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thesis entitled

Predictors of Seeking Psychological Counseling:
Distress, Prior Exposure, Fear, and
Downward Comparison

presented by

Jason R. Dahn

has been accepted towards fulfillment
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II | l

MSU I. An Affirmative Action/Equal Opportunity Intuition
Maui

Predictors of Seeking Psychological Counseling:
Distress, Prior Exposure, Fear, and Downward Comparison

BY

Jason R. Dahn

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of Psychology

1995

ABSTRACT

Predictors of Seeking Psychological Counseling:
Distress, Prior Exposure, Fear, and Downward Comparison

BY

Jason R. Dahn

This study was designed to replicate previous findings regarding
distress, prior exposure to psychological counseling, and fear of
psychological counseling as well as to also identify the effects
of downward comparison across 334 undergraduate women. Both
distress and prior exposure correlated significantly (rs = .22
and -.13, p < .05, respectively) but oppositely with fear of
psychological counseling. Distress and exposure did not
demonstrate an anticipated interaction. Downward comparison was
assessed by vignette-induced mood shifts. As expected, distress
predicted negative mood reductions (p < .05). Participants’
reported likelihood of seeking future psychological counseling
was associated with prior exposure, personal distress, and the
interaction of these variables. A robust 33% of the variance in
the likelihood of seeking future counseling was predictable from

these measures.

ACKNOWLEDGMENTS

I would like thank Drs. Robert Caldwell and Norman
Abeles for their interest and constructive comments as
committee members. I am especially appreciative of Dr. John
Hurley who provided many helpful observations and comments
and gave abundant support to my work throughout the project.

Credit for the data collection of this study goes
almost entirely to Rosa M. Rigol, M.S., who devoted many
hours to assessing participants. Her clinical training was
invaluable in assuring that the testing environment was
sensitive to participants’ questions. Additionally, I would
like to thank her for her patience and constructive feedback
throughout the duration of the project. I would also like
to thank Janelle Ettema for her efforts in data collection.

Finally, I would like to express my gratitude to Dr.
Jane Harding for inspiring and nurturing an interest in
research. Her support of my educational interests and
willingness to share her own knowledge made this study

possible.

iii

TABLE OF CONTENTS

LIST OF TABLES ..........................................
INTRODUCTION ............................................
Prevalence and Utilization Rates ...................
Help Seeking and Non-Help Seeking ..................
Hypotheses .........................................
METHOD ..................................................
Participants .......................................
Materials ..........................................
Procedure ..........................................
Analyses ...........................................
RESULTS .................................................
Thoughts About Psychotherapy Survey (TAPS) .........
Reliability and Validity of Mood Measures ..........
Vignette Manipulation Checks .......................
Mood Change Difference Scores ......................
Mood Change and Distress ...........................
Need for Psychological Counseling ..................

Probability of Seeking Psychological Counseling....

DISCUSSION ..............................................

iv

Page

vi

18
20
20
21
3O
32
35
35
37
42
42
43
49
49

54

:11 63 "El [11 U O on 3’

APPENDICES
Verbal Administration Instructions ............
Informed Consent Agreement ....................
Questionnaire Packet Instructions .............

Thoughts About Psychotherapy Survey (TAPS)....

NEO-FFI .......................................
Brief Symptom Inventory .......................

Need for Psychological Counseling .............
Problem Checklist .............................

I: Mood Assessment (MAACL) .......................
J: Mood Assessment (PANAS) .......................
K: Vignette ......................................
L: Post-Vignette Questions .......................
M: Contact with Mental Health Services ...........
N: Follow-up Questions ...........................
0: Feedback Sheet ................................
BIBLIOGRAPHY ............................................

63

64

65

66

67

69

71

73

75

76

77

79

80

83

85

87

LIST OF TABLES

Page
Factor loadings for the Thoughts About
Psychotherapy Survey (TAPS) ........................ 36
Intercorrelations, means, standard deviations,
and alpha coefficients for TAPS total and
subscale scores .................................... 37
Hierarchical multiple regression analyses
predicting the TAPS ................................ 4O
Mood scale alpha coefficients and correlations
with Neuroticism and the General Severity Index
(GSI) at pretest ................................... 41
Mood change ........................................ 43
Regression analyses predicting Mood Index Change
Scores (MICS), Positive Affectivity (PA) change,
and Negative Affectivity (NA) change ............... 45

Regression analyses predicting posttest mood scores
-- using pretest mood scores as a covariate ........ 46

Mood change with tertile division of the GSI:
Within group paired-sample t—tests and between
group ANOVAs ....................................... 48

Hierarchical multiple regression analyses
predicting Probability of Help—Seeking ............. 51

vi

I NTRODUCT I ON

Substantial evidence indicates that a large percentage
of the general population suffers from psychological
distress and yet only a small fraction utilizes mental
health services. Wills (1983) concluded that seeking
professional help for psychological problems is a minority
response. Extensive research has assessed the need for
mental health services and sought to identify those persons
who seek services. Additional studies have concerned what
distinguishes help seekers from non-help seekers. Barriers
to seeking mental health services studied include cultural,
social, and personality factors. This paper reviews related
prevalence and utilization rates and explores selected
variables related to help-seeking, including psychological
distress, prior exposure to mental health services, fear of
mental health services, and social comparison.

Prevalence and Utilization Rates
General Population

One of the largest attempts to assess prevalence rates
was the Epidemiological Catchment Area (ECA) Study. Data
were collected from 20,291 persons over 18 years-old in five
U.S. cities. Results from the study identified prevalence

1

2
rates for any alcohol, other drug, or mental disorders based
on the Diagnostic Interview Schedule (DIS) to be 15.7% for
one-month, 19.5% for 6-months, and 32.7% for lifetime in the
US population (Regier et al., 1990). Thus in a six-month
period, approximately 20% of the individuals interviewed
suffered from symptoms disruptive enough to warrant a
psychiatric diagnosis.

Using an ECA sub-sample to assess utilization, Shapiro
et al. (1984) reported that 6—7% of an adult population
sought medical or psychological help for a mental health
problem in the six months prior to the study. When only
those diagnosed with a psychiatric disorder were considered,
merely 17.6% had sought medical or psychological services in
the six-months prior to the survey. This suggests that
while almost 20% of individuals suffered symptoms warranting
a psychiatric diagnosis in a 6-month period less than one-
fifth of them sought help.

The above rates provide estimates of prevalence and
utilization for the general population. However, the issue
about why some individuals seek psychological help and
others do not is complex, and there are notable variations
associated with age, sex, culture, social-economic status,
availability of mental health services, and other variables
(Shapiro et al., 1984). Help-seeking research has been
fragmented in its focus and implicates a range of phenomena

from personality characteristics (DePaulo, Nadler, & Fisher,

3
1983) to ecological/community service barriers (Nadler,
Fisher, & DePaulo, 1983). Because of these complexities,
much of the help-seeking research has focused on the more
homogeneous population of college students who are available
in a somewhat static system for four—year intervals, have
accessible records, can be followed through alumni
membership (Reifler & Liptzin, 1969), and who typically have
some access to free or low cost university psychiatric and
counseling programs.
College Students

Many studies since the 1920's have assessed prevalence
rates for psychiatric illness and psychological distress in
college students. These works have yielded a wide range of
rates that reflect differing cutoffs for what constitutes
disorder or impairment and instruments differing in whether
they focus on psychophysiological or behavioral symptoms.
Extensive reviews have provided the most accurate estimates
since they combine studies and narrow what are individually
only rough estimates. They also tend to focus on
methodologically superior studies, usually those with large
sample sizes.

In a comprehensive review of epidemiological studies
from 1920 to 1966, Reifler and Liptzin (1969) found
prevalence rates for "emotional disturbance" in college
students to range from 6-16.4%. In a review of four studies

from 1973 to 1980 with large sample sizes (us from 1200 to

4
2100), "definite impairment" was found to range from 5.3-11%
(Schwartz & Reifler, 1984). When less severe criteria were
used, much higher proportions were obtained including 45%
"some impairment" (Mechanic & Greenley, 1976), 17%
"borderline-psychiatric disorder" (Thompson & Bentz, 1975),
55% "subclinical impairment" (Thompson, Bentz, & Liptzin,
1973), and 30.2% some impairment (Nagelberg & Shemberg,
1980) .

More recent studies reflect changing methodologies and
higher rates. Following a cohort of college students for
four years, Rimmer, Halikas, and Schuckit (1982) found a
four-year prevalence rate of 39% for psychiatric illness.
Illness was diagnosed by trained psychiatric interviewers
who based their decisions on behavioral symptom criteria
clusters from DSM-III. In an epidemiological study of high
school students, 60 were followed-up through their first
year of college, and of those, 20% were considered disturbed
(Offer & Spiro, 1987). In a recent Ivy League survey, more
than a quarter of the respondents indicated that
suicidal/homicidal thoughts were a concern for them with 6%
indicating that these were a crucial concern (Bertocci,
Hirsch, Sommer, & Williams, 1992). Respondents were also
concerned about depression, sadness, and mood changes (76%,
19% crucial) and anxieties, phobias, and panic attacks (56%,
10% crucial). These studies indicate a substantial level of

psychological distress among college students when measured

5
by a variety of instruments based on both
psychophysiological and behavioral symptoms.

Usage rates represent the proportion of students who
sought mental health services regardless of level of
distress or presence or absence of a diagnostic label.
Summarizing results from 14 colleges and universities
between 1930 to 1966, Reifler and Liptzin (1969) found a
median usage rate of 6.3% with a range of 1.5-9.9%.
Reviewing methodological developments and major studies over
the subsequent 15 years, Schwartz and Reifler (1984)
concluded that the usage rate for volunteer, unsystematic,
modest-sized institutions seemed stable and estimated it
between 4-7%. Thus, multi-study reviews indicate that usage
rates are relatively low compared to the level of impairment
suggested by prevalence studies.

Recent studies seem to find higher usage rates,
although this is often confounded by methodological or
sampling problems. Reinhold (1973) found that of 1290
students matriculated in 1964 and graduating in 1968 from a
large midwestern university 19.4% had utilized the
university counseling and/or psychiatric services.

Following 158 cohorts for four years, Rimmer and colleagues
(1982) reported an average usage rate of 14%. Twelve
percent of freshman at a small, liberal arts college for
women received services at the counseling center at least

once during their first year (Clary & Fristad, 1987). A

6
random survey of students at Columbia University (Bertocci
et al., 1992) found that 16% had used the university mental
health services, and overall, 39% reported previous contact
with a mental health practitioner. Similarly, Robbins
(1981) found in a random survey that 29% of students at a
private New England university had previously obtained
psychiatric or psychological services.

These more recent studies highlight higher usage rates,
but are still well below many of the prevalence rates
indicating distress and impairment. Overall, prevalence and
usage rates demonstrate an increasing number of students who
appear to need services and students who are seeking them,
and a substantial number of students indicate seeking
counseling prior to, or outside of, university-provided
services. Yet despite increases in usage, there still seems
to remain a significant proportion of students who are
distressed and would benefit from mental health services,
but who do not access those services.

Help Seeking and Non-Help Seeking

The difference between prevalence and usage rates
brings to the fore the distinction between help-seekers and
non-help seekers. Wills (1983) noted that there is an
obvious ambivalence on the part of those in distress to seek
mental health services, and that "help-seeking from
professionals is a minority response" (p. 117). Several

factors are likely to contribute to this difference,

7
including fear of mental health services, psychological
distress, exposure to mental health services, and downward
social comparison.

Kushner and Sher (1991) reviewed the literature on fear
of psychological counseling and avoidance of mental health
services. They noted that help seeking can be
conceptualized effectively as a classic approach-avoidance
conflict as delineated by Miller (1944). In this conflict,
a person has strong tendencies (gradients) to both approach
and avoid the same goal (help seeking) and is "trapped part
way to the goal, unable to either achieve or leave it"
(Miller, 1944, p. 451) where the approach and avoidance
gradients intersect. Resolving the conflict (reaching the
goal) is dependent on the strength or steepness of the
gradients. If the approach gradient is raised and the
avoidance gradient is lowered, the individual will likely
move closer to the goal, or may even reach it if these
gradients no longer intersect.

This paradigm seems particularly suited for
understanding help-seeking where individuals have strong
tendencies to seek help because of distress, impairment, and
exposure to the positive effects of seeking help, but must
also face significant psychological and/or financial costs.
Individuals must also confront and overcome the fear
associated with seeking services and must risk the

possibility of being stigmatized and negatively evaluated.

8

While they may want help, they simultaneously work to avoid
it both to protect their self-esteem and to avoid the time
and monetary costs of treatment.
Fear of Mental Health Services

Recent research on the difference between help-seekers
and non—help seekers has also attended to the fear of mental
health services. Fear of services has been recognized as a
factor inhibiting help-seeking behavior with treatment
fearfulness defined as "a subjective state of apprehension
arising from aversive expectations surrounding the seeking
and consuming of mental health services" (Kushner & Sher,
1989, p. 251). Cook et al. (1984) found that while 83% of
students agreed that counseling was helpful for a variety of
problems, most also had multiple fears about entering
counseling. Students were fearful that others would know
about it (74%), their problems would not be taken seriously
(69%), and friends or family would disapprove if they sought
counseling (81%). In a community sample, reasons for
delaying or avoiding seeking mental health services focused
on fears of exposing and facing problems (Amato & Bradshaw,
1985). Assessing the perceived advantages and disadvantages
of counseling, Halgin, Weaver, and Donaldson (1985) found
that prevention was the most frequently cited advantage by
non-help seekers, but wholly unmentioned by help-seekers.
This suggests that to non-help seekers psychological

distress is something to be prevented or warded-off in order

9
to protect self-esteem. This interpretation is congruent
with a second finding which indicated that non-help seekers
perceived a disadvantage of counseling as indicative of a
lack of self-effectiveness.

