Methods and Techniques
Reducing Mental Illness Stigma in
the Classroom
Teaching of Psychology
39(2) 121-124
ª The Author(s) 2012
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0098628312437720
http://top.sagepub.com
Elizabeth K. Matteo1 and Di You1
Abstract
Undergraduates in 3 introductory psychology courses participated in teaching interventions designed to reduce mental illness
stigma. Expanding on previous research, the researchers tested the effects of education, video, and contact interventions. Results
of the pretest and posttest scores on a social distance measure revealed a statistically significant reduction in social distancing for
the contact intervention. The researchers emphasize the use of stigma-reducing pedagogies in teaching psychopathology to
undergraduates.
Keywords
stigma, abnormal psychology, introductory psychology, mental illness
Past research on mental illness1 stigma reveals that it is
widespread in the United States (see Corrigan & Penn, 1999,
for a review) and is one of the largest barriers to mental health
treatment (U.S. Surgeon General, 1999). Other research shows
that prejudice against those with mental illness may affect their
ability to obtain housing and employment, which ultimately
reduce resources for mental health services (Corrigan & Penn,
1999; Hinshaw & Cicchetti, 2000). Furthermore, sociological
data of public perceptions of mental illness in the past 50 years
show that many negative attitudes persist (Pescosolido et al.,
2008).
Despite ample research on the causes and consequences of
mental illness stigma, few researchers have explored classroom
pedagogies to reduce it, especially in U.S. undergraduates
(Chan, Mak, & Law, 2009; Chung, Chen, & Liu, 2001; Graham, 1968; Morrison, Cocozza, & Vanderwyst, 1978; Morrison & Teta, 1980). However, a recent study shows that
teaching psychopathology to introductory psychology classes
using a traditional approach, emphasizing symptoms and
causes of disorders, had no effect at reducing mental illness
stigma, but humanizing it using first-person narratives did
(Mann & Himelein, 2008).
Considering that the American Psychological Association
(2007) indicated several student-learning outcomes related to
increasing students’ sensitivity for diverse groups (Goal 8),
psychology programs ought to explore stigma-reducing pedagogies as part of their curricula. The fact that many psychology
majors pursue careers in settings (e.g., education, healthcare,
business) where they will work directly with diverse groups
also highlights the importance of specifically addressing
mental illness stigma. Moreover, many institutions require
nonmajors to take introductory psychology. Therefore, not
addressing mental illness stigma wastes an opportunity to
educate large numbers of students who may have little
exposure to this serious public health issue and who may either
personally and professionally confront this issue.
In this study, we build on research showing that humanizing
mental illness reduces college students’ stigmatizing attitudes
(Mann & Himelein, 2008). However, instead of exposing
students to first-person narratives, we specifically test education, video, and contact interventions. Although laboratory
research has shown that video and contact yield similar results
in reducing mental health stigma (Reinke, Corrigan, Leonhard,
Lundin, & Kubiak, 2004), we aimed to test whether we could
replicate this finding in a college classroom. Specifically, three
groups of introductory psychology classes received an education, video, or contact intervention. We predicted that the video
and contact interventions would be significantly more effective
at reducing stigmatizing attitudes than education alone.
Method
Participants
A total of 69 students (41 female, 28 male) in three introductory
psychology classes from a small, Catholic, liberal arts university in the northeast United States participated. Students were
1
Department of Psychology and Counseling, Alvernia University, Reading, PA,
USA
Corresponding Author:
Elizabeth K. Matteo, Department of Psychology and Counseling, Alvernia
University, Reading, PA 19607, USA
Email: elizabethmatteo@alvernia.edu
122
19 years of age on average (SD ¼ 2.95). The three classes were
similar in terms of demographics. The majority reported freshman status (78%). Although we did not ask participants to
report religious affiliation, approximately 38% of the student
population is reportedly Catholic, 34% other Christian, and the
remaining report a variety of religious backgrounds or no
affiliation. We chose specific classes based on convenience and
randomly assigned them to the interventions. Participation was
completely voluntary, and we coded responses to protect anonymity. All students chose to participate. Data were discarded if
a student was absent for either pretest or posttest.
