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Most people have been harmed by another at some point in their lives. Many of these hurts linger in the lives of those who were hurt, through anger, fear, and rumination. Forgiving others, when it is safe and prudent to do so, can be one route toward healing these past hurts. Group therapy has specific strengths that might help people to effectively forgive others. One of those strengths is the creation of therapeutic factors. In the current paper we discuss how group forgiveness interventions and the development of three specific therapeutic factors (universality, cohesion, and altruism) can help to promote forgiveness. We review prior work on forgiveness interventions in group therapy, focused on effectiveness generally. We then provide an applied case study of a specific group that used Worthington's REACH Forgiveness model. In this case study we highlight the themes of universality, cohesion, and altruism to illustrate the benefit of forgiveness interventions in group therapy. [ABSTRACT FROM AUTHOR]

Empathy toward one's offender has been identified as an important variable in the forgiveness process, but elements of the empathy-forgiveness connection have yet to be explored. The current study experimentally examined both direct and indirect methods of promoting general empathy (i.e., empathy not connected specifically to the offense) toward a confederate who behaved inconsiderately, and how those methods of general empathy promotion affected forgiveness. Results demonstrated that a direct method of promoting empathy (i.e., being instructed to empathize with the confederate) increased empathy toward the confederate, whereas an indirect method (i.e., the confederate's display of emotional vulnerability) did not significantly increase empathy. The direct promotion of general empathy facilitated higher levels of self-reported forgiveness, whereas the indirect attempt to promote general empathy resulted in lower self-reported and behavioral forgiveness. The results help to refine our understanding of the empathy-forgiveness connection by questioning the types and forms of empathy that might be useful for promoting forgiveness., Author(s): Marilyn A. Cornish [sup.1], Max Guyll [sup.2], Nathaniel G. Wade [sup.2], Daniel G. Lannin [sup.3], Stephanie Madon [sup.2], K. Christine Chason [sup.1] Author Affiliations: (1) grid.252546.2, 0000 0001 2297 [...]

Stigma is considered an important barrier to seeking mental health services. Two types of stigma exist: public stigma and self-stigma. Theoretically, it has been argued that public stigma leads to the development of self-stigma. However, the empirical support for this assertion is limited to cross-sectional data. Therefore, the goal of this research was to examine the relationship between public stigma and self-stigma over time. Perceptions of public and self-stigma were measured at Time 1 (T1) and then again 3 months later at Time 2 (T2). Using structural equation modeling, we conducted a cross-lag analysis of public stigma and self-stigma among a sample of 448 college students. Consistent with assertions that public stigma leads to the development of self-stigma, we found that public stigma at T1 predicted self-stigma at T2, whereas the converse was not true. These findings suggest that if self-stigma develops from public stigma, interventions could be developed to interrupt this process at the individual level and reduce or eliminate self-stigma despite perceptions of public stigma. (Contains 1 table, 2 figures and 2 footnotes.)

Researchers have found that the stigma associated with seeking therapy--particularly self-stigma--can inhibit the use of psychological services. Yet, most of the research on self-stigma has been conducted in the United States. This is a considerable limitation, as the role of self-stigma in the help-seeking process may vary across cultural groups. However, to examine cross-cultural variations, researchers must first develop culturally valid scales. Therefore, this study examined scale validity and reliability of the widely used Self-Stigma of Seeking Help scale (SSOSH; Vogel, Wade, & Haake, 2006) across samples from 6 different countries (England, Greece, Israel, Taiwan, Turkey, and the United States). Specifically, we used a confirmatory factor analysis framework to conduct measurement invariance analysis and latent mean comparisons of the SSOSH across the 6 sampled countries. Overall, the results suggested that the SSOSH has a similar univariate structure across countries and is sufficiently invariant across countries to be used to explore cultural differences in the way that self-stigma relates to help-seeking behavior. (Contains 5 tables and 1 footnote.)

Fifty-four counselors at 9 university counseling centers participated in a study regarding religion and spirituality (R/S) in group counseling. The majority indicated that R/S is an appropriate topic for group counseling and that some religious and spiritual interventions are appropriate to use. However, counselors rarely use these interventions. Counselors endorsed higher ratings for spiritual interventions compared to their religious counterparts. After reading 1 of 2 vignettes depicting either a religious or spiritual concern raised by a group client, counselors rated their likelihood of responding in different ways. We observed no differences in the responses based on the different vignettes.