Non-help seeking students often have fears and negative
expectations about university counseling services (Figueroa,
Calhoun, & Ford, 1984). More than help-seekers, non-help
seekers tend to believe that counselors will see mental
illness in whatever problem a person brings in and that
university counseling services exist more to train graduate
students than to help students with problems. They also
expressed less optimism about being helped through therapy
than help-seekers.

Individuals who do not seek help were also found to be
more fearful of seeking help. After developing their
Thoughts About Counseling Survey (TACS) to assess client
fears, Pipes, Schwartz, and Crouch (1985) found that
students who had sought services at the university mental
health center had significantly less fear than those not
seeking therapy, both overall and on two specific subscales
(Therapist Responsiveness and Image Concerns). In a
replication and extension of the study by Pipes et al.
(1985), Kushner and Sher (1989) added a third factor,
Coercion Concerns, to assess fear of coercion or pressure to
change. They found that students seeking services at the

university mental health center reported less fear than non-

10

help seeking students on all three subscales. Because these
help-seekers were assessed prior to service delivery, it
could not be determined whether fearfulness initially
moderated the decision to seek services or whether
initiating services had decreased fearfulness.

In an attempt to diminish this ambiguity, Kushner and
Sher (1989) also classified the non—help seeking students by
history of treatment needs and service utilization into
Avoiders (those claiming to have needed treatment but not
sought it), Seekers (those claiming to have needed treatment
and sought it), and Never Needed (those claiming to have
never needed treatment). Avoiders were found significantly
more fearful than Seekers. That is, individuals without
prior exposure to mental health services, but who had felt
the need for treatment, seemed more fearful and less likely
to get help. For this total sample, treatment fearfulness
was also positively associated with psychological distress
as measured by the Brief Symptom Inventory (BSI; Derogatis,
1975). Thus, congruent with the approach-avoidance
conflict, individuals experiencing more distress were also
those more fearful of seeking help to alleviate their
distress.
Psychological Distress

Suggesting that distress is a motivator for seeking
services, help-seekers have also been consistently found to

be more distressed than non-help seekers (Mechanic &

ll

Greenley, 1976). Using a measure of psychophysiological
symptoms, Thompson and Bentz (1975) reported that 286
undergraduate students who sought psychiatric services
through the university had significantly more symptoms than
the incoming freshman class (N = 2,121). At the end of the
school year, 52 of these freshman (2.5 percent) had sought
psychiatric services. A post hoc analysis indicated that
those freshman who sought services reported significantly
more symptoms at the beginning of the school year than those
students who did not seek services. Lubin and Rubio (1985)
found that students attending a university counseling center
reported more stressful life events occurring over the past
year than matched non—client controls. Clients perceived
less choice and control over these events, and they felt
more pressure and need to adjust to the events. Thus, it
appears that help seekers indicate more distress, less
control, and more need to seek professional help compared to
non-help seekers and matched controls.
Exposure to Mental Health Services

Help-seekers have also indicated more prior experience
with mental health services, both personally and by their
family members (Figueroa, Calhoun, & Ford, 1984; Narikiyo &
Kameoka, 1992). DeBarot (cited in Fischer, Winer, &
Abramowitz, 1983) found that those who personally knew
someone in psychotherapy had more positive attitudes toward

seeking psychiatric help than those who knew no one in

12

psychotherapy. Those seeking help at the university
counseling center during their freshman year had more
previous experiences with mental health services than those
not seeking help (Clary & Fristad, 1987). When assessing
presenting concerns and history of services, clients were
more likely to endorse personal concerns (as opposed to
academic, vocational, or educational concerns) if they had a
history of previous counseling (Tracey, Leong, & Glidden,
1986). Thus, exposure to services may serve to destigmatize
being a client, leading individuals to feel more supported
in the decision to access services, and it may enable an
individual to seek services and maintain a favorable
impression of oneself.
W

Although both level of distress and prior exposure to
mental health services appear important factors in
determining whether or not an individual seeks help, the
influence of social comparisons may also be relevant.
Seeking professional help may result in unfavorable
comparisons with those who do not seek help (Wills, 1983);
individuals who seek help have also been found to be more
disliked, rejected, and avoided. Non-help seekers, compared
to help—seekers, were found to perceive the average help-
seeker as more disturbed (Bosmajian & Mattson, 1980).
Sibicky and Dovidio (1986) found that perceiving someone as

a counseling center client had significant effects on

13
interpersonal interaction. Those who believed that they
were interacting with a client formed more negative
impressions of the person prior to their interaction and
behaved in less socially desirable ways than those who
interacted with someone from a psychology class (the neutral
condition). The former also reported being less comfortable
while interacting and enjoying the interaction less than
those in the neutral condition.

Research also indicates that psychiatric diagnoses are
associated with legitimate fears of negative social
comparisons. Purvis, Brandt, Rouse, Vera, and Range (1988)
found that persons assigned a psychiatric diagnosis, as
compared to those with a similarly debilitating medical
diagnosis, were judged less desirable as friends, less able
to function in the community, and less likely to receive
help when obtaining a job. Compared with identically
behaving physically ill persons, those labeled as mentally
ill were also viewed as more rejected, believed to be less
predictable, and thought to have less hopeful outcomes
(Socall & Holtgraves, 1992). Though distressed individuals
may want to ameliorate their distress by seeking help, there
appears to be solid ground for conflict, as seeking help may
lead to more negative evaluations from others and an

unfavorable view of the self.

14

Downward Comparison

Research on social comparison indicates that
individuals alleviate distress by comparison with and/or
derogation of others. A review of such studies indicates
that individuals can "increase their subjective well-being
through comparison with a less fortunate" or equally
unfortunate other (Wills, 1981, p. 245). This process is
referred to as self-enhancement through downward comparison
(DC). Wills (1983) posited several stages linking coping
and help-seeking. As the level of distress increases,
individuals are more likely to engage in self-enhancing
comparison. Downward comparison is more likely to occur
when individuals are stressed, unhappy, or low in self—
esteem. In numerous studies reviewed by Wills (1981),
downward comparison occurred when there was some type of ego
threat. Hence, increased distress seems to lead to
increased downward comparison as a means to cope with the
distress. Typically, comparison targets are individuals
with similar problems. This mechanism may provide an
alternative to seeking help and be influenced by the desire
to minimize anticipated unfavorable evaluations from others.
Downward comparison allows a distressed individual to
temporarily see themselves in a positive light relative to
another perceived as equally or more disadvantaged.

Target choice. Several recent studies support this

formulation. Gibbons (1986) found that depressed persons

15
induced into a negative mood chose significantly more
negative comparison targets than nondepressed-negative mood,
depressed-positive mood, and nondepressed-positive mood
groups. In a review of studies with cancer patients
(individuals considered under threat), downward comparisons
were consistently found using several different
methodologies (Taylor & Lobel, 1989, p. 571).

MgggA In addition to distressed individuals choosing
downward for comparison targets, Wills (1981, 1983) proposed
that distressed individuals’ use of downward comparison
reduces negative affect. Recent research supports this
contention. After reading about someone's negative life
experiences, depressed persons had significantly greater
mood increases than those who were not depressed (Gibbons,
1986). Gibbons and Gerrard (1989) noted that the mood state
of individuals low in self-esteem improved significantly
when given downward comparison information while this
information had little effect on the mood state of persons
high in self-esteem. In a later study employing a threat
manipulation, Gibbons and McCoy (1991) found that persons
low in self-esteem and highly threatened had significant
positive mood changes that exceeded those of any comparison
group in two experiments. This finding was replicated by
Aspinwall and Taylor (1993) in two experiments. Their first
study noted that, of low and high self—esteem groups induced

into positive and negative moods, only the low self-

16
esteem/negative mood group reported increased positive mood
after downward comparison. Their second study found that a
low self-esteem group under naturalistic threat (academic
difficulties) reported more favorable self-evaluations and
expectations about future success after receiving downward
comparison information than those who had received no
comparison information. Thus, numerous studies indicate
that persons who are clinically depressed and/or low in
self-esteem under both induced and naturalistic threat
respond to downward comparison with increased positive mood
and self-evaluations. It seems likely that the coping
benefits of downward comparison may also discourage or
inhibit those who are distressed from seeking mental health
services. However, these benefits may be short-lived and
ultimately a liability because of the absence of information
about more successful long—term coping.

Derogation. Some findings suggest that downward
comparison involves a more complex process. Gibbons and
McCoy (1991) found that under threat, high, but not, low
self-esteem persons derogated a downward comparison target.
When threatened, individuals high in self—esteem gave
significantly more negative ratings of adjustment to a
downward comparison target than did either threatened, low
self-esteem and non-threatened, low and high self-esteem
groups. These results seem to be based on the effects of

perceived similarity. The low self-esteem group rated

17
themselves as significantly more similar to the downward
comparison target than did those high in self-esteem.
Additionally, a substantial correlation (.53, p < .003) was
found only among those low in self—esteem between similarity
ratings and mood change.

Another recent study found results which undermine
several downward comparison predictions. Using a new
instrument (Rochester Social Comparison Record, RSCR) to
study social comparisons over a two-week period, Wheeler and
Miyake (1992) found that participants who felt better were
more likely to compare downward and that persons high in
self—esteem were more likely to make downward comparisons
than those low in self-esteem. One finding was consistent
with downward comparison predictions and indicated that
participants felt significantly better after comparing
downward relative to comparing upward. These discrepancies
should be approached with caution since the RSCR is a new
instrument and differs methodologically from paradigms
typically used to assess downward comparison.

Overall, the research evidence suggests that
threatened, low self-esteem or distressed persons tend to
choose a comparison target such that a downward comparison
can be made. Choosing such targets seems to result in
improved mood consistently and may serve as self—enhancement
in an otherwise threatening situation. However, when given

the opportunity for active derogation of a downward

18

comparison target, only threatened, high self-esteem
participants engage to a significant degree and without any
resultant change in mood. Persons low in self-esteem seem
relieved to know that others are equally or worse off while
those high in self-esteem respond with derogation.
Derogation seems to be moderated by perceived similarity
with the target.

Hypotheses

The present study sought to replicate previous findings
regarding fear of mental health services, specifically, fear
of psychological counseling in a college student population.
Students with personal experience in psychological
counseling and/or those with family or friend-based exposure
to psychological counseling were predicted to indicate less
such fear than those without such experiences; that is, fear
of psychological counseling was predicted to be negatively
correlated with prior exposure to psychological counseling.
This fear was also expected to correlate positively with
level of psychological distress, and to be moderated by
exposure to psychological counseling.

The study attempted to demonstrate that downward
comparison is an additional inhibitor to help—seeking among
distressed college students. Downward comparison was
measured by mood shifts after reading a target vignette.

The downward comparison literature suggested that persons

experiencing distress will show greater reductions in

19
negative mood after reading such a vignette.

Participants also rated statements reflecting a range
of psychological, social, and occupational functioning on
how much they indicate a need for psychological counseling.
Perceived need for psychological counseling was predicted to
correlate negatively with downward comparison and distress.
That is, distressed participants were predicted to identify
with statements reflecting distress and because of their
fear of psychological counseling, not see a need for such
services. Finally, participants rated the probability of
their seeking psychological counseling over three specific
time periods. Distress, exposure, fear, and downward
comparison were expected to be significant predictors of
participants’ probability of seeking psychological

counseling ratings.

Method
Participants

Participants were recruited from undergraduate
psychology courses at a large, midwestern university. The
sample included 334 women who volunteered, provided informed
consent, and received partial course credit. Participation
was anonymous to insure the confidentiality of respondents.
Ninety-seven percent of the sample was between 17 and 24
years of age; participants identified themselves as 84%
White, 8% Black, 1% Hispanic, 5% Asian, and 2% Other.

This study was limited to women for several reasons.
First, Kessler, Reuter, and Greenley (1979) using data from
a student population at a large midwestern university found
that women are more likely to seek treatment "due both to
differential propensities to seek help for problems and also
to differential numbers of problems" (p. 557). Nagelberg
and Shemberg (1980) found psychological impairment in
undergraduate women (12.4%) to be twice that of men (6.0%),
and counseling center women clients reported significantly
higher rates of psychological symptoms than men clients
(Johnson, Ellison, & Heikkinen, 1989). Second, the
experimental vignette will be based on difficulties more
relevant to women.

20

21

Lager—isle

Fear of psychological counseling. The Thoughts About
Psychotherapy Survey (TAPS; Kushner & Sher, 1989) is based

on the Thoughts About Counseling Survey (TACS; Pipes et al.,
1985) with several modifications (see Appendix D). The
latter was developed to discriminate 91 college counseling
center clients from 104 non-client students. Pipes et al.
(1985) reported alpha coefficients for the factors of
Therapist Responsiveness (alpha = .92) and Image Concerns
(alpha = .84). Kushner and Sher (1989) modified this
instrument by adding a third factor to assess Coercion
Concerns and replaced "counselors" and "counseling" with the
broader terms of "therapists" and "therapy". They found the
internal reliability (i.e., Cronbach’s Alpha) of all three
TAPS subscales to be satisfactory (Therapist Responsiveness
= .92, Image Concerns = .87, and Coercion Concerns = .88).
For each of the 19 TAPS items, respondents rate their level
of concern on a 5-point Likert-type scale (1 = No concern, 2
= Little concerned, 3 = Somewhat concerned, 4 = Much
concerned, and 5 = Very concerned) with higher scores
indicating more fear and concern. The total TAPS and
subscale scores were analyzed to assess the most robust
measure(s) of fear.

