Attentional bias for self-stigmatizing stimuli in people with schizophrenia experiencing habitual self-stigma: Evidence from the emotional stroop task

1) Background: Schizophrenia research has indicated that self-stigma is associated with increased defensive coping strategies, specifically secrecy and withdrawal. People with schizophrenia who tend to avoid or sup-press self-stigmatized experiences are prone to frequent and, over time, habitual (and thus, automatic) self-stigmatizing thinking. These individuals’ unwillingness to nonjudgmentally accept self-stigmatizing thoughts and feelings may eventually result in a bias towards under-allocating attention to process the semantic content of self-stigmatizing stimuli (e.g. failure, stupid, incompetent) that could be interpreted as personally relevant but threatening. The present study aims to examine the nature of information-processing biases (i.e., automatic attentional biases) involved in the mental habit. 2) Methods: A community sample of 114 people with schizophrenia spectrum or psychotic disorder was recruited in Hong Kong. Habitual self-stigma was assessed with the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale. Participants completed an Emotional Stroop Task designed with self-stigmatizing words as experimental stimuli, along with affectively neutral words as control stimuli. Attentional bias to (or away from) the meaning of self-stigmatizing stimuli was characterized by longer (or shorter) response latencies in naming the color of the self-stigmatizing words, compared to the affectively neutral words. As the Emotional Stroop task may tap into the cognitive ability of selective attention, this study also included the Cognitive Stroop Task to assess selective attention, so that the Emotional Stroop effects could be interpreted in light of other cognitive findings. 3) Results: Participants with a strong habit exhibited faster color-naming of the self-stigmatizing (compared to the non-affective) stimuli (latency difference = 10.23 ms), suggesting facilitation effect for (i.e., attentional bias to) the self-stigmatizing stimuli. Such facilitation effect was significantly correlated with habitual self-stigma (r=−0.185, p=0.048). The Cognitive Stroop effects were not correlated with habitual self-stigma (r=−0.044, p=0.66) and the Emotional Stroop effects (r=0.019, p=0.853). 4) Discussion: Our findings point to a specific relationship between habitual self-stigma and attentional bias away from self-stigmatizing stimuli. Such biased processing of self-stigmatizing information was not attributable to the selective attention competencies in participants, because the Cognitive Stroop effects were not correlated with the STAR scale. This study is the first to demonstrate a specific cognitive bias in processing negatively valenced stimuli in self-stigmatizing thinkers. Self-stigma interventions should target the information-processing biases (i.e., automatic attentional biases) involved in the mental habit.