One of the major obstacles to seeking psychological help is the stigma associated with counseling and therapy. Self-stigma, the fear of losing self-respect or self-esteem as a result of seeking help, is an important factor in the help-seeking process. In the present study, college students meeting a clinical cutoff for psychological symptoms participated in 1 session of group counseling that either contained therapist self-disclosure or did not. In general, participants reported significantly less self-stigma following the session. Working alliance-bond and session depth significantly predicted the change in self-stigma. Furthermore, self-stigma (as well as bond, depth, psychological symptoms, and being female) predicted the intention to seek help following the session. Self-stigma and session depth also predicted interest in continuing with counseling. The therapist self-disclosure condition, however, had no effect on the change in self-stigma, intentions to seek help, or interest in continuing with group counseling. (Contains 3 tables and 3 footnotes.)

Combat exposure is a consistent predictor of posttraumatic stress (PTS). Understanding factors that might buffer the effects of combat exposure is crucial for helping service members weather the stress of war. In a study of U.S. Marines returning from Iraq, hierarchical multiple regression analyses revealed that unit cohesion and combat exposure predicted PTS, depression, and anger. Furthermore, results indicated that unit cohesion may be an important buffer, possibly limiting the development of PTS and depression following combat exposure.

Public and self-stigmas have been implicated as factors in the underutilization of individual counseling. However, group counseling is also underutilized, and yet scholars know very little about the role of different types of stigma on attitudes toward seeking group counseling. Therefore, the current study examined the relationships between public and self-stigma and attitudes toward group counseling among a sample of 491 U.S. college students. Results of structural equation modeling analyses indicated that public stigma is internalized as self-stigma and self-stigma is then negatively related to attitudes toward group counseling. Furthermore, public stigma and self-stigma explained 52% of the variance in attitudes toward seeking help. (Contains 2 tables and 1 figure.)

This study examined the relationship between self-stigma, anticipated risks and benefits associated with seeking counseling, and attitudes toward seeking counseling among college students with disordered eating attitudes and behaviors. The results of hierarchical regression analyses demonstrated that self-stigma and the anticipated risks and benefits significantly predicted attitudes toward counseling for people with disordered eating. In addition, self-stigma had a stronger relationship with men's attitudes toward counseling than with women's, and anticipated benefits had a stronger relationship with women's attitudes toward counseling than with men's.

Fear of being stigmatized is the most cited reason why individuals avoid psychotherapy. Conceptually, this fear should be strongest when individuals consider the reactions of those they interact with. Across 5 samples, the authors developed the Perceptions of Stigmatization by Others for Seeking Help (PSOSH) scale. In Sample 1 (N = 985), the 5 items of the PSOSH were selected ([alpha] = 0.91). In Sample 2 (N = 842), the unidimensional factor structure of the scale was examined across a diverse sample. In Sample 3 (N = 506), concurrent validity was supported through moderate associations with 3 different stigma measures (i.e., public stigma toward counseling, r = 0.31; public stigma toward mental illness, r = 0.20; and self-stigma, r = 0.37). In Sample 4 (N = 144), test-retest reliability across a 3-week period was calculated (0.82). Finally, in Sample 5 (N = 130), reliability ([alpha] = 0.78) and validity were explored with a sample experiencing symptoms of psychological distress. Relationships between variables (i.e., public stigma toward counseling, r = 0.31, and self-stigma, r = 0.40) were similar to those in previous samples. (Contains 4 tables.)

Forgiveness interventions can help people forgive past offenses. However, few studies have compared forgiveness interventions with genuine alternative treatments. The authors compared forgiveness interventions with a therapeutic alternative treatment. Participants reduced unforgiveness and increased forgiveness regardless of treatment condition. Trait forgivingness was not related to change in forgiveness, whereas greater offender contrition was related to greater reductions in unforgiveness. The type of treatment may not be as important as factors common to the interventions.