Materials
Participants in all classes completed identical pretest and posttest questionnaires. The questionnaires included demographic
items, two vignettes describing Bill, diagnosed with bipolar
disorder, and John, diagnosed with paranoid schizophrenia,
taken from Mann and Himelein (2004, 2008). After each vignette, six social distance items derived from a 19-item social distance measure developed by Chung et al. (2001) measured
participants’ comfort with Bill and John in social situations
such as having them as a roommate or collaborating on a project (Mann & Himelein, 2004, 2008). Scores ranged on a Likerttype scale from 1 (very uncomfortable) to 5 (very comfortable).
The pretest and posttest reliability for both social distance measures was consistent with the reliability reported by Mann and
Himelein (2004, 2008); Cronbach’s a ¼ .83. Although
researchers have raised questions concerning the internal validity of social distance measures (Link, Yang, Phelan, & Collins,
2004), they are common, quick to administer, and for our purposes took little time away from instruction.
All groups had identical textbooks and curricula and differed only in this method of instruction. Griggs’s (2009) textbook primarily focuses on diagnoses, symptoms, and causes
of mental illness.
Procedure
Two weeks prior to introducing the psychopathology chapter,
we obtained informed consent and students completed the pretest measure at the end of a class period.
For the 2-week period during which instruction covered psychopathology, all groups received similar content and instruction based on the prepackaged slides offered by the textbook
publisher. Each group received 6 hr of total instruction for the
chapter and 1 hr and 45 min of that time on the topic of mental
illness stigma. For all groups, the intervention occurred after
they had approximately 1 hr of class introducing them to the
general criteria used to establish psychopathology, the background and purposes of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), and the advantages and disadvantages of diagnostic
labels. Instructors dedicated the last 15 min of the first class on
psychopathology and the entire following class to the interventions. After the interventions, students continued to learn about
Teaching of Psychology 39(2)
symptoms and diagnosis of various disorders and types of
treatments. All instructors administered a 20-item multiplechoice psychopathology chapter quiz a week after they
completed instruction of the topic. Approximately 2 weeks after
the psychopathology unit, all groups completed the posttest
measure.
Education. The education group engaged in a 15-min,
small-group activity that required them to generate cultural
stereotypes and myths about individuals with mental illness.
In the next class, 90 min in length, the lecture and discussion
dealt with the stereotypes and misconceptions associated with
mental illness. The information challenged the causes, timeline, consequences, controllability, and common representations of mental illness often viewed in the media using an
evidence-based approach.
Video. The video group also engaged in a 15-min, smallgroup activity. However, the groups generated questions they
would ask a person with a mental illness. The instructor told
students to not self-censor but consider what they would be
interested in knowing about the person’s experience with mental illness. Students then completed an out-of-class assignment
in which they had to view three public service announcements
produced by a nonprofit organization whose mission is to
reduce stigma surrounding mental illness. The website (http://
www.bringchange2mind.org) features firsthand accounts about
mental illness. Afterward students completed a short 1- to 1.5page reflection paper addressing the following two questions:
‘‘How can we as a society reduce the stigma associated with
mental illness? Do you think the website is effective? Support
your answer.’’ To control exposure time, instructors told the
students that the total assignment should take them 1.5 hours.
Contact. The contact group engaged in the same 15-min,
small-group activity as did the video group. Two days later,
in the following class period (90 min), students met three members from the local community diagnosed with a mental illness
(diagnoses included schizophrenia, major depression, and
attention deficit-hyperactivity disorder). The members were all
middle-aged men affiliated with a local mental health advocacy
group. Each spent approximately 5 min (15 min total) providing background information about their lives (e.g., age of diagnosis, how they manage their illness, occupation and family
information). The instructor then told students to sit with their
groups from the previous class activity. The community members circulated to the groups for 15 min each so that every
group had an opportunity to meet and ask questions to each
member. We devised this procedure to engage the students and
provide a more personal contact experience than a panel
discussion.
Results
A one-way ANOVA reveals no significant difference for age,
race, and gender on the pretest measure across the three groups.
Matteo and You
123
Table 1. Means and Standard Deviations of Social Distance Scores
Pretest
Education
Video
Contact
Posttest
M
SD
M
SD
2.53
2.60
2.40
0.55
0.79
0.47
2.73
3.10
3.07
0.79
0.83
0.51
Higher scores indicate greater comfort.
