Reducing stigma against depression: Evaluation of a metacognitive intervention targeting processes of stigmatization

Abstract

A variety of cognitive mechanisms contribute to public stigmatization of depression, including mood misattribution, classical conditioning, illusory correlation, expectancy bias, just world beliefs, and social identity. Although these processes are fundamental to stigmatization, they are not directly addressed by existing anti-stigma approaches. It is posited that these cognitive mechanisms could be targeted for change using an approach of metacognition or “thinking about one’s thinking”. From this theoretical background emerged a novel anti-stigma strategy, which uses metacognition to enhance awareness and control of the cognitive mechanisms involved in stigmatization of depression. Over a series of two studies, the viability of this innovative metacognitive intervention was explored in student and community populations and evaluated against the leading anti-stigma strategies of factual education about depression and personal contact with a formerly depressed person. A variety of outcome measures were utilized, including attributional measures, an attitudinal scale, a measure of cognitive processes, and a behavioural measure. Study 1 provided initial support for the metacognitive intervention in a university student population, in comparison to education and an intervention that combined education and metacognition. Study 2 further established the utility of the metacognitive intervention in a community population, in comparison to education and contact. Across the two studies, results support the viability of the metacognitive intervention as an effective stand-alone anti-stigma strategy. Furthermore, the impact of the metacognitive intervention was found to be comparable to that of the education and contact approaches. Concordant with the theoretical literature, results of the present studies suggest that social identity, just world beliefs, expectancy bias, and mood misattribution are primary mechanisms of stigmatization. Further investigation into mechanisms of change is recommended. The utility of the metacognitive intervention in a variety of populations and in regard to a variety of stigmatized conditions offers a significant area for future development. A metacognitive intervention potentially has broad applicability because it addresses mechanisms that are common to all stigmatized conditions. With initial support for the viability of a metacognitive anti-stigma intervention established, further research related to this novel approach is warranted.