The tendency to ruminate has been consistently linked to psychological disturbances, such as increased stress, anger, and fear in response to provocations. However, existing measures of rumination focus on the disposition to ruminate rather than on rumination about a specific situation. This limits the ability to explore rumination about a specific situation and makes the assessment of change as a result of time, contextual factors, or psychological interventions difficult. Across three samples, including a clinical sample, the reliability and validity of the Rumination About an Interpersonal Offense scale (RIO) was examined. Exploratory and confirmatory factor analyses provided support for a unidimensional structure. Internal consistency and test-retest reliabilities were adequate. Convergent and discriminant validity were also supported. (Contains 2 table.)

This study examined the mediating effects of the self-stigma associated with seeking counseling and attitudes toward seeking counseling on the link between perceived public stigma and willingness to seek counseling for psychological and interpersonal concerns. Structural equation modeling of data from 676 undergraduates indicated that the link between perceived public stigma and willingness to seek counseling was fully mediated by self-stigma and attitudes. Perceptions of public stigma contributed to the experience of self-stigma, which, in turn, influenced help-seeking attitudes and eventually help-seeking willingness. Furthermore, 57% of the variance in attitudes toward counseling and 34% of the variance in willingness to seek counseling for psychological and interpersonal concerns were accounted for in the proposed model.

Self-stigma is an important factor in people's decisions not to engage in therapy. To measure this construct, the authors developed the 10-item Self-Stigma of Seeking Help (SSOSH) scale. In Study 1 (n = 583), the SSOSH had a unidimensional factor structure and good reliability (0.91) among participants. Study 2 (n = 470) confirmed the factor structure. Studies 2, 3 (n = 546), and 4 (n =217) cross-validated the reliability (0.86 to 0.90; test-retest, 0.72) and showed evidence of validity (construct, criterion, and predictive) across the study samples. The SSOSH uniquely predicted attitudes toward and intent to seek psychological help. Finally, in Study 5 (n = 655) the SSOSH differentiated those who sought psychological services from those who did not across a 2-month period.

The stigma of seeking counseling and negative attitudes about counseling are primary barriers to its use. In the only known study examining the utility of attending a group counseling session to ameliorate stigma (no control group), participation was associated with reductions in self-stigma (Wade et al., 2011). Self-affirmation interventions have shown promising results in reducing stigma and promoting positive expectations about counseling, but no research has examined its effects on a counseling session. In the present, two-part study, 172 college students who had previously completed an online screening survey, including measures of stigma, participated in a single session of group counseling at a mental health clinic. Upon arrival, participants completed a self-affirmation intervention before viewing psychoeducation (n = 66; 12 groups) or only viewed psychoeducation (n = 72; 14 groups); both groups then completed a session of group counseling. After, participants completed these same measures along with measures of group relationships. The remaining participants (n = 34; 7 groups) viewed psychoeducation and completed the same stigma measures before being informed of randomization to the wait-list control condition. Our results replicate and extend findings from Wade et al. (2011): Completing a single session of group counseling reduced self-stigma and promoted positive attitudes toward counseling. Further, completing self-affirmation reduced postsession perceptions of public stigma. Self-affirmation had no impact on group relationships. Overall, findings suggest the utility of offering a "try-out" session of group counseling as a stigma-reduction intervention; preceding with a brief self-affirmation intervention provides further benefits by reducing perceptions of public stigma. [ABSTRACT FROM AUTHOR]

Combat exposure is a consistent predictor of posttraumatic stress (PTS). Understanding factors that might buffer the effects of combat exposure is crucial for helping service members weather the stress of war. In a study of U.S. Marines returning from Iraq, hierarchical multiple regression analyses revealed that unit cohesion and combat exposure predicted PTS, depression, and anger. Furthermore, results indicated that unit cohesion may be an important buffer, possibly limiting the development of PTS and depression following combat exposure., The current conflicts in Iraq and Afghanistan have resulted in a number of investigations examining the postdeployment mental health among military personnel serving in these regions. Although the published rates [...]

