

“Brush it off and move on.”

“You’re stronger than that.”

“Don’t let others see your weaknesses.”

“You can feel however you feel. Just don’t show it.”

Military culture often focuses on the needs of the larger group over the individual. That culture can encourage service members to push forward even when they are suffering. When these cultural norms persist after a service member transitions from the military, they can be detrimental — and in some cases extremely harmful — to a Veteran’s mental health and wellness.

Add to this cultural pressure the stigma that many Veterans already associate with mental health conditions, and it becomes quickly apparent why seeking help can be extremely challenging for many of the Veterans who need it most.

The two most common types of stigma stem from external stereotypes and internal perceptions. Societal stigma involves prejudice and discrimination directed at a specific group by the larger population. For example, society often stigmatizes those with specific mental health conditions, such as depression and PTSD. Self-stigma occurs when people come to believe that negative stereotypes are true for themselves because they have a stigmatized condition.

When Veterans associate their mental health challenges with weakness, failure, or other negative and false stereotypes, this self-stigma can be a debilitating barrier to self-esteem and help-seeking. That’s why mental health staff members at VA are focusing on helping Veterans avoid and address self-stigma as an integral part of the mental health treatment process.

Addressing self-stigma among Veterans

More than 100 programs across the U.S. and abroad are offering ESS, many within the VA health care system. To learn more about the course, explore the ESS manual.

Researchers at the VISN 5 MIRECC developed the Ending Self Stigma program, or ESS. This program helps people with mental health conditions mitigate the effects of both societal stigma and self-stigma through personalized strategies that embody cognitive behavioral therapy, recovery principles, and other coping techniques. The ESS program consists of nine sessions and is offered in groups of 6-8 Veterans led by 1-2 facilitators. Each session incorporates cognitive and skill-building techniques, strategy practice, and interactive discussions. Participants share their experiences, personalize the strategies, and learn from one another.

Lessons learned about reducing self-stigma

In developing the ESS program, and through research on its effectiveness and overall impact, the VISN 5 team has found the following tactics effective for Veterans dealing with self-stigma:

“[Stigma] bothers me sometimes, but I’m getting better at [overcoming] it. I’m realizing that I still have to take care of myself, and I still have to consider myself as someone, even though I might have some problems.” — ESS participant

• Remind yourself consciously and repeatedly that stigmatizing messages and assumptions are not true.
• Grow positive aspects of your self-concept by identifying your values, strengths, and roles.
• Lessen your exposure to stigmatizing messages and experiences to reduce the risk of internalizing them.
• Delegitimize stigmatizing messages as untrue, ignorant, and harmful.

Get involved

The Ending Self Stigma manual provides a wealth of information, including the full curriculum and accompanying tips and worksheets. Ask your mental health point of contact if ESS is available at your location. VA staff members can download the free manual to start offering it at any VA facility.

The ESS team has created additional resources for specific audiences:

• ESS for PTSD, a program for Veterans, has been tailored to address specific elements of stigma related to trauma and PTSD. To learn more visit https://www.mirecc.va.gov/visn5/ and scroll to the bottom of this front page to find information on ESS and other stigma resources.
• Fighting Internalized Stigma’s Impact on Families and Consumers, a workshop for family members of Veterans with serious mental illness. This workshop offers information and strategies for addressing mental health stigma. To learn more, visit https://www.mirecc.va.gov/visn5/ and scroll to the bottom of this front page to find information on ESS and other stigma resources.
• EASE-ing Self-Stigma is a workshop to help mental health staff members serve as anti-stigma allies. Full directions and materials for conducting the workshop at your location are available online at www.mirecc.va.gov/visn5, along with a link to a recorded webinar in TMS. To learn more, visit https://www.mirecc.va.gov/visn5/ and scroll to the bottom of this front page to find information on ESS and other stigma resources.

To watch videos about how Veterans and their loved ones have created healthy environments to overcome self-stigma, visit MakeTheConnection.net.

About the VISN 5 MIRECC

The VISN 5 MIRECC mission is to support and enhance the recovery and community functioning of Veterans with serious mental illness. Its integrated programs of research, education, and clinical training and consultation focus on the development, evaluation, and implementation of recovery-oriented, evidence-based treatments and services for Veterans. VISN 5’s practice areas currently include health and wellness, family-oriented services, stigma reduction, psychopharmacology and neurobiological bases of serious mental illness, treatment and community engagement. For more information about the VISN 5 MIRECC, visit www.mirecc.va.gov/visn5/index.asp.

 Author Bios

Dr. Amy Drapalski is a clinical research psychologist and Associate Director of the Clinical Core at the VISN 5 MIRECC. She earned her doctorate from George Mason University and completed a postdoctoral fellowship at the VISN 5 MIRECC. Her work focuses on developing and testing consumer-centered strategies and tools to improve the quality of care of individuals with mental illness and their families and addressing barriers to mental health recovery, including internalized stigma.

Dr. Alicia Lucksted is a clinical-community research psychologist and research investigator at the VISN 5 MIRECC. She earned her doctorate from the University of Maryland. She completed a postdoctoral fellowship in mental health services research at the University of Pennsylvania. Her work focuses on mental health recovery and mental health services research among Veterans and other adults, with an emphasis on reducing the burden of societal and internalized stigma on individuals with mental health concerns.