Distress. In regard to help seeking, Bosmajian and
Mattson (1980) found that level of maladjustment was crucial

to measure. Only by controlling for level of maladjustment

22

could the relationships between adjusted and maladjusted,
help-seekers and non-help seekers be understood. Watson and
Clark’s (1984) review of the literature suggests that
measures of maladjustment and distress (e.g., anxiety,
repression, ego strength, depression, and neuroticism) seem
to assess a stable and pervasive trait called negative
affectivity. Two measures of this construct were used.

Neuroticism was measured using the NBC Five Factor
Inventory (NEO-FFI), a short form of the Revised NEO
Personality Inventory (NEO-PI-R; Costa & McCrae, 1992; see
Appendix E). NEO-FFI’s developers noted that the core of
the neuroticism domain is the "general tendency to
experience negative affects such as fear, sadness,
embarrassment, anger, guilt and disgust" (p. 14).
Additionally, neuroticism captures inclinations for
irrational thought, poor impulse control, and inadequate
coping under stressful conditions. The NEO-FFI consists of
60 statements to which respondents indicate their degree of
agreement (ranging from Strongly Agree to Strongly
Disagree). The .86 reported alpha coefficient for NEO—FFI’s
12-item, neuroticism scale indicates good internal
consistency.

Also used to assess psychological distress was the
Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982; see
Appendix F). The B81 is a 53-item, self-report symptom

inventory using a 5-point scale of distress (Not at All to

23
Extremely). The BSI consists of three global indices of
distress. Derogatis and Melisaratos (1983) found that the
General Severity Index (GSI) was the best indicator of
present distress levels and had a 2-week test—retest
reliability of .90.

Need for psychological counseling. Most studies
assessing perceived need for psychological counseling have
participants rate the severity of problems and need for
psychological counseling in response to case vignettes
(Robbins, 1981; Flaskerud, 1984). The typical vignette
describes gross psychopathology, psychiatric syndromes, or
at the least, the information necessary for psychiatric
diagnosis. This method of assessing need for psychological
counseling has several disadvantages. Robbins (1981) notes
that education is often a strong predictor in recognizing
mental illness, and as such, is basically held constant in
college student populations. Additionally, the use of
vignettes restricts the potential range of responses; only
one judgment of perceived need can be made per vignette and
the pool of valid vignettes is quite limited.

To overcome these difficulties, a Need for
Psychological Counseling (NPC) measure was developed for the
present study (see Appendix G). Based roughly on the Global
Assessment of Functioning (GAP) Scale (APA, 1994), the NPC
has 65 statements reflecting a range of psychological,

social, and occupational functioning. Participants were

24
asked to consider each statement to be true for them, and
then rate on a 5-point scale the degree to which they felt
it indicated a need for psychological counseling (ranging
from Not at All to Extreme). Results from the NPC were
factor analyzed to obtain a scale reflecting the construct
of perceived need for psychological counseling.

Self-Awarengss. Research suggests that self—focused
attention increases awareness of the current affective
state. Scheier and Carver (1977) found that self-focused
students, following induced positive or negative moods,
reported stronger positive and negative moods, respectively,
than those less self-focused. Similar findings were
demonstrated with general psychiatric patients, especially
in relation to negative mood (Gibbons et al., 1985); self-
focused patients reported significantly more negative mood
than patients not self-focused. Research suggests that
self-focusing may also result from emotional experiences
(Salovey, 1992) and despondent moods (Carr, Teasdale, &
Broadbent, 1991).

To induce negative mood and self-focusing, participants
have commonly been asked to write essays about their own sad
or troublesome experiences. Berkowitz (1987) had students
write about an incident that made them very sad and describe
their feelings on the occasion. In order to encourage
downward comparison, Gibbons and Gerrard (1989) had students

write about difficulties related to the demands of college

25
life. To obtain self—focusing data, a naturalistic study
had participants write about the most troublesome event of
the day at the end of everyday for 30 days (Wood, Saltzberg,
Neale, Stone, & Rachmiel, 1990). Baker and Guttfreund
(1993) effectively induced and reduced both anxious and
depressive mood states by having participants think for ten
minutes about painful or happy life events. These findings
suggest that having individuals write and think about their
experiences seems to reliably induce negative mood and self-
focusing.

To focus students’ attention on their current
psychological problems and induce the associated affect, the
present study asked students to complete a self-report
checklist of 38 potential problems in the areas of
academics, interpersonal relationships, mental states (e.g.,
depression, anxiety, fears), psychophysiological symptoms
(e.g., tiredness, headaches), and others (see Appendix H).
Next, they were asked to write a short paragraph for each of
the three difficulties they considered to be the most
serious, describing briefly the nature of the problem and
their feelings about it. A reminder that this information
was anonymous and confidential was included on this task.

Mppgp Mood was assessed on two occasions using two
mood measures each time. The first measure consisted of 16
adjectives from the Multiple Affect Adjective Checklist

(MAACL; Zuckerman & Lubin, 1965; see Appendix I). Eight

26

adjectives, four positive (happy, secure, pleased, and
satisfied) and four negative (hopeless, discontented,
discouraged, and tense), were given at pretest. At
posttest, the polar opposite adjectives were used in order
to reduce suspicion of the pre-post measurement; these
included (negative) sad, insecure, displeased, dissatisfied,
(positive) hopeful, content, encouraged, and calm. Response
anchors ranged from Not at All to Vepy Much on a 7-point
scale. At posttest, a different response format was used to
reduce the transparency (of. Aspinwall & Taylor, 1993) of
this repeated measure, e.g., A = Not at All at pretest and 1
= Not at All. Negative adjective scores were subtracted
from positive adjective scores to form a mood index.

This method of assessing mood change has been used
repeatedly with moderate and consistent reliability.
Gibbons and Gerrard (1989) found average interitem
correlations to be .60 for six positive adjectives and .70
for six negative adjectives anchored on a 9-point scale.
Gibbons and McCoy (1991) reported reasonable reliability
based on the intercorrelations of positive and negative
adjectives (minimum alpha = .78; M alpha = .82) for 16
adjectives with a 13-point scale. Using a similar format
with 14 adjectives and a 7-point scale, Aspinwall and Taylor
(1993) found alpha reliabilities of .93 at pretest and .89
at posttest.

Additionally, the 20-item Positive and Negative Affect

27
Schedule (PANAS; Watson, Clark, & Tellegen, 1988) was
administered immediately following the first mood measure at
both pretest and posttest (see Appendix J). PANAS differs
from other mood scales in that it was developed to
independently measure positive affectivity (PA) and negative
affectivity (NA) and can be used to rate mood across a range
of time frames. This study had participants rate mood "at
the present moment" using a 5—point scale ranging from yppy
slightly or not at all to extremely. Watson et al. (1988)
reported alpha reliabilities for this time frame to be .89
for PA and .85 for NA. Positive and negative items are
summed separately for PA and NA scales. No overlap exists
between the adjectives used in the MAACL and the PANAS.
Thus, these measures provided independent assessment of mood
change in a split-half (MAACL) and repeated measures (PANAS)
format.

Vignettes. It would be unethical to attempt to
manipulate the decision to use or not use mental health
services. Also prohibited ethically is using actual
distressed persons as study participants to test hypotheses
related to identification and judgment of those
psychologically distressed, the impact and deleterious
effects of labeling, and interpersonal responses to those
diagnosed psychiatrically. As a result, analogue measures
are typically employed. One technique, well-represented in

the literature, is the use of case vignettes. Case

28
vignettes are written or videotaped presentations of a
particular problem and allow for control of factors which
otherwise might be contaminating.

Vignettes have been previously used to provide downward
comparison targets; researchers have attempted to make such
vignettes relevant and salient. Based on self—reports from
previous participants, Gibbons and Gerrard (1989) used a
short paragraph describing successful or problematic
adjustment to college difficulties to manipulate type of
comparison target. Gibbons and McCoy (1991) instructed
students to create a tape recording regarding their
adjustment to college, and then led them to believe that
they had switched tapes with another student, who was
actually a study confederate. The target tape
(approximately 3.75 minutes long and given to all
participants) presented a student having trouble adjusting
to college, academic difficulties (problems with school
work, grades, and study time), and problems with an ex-
girlfriend or boyfriend. Similarly, Aspinwall and Taylor
(1993) used a ZOO-word taped testimonial interview to
present a female student failing at the university because
of homesickness, few friends, and poor school work. Due to
the importance of similarity to the distressed person
(Wills, 1983), a same-sex vignette was used in this study as
in previous research (Gibbons & McCoy, 1991). The vignette

was similar to those used in previous research by

29
emphasizing problems relevant to women in college (see
Appendix K).

Exposure to psychological counseling. Seven questions
were asked to assess previous contact with psychological
counseling (see Appendix M). Questions included personal
contact, as well as contact through family and friends.
Additionally, perceptions of how helpful participants
thought that psychotherapy might be was assessed.
Participants were asked to indicate the extent of exposure
to psychological counseling on a 5-point scale (ranging from
No Experience to Extensive Experience). Exposure scores
were computed by totaling each participant’s responses.

Probability of seeking psychological counsgling. To
determine the likelihood of help-seeking, Deane and
Chamberlain (1994) used a 9-point Likert scale asking, "If
you did have a personal problem, how likely is it that you
would seek help from a professional psychologist or
counselor." The likelihood of help-seeking for
psychological counseling (see Appendix N) was addressed
slightly differently in the present study. Participants
rated the probability of help-seeking for three time periods
(i.e., next 30 days, six months, and year). Ratings ranged
from 0-100%, the latter indicating ongoing psychological
counseling. Ratings for the three time periods were

averaged for a probability of help-seeking variable.

30
Pr c re

Women students were assessed in groups of 10-30. They
were informed that the experiment was anonymous and that
their responses were confidential (see Appendix A). They
were also advised that it involved questions about
difficulties they may be currently experiencing and that
some persons may consider some of the questions to be
intrusive. Participants were reminded of their option to
not participate in the study and still receive research
credit. They were presented with an Informed Consent
Agreement describing the parameters of participation (see
Appendix B). After reading the Informed Consent Agreement,
they were instructed to open their questionnaire packet and
begin. Instructions discouraged using any identifying
information (see Appendix C). Since participants provided
information on both the questionnaire packet and answer
sheets, these items were coded for later matching before
testing. Completing these measures took approximately one-
hour.

Participants were first presented the TAPS
questionnaire to assess concerns and fears regarding
psychotherapy; then they completed the NEO-FFI, the NPC, and
the B81 in that order. Next, participants identified
problems they were currently experiencing from the self-
report checklist and wrote briefly about the three problems

they considered most serious. The third pre-vignette task

31
assessed mood by using two measures. They rated themselves
on eight MAACL adjectives and completed the entire PANAS
scale.

After completing all foregoing measures, participants
were requested to read an approximately 1000-word vignette.
The vignette presented "Cheryl", a woman experiencing a
variety of problems common to a college student population
and who is seeking career counseling at the university
counseling center. Each was asked to rate "Cheryl"
concerning her level of distress and need for psychological
services (Appendix L); two additional questions assessed the
respondents’ reading comprehension. Afterwards,
participants' mood was reassessed. They rated themselves on
the polar-opposite MAACL adjectives and the entire PANAS
scale. Finally, they completed the exposure to
psychotherapy questionnaire and follow—up questions.
Follow-up questions asked respondents to indicate the
probability of their seeing a therapist over three time
periods (i.e., next month, six months, and year) and
assessed basic demographic information.

After returning all questionnaires, they were given a
brief feedback sheet that also explained how to obtain more
information (see Appendix 0). Additionally, the feedback
sheet explained that some people find that thinking about
life problems and difficulties creates an interest in

psychotherapy or counseling, but people do not know where to

32
go to obtain such services. Information about the
university counseling center was provided.
Analyses

Power. The two studies assessing fear of psychotherapy
with clinical and non-clinical participants have yielded
effect sizes between .30 and .50 (Kushner & Sher, 1989;
Pipes et al., 1985). Previous studies of downward
comparison found mood change effect size for low self—esteem
and depressed persons to be approximately ; = .53 (Gibbons,
1986; Gibbons & McCoy, 1991; Aspinwall & Taylor, 1993).
According to Cohen (1992), these represent medium to large
effect sizes and with power of .80 and an alpha of .05
suggest that the N = 85. In an attempt to increase power,
compensate for lower effect sizes, and offset students who
drop out or submit incomplete data, this study recruited 334
students.

Statistics. Most participants completed their
questionnaire packet, resulting in little missing data.
However, listwise deletion was used for all analyses
resulting in slight variations in sample sizes across
analyses.

Hierarchical multiple regression was used to assess the
relationships between the fear score (total TAPS; dependent
variable) and distress (Neuroticism and G81) and exposure to
psychological counseling (independent variables). To assess

whether participants’ mood corresponds to psychological

33
distress following the self-awareness component, pretest
PANAS scores were correlated with distress measures
(Neuroticism and GSI). Moderate negative and positive
correlations were predicted for the PA and NA scale,
respectively.

Several questions were used to check the effect of the
vignette manipulation. All participants were expected to
perceive "Cheryl" as moderately to extremely distressed and
in need of mental health services. Two questions assessed
how thoroughly participants read the vignette.