There has been increased discussion of the need to attend to clients' spirituality and religion as a part of the counseling process, but much of the literature to date has focused on individual counseling. How do the research and resulting practice implications apply to group counseling? This article provides a rationale for attending to spirituality and religion in counseling, explores the opportunities and barriers in attending to spirituality and religion in group counseling, and reviews the literature on the growing number of group interventions with a spiritual or religious focus. The article ends with specific guidelines for when and how to incorporate spirituality and religion into group counseling. Keywords: spirituality, religion, group counseling, group therapy DOI: 10.1037/a0020179

This study examined the relationship between self-stigma, anticipated risks and benefits associated with seeking counseling, and attitudes toward seeking counseling among college students with disordered eating attitudes and behaviors. The results of hierarchical regression analyses demonstrated that self-stigma and the anticipated risks and benefits significantly predicted attitudes toward counseling for people with disordered eating. In addition, self-stigma had a stronger relationship with men's attitudes toward counseling than with women's, and anticipated benefits had a stronger relationship with women's attitudes toward counseling than with men's., Although between 5% and 17% of college students have an eating disorder such as anorexia nervosa or bulimia nervosa (Becker, Franko, Nussbaum, & Herzog, 2004; Prouty, Protinsky, & Canady, 2002), [...]

Fear of being stigmatized is the most cited reason why individuals avoid psychotherapy. Conceptually, this fear should be strongest when individuals consider the reactions of those they interact with. Across 5 samples, the authors developed the Perceptions of Stigmatization by Others for Seeking Help (PSOSH) scale. In Sample 1 (N = 985), the 5 items of the PSOSH were selected ([alpha] = .91). In Sample 2 (N = 842), the unidimensional factor structure of the scale was examined across a diverse sample. In Sample 3 (N = 506), concurrent validity was supported through moderate associations with 3 different stigma measures (i.e., public stigma toward counseling, r = .31; public stigma toward mental illness, r = .20; and self-stigma, r = .37). In Sample 4 (N = 144), test-retest reliability across a 3-week period was calculated (.82). Finally, in Sample 5 (N = 130), reliability ([alpha] = .78) and validity were explored with a sample experiencing symptoms of psychological distress. Relationships between variables (i.e., public stigma toward counseling, r = .31, and self-stigma, r = .40) were similar to those in previous samples. Keywords: public stigma, social stigma, therapy, help seeking, psychological services

Forgiveness interventions can help people forgive past offenses. However, few studies have compared forgiveness interventions with genuine alternative treatments. The authors compared forgiveness interventions with a therapeutic alternative treatment. Participants reduced unforgiveness and increased forgiveness regardless of treatment condition. Trait forgivingness was not related to change in forgiveness, whereas greater offender contrition was related to greater reductions in unforgiveness. The type of treatment may not be as important as factors common to the interventions., A new and sometimes controversial topic, forgiveness, has emerged from the psychological literature in counseling and psychotherapy. Many have claimed that forgiveness is a reasonable and worthwhile goal when attempting [...]

The role of religion and spirituality in psychotherapy has received growing attention in the last two decades, with a focus on understanding the ways that religion and spirituality relate to therapists, clients, and treatment methods. The authors reviewed recent empirical research on religion and spirituality in psychotherapy to inform practitioners about effective ways to incorporate the sacred into their clinical work. Three main areas are covered: religion/ spirituality and therapists, religion/spirituality and clients, and religious/spiritual interventions. Research indicates that therapists are open to religious/spiritual issues, that clients want to discuss these matters in therapy, and that the use of religious/spiritual interventions for some clients can be an effective adjunct to traditional therapy interventions. Keywords: religion and spirituality; psychotherapy; religious interventions; clinical research

