Automatic self-stigma-relevant associations in people with schizophrenia experiencing habitual self-stigma: Evidence from the brief implicit association tests

1) Background: While self-stigmatizing thoughts constitute a cognitive vulnerability factor for poor mental health, dysfunctional coping (i.e., experiential avoidance and lack of mindfulness) with self-stigma may pose an additional risk factor for this propensity by leading to frequent activation of self-stigmatization, which may then make self-stigmatizing thinking habitual and automatic (namely, a mental habit). This concept of habitual self-stigma points to the importance of understanding the automatic, implicit aspects of self-stigma. The present study aims to investigate the possibility of a pattern of more automatic self-stigma-relevant associations among people with schizophrenia having habitual self-stigma. 2) Methods: A community sample of 62 people with schizophrenia spectrum or other psychotic disorder was recruited in Hong Kong. Habitual self-stigma was assessed with the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale. Considering that self-stigma refers to internalizing the negative attributes associated with the mental illness (MI) identity for the self, three different Brief Implicit Association Tests (BIATs) were used to assess the automatic processing of the “self-MI” association (i.e., high centrality of the MI identity to the self), the “MI-negative” association (i.e., negative attitudes toward MI), and the “self–negative” association (i.e., low self-esteem). 3) Results: The automatic “self-MI” association (r=0.342, p=0.006), but not the “MI-negative” association (r=0.196; p=0.126) and the “self-negative” association (r=−0.079; p=0.544), was correlated with stronger self-stigmatizing thinking habit. Repetitive self-stigma (r=0.341, p=0.007) and automatic self-stigma (r=0.324, p=0.01) were also correlated with more automatic processing of the “self-MI” association. 4) Discussion: While there has been extensive research on the demographic, clinical, and psychosocial correlates of self-stigma, there has been little research on its cognitive or information-processing profile. This study provides a direct test of the relevance of automatic evaluation in understanding the nature of automatic cognitive processing in habitual self-stigma. Our findings suggest that the mental illness identity may be more central to the self-definition of participants with stronger self-stigmatizing thinking habit. The significant correlation between the STAR scale and the automatic quality of response latencies in the BIAT strengthens the assumption that the scale does have validity in reflecting cognitive processes that take place automatically.