To test for an association, we computed correlations on
participants’ pretest and posttest total social distance scores for
the two vignettes. The correlations were significant, r(69) ¼
.58, p < .01, and r(69) ¼ .77, p < .01, respectively. Therefore,
we combined the vignette scores to form a total mean social
distance score (theoretical range2 was 1–5). Table 1 shows the
mean social distance scores for the groups at pretest and
posttest.
An ANCOVA performed on the total mean social distance
scores, with the total mean pretest social distance scores as a
covariate, yielded a significant condition effect at posttest,
F(2, 68) ¼ 3.92, p ¼ .03, partial Z2, ¼ 0.11. Follow-up
Bonferroni-adjusted pairwise comparisons reveal that the contact group reported greater comfort with a person with a mental
illness compared to the education group (p ¼ .03, d ¼ 0.50).
We found no significant differences when comparing the video
and education group or the contact and video group (p > .05).
We also computed change scores by subtracting the pretest
social distance scores from the posttest social distance scores.
Results of a one-way ANOVA reveal a significant effect,
F(2, 68) ¼ 4.03, p ¼ .02 (see Table 2 for mean change scores).
Follow-up Bonferroni-adjusted pairwise comparisons show the
contact group had a statistically significant reduction in social distance (p ¼ .02, d ¼ 0.78) compared with the education group. We
found no significant differences when comparing the video and
education group or the contact and video group (p > .05).
Finally, we assessed students’ knowledge of mental illness
by obtaining scores on the psychopathology chapter quizzes.
Analyses revealed no significant differences in performance
across the three groups.
Discussion
This study compared the effectiveness of three interventions in
reducing introductory psychology students’ stigmatizing attitudes of individuals with mental illness. Results partially support our hypothesis, indicating students became significantly
more comfortable with individuals with mental illness after a
contact intervention. Although the pattern of means shows that
the video group reported greater comfort with individuals with
mental illness at posttest, the amount of change is not significant.
Table 2. Means and Standard Deviations of Social Distance Change
Scores
Intervention
Education
Video
Contact
M
SD
n
0.19
0.50
0.66
0.48
0.65
0.57
24
24
21
future research. First, the posttest social distance scores for the
contact group revealed relatively more comfort, but participants were still not highly comfortable. Similar research by
Chan et al. (2009), with ninth graders in Hong Kong, also found
only moderate levels of comfort after a combined educationvideo intervention, and the effects lessened after 1 month.
Moreover, Chan et al. found a 15-min video intervention to
be effective only after 30 min of a demythologizing lecture, not
when the lecture came afterward. In our study, the video was
not effective, but perhaps pairing it with a similar demythologizing lecture would have led to greater attitude change.
Another limitation that might have lessened the effectiveness
of the video intervention was our inability to precisely control
students’ exposure time. Time and level of engagement would
have more closely matched the other groups if students
watched the video during class. We recommend that instructors, especially those without the time or ability to facilitate
contact, still consider video as a viable method but to include
prior education before exposure. To avoid possible demand
effects, future research should also consider embedding the
social distance measures within other attitude measures and
have others administer the surveys.
In conclusion, multiple findings suggest educating students
using traditional approaches, including lecture and discussion,
does little to reduce mental illness stigma. Our research
provides a practical classroom intervention for reducing mental
illness stigma. Similarly, other research has found that interpersonal contact with the mentally ill through undergraduate
internships also reduces stigma (Kolodziej & Johnson, 1996).
Our intervention was designed to increase perspective taking
and provide counter-stereotypic examples of individuals with
mental illness. Future theoretical research should tease apart
what aspects of contact lead to attitude change and if it coincides with actual behavior change (Couture & Penn, 2003).
Finally, we strongly recommend that undergraduate psychology programs currently using traditional approaches to
teaching psychopathology consider contact and other
evidence-based instructional methods.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Limitations and Future Directions
Funding
Despite showing the benefits of a contact intervention in the
classroom, we address several limitations and possibilities for
The authors disclosed receipt of the following financial support for the
research, authorship, and/or publication of this article: This research
124
was partially supported by a Faculty Excellence Grant awarded by
Alvernia University.