Mood change was assessed in two ways. First, the
difference in mood index scores on the MAACL adjectives was
calculated (posttest minus pretest). To control for pretest
mood differences, the second calculation of mood change
covaried out pretest mood to assess mood change from a
common average across participants. To assess the effects
of downward comparison, separate hierarchical regression
analyses were run with each calculation (similar results
were expected) to determine the relationship between mood
change (dependent variable) and distress (independent
variable).

Hierarchical multiple regression was used to identify
the relationships between perceived need for psychological
counseling (dependent variable) and downward comparison and
distress (independent variables). Hierarchical multiple

regression was also used to assess the impact of distress,

34
prior exposure, fear of psychological counseling, and mood
change on the probability of seeking psychological

counseling. All suspected interactions were also assessed

for significance.

Results

Thou hts About Ps chothera Surve TAPS

Factor analysis of the TAPS. To determine whether the
TAPS had a factor structure consistent with previous studies
(Pipes et al., 1985; Kushner & Sher, 1989), factor analysis
was performed using principal components with iteration and
varimax rotation. This analysis was modeled after the
procedures used by Kushner and Sher (1989) who found that
the TAPS items identified three factors of satisfactory
reliability. As expected, a three-factor solution was found
which accounted for 60.8% of the variance. Though
replicating their basic factor structure, several
differences were noted in the items which comprised these
factors (see Table 1 for factor loadings). For instance,
Kushner and Sher (1989) did not include items 1 and 5 on any
of their factors. The present analysis excluded only items
17 and 18 due to equivalent factor loadings on more than one
factor. This procedure added two items (1 & 5) to their
first factor, Therapist Responsiveness, and reduced their
four-item third factor, Coercion Concerns, to only two
items. As a result of these changes, means and standard

deviations are not directly comparable across studies.

35

36
Table 1

Factor loadipgs fo; the Thoughts Apput Psychotherapy survey (TAPS)

 

 

Item Factor 1 Factor 2 Factor 3

1d .65a -.02 .17
25 .81a .13 .16
3s .87. .13 .16
48 .88a .17 .13
5d .55” .38 -.02
65 .80a .15 .14
7s .42 .60” -.01
83 .76a .31 .07
9s .07 .77” .02
105 .22 .65” .18
113 .19 .71” .23
125 .08 .74” .22
13s .02 .67” .28
14s .738 .02 .23
155 .35 .20 .75c
168 .24 .31 .77c
17d .17 .53 .62
18d 18 48 39
19s 01 53” 41

Note. Superscripts (”'b"°) denote items used to form Factors 1, 2, and
3; a factor loading had to be at least .11 (significant at .05 level) or
greater than both other factors to be included. Lower case letters
denote same (8) or different (d) than factors generated by Kushner &
Sher (1989).

37
Reliability and ysliditv of the TAPS. Using the factor
structure generated by Kushner and Sher (1989), Deane and
Chamberlain (1994) reported notable correlations between the
TAPS total score and some of its subscales. These varied
from .51 to .80 with one exception, Therapist Responsiveness

and Image Concerns (.36). Table 2 presents all TAPS

 

Table 2

Intercorrelations, means, standard deviations, and alpha

coefficients for the TAPS total and subscale scores

 

TAPS scales

 

TAPS measure 1 2 3 4 Mean SD Alpha
1. Total --- .86 .80 .73 57.62 14.7 .92
2. Therapist

Responsiveness --— .43 .51 28.91 8.2 .91
3. Image Concerns --- .54 18.14 5.9 .84
4. Coercion Concerns --- 5.52 2.1 .76

Note. N = 326 and p < .001 for all statistics.

 

correlations, means, standard deviations, and Cronbach alpha
coefficients. Results were consistent with previous
findings.

Deane and Chamberlain (1994) also reported the TAPS

total and subscale scores to have concurrent validity with a

38
measure of state anxiety (correlations ranging from .13 to
.48). Concurrent validity was established in the present
study by correlating the total TAPS and all subscales with
both Neuroticism and the GSI. Incidentally, Neuroticism and
the G81 correlated strongly (; = .66, p < .001; N = 326).
With one exception (Therapist Responsiveness and
Neuroticism: ; = .07, p = .20), all TAPS scores correlated
with the two distress measures significantly (gs = .13 to
.30, p < .05), although these relationships were generally
weak. The results indicate that the TAPS scales have rather
modest external parallelism with other measures of distress.
They also raise the possibility that the TAPS may be
measuring a unidimensional construct rather than
multidimensional aspects of treatment fearfulness (i.e.,
Therapist Responsiveness, Image Concerns, Coercion
Concerns).

To test this latter notion, TAPS items were randomly
assigned to one of three factors. Satisfactory
reliabilities would indicate that the TAPS scales measure
one unidimensional construct, and that using the factor
subscales would result in superfluous divisions and
measurement errors. Internal consistency analysis of the
randomly assigned items supported the notion of a
unidimensional construct. Cronbach’s alpha coefficients
were .83, .72, and .76 for factors 1 (8 items), 2 (5 items),

and 3 (6 items), respectively. As a result of these

39
findings, only the total TAPS score was used in all
subsequent analyses.

Predictors of TAPS. It had been hypothesized that
measures of distress (GSI and Neuroticism) and Exposure
would correlate positively and negatively, respectively,
with the total TAPS score. The interaction of distress and
Exposure was predicted to account for a significant amount
of TAPS variance. Hierarchical multiple regression was used
to assess these relationships. The independent variables
demonstrated satisfactory internal consistency (alpha
coefficients for this study: .86 = Neuroticism, .96 = GSI,
and .76 = Exposure). The hypothesis that distress and
exposure would be positively and negatively correlated,
respectively, was supported (see Table 3). When the GSI,
Neuroticism, and Exposure were entered simultaneously, they
accounted for 9% of the of the TAPS total score variance (32
= .09, p < .001), only the GSI (beta = .20, p < .01) and
Exposure (beta = -.18, p < .001) were significant.

The interaction between distress and exposure was
tested separately for the GSI and Neuroticism. The
hypothesized interaction between distress and exposure was
not supported. Neither interaction variable accounted for
significant additional variance.

Reliability and Validity of Mood Measures
The average intercorrelations for the summed positive

and negative adjectives of the MAACL at pretest were .67 and

40

Table 3

Hierarchical multiple regression analyses predicting the TAPS

 

Total sspple (N - 324)

 

s 32 Delta R2 Beta
1. First step entry
a. GSI .22 .05".
b. Neuroticism (N) .21 .04"‘
c. Exposure (E) .13 .02'
2. Second step entry
a. GSI & N .24 .06'"
Adding N to GSI .01
Adding GSI to N .01'
b. GSI & E .29 .08‘""
Adding E to GSI .03"'
Adding GSI to E .06"'
C. N & E .26 .07‘""
Adding E to N .02"
Adding N to E .05‘"
3. Third step entry
a. All variables .30 .09"'
GSI .20"
N .09
E -.18"'
b. Adding E to GSI & N (2a.) .03"'
Adding N to GSI & E (2b.) .00
Adding GSI to N & E (2a.) .02"
4. Interaction
a. Adding GSI*E to GSI & E .00
b. Adding N*E to N & E .00

 

41
.52, respectively. Alpha coefficients are presented for
these scales and the PANAS scales in Table 4. All scales
possessed satisfactory internal consistency. To assess
whether participants’ mood corresponded to their level of
psychological distress, these scales were correlated with
Neuroticism and the GSI (see Table 4). All correlations
were in the expected direction and significant (p < .001).
As predicted, negative mood had a moderate and consistently
positive relationship with measures of distress. Positive
mood was reflected by negative correlations of somewhat

lesser strength, especially for the PANAS.

 

Table 4

Mood scale alpha coefficients and correlations with

Neuroticism and the General Severit Index GSI at retest

 

Alpha Neuroticism GSI
1. MAACL—Positive Adjectives .89 -.51 -.47
2. MAACL-Negative Adjectives .80 .53 .65
3. PANAS-Positive Affect .89 -.34 -.21
4. PANAS-Negative Affect .89 .43 .58

Note. For all correlations, N = 301 and p < .001.

 

42

Vignette Manipulation Checks

It had been expected that "Cheryl", the fictitious
individual presented in the vignette, would be perceived as
moderately to extremely distressed and in need of help with
her problems. These expectations were confirmed.
Participants found "Cheryl" to be between moderately and
extremely distressed (N = 4.1, S2 = .69) and similarly in
need of help (N = 4.2, SQ = .72). Additionally, they judged
her as having only "a little" ability to overcome her
problems without help (N = 1.9, SD = .97). Post-vignette
questions (i.e., items 4 and 5) which assessed how
thoroughly participants read the vignette indicated that 98%
seemed to have read the entire vignette. Analyses of the
remaining 2% indicated that the cases were not statistically
different from the overall sample. As a result, they were
included in all subsequent analyses.
Mood Chsngs Difference Scpres

Mood index scores were formed by subtracting the MAACL
negative score from the positive score separately at pretest
and posttest. Then this pretest score was subtracted from
the posttest score to obtain a mood index change score
(MICS; see Table 5). Given the PANAS assessment of two
independent factors, Positive Affect (PA) and Negative
Affect (NA) (Watson et al. , 1988), and the possibility that
combining the scales into a composite might mask the

relationship of distress and negative mood, the PA and NA

43

 

Table 5

Mood change

 

Pretest Posttest Mood p-value
Mood Mood Change
fiééé'ifié;;méiéi'2;i§§"'éiéé‘iéiéi""Tié'iéiéi"'3f;;""
Positive 15.75 (5.8) 14.59 (5.4) -1.16 (5.2) 3.99“‘
Negative 9.08 (4.7) 7.76 (4.8) —1.32 (3.8) 6.21”*
PA 25.61 (8.4) 25.22 (9.1) -.39 (4.8) 1.43
NA 15 69 (6 6) 14 82 (6 0) - 87 (3 7) 4 15"'
taggers;iga;;'g;';;;;‘;;;';g';ga‘.'.;;;;;;;g:3;"
p < . 1.

 

scales were maintained separate. Difference scores were
obtained by subtracting pretest from posttest scores. Mood
change was assessed for each scale using a paired sample p-
test (see Table 5). The mood index change score was found
to be marginal and not significant, even though each of its
components (positive and negative) declined significantly,
ps(321) = 3.99 and 6.21. As suspected, participants'
decreases in both positive and negative mood scores offset
each other. Consequently, subtracting the negative from the
positive to form the Mood Index Change Score was basically
nullifying. For the PANAS, only Negative Affectivity
declined significantly, p(310) = 4.15.

Mood Change and Distress

Mood change and its relationship to distress was

44
analyzed in two ways. First, distress measures were used to
predict mood change scores (i.e., MICS, PA, and NA). The
relationship between mood change and distress was tested by
regression analysis. The findings are shown in Table 6.
The hypothesis that mood change and distress would correlate
positively was partially supported. Initially, the GSI and
Neuroticism were used separately to predict the MICS. Each
significantly predicted the MICS, though neither accounted
for much variance (Neuroticism: B? = .04, p < .001; GSI: 3%:
.03, p < .001). Jointly entered, these two measures
accounted for 5% of the variance (32:: .05, p < .001), but
only Neuroticism contributed significantly (beta = .17, p <
.05). Next, the GSI and Neuroticism were used to predict PA
and NA change scores. Neither distress measure accounted
for a significant amount of the PA or NA score variance,
either separately or simultaneously.

In the second method, distress measures were used to
predict posttest mood scores after pretest mood scores were
entered as a covariate. Results of these hierarchical
multiple regressions are presented in Table 7. In each case
the pretest measure was entered first. Then the two
distress measures were entered simultaneously to see if they
could account for a significant amount of additional
variance. After controlling for the pretest Mood Index
Score (32:: .55, p < .001), the distress measures accounted

for an additional 1% of the posttest Mood Index Score

45

Table 6
Re ression anal ses redictin Mood Ind x Chan e Sc res MI S

Positive Affectivit PA chan e and Ne ative Affectivity (NA)

 

 

m
B 32 Beta
I. MICS
1. a. GSI .18 .03"'
b. Neuroticism (N) .21 .04“'
2. GSI & N .22 .05"‘
a. GSI .07
b. N .17'
II. PA Change Score
1. a. GSI .07 .00
b. N .05 .00
2. GSI & N .07 .01
a. GSI -.08
b. N .02
III. NA Change Score
1. a. GSI .09 .01
b. N .05 .00
2. GSI & N .09 .01
a. GSI -.11
b. N .03

Note. N = 322 for MICS analysis; N = 303 for PA and NA analyses.
'p < .05,- “'p_ < .001.

46

Table 7

 

ngression analyses predicting posttest mood scores -- using

pretest mood scores as a covariate

 

B
I. Posttest Mood Index Score
1. First entry
a. Pretest mood
index score .74
2. Second entry
a. GSI
b. N
II. Posttest PA Score
1. First entry
a. Pretest PA Score .86
2. Second entry
a. GSI
b. N
III. Posttest NA Score
1. First entry
a. Pretest NA Score .84
2. Second entry
a. GSI
b. N

32 Delta R2

. 55‘1'.’
.01'
73fitt
.00
. 70*fii
02"!

 

.11H
.06

Note. N = 314 for Mood Index Score analysis; N = 303 for PA

and NA analyses. 'p < .05; “p < .01;

"*9 < .001.

47
variance (Delta 32:: .01, p < .05). Only the GSI made a
significant contribution (beta = -.12, p < .05).

The PA pretest accounted for 73% of the PA posttest
variance (32:: .73, p < .001). No additional variance was
accounted for by either distress measure. In regard to NA,
the pretest score accounted for 70% of the posttest variance
(3? = .70, p < .001). An additional 2% of the
variance was accounted for by distress with only the GSI
contribution significant (beta = .11, p < .01).