Depression (DEP) is prevalent and current treatments are ineffective for many people. This pilot study's purpose was to assess the feasibility, acceptability, and plausible efficacy of an 8-week intervention employing 30 min of prescribed moderate intensity exercise ("ActiveCBT") compared to 30 min of usual activities ("CalmCBT") immediately prior to weekly online CBT sessions. Ten adults with DSM-5-diagnosed current DEP were randomized to groups and completed: an intake assessment, eight weekly CBT sessions, final assessment, and 3-month follow-up. ActiveCBT participants were prescribed 30-min of moderate exercise immediately prior to each standardized 50-min CBT session. CalmCBT participants continued with normal activities for 30 min before therapy. Questionnaires regarding DEP symptom severity (Patient Health Questionnaire-9 [PHQ-9]), between-session effectiveness (Behavioral Activation for Depression Survey [BADS], Automatic Thoughts Questionnaire [ATQ]), in-session effectiveness (Working Alliance Inventory-Short Revised [WAI]), and state anhedonia (Dimension Analog Rating Scale [DARS], Visual Analog Scale [VAS]; assessed 3 times: before Active/Calm condition, after, and after therapy) were completed each week. Therapy fidelity ratings were independently coded via a standardized codebook. The Structured Clinical Interview for DSM-5 (SCID) and Hamilton Rating Scale for Depression (HAMD) were used to assess DEP at intake, final, and 3-month follow-up. We found strong feasibility and acceptability (100% adherence, 100% retention at final visit, 74.6% therapy fidelity, and high patient satisfaction ratings). Differences between groups favoring ActiveCBT in anhedonia (DARS, Hedges' g = 0.92; VAS, g = 3.16), within- (WAI, g = 0.1.10), and between-session effectiveness (ATQ g = −0.65; BADS g = −1.40), suggest plausible efficacy of ActiveCBT for enhancing CBT. DEP rates were reduced in both groups from baseline to final (60% MDD SCID remission) and at follow up (Active: 40%; Calm: 25%). Larger and potentially quicker symptom improvement was found favoring the Active condition to the final visit (HAMD, between-group changes g = −1.33; PHQ-9, g = −0.62), with small differences remaining at follow-up (HAMD, g = −0.45; PHQ-9, g = −0.19). Exercise priming appears acceptable and plausibly efficacious for enhancing mechanisms of CBT and overall outcomes, though the present small sample precludes efficacy determinations. It appears feasible to conduct a randomized controlled trial comparing ActiveCBT to CalmCBT. Future trials evaluating this potentially promising treatment approach and mediating mechanisms are warranted. [ABSTRACT FROM AUTHOR]

The tendency to ruminate has been consistently linked to psychological disturbances, such as increased stress, anger, and fear in response to provocations. However, existing measures of rumination focus on the disposition to ruminate rather than on rumination about a specific situation. This limits the ability to explore rumination about a specific situation and makes the assessment of change as a result of time, contextual factors, or psychological interventions difficult. Across three samples, including a clinical sample, the reliability and validity of the Rumination About an Interpersonal Offense scale (RIO) was examined. Exploratory and confirmatory factor analyses provided support for a unidimensional structure. Internal consistency and test-retest reliabilities were adequate. Convergent and discriminant validity were also supported. Keywords: state rumination, forgiveness, clinical outcomes, interpersonal offense

The decision to seek psychological help may be hindered or facilitated by many factors. Two potential factors that might facilitate help seeking are having a relationship with someone (a) who recommends seeking help or (b) who themselves have sought help. In two studies (N= 780, N= 746), we explored the relationship between these factors and intentions to seek mental health services. In Study 1, being prompted to seek help and knowing someone who had sought help were both related to positive expectations about mental health services. In Study 2, being prompted to seek help and knowing someone who had sought help were related to more positive attitudes toward help seeking. Also, knowing someone who had sought help was related to the intention to seek help. Of those who sought psychological help, approximately 75% had someone recommend that they seek help and about 94% knew someone who had sought help. Keywords: help seeking; attitudes; social influence; social network

This study examined the mediating effects of the self-stigma associated with seeking counseling and attitudes toward seeking counseling on the link between perceived public stigma and willingness to seek counseling for psychological and interpersonal concerns. Structural equation modeling of data from 676 undergraduates indicated that the link between perceived public stigma and willingness to seek counseling was fully mediated by self-stigma and attitudes. Perceptions of public stigma contributed to the experience of self-stigma, which, in turn, influenced help-seeking attitudes and eventually help-seeking willingness. Furthermore, 57% of the variance in attitudes toward counseling and 34% of the variance in willingness to seek counseling for psychological and interpersonal concerns were accounted for in the proposed model. Keywords: public stigma, self-stigma, attitudes, counseling, help seeking