Notes
1. Mental illness has been commonly adopted by other researchers
and the Surgeon General to describe those with various psychiatric
diagnoses. For the sake of consistency, we have also adopted this
term here, but we acknowledge that it is a problematic term that may
influence public attitudes negatively (see Wilmouth, Silver, & Severy, 1987).
2. The original measure had one item for each vignette that asked how
comfortable participants would be ‘‘dating Bill and John?’’ We
dropped the item because many male participants indicated ‘‘not
applicable.’’ The rationale to drop it from the measure was because
of concern that gender was a confounding factor. Heterosexual men
might indicate being uncomfortable dating other men irrespective
of their having mental illness.
References
American Psychiatric Association. (1994). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychological Association. (2007). APA guidelines for the
undergraduate psychology major. Washington, DC: Author.
Retrieved from http://www.apa.org/ed/precollege/about/psymajor-guidelines.pdf
Chan, J. Y. N., Mak, W. W. S., & Law, L. S. C. (2009). Combining
education and video-based contact to reduce stigma of mental illness: ‘‘The same or not the same’’ anti-stigma program for secondary schools in Hong Kong. Social Science and Medicine, 68,
1521-1526.
Chung, K. F., Chen, E. Y. H., & Liu, C. S. M. (2001). University students’ attitudes towards mental patients and psychiatric treatment.
International Journal of Social Psychiatry, 47, 63-72.
Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54,
765-776.
Couture, S. M., & Penn, D. L. (2003). Interpersonal contact and the
stigma of mental illness: A review of the literature. Journal of
Mental Health, 12, 291-305.
Graham, J. R. (1968). Effects of introductory and abnormal psychology courses on students’ attitudes toward mental illness. Psychological Reports, 22, 448.
Teaching of Psychology 39(2)
Griggs, R. A. (2009). Psychology: A concise introduction (2nd ed.).
New York, NY: Worth.
Hinshaw, S. P., & Cicchetti, D. (2000). Stigma and mental disorder:
Conceptions of illness, public attitudes, personal disclosure, and
social policy. Developmental Psychopathology, 12, 555-598. doi:
10.1017/50954579400004028
Kolodziej, M. E., & Johnson, B. T. (1996). Interpersonal contact and
acceptance of persons with psychiatric disorders: A research synthesis. Journal of Consulting and Clinical Psychology, 64(6),
1387-1396.
Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma. Schizophrenia Bulletin, 30(3),
511-541.
Mann, C. E., & Himelein, M. J. (2004). Factors associated with stigmatization of persons with mental illness. Psychiatric Services, 55,
185-187.
Mann, C. E., & Himelein, M. J. (2008). Putting the person back in psychopathology: An intervention to reduce mental illness stigma in
the classroom. Social Psychiatry and Psychiatric Epidemiology,
43, 545-551. doi:10.1007/s00127-008-0324-2
Morrison, J. K., Cocozza, J. J., & Vanderwyst, D. (1978). Changing
students’ constructs of mental patients by means of educative seminars. Journal of Clinical Psychology, 34, 482-483.s
Morrison, J. K., & Teta, D. C. (1980). Reducing students’ fears of
mental illness by means of seminar induced belief change. Journal
of Clinical Psychology, 36, 275-276.
Pescosolido, B., Martin, J., Long, S., Medina, T., Phelan, J., & Link,
B. (2008, August). Can medical science erase the stigma of mental
illness? Paper presented at the annual meeting of the American
Sociological Association, Boston, MA.
Reinke, R. R., Corrigan, P. W., Leonhard, C., Lundin, R.K., &
Kubiak, M. A. (2004). Examining two aspects of contact on the
stigma of mental illness. Journal of Social and Clinical Psychology, 23, 377-389.
U. S. Surgeon General. (1999). Mental health: A report of the Surgeon
General. Washington, DC: U.S. Department of Health and Human
Services. Retrieved August 25, 2010, from http://www.surgeongeneral.gov/library/mentalhealth/toc.html
Wilmouth, G. H., Silver, S., & Severy, L. J. (1987). Receptivity and
planned change: Community attitudes and deinstitutionalization.
Journal of Applied Psychology, 72, 138-145. doi:10.1037/00219010.72.1.138