The hypothesis that distress would predict mood change
scores was partially supported. Both distress measures were
statistically significant, but quite weak predictors of the
Mood Index Change Score. However, neither PA nor NA change
scores were predicted by either distress measure. When
predicting posttest scores, using pretest scores as a
covariate, the distress measures accounted for an additional
1% of posttest mood index score variance. While no
additional PA score variance was explained beyond that of
the pretest, the distress measures accounted for an
additional 2% of the posttest NA score variance.

To better understand the patterns of mood change, GSI
scores were divided into tertiles. For each level of
distress, paired sample p-tests were conducted to assess the
significance of mood changes (see Table 8). Although five
out of six mood index component scores were significant,

only the high distress group evidenced a significant Mood

48
Index Change Score (MICS) difference, p(105) = 2.60, p <
.01. This group also demonstrated the only significant
PANAS mood decline with their NA scores dropping an average
of 1.5 points, p(100)= 3.61, p < .001.

Additionally, ANOVAs were conducted to assess the
significance of change across these three tertiles.
Significant E-values were found for the MICS, 3(2, 300) =
4.82, p < .01, negative mood index component score E(2,
300) = 4.02, p <.05, and NA 2(2, 290) = 3.04, p < .05.

Neither measure of positive mood reached significance.

 

Table 8

Mood change with tertile division of the GSI: Within group
paired-sample t-tests and between group ANOVAs

 

Lowera Middleb UpperC E
MICS -.72 (6.3) -.64 (6.1) 1.72 (6.8)“ 4.82"
Pos -1.51 (5.0)“ -1 63 (5.1)" -.44 (5.2) 1.69
Neg -.79 (2.4)" -.99 (3.6)“ -2.16 (4.8)*“ 4.02'
PA .37 (5.1) -.77 (4.5) -.66 (4.8) 1.67
NA -.26 (2.8) -.61 (3.8) -1.51 (4.2)*“ 3.04'

Note. aLower (GSI <= .37). WMiddle (.38 < GSI <.77). cUpper
(GSI >= .78). MICS: N8 = 98\99\106. PA & NA: N9 =

iii

95\97\101. 'p < .05; "p < .01; p < .001.

 

 

49

An interesting pattern was noted in the mood index component
scores of the upper and lower tertiles. The upper group had
minimal positive mood changes from pre- to posttest, but
substantial declines in negative mood. The lower group had
statistically significant mood shifts on both the positive
and negative scales, but in contrast to the upper group,
their largest mood change was on the positive scale. The
significance of the lower group’s negative shift was in part
due to a relatively small standard deviation. Thus, while
distressed participants primarily declined in negative mood,
the non-distressed had much lesser negative mood reductions
but strong reductions in positive mood.
Need for Ps cholo ical Counselin NPC

A significant problem developed in regard to the NPC
measure, seemingly because of its administration between the
two distress measures. Though each questionnaire began with
new instructions and any important changes were in boldface
type, approximately 130 participants seemed to either
misinterpret or fail to fully comprehend the NPC
instructions. This became apparent on the extreme items
where they responded to the NPC as if it were a distress
measure rather than a measure of the "need for psychological
counseling". Given this measure’s compromised validity, it
was dropped from further analyses.

Probability of Seeking Psycholpgical Counseling

Participants’ were questioned about the probability of

50

their seeking psychological counseling in the next 30 days,
six months, and one year. For these time periods, the means
and standard deviations were: 30-days (N = 9.91, s2 =
23.1), six months (N = 14.87, SQ = 26.5), and one year (N =
18.31, §Q = 28.6). Results from the three periods were
averaged across participants to form a Probability of Help-
Seeking (PHS) score. Distress, exposure, fear, and mood
change (i.e., MICS) were expected predictors of PHS scores.

These relationships were tested using hierarchical
multiple regression (see Table 9). When entered separately,
all variables except the TAPS were found to be significant
predictors; as a result, the TAPS was only included in
interaction analyses. Variables were combined in pairs, and
then the remaining variables were added to assess changes in
B}. The Mood Index Change Score was not found to explain
any additional variance after the effects of either distress
measure and Exposure. Exposure retained predictive power,
even when entered after the MICS and distress (Delta N2==
.18 to .20, p < .001). Regarding the distress measures,
while Neuroticism explained additional variance after MICS
and Exposure (Delta 32:: .04, p < .001), it accounted for no
significant variance when entered after the GSI. The GSI
added unique variance (Delta 33 = .04 to .07, p <.001) after
any combination of Neuroticism, Exposure, and MICS.

The GSI and Exposure accounted for 31% of the PHS

variance (32:: .31, p < .001). Though the addition of

51

Table 9

Hierarchical multiple regression analyses predicting
Probability of Help-Seeking (PHS)

 

Totsl sspple (N'- 317) N 32 Delta R2 Beta
1. First step entry
a. GSI .37 .14'"
b. Neuroticism (N) .26 .07"'
c. Exposure (E) .47 .22"'
d. TAPS .02 .00
e. MICS .13 .02'
2. Second step entry
a. GSI & N .37 .14'"
Adding N to GSI .00
Adding GSI to N .07"'
Adding E to GSI & N .18"'
Adding MICS to GSI & N .00
b. GSI & E .56 .31".
Adding E to GSI .18"*
Adding GSI to E .08"'
Adding MICS to GSI & E .00
Adding N to GSI & E .00
C. N 8: E .53 .28."
Adding E to N .20"'
Adding N to E .05“'
Adding GSI to E & N .04"'
Adding MICS to E & N .01
d. GSI & MICS .37 .14".
Adding MICS to GSI .00
Adding GSI to MICS .12“'
Adding N to GSI & MICS .00
Adding E to GSI & MICS .18"'
e. N & MICS .27 07'"
Adding MICS to N .00
Adding N to MICS .06“‘
Adding GSI to N & MICS .07'"
Adding E to N & MICS .20"'
f. E & MICS .49 .24“*
Adding MICS to E .02“
Adding E to MICS .22“*
Adding GSI to E & MICS .07"*
Adding N to E & MICS .04"'

52

 

Table 9 (cont’d).
Tot 1 a lo N'- 17 N 32 Delta R2 Beta
3. Fourth step entry
All variables .56 .31"'
GSI .25'"
N .05
E .43".
MICS .06
4. Interactions
a. Adding GSI*E to GSI & E 02"
b. Adding N*E to N & E .01"
C. Adding GSI*TAPS to GSI & TAPS .00
d. Adding N*TAPS to N & TAPS .00
Note 'p < 05, "p < 01, ”p < .001

 

53
Neuroticism and Exposure produced no increase in explained
PHS variance, additional variance was accounted for by
distress and Exposure interaction effects. The product of
the GSI and Neuroticism with Exposure accounted for an
additional 2% and 1% of PHS variance, respectively. The
interaction of distress and the TAPS was not significant.
Thus the GSI, Exposure, and their interaction accounted for
33% of the PHS variance.

Of additional interest, the Exposure measure was
examined for only personal experience with psychological
counseling. Eight percent of participants indicated that
they were currently receiving some type of psychological
counseling. A surprising 44% responded that they had
received some type of psychological counseling in their
lifetime; of these, 23% noted that they had attended 13 or

more sessions.

Discussion

The participants in this study are thought to
accurately represent women from a large midwestern
university population. However, given their recruitment
from both lower- and upper-level psychology courses, they
may be more "psychologically-minded" and/or have more
psychology related experiences (e.g., previous counseling)
than the average undergraduate. The sample was relatively
homogeneous in terms of both age and ethnicity.

As emphasized earlier, only a small proportion of
persons experiencing distress actually seek psychological
counseling. This discrepancy is especially puzzling in
university populations where counseling services are often
readily accessible and of minimal cost. Of these college
women, eight percent indicated that they were currently
receiving some type of psychological counseling, a figure
consistent with the utilization rates of previous studies.
A surprising 44% responded that they had received some form
of psychological counseling at some time in their life;
though this figure seemed high, it is close to the 39%
reported by Bertocci et al. (1992). These figures suggest
that even though prevalence rates for distress may be higher
than utilization rates for services, a large number of

54

55
college women have been exposed to psychological counseling
to some degree. That is, failure to make use of such
services is not due to an ignorance of psychological
counseling’s availability.

Fear of psychological counseling among these college
women was assessed with the TAPS (Pipes et al, 1985; Kushner
& Sher, 1989), previously found to assess multidimensional
aspects of treatment fearfulness. In contrast to these
prior studies, the TAPS evidenced only weak
multidimensionality in the present sample, and was fairly
uniform in its factor intercorrelations and correlations
with multiple distress measures (see also Deane &
Chamberlain, 1994). Additionally, the random assignment of
the TAPS items to three factors produced satisfactory
internal consistency. These results suggest that the TAPS
factors, though perhaps conceptually meaningful, did not
assess independent factors, but appear to be superfluous
divisions of a unitary construct. Given these findings, the
TAPS total score was used exclusively to minimize
measurement error.

Fear of psychological counseling was predicted by both
distress and prior exposure to psychological counseling.
The variables made independent contributions without
interacting. Together, they accounted for 9% of the TAPS
score variance. The GSI was a slightly better predictor

than the Neuroticism factor of the NEO-FFI, while exposure

56
was the weakest predictor.

Overall, the findings replicate those of Kushner and
Sher (1989), despite several differences in methodology.
Different measures of exposure were used, and the current
study controlled for gender by restricting participants to
college women. Kushner and Sher (1989) compared male and
female students who sought counseling services, but had not
yet begun treatment, with "nonclinical" students. The
present study addressed a wider range of prior exposure to
psychological counseling, including both personal experience
and the experiences of family and friends among college
women.

The finding that distress and fearfulness of
psychological counseling act counter to each other has led
some to conceptualize the relationship as an approach-
avoidance conflict (Kushner & Sher, 1989). This study’s
results support this notion, in part; however, the limited
explanatory power of distress, even when combined with
exposure, indicates that this interpretation should be made
cautiously. Fear of psychological counseling appears
impacted by a number of other factors not yet identified.
These unknowns must be identified and explored before we can
more fully understand treatment fearfulness and the failure
to seek help for distress.

One possibility for the lack of explanation lies in the

notion of measuring fear of psychological counseling, and

57
for that matter, distress. Much research calls into
question the total reliance on self-report questionnaires
which are subject to biases from personality traits
(Schmitt, 1994) and unconscious defenses (Shedler, Mayman, &
Manis, 1993). As a result of these problems, self—report
measures may not accurately measure the intended construct.
Additionally, they do not lend themselves to explaining
causal relations, especially when used in cross-sectional
designs (Spector, 1994) as utilized in this study.

These issues seem especially pertinent when asking
questions about such culturally stigmatized topics as mental
health, distress, and psychological counseling which tend to
elicit socially desirable responses. For example, it seems
quite plausible that while some individuals would
defensively deny their distress, they might admit
fearfulness or apprehension to seek treatment. Thus, self-
report questionnaires make the task of identifying personal
barriers to help-seeking quite elusive and suggest caution
when interpreting such results.

Previous research suggests that distressed individuals
tend to engage in downward comparison when presented with a
distressed target individual (Wills, 1981). The effect of
this process is a reduction of negative mood and enhanced
self-esteem (Gibbons, 1986; Gibbons & Gerrard, 1989;
Aspinwall & Taylor, 1993). The present study hypothesized

that downward comparison would prevent help-seeking. That

58
is, if a more distressed person can be targeted and compared
to the self, then there is a temporary relief of negative
mood, and less of an immediate need to seek counseling.
"Cheryl" was presented here as such a target. She was
perceived as quite distressed and in need of help, and only
attributed "a little" ability to overcome her difficulties
without help.

Regression analyses indicated that distress was a
significant predictor of the Mood Index Change Score (MICS)
as expected, though curiously it predicted neither PANAS
scale. Similar results were found when distress was used to
predict posttest mood scores after controlling for pretest
scores. However, distress also accounted for a significant
amount of Negative Affectivity (NA) posttest variance.

This study found pre- to posttest change on the mood
index scores to be nonsignificant, although its positive and
negative components differed significantly. A closer look
at these elements offered an explanation. When the mood
index was calculated, positive and negative mood change
cancelled each other out, producing the misleading finding
of no overall mood change.

When the sample was divided into tertiles based on
distress scores, this finding was more fully elucidated.
These groups differed significantly on their overall mood
change (i.e., MICS). Of particular interest, the low and

high distress groups had unique patterns of positive and

59

negative mood change. After reading about "Cheryl", the low
distress group evidenced both positive and negative mood
change with the former much larger than the latter. The
high distress group changed significantly only in negative
mood. Thus, while the low distress group had primarily a
reduction in positive mood, the high distress group had a
reduction in negative mood.

These results suggest that those low in distress have
more to lose by comparing downward or identifying with a
distressed individual; that is, such a comparison diminishes
their positive mood. This phenomena may offer an
explanation for the "active" downward comparison or
derogation among high self-esteem students reported by
Gibbons and McCoy (1991). In individuals with low distress,
active derogation might serve to preserve positive mood.
The present study provided no opportunity for derogation.
This represents an area for future research, especially
insofar as high self-esteem individuals are not typically
thought of as having the need to derogate others. Yet it
may be an effective coping mechanism for maintaining
positive mood. For those high in distress, there seems to
be an "affective" benefit to reading about someone’s
distress: Positive mood is relatively unchanged and
negative mood is significantly reduced.