Despite the presence of quality mental health care in many communities, people tend to avoid seeking help and wind up languishing in their problems unnecessarily. For the professional to better understand how to reach these individuals, an information-processing model is presented that examines the effects of people's interpretation of their environment and their symptoms on their decision to seek mental health services. Using the model as a guide, suggestions are presented for practitioners who wish to provide services to those who are in need of professional help, yet are hesitant to obtain it. Keywords: information processing, help seeking, mental health, professional help

Self-stigma is an important factor in people's decisions not to engage in therapy. To measure this construct, the authors developed the 10-item Self-Stigma of Seeking Help (SSOSH) scale. In Study 1 (n = 583), the SSOSH had a unidimensional factor structure and good reliability (.91) among participants. Study 2 (n = 470) confirmed the factor structure. Studies 2, 3 (n = 546), and 4 (n = 217) cross-validated the reliability (.86 to .90; test-retest, .72) and showed evidence of validity (construct, criterion, and predictive) across the study samples. The SSOSH uniquely predicted attitudes toward and intent to seek psychological help. Finally, in Study 5 (n = 655) the SSOSH differentiated those who sought psychological services from those who did not across a 2-month period. Keywords: self-stigma, public stigma, help seeking, psychological services

Broken trust, broken hearts, and broken spirits: these are all potential issues facing clients who have been hurt by others. Some have claimed that helping clients explicitly forgive those who have hurt them is a legitimate therapeutic intervention. However, do clients need explicit forgiveness interventions? Do clients want them? After they are received, are these interventions helpful? For the majority of 59 clients from 3 university counseling centers the answers were mostly affirmative. They had experienced a hurt that they wanted to forgive and wanted to talk about in therapy. Those who talked explicitly about forgiveness reported more overall improvement in their presenting symptoms. Implications for using explicit forgiveness interventions with clients are discussed. Keywords: forgiveness in therapy, counseling effectiveness, predictors of forgiveness

Almost everyone is unforgiving at times. Many people seek to deal with the revenge and avoidance of unforgiveness by forgiving. The authors explore potential predictors of unforgiveness and forgiveness for a specific offense in 91 undergraduates. Positive feelings of forgiveness were uniquely predicted by dispositional forgivingness and by the participants' deliberate attempt to forgive the offense. Different patterns of predictors suggest that unforgiveness and forgiveness are not necessarily reciprocally related. This implies that interventions might be developed to reduce unforgiveness without attempting to promote forgiveness. This may be crucial in situations where forgiveness is not desirable., Many problems in living, both clinically severe and normal ones, have their roots in or are exacerbated by interpersonal offenses. Psychoeducational interventions have been successful in helping people overcome interpersonal [...]

The authors report the development of the Religious Commitment Inventory--10 (RCI-10), used in 6 studies. Sample sizes were 155, 132, and 150 college students; 240 Christian church-attending married adults; 468 undergraduates including (among others) Buddhists (n = 52), Muslims (n = 12), Hindus (n = 10), and nonreligious (n = 117); and 217 clients and 52 counselors in a secular or 1 of 6 religious counseling agencies. Scores on the RCI-10 had strong estimated internal consistency, 3-week and 5-month test--retest reliability, construct validity, and discriminant validity. Exploratory (Study 1) and confirmatory (Studies 4 and 6) factor analyses identified 2 highly correlated factors, suggesting a 1-factor structure as most parsimonious. Religious commitment predicted response to an imagined robbery (Study 2), marriage (Study 4), and counseling (Study 6).

This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale–21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States (N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four different factor structures of the DASS-21: a unidimensional model, a three-correlated-factors model, a higher order model, and a bifactor model. The bifactor model, with three specific factors (depression, anxiety, and stress) and one general factor (general distress), presented the best fit within each country. We also calculated ancillary bifactor indices of model-based dimensionality of the DASS-21 and model-based reliability to further examine the validity of the composite total and subscale scores and the use of unidimensional modeling. Results suggested the DASS-21 can be used as a unidimensional scale. Finally, measurement invariance of the best fitting model was tested across countries indicating configural invariance. The traditional three-correlated-factors model presented scalar invariance across Canada, Hong Kong, Romania, Taiwan, and the United States. Overall, these analyses indicate that the DASS-21 would best be used as a general score of distress rather than three separate factors of depression, anxiety, and stress, in the countries studied. [ABSTRACT FROM AUTHOR]