Several issues may have impacted these results and

should be considered regarding interpretations and

60

comparisons with previous reports. First, this study used
polar opposite adjectives at pre- and posttest to reduce the
obviousness of repeated measures, a fairly common
methodological strategy (Gibbons & Gerrard, 1989; Gibbons &
McCoy, 1991; Aspinwall & Taylor, 1993). Despite its popular
use, no reports were found regarding the equivalency of
these two sets of adjectives, and no present attempt was
made to assess their equivalency. Second, the vignette
manipulation provided a potentially more affect-loaded
scenario (i.e., a woman seeking therapy presented in
transcript form) than previous studies which typically use
more academic/adjustment to college themes.

Incidentally, the PANAS which measures separate PA and
NA scales, only exhibited significant NA mood change. When
divided in tertiles based on distress, the only
statistically significant PANAS finding was NA mood change
in the high distress group. Several factors may explain why
the MAACL adjectives indicated stronger mood change, for
both positive and negative mood, than the PANAS scales.
First, the MAACL adjectives were presented prior to the
PANAS at both pre- and posttest. Second, the MAACL
adjectives were "disguised" at posttest by using polar
opposites with a different response format while the PANAS
were merely repeated. Thus, MAACL adjectives may have
tapped a primacy effect by being presented first.

Alternatively, or in addition, "disguising" the adjectives

61
may have prevented participants from answering rotely or
mechanically (to what some participants responded to in a
Comments Section as "too many of the same questions").
Again, the potential inequivalency of MAACL adjectives might
also explain these differences.

Given its compromised validity, the NPC measure was
excluded from analyses. Instead, the Probability of Help-
Seeking (PHS) was the final construct assessed. Overall,
the GSI, Exposure, and their interaction produced the best
explanation of variance in PHS scores, accounting for 33%.
Neuroticism was also a significant predictor, although not
as robust as the GSI, and prior Exposure was the strongest
single predictor of PHS ratings. The Mood Index Change
Score (MICS), assessing downward comparison, was also a
significant predictor of PHS and added to the variance
explained by Exposure, but failed to account for any
additional PHS variance. Of interest, fear of psychological
counseling was not a significant predictor.

Overall, these results call the TAPS measure of
fearfulness into question. Variance in TAPS scores was only
minimally explained by distress and exposure to
psychological counseling, and TAPS failed to predict PHS
ratings. As a result of these findings, TAPS’ had little
apparent relevance. The likelihood of help-seeking was best
predicted by standard measures of distress and a measure of

prior exposure to psychological counseling. Given the

62
limitations of a cross-sectional design, future research
might profitably focus on distress, exposure, and help-
seeking behavior by using a longitudinal design.

The results demonstrated that persons scoring high on
distress tend toward negative mood reduction after being
presented a downward comparison target. Unexpectedly,
persons scoring low on distress have a similar reduction in
positive mood. As mentioned earlier, these results suggest
different coping mechanisms may regulate mood based on level
of distress. In this context, the findings highlight the
potential use of downward comparison in mood regulation and
enhancement, and they give some direction to a promising
area of research. That is, future studies of downward
comparison might investigate under what conditions it is
employed and the affective result for both low and high
distress groups. Studies might also assess the duration of
the affective change for each group. Additionally, research
might address how persons low in distress tend to regulate
the reduction in positive mood when forced to engage with a

salient downward comparison target.

APPENDICES

63

Appendix A

Verbal Administration Instructions

Please make sure you are separated from the next person
by at least one chair. You have signed up for a study about
help-seeking. The questionnaires you will be asked to
complete require approximately one and a half to two hours
to complete. Some of the questions may relate to
difficulties you are currently experiencing. Some people
find some of the questions to be personal and intrusive.
Therefore, please keep in mind that participation is
voluntary, and you may withdraw from participating at any
time without penalty.

All the information you provide will be kept anonymous
and entirely confidential, so please do not write any
identifying information, such as your name or personal
identification (PID) number, on the questionnaire packet or
answer sheet. Most answers will go on the "bubble" answer
form, but some answers you will write in the questionnaire
packet. The instructions should be clear. If you have any
questions about the materials, please raise your hand.

64

Appendix B

Informed Consent Agreement

I have freely consented to take part in a

scientific study being conducted by Jason Dahn, under
the supervision of John Hurley, Ph.D., Professor of
Psychology.

This study is being conducted to investigate my
feelings about seeking help for personal problems. As
a participant, I will be asked to complete a
questionnaire packet, and I have been informed that
this will take less than 2 hours.

I have been informed that some people find some of
the questions to be personal and intrusive. I
understand that my participation is voluntary and am
aware that I may withdraw from participating at any
time without penalty.

I understand that my answers and all other
information will be kept strictly confidential, and
that I will remain anonymous. On request and within
these restrictions results of the overall study may be
made available to me.

I understand that my participation in the study
does not guarantee any beneficial results to me.

I understand that I will receive some feedback

about the study after I complete the questionnaire
packet and that more detailed information about the
purposes of the overall study will be available after
its completion.

I have read the material above, and any questions

I may have asked have been answered to my satisfaction.
If I have questions later, I may contact Jason Dahn or,
if he is not available, Professor Hurley.

I understand that by completing and returning this
questionnaire I am indicating my voluntary agreement to
participate.

65

Appendix C

Questionnaire Packet Instructions

Before you begin, please check to see that you have a
"bubble" answer form. Also make sure that the code number
in the upper right corner of your Informed Consent Agreement
matches the number coded in the PIN area of your answer
sheet. If it does not, raise your hand. Do not write your
name or personal identification number (PIN) on the answer
sheet or questionnaire packet.

The following packet contains a series of
questionnaires. Each section begins on a new page. Be sure
to read the short instructions for each section. Please
answer all questions on your answer form unless the
instructions indicate otherwise. Darken your answers
completely and do not skip any questions. If you are
unclear about a question or how to proceed, please raise
your hand.

Note: There are many terms used for the situation when
a person seeks out a mental health profession for services.
For the questionnaires you are about to complete
psychotherapy, counseling, and psychological counseling will
be used interchangeably to describe the situation where an
individual seeks out a mental health profession (e.g.,
social worker, counselor, psychologist, psychiatrist etc.)
for individual therapy services.

66

Appendix D

Thoughts About Psychotherapy Survey (TAPS)

Instructions: If you were to imagine seeking psychotherapy or have been
engaged in psychotherapy, please indicate the amount of concern you have
in regard to each of the following statements.

0101th I'-'|

\l

11.

12.

13.

14.

15.

16.

17.

18.

19.

 

1 2 3 4 5
no little somewhat much very
concern concerned concerned concerned concerned

 

Whether therapy is what I need to help me with my
problems?

Whether I’ll be treated as a person in therapy?
Whether the therapist will be honest with me?

Whether the therapist will take my problem seriously?
Whether the therapist will share my values?

Whether everything I say in therapy will be kept
confidential?

Whether the therapist will think I'm a bad person if I
talk about every thing I have been thinking and
feeling?

Whether the therapist will understand my problem?
Whether my friends will think I’m abnormal for coming?
Whether the therapist will think I’m more disturbed
than I am?

Whether the therapist will find out things I don’t
want him/her to know about me and my life?

Whether I will learn things about myself I don’t really
want to know?

Whether I’ll lose control of my emotions while in
therapy?

Whether the therapist will be competent to address

my problem?

Whether I will be pressured to do things in

therapy I don’t want to do?

Whether I will be pressured to make changes in my
lifestyle that I feel unwilling or unable to make right now?
Whether I will be pressured into talking about

things that I don’t want to?

Whether I will end up changing the way I think or

feel about things and the world in general?

The thought of seeing a therapist would cause me

to worry, experience nervousness or feel fearful in general?

67

Appendix E

NEO-FFI

Instructions: Read each statement carefully. For each statement darken
the number with the response that best represents your opinion.

W

10.

19.

20.

21.
22.
23.
24.

25.

26.
27.
28.
29.

30.
31.
32.
33.

34.
35.

(DQO‘U'Ithh-DMH

 

1 2 3 4 5
strongly disagree neutral or agree strongly
disagree equally true/false agree

 

am not a worrier.

like to have a lot of people around me.

don’t like to waste my time daydreaming.

try to be courteous to everyone I meet.

keep my belongings clean and neat.

often feel inferior to others.

laugh easily.

Once I find the right way to do something, I stick to
it.

I often get into arguments with my family and co-
workers.

I’m pretty good about pacing myself so as to get things
done on time.

HHHHHHH

. When I’m under a great deal of stress, sometimes I feel

like I’m going to pieces.

I don’t consider myself especially "light-hearted."

I am intrigued by the patterns I find in art and
nature.

Some people think I’m selfish and egotistical.

I am not a very methodical person.

I rarely feel lonely or blue.

I really enjoy talking to people.

I believe letting students hear controversial speakers
can only confuse and mislead them.

I would rather cooperate with others than compete with
them.

I try to perform all the tasks assigned to me
conscientiously.

I often feel tense and jittery.

I like to be where the action is.

Poetry has little or no effect on me.

I tend to be cynical and skeptical of others'
intentions.

I have a clear set of goals and work toward them in an
orderly fashion.

Sometimes I feel completely worthless.

I usually prefer to do things alone.

I often try new and foreign foods.

I believe that most people will take advantage of you
if you let them.

I waste a lot of time before settling down to work.

I rarely feel fearful or anxious.

I often feel as if I’m bursting with energy.

I seldom notice the moods or feelings that different
environments produce.

Most people I know like me.

I work hard to accomplish my goals.

36.
37.
38.

39.
40.

41.

42.
43.

44.
45.

46.
47.
48.

49.

51.

52.
53.
54.
55.
56.
57.

58.
59.

60.

68

Appendix E (cont'd).

I often get angry at the way peOple treat me.

I am a cheerful, high-spirited person.

I believe we should look to our religious authorities
for decisions on moral issues.

Some people think of me as cold and calculating.

When I make a commitment, I can always be counted on to
follow through.

Too often, when things go wrong, I get discouraged and
feel like giving up.

I am not a cheerful optimist.

Sometimes when I am reading poetry or looking at a work
of art, I feel a chill or wave of excitement.

I’m hard-headed and tough-minded in my attitudes.
Sometimes I'm not as dependable or reliable as I should
be.

I am seldom sad or depressed.

My life is fast-paced.

I have little interest in speculating on the nature of
the universe or the human condition.

I generally try to be thoughtful and considerate.

I am a productive person who always gets the job done.
I often feel helpless and want someone else to solve my
problems.

I am a very active person.

I have a lot of intellectual curiosity.

If I don’t like people, I let them know it.

I never seem to be able to get organized.

At times I have been so ashamed I just wanted to hide.
I would rather go my own way than be a leader of
others.

I often enjoy playing with theories or abstract ideas.
If necessary, I am willing to manipulate people to get
what I want.

I strive for excellence in everything I do.

69

Appendix F

Brief Symptom Inventory

Instructions: Listed below are problems people sometimes have. Please
read each one carefully, and darken the circle on your answer sheet that
best describes HOW MUCH THAT PROBLEM HAS DISTRESSED OR BOTHERED YOU
DURING THE PAST 7 DAYS INCLUDING TODAY. Blacken the circle for only one
number for each problem and do not skip any items. If you change your
mind, erase your first mark carefully.

 

 

l 2 3 4 5
not a little moderately quite extremely
at all bit a bit
1. Nervousness or shakiness inside
2. Faintness or dizziness
3. The idea that someone else can control your
thoughts
4. Feeling others are to blame for most of your
troubles

5 Trouble remembering things

6. Feeling easily annoyed or irritated

7. Pains in heart or chest

8. Feeling afraid in open spaces or on the streets

9. Thoughts of ending your life

10. Feeling that most people cannot be trusted

11. Poor appetite

12. Suddenly scared for no reason

13. Temper outbursts that you could not control

14. Feeling lonely even when you are with people

15. Feeling blocked in getting things done

16. Feeling lonely

17. Feeling blue

18. Feeling no interest in things

19. Feeling fearful

20. Your feelings being easily hurt

21. Feeling that people are unfriendly or dislike you

22. Feeling inferior to others

23. Nausea or upset stomach

24. Feeling that you are watched or talked about by
others

25. Trouble falling asleep

26. Having to check and double-check what you do

27. Difficulty making decisions

28. Feeling afraid to travel on buses, subways, or
trains

29. Trouble getting your breath

30. Hot or cold spells

31. Having to avoid certain things, places, or
activities because they frighten you

32. Your mind going blank

33. Numbness or tingling in parts of your body

34. The idea that you should be punished for your sins

35. Feeling hopeless about the future

36. Trouble concentrating

37. Feeling weak in parts of your body

38. Feeling tense or keyed up

39.
40.
41.
42.
43.

44.
45.
46.
47.
48.

49.
50.
51.

52.
53.

70

Appendix F (cont'd).

Thoughts of death or dying

Having urges to beat, injure, or harm someone
Having urges to smash or break things

Feeling very self-conscious with others

Feeling uneasy in crowds, such as shopping or at a
movie

Never feeling close to another person

Spells of terror or panic

Getting into frequent arguments

Feeling nervous when you are left alone

Others not giving you proper credit for your
achievements

Feeling so restless you couldn't sit still
Feelings of worthlessness

Feeling that people will take advantage of you if
you let them

Feelings of guilt

The idea that something is wrong with your mind

71

Appendix G

Need for Psychological Counseling

Instructions. Read each statement and consider it to be true for you.
Then identify the degree to which you feel it indicates a need for
psychological counseling. That is, If the statement were true of you,
how much do you feel it would indicate a need for psychological
counseling. Darken the corresponding number.

1 2 3 4 5
not a little moderate qu1te extreme
at all bit a bit

1. I am often overwhelmed by school or work tasks.
2. I have only minimal problems or difficulties.
3. My feelings often interfere with my progress in school
or work.
I occasionally leave my body.
I occasionally think about suicide.
I sometimes find myself frustrated.
I act violently without understanding the consequences
of my actions.
. Occasionally, I have trouble overcoming feeling down or
depressed.
9. I cannot attend school or work because my thoughts are
so confused.
10. I am sometimes too scared to leave my home for days.
11. I avoid making friends.
12. I often feel nervous or anxious.
13. Most of my relationships are satisfying.
14. I am unhappy with my progress in school or work.
15. My relationships are mostly satisfying.
16. I’m afraid that if I told someone how I feel they would
misunderstand me or think I was crazy.

Qmmb

Q

17. I function generally well in all areas of my life.

18. I sometimes have difficulties with school or work.

19. I sometimes have feelings of terror.

20. I sometimes think about hurting other people.

21. I occasionally have feelings of an overwhelming panic.
22. I am dissatisfied with my friends.

23. Usually, my problems are expectable reactions to life
stressors.

24. I am sometimes preoccupied with killing myself.

25. All my relationships are meaningless and dissatisfying.

26. I have tried in the past to kill myself without
realizing the implications of my actions.

27. I have a lot of trouble making friends.

28. I would rather spend time alone than with others.

29. I sometimes think that I live in a different world than
everyone else.

30. I sometimes hear voices that other people around me
cannot hear.

31. I feel like most of my relationships are superficial.

32. I always get hurt in relationships.

33. I often wish my relationships were more fulfilling.

34. I don’t have any difficulties or problems.

35. I can sometimes be violent and dangerous to myself and
others.

36.

37.
38.
39.

40.
41.
42.

72

Appendix G (cont’d).

I have thoughts and ideas that other people don’t
understand.

I never have problems which seem to get out of hand.
I occasionally have arguments with friends.

I frequently have difficulty completing tasks at school
or work.

I often think of ways to "get back" at others.

My relationships are frequently dissatisfying.

I am upset or dissatisfied with my life most of the
time.

I think of suicide as a possibility.

I am sought out by others because of my many positive
qualities.

I think about and plan ways to hurt others.

I usually feel as if I am in a fog.

. My problems are typically short-lived and transient.

I am often afraid or unable to express myself.

I am interested and involved in a wide range of
activities.

I sometimes don’t feel much of anything.

I can frequently be dangerous to myself and others.

I have difficulties accomplishing my tasks at school or
work.

I have no more than everyday problems or concerns.

I often think people are trying to take advantage of me.

. Relationships often leave me feeling empty and

unfulfilled.

I sometimes do things without being able to stop myself.
Sometimes my thoughts scare me.

I find life to be quite stressful and overwhelming.

I am sometimes dissatisfied with my friends.

I have difficulty understanding my thoughts.

I frequently feel upset or stressed.

I often feel more like a robot than a person.

I sometimes think and feel so many things that it can be
confusing.

. My problems last longer than other people I know.

I don’t get meaningfulness or fulfillment from
relationships.

73

Appendix H

Problem Checklist

Many students consider counseling at some point while
they are in school. The list below contains many of the
difficulties people may experience. If you were to consider
counseling at the present time, please mark all of the items
that are of concern to you by filling in the number 1 for
the corresponding question number on your answer sheet; if
the item is pg; of concern to you, mark the number 2.

For example, if you are concerned about depression
(Item 22), bubble number 1 for depression:

22. Depression Answer Sheet 153. 1 2 3 4 5

If you are not concerned about depression, mark number 2:

22. Depression Answer Sheet 153. 1 2 3 4 5
Remember that your responses are anonymous and confidential.

School work and grades
Procrastination, getting motivated, managing time
Concentration

Test anxiety or panic

Stage fright, speaking or performance anxiety
Decision about major or career

Work or job related issues
Relationship with friends
Relationship with roommate

10. Relationship with family and parents
11. Relationship with romantic partner
12. Relationship with husband or wife

13. Relationship with your children

14. Loss/death of significant person

15. Sexual matters

16. Gay/lesbian issues

17. Racial, ethnic, or cultural issues
18. Religious matters

19. Shyness, being assertive

20. Self—esteem, self-confidence

21. Loneliness, homesickness

22. Depression

23. Anxiety, nervousness, worrying

24. Fears

25. Irritability, anger, hostile feelings

\OmxlmU'libWNE-J

74

Appendix H (cont’d).

26. Tiredness

27. Troublesome thoughts
28. Suicidal feelings, behavior

29. Headaches, stomach pains, muscle tension
30. Sleep problems

31. Pregnancy

32. Alcohol or drug related issues

33. Eating problems

34. Legal problems

35. Financial problems

36. Sexual assault, past sexual abuse

37. Victim of other violence

38. Other (please specify)

 

Please consider the three concerns, from the above list,
that you feel to be the most serious. Below, briefly
describe the general nature of the problem which makes the
item a concern to you and your feelings about it. If you
have less than three concerns, please write about as many as
you listed.

1. Write the term as it is listed in the above checklist:
Describe the nature of your concern and
your feelings about it:

 

 

 

 

 

2. Write the term as it is listed in the above checklist:
Describe the nature of your concern and
your feelings about it:

 

 

 

 

 

3. Write the term as it is listed in the above checklist:
Describe the nature of your concern and
your feelings about it:

 

 

 

 

 

75

Appendix I

Mood Assessment (MAACL)

Instructions: Listed below are a number of words that
describe different feelings and emotions. Read each item
and darken the appropriate response on your answer sheet.
Indicate to what extent you feel this way right now, that
is, at the present moment. Use the following scale from A
(1) to B (7) to determine your response.

 

 

 

 

A B C D E F G
not a somewhat moderately quite much very
at all little a bit much
1. happy
2. hopeless
3. secure
4. discontented
5. pleased
6. discouraged
7. satisfied
8. tense
1 2 3 4 5 6 7
not a somewhat moderately quite much very
at little a bit much
all
9. calm

10. dissatisfied
11. encouraged
12. displeased
13. content

14. insecure

15. hopeful

16. sad

76

Appendix J

Mood Assessment (PANAS)

Instructions: Below are different words that describe
feelings and emotions. Read each item and then mark the
appropriate response on your answer sheet. Indicate to what
extent you feel this way right now, that is, at the present
moment. Use the following scale from 1 to 5 to determine
your response.

 

1 2 3 4 5
very a little moderately quite extremely
slightly a bit
or not
at all

 

interested
distressed
excited
upset
strong
guilty
scared
hostile
enthusiastic
10. proud

11. irritable
12. alert

13. ashamed
14. inspired
15. nervous
16. determined
17. attentive
18. jittery
19. active

20. afraid

\OCDQONU'IthE-i

77

Appendix K

Vignette

The following passage was transcribed from a taped intake
interview at a University Counseling Center. The client provided
written consent for its use. Due to the legal confidentiality of this
material, the individual’s name and background information have been
altered to protect her identity. All other information is provided
verbatim as she presented herself. A series of periods (. . .)
represents pauses in her presentation. This passage represents
approximately 7 minutes of a 50 minute interview.

Background Information

Cheryl is a 19 year old sophomore who transferred to MSU after
completing a year at a small community college in western Michigan.
Recent events prompted her to seek academic counseling. She came into
the Center on November 12, 1993 concerned that she was going to "fail
out of MSU".

Cheryl’s parents were divorced when she was 11, and she reports
seeing her father who lives in Florida only once or twice a year. She
has an older brother (24 years) who lives in Florida and a younger
sister (17 years) who resides with her mother near Holland, Michigan.

Transcript

Cheryl: It has just been really hard getting used to being away from
home. I mean, I thought I was ready but now . . . I don’t know .
(beginning to cry) Just like this, I can’t seem to stop crying, and I
don't know why I’m doing it . . . It really bothers me . . . (crying
more heavily). It just makes it where I can’t get anything done. All I
want to do is sit and cry, and I know no one wants to be around me. I
feel like I’m driving everyone away. My roommates say they understand,
but I know they are getting tired of it. I don’t care about doing
anything, and they want to go out all the time. When I go out I just
don’t feel a part of it, like I’m just seeing things happen. It feels
so alone, and I don’t get anything done. I’d rather be in my room and
feel that way. I’d rather be sleeping. I sleep a lot; I try to sleep a
lot because if I'm sleeping then I’m not crying, and I can cry myself
right to sleep . . . I don’t know. I hate it, whether I go out or not I
just can’t focus, and I don’t know what to do.

Interviewer: For how long have you been feeling like
this?

78

Appendix K (cont’d).

Cheryl: What, the crying? Basically, for as long as I can remember. I
mean, I’ve always been an emotional person, but it seems to have gotten
much worse. And this semester, it has really messed everything up,

I don’t know what I’m going to do. I dropped from four classes to two
and I'm failing both of them. In one, I try and try and I just can’t
seem to pass the quizzes, and in another, well, I’ve only been to it
four or five times this semester and the final is coming up and I know
I’ m going to fail it, but in all my classes when I sit down to read my
eyes just move over the words, and next thing I know I’ m crying .
and I just give up and cry because it' 8 too frustrating . . . I don’ t go
to one of the classes because my ex-boyfriend is in it. We agreed to
take the course together, but then we started fighting and broke up and
I just don’t want to see him. I mean it is just hard because I really
still care for him (beginning to cry again) but seeing him just brings
it all back, and I remember everything that happened and I think over
and over: What should I have done, what did you do wrong, if you
would’ve given him more space . . . then you wouldn’t be flunking out of
school . . . Also, seeing him reminds me of how lonely I am, and how I
need someone in my life (crying), and I start crying like this, I don’t
know what to do . . . But, I’m going to fail this class and screw up my
GPA because I can’t deal with these feelings for him. And I feel so
guilty for feeling like this; why can’t I handle this. I mean I did
fine at a smaller school, and I was doing more things than I do now. Is
it just because we broke up, why do I let it affect me so?

Interviewer: How long ago did you break up with him?

Cheryl: Well, we broke up for the first time after dating 11 months.
That was this past summer, but then we got back together when we both
moved here for school. Then he decided he wanted to see other people in
October, and that’s when we broke up again . . . I should’ve known
better. My mother told me it wouldn’t work when I moved here.

Interviewer: What’s your relationship with your mother
like, how often do you talk with her?

Cheryl: It’s OK. I mean, I call home, or we talk about once a week,
but I know she’s busy and that I can’t put too much of all this on her.
I mean, I’ve always been pretty independent; I had to be after the
divorce. The next year my brother moved to Florida to go to college,
and my mother

started working, she’ s had to struggle to make ends meet, and I helped
by taking care of my sister. We talk now, but never for very long . .

I can’ t put this on her. She struggles too much anyway, and I shouldn’ t

have to rely on her. She thinks I’ m doing fine in classes . . . She
expects me to be independent . . . and I don't know if I can do it
(crying) . . . I just feel so bad about it all, and I don’t know what to

do. It is just so hard to keep feeling like this.

79

Appendix L

Post-Vignette Questions

1. After reading about the difficulties Cheryl is
experiencing, how would you rate her overall level of
psychological distress?

l 2 3 4 5
very a little moderate quite extreme
slightly a bit

or not

at all

2. How would you rate her need for help with the
problems she is facing?

1 2 3 4 5
very a little moderate quite extreme
slightly a bit
or not
at all

3. If Cheryl were to choose after this interview pp;

to seek additional services, how would you rate her
ability to overcome these difficulties on her own?

1 2 3 4 5
very a little moderate quite extreme
slightly a bit

or not

at all

4. How would you characterize Cheryl’s relationship
with her mother?

1 2 3 4 5
very close close average distant very distant

5. How would you characterize Cheryl's relationship
with her father?

1 2 3 4 5
very close close average distant very distant

6. What percentage of students on campus do you
estimate have problems such as Cheryl’s?

Write your answer here %

80

Appendix M

Contact with Mental Health Services

Instruction. The following questions address the extent to which you
have had contact with mental health services personally or through
family and friends. Mental health services specifically refers to
experience with psychotherapy or counseling. The general term
psychological counseling will be used to refer to these types of
experiences. Read each question carefully and darken the number which
best represents your experiences. Be sure to darken only one answer for
each question.

To help you decide on the extent of your experience with psychological
counseling, please refer to the following guidelines:

1 = no experience

2 = one to six sessions of psychological counseling

3 = seven to twelve sessions of psychological
counseling

4 = thirteen to twenty-four sessions of psychological
counseling

5 = over twenty-four sessions of psychological
counseling

1. Indicate the extent of your personal experience in
psychological counseling at the present time? (That is, if you
are presently receiving services, how many sessions have you
attended.) If you are not presently participating in
psychological counseling, mark number (1).

no experience

a little experience
moderate experience
quite a bit of experience
extensive experience

U'IOUJNH
I I I I ll

2. Indicate the extent of your experience in
psychological counseling over ygur lifepims? If you have never
participated in counseling, mark number (1).

no experience

a little experience
moderate experience

quite a bit of experience
extensive experience

Wit-WNW
I I I II I

81

Appendix M (cont’d).

3. Indicate the extent of your mother’s experience in
psychological counseling, over her lifetime, that you know about?
If you also have step- or foster mother relationships, use the
total number of sessions when all these relationships are
combined.

no experience

a little experience
moderate experience

quite a bit of experience
extensive experience

UluhUJNH
IIIIIII

4. Indicate the extent of your father’s experience in
psychological counseling, over his lifetime, that you know about?
If you also have step- or foster father relationships, use the
total number of sessions when all these relationships are
combined.

II

no experience

a little experience
moderate experience

quite a bit of experience
extensive experience

UlnbUNH
II II I ll

5. Indicate the extent of your brothers’ and sisters’
experience in psychological counseling, over their lifetime, that
you know about? Include step-, half-, and foster sibling
relationships and use the total number of sessions when all these
relationships are combined. If you do not have sibling
relationships, mark number 1.

no experience

a little experience
moderate experience

quite a bit of experience
extensive experience

UlanNH
II II II II I

6. Indicate the extent of your friends’ experience in
psychological counseling, pysr thsir lifetime, that you know
about? If more than one friend has had such experiences, use the
combined number sessions across all friends with such experiences.

no experience

a little experience
moderate experience

quite a bit of experience
extensive experience

UlnbUNH
II II II II II

82

Appendix M (cont’d).

7. Think about your experiences and all of the people
you have close relationships with, family and/or friends, and
their lifetime experiences with psychological counseling.
Indicate below how much experience you feel you have had
personally and through these relationships with psychological

counseling?

1 = no experience

2 = a little experience

3 = moderate experience

4 = quite a bit of experience
5 = extensive experience

8. Considering again all the experience you feel you
have had with psychological counseling. How helpful would you
generally rate such services to be?

not helpful

a little helpful
moderately helpful
quite a bit helpful
extremely helpful

U‘IibWNH
II II II II II

9. Considering again all the contact you feel you
have had with psychological counseling. How likely is it that you
would recommend such services?

not likely

a little likely
moderately likely
quite a bit likely
extremely likely

U'lnwaH
II II II II II

83

Appendix N

Follow-up Questions

Given your feelings about yourself and the
difficulties you are facing at the present time. What
is the probability of your seeking psychotherapy or
counseling within the next 30 days (0-100%)? (For
example, if you feel there is a 50 percent chance,
indicate 50%.)

Write your answer here: %

Given your feelings about yourself and the
difficulties you are facing at the present time. What
is the probability of your seeking psychotherapy or
counseling within the next 6 months?

Write your answer here: %

Given your feelings about yourself and the
difficulties you are facing at the present time. What
is the probability of your seeking psychotherapy or
counseling within the next year?

Write your answer here: %

This experiment presented a short passage from an interview
with a student named Cheryl. If you think back on your
perception of the interview:

How realistic did you find the interview with
Cheryl to be?

2 3 4 5
a little moderately quite extremely
at all a bit

How believable did you find the interview with
Cheryl to be?

2 3 4 5
a little moderately quite extremely
at all a bit

What is you current age?

2 3 4 5

(17-18) (19-20) (21-22) (23-24) (over 24)

84

Appendix N (cont’d).

7. Ethnicity?

1 2 3 4 5*
White Black Hispanic Asian Other

 

*If you indicated Other, please write in:

Thank you very much for participating in this study about
help-seeking. Please return your packet to the front of the
room to receive experimental credit. Be sure and pick-up a

Feedback Sheet.

85

Appendix 0

Feedback Sheet

Note: In order to prevent bias in future participants and to
protect the integrity of study results, please keep this information
confidential and do not share it with others who may be signed up for
the study. This assures that results are not biased by preconceptions
of study content and is essential for valid results.

College students have been extensively researched since the 1920’s
in regard to level of psychological distress and usage of psychological
counseling services. A consistent finding is that there are more
distressed students than users of available mental health services.

This situation raises questions about what motivates a student to seek
help, or conversely, what inhibits a student from seeking help. Several
factors seem to contribute.

This study is examining the impact of distress, fear of
psychological counseling, exposure to services, and downward comparison.
Distress consists of a variety of problems. It may involve other people
such as parents, friends, and significant relationships, or it may be
more intra-personal such as depressive feelings, anxiety, or headaches.
Distress seems to be the primary reason people seek help -- they want
help in understanding and relieving the distress. However, many
distressed students do not seek help.

Based on previous research, fear seems to be a strong inhibitor of
seeking services. This study attempts to replicate previous findings
and hypothesizes that fear acts in conjunction with distress to inhibit
help-seeking. That is, the more distressed a student is the more they
will fear seeking help.

Research suggests that exposure to services acts in the opposite
direction. The more experiences someone has had personally or through
family and friends with services, the less fear they will have and the
more likely they will seek help for distress. This study hypothesizes
that those with more exposure will have less fear regardless of distress
level.

The last factor this study examined is a process called downward
comparison. In this process, a person feels better about themselves if
they can compare themselves to a less fortunate person. The ability to
make downward comparisons may lead a person to postpone help-seeking
since there are others who are worse off. Research suggests a positive
association between downward comparison and distress. This study seeks
to replicate this finding and also postulates a negative association
between downward comparison and perceived need of psychological
counseling.

Several aspects of this study focused on current problems and
difficulties. Some people find that thinking about their difficulties
creates an interest in psychological counseling, but often they do not
know where to access such services. If you are interested in
counseling, please contact the Michigan State university Counseling
Center. The Center is located in two locations: 207 Student Services
Building (355-8270) and 33S Olin Health Center (355-2310). Feel free to
contact either location for walk-in hours.

Thanks again for participating in this study. If you have any questions
or are interested in the results of the study, please feel free to
contact me at my office, 133 Snyder Hall, 462-3684.

Jason R. Dahn

B IBLIOGRAPHY

BIBLIOGRAPHY

Amato, P. R., & Bradshaw, R. (1985). An exploratory
study of people’s reasons for delaying or avoiding help

seeking. Australian Psychologist, gs, 21-31.

American Psychiatric Association._(1994). Diagnostic
and statistical msnual of msntal disorders (4th ed.).

Washington, DC: American Psychiatric Association.

Aspinwall, L. G., & Taylor, S. E. (1993). Effects of
social comparison direction, threat, and self-esteem on
affect, self-evaluation, and expected success. Journal of

Personality and Social Psychology, ss, 708-722.

Baker, R. C. & Guttfreund, D. G. (1993). The effects of
written autobiographical recollection induction procedures

on mood. Journal of glinissl Psyshplpgy, 22. 563-567.

Berkowitz, L. (1987). Mood, self-awareness, and

willingness to help. Journal of Personality and Social
Psychology, ss, 721-729.

Bertocci, D., Hirsch, E., Sommer, W., & Williams, A.
(1992). Student mental health needs: Survey results and

implications for service. Qournal of American College Health

Association, QL, 3-10.

Bosmajian, C. P., & Mattson, R. E. (1980). A controlled
study of variables related to counseling center use. Journal

of Counseling Psychology, s1, 510-519.

Carr, S. J., Teasdale, J. D., & Broadbent, D. (1991).
Effects of induced elated and depressed mood on self-focused

attention. British Journal of Clinical Psychology, 1;, 273—
275.

Clary, E. G., & Fristad, M. A. (1987). Predictors of
psychological help seeking on a college campus. Journal of

College Student Personnel, gs, 180-181.

Cohen, J. (1992). A power primer. Psychological
Bulletin, 112, 155-159.

86

87

Cook, E. P., Park, W., Williams, G. T., Webb, M.,
Nicholson, B., Schneider, D., & Bassman, S. (1984).
Students’ perceptions of personal problems, appropriate help
sources, and general attitudes about counseling. Journal of

College Studenp Perspnnel, gs, 139-145.

Costa, P. T., & McCrae, R. R. (1992). The Revised NEO

Personality Inventosy manusl. Odessa, FL: Psychological
Assessment Resources.

DePaulo, B. M., Nadler, A., & Fisher, J. D. (Eds.).

(1983). New Directipns in Helping: Help-seeking (Vol. 2).
New York: Academic Press.

Derogatis, L. R. (1975). Brief Symptom Inventory.
Baltimore: Clinical Psychometric Research.

Derogatis, L. R. (1983). The brief symptom inventory:
An introductory report. Psychological Medicine, ss, 595-605.

Derogatis, L. R., & Spencer, M. S. (1982). The Brisf
S tom Invento SI A mini t i n c rin n
Procedures Manual-I. Baltimore: John Hopkins University
School of Medicine, Clinical Psychometrics Research Unit.

Figueroa, R. H., Calhoun, J. F., & Ford, R. (1984).
Student utilization of university psychological services.

College Stpdsnt Journal, ;§, 186-196.

Fischer, E. H., Winer, D., & Abramowitz, S. I. (1983).
Seeking professional help for psychological problems. In A.
Nadler, J. D. Fisher, & B. M. DePaulo (Eds.), New Directions
in Helping: Hslp-seeking (Vol. 3). New York: Academic Press.

Flaskerud, J. H. (1984). A comparison of perceptions of
problematic behavior by six minority groups and mental
health professionals. Nursing Research, ss, 190-197.

Gibbons, F. X. (1986). Social comparison and
depression: Company’s effect on misery. Journal of

Personality and Social Psychology, pl, 140-148.

Gibbons, F. X., & Gerrard, M. (1989). Effects of upward
and downward social comparison on mood states. Journal pf

Social and Clinical Psychology, s, 14-31.

Gibbons, F. X., & McCoy, S. B. (1991). Self-esteem,
similarity, and reactions to active versus passive downward

comparison. gpurnal pf Perspnality and Social Psychology,
50. 414-424.

88

Gibbons, F. X., Smith, T. W., Ingram, R. E., Pearce,
K., Brehm, S. S., & Scroeder, D. J. (1985). Self—awareness
and self-confrontation: Effects of self-focused attention on
members of a clinical population. Joprnal of Personality and

Sggial Psychglggy, as, 662-675.

Halgin, R. P., Weaver, D. D., & Donaldson, P. E.
(1985). College students’ perceptions of the advantages and
disadvantages of obtaining psychotherapy. gournal of Social

Service Research, a, 75-86.

Johnson, R. W., Ellison, R. A., & Heikkinen, C. A.
(1989). Psychological symptoms of counseling center clients.

Journal of Counseling Psychology, as, 110-114.

Kessler, R. C., Reuter, J. A., & Greenley, J. R.
(1979). Sex differences in the use of psychiatric outpatient

facilities. Sosial Fprses, as, 557-571.

Kushner, M. G., & Sher, K. J. (1989). Fear of
psychological treatment and its relation to mental health

service avoidance. Profsssional Psychology: Researsh and
Pratice, 29, 251-257.

Kushner, M. G., & Sher, K. J. (1991). The relation of
treatment fearfulness and psychological service utilization:

An overview. Professional Psychology: Research and Pratice,
2;, 196-203.

Lubin, B., & Rubio, C. T. (1985). Strain-producing
aspects of life events. Psychological Reports, s1, 259-262.

Mechanic, D., & Greenley, J. R. (1976). The prevalence
of psychological distress and help-seeking in a college

student population. Sosial Psychiasgy, 11. 1-14.

Miller, N. E. (1944). Experimental studies of conflict.

In J. McV. Hunt (Ed.), Psrsonality ana ths Bshavipr
Disorders (Vol 1, pp. 431—465). New York: Ronald Press.

Nadler, A., Fisher, J. D., & DePaulo, B. M. (Eds.).

(1983). New Dirsctions in Helping: Help-sesking (Vol. 3).
New York: Academic Press.

Nagelberg, D. B., & Shemberg, K. B. (1980). Mental
Health on the college campus: An epidemiological study.

Journal of American College Health Assosiation, 28. 228-230.

Narikiyo, T. A., & Kameoka, V. A. (1992). Attributions
of mental illness and judgements about help seeking among
Japanese-American and white American students. Journal of

gpunseling Psychology, 32, 363-369.

89

Nunnally, J. (1978). Psychometric Theory. New York:
McGraw-Hill.

Offer, D., & Spiro, R. P. (1987). The disturbed
adolescent goes to college. Journal of American College
Health, ii: 209-214.

Pipes, R. B., Schwartz, R., & Crouch, P. (1985).

Measuring client fears. Qournal of Consulting and Clinical
Psyshology, aa, 933-934.

Purvis, B., Brandt, R., Rouse, C., Vera, W., & Range,
L. M. (1988). Students attitudes toward hypothetical
chronically and acutely mentally and physically ill
individuals. Psyshological Reports, 52. 627-630.

Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. 2.,
Keith, S. J., Judd, L. L., & Goodwin, F. K. (1990).
Comorbidity of mental disorders with alcohol and other drug
abuse: Results from the epidemiologic catchment area (ECA)
study. Journal of the American Medical Association, gag,
2511-2518.

Reifler, C. B., & Liptzin, M. B. (1969).
Epidemiological studies of college mental health. Archives

of General Psychiatry, ng 528-540.

Reinhold, J. E. (1973). Users and nonusers of college
counseling and psychiatric services. gournal pf American

College Healsh Assosiation, a;, 201-208.

Rimmer, J., Halikas, J. A., & Schuckit, M. A. (1982).
Prevalence and incidence of psychiatric illness in college
students: A four year prospective study. apprnal pf American

College Health Association, as, 207-211.

Robbins, J. M. (1981). Lay attribution of personal
problems and psychological help-seeking. Social Psychiatry,
as, 1-9.

Salovey, P. (1992). Mood-induced self-focused

attention. Journal of Personalipy and Social Psychology, _s,
699-707.

Scheier, M. F., & Carver, C. S. (1977). Self-focused
attention and the experience of emotion: Attraction,
repulsion, elation, and depression. Journal of Personality

and Spcial Psycholggy, aa, 625-636.

Schmitt, N. (1994). Method bias: The importance of
theory and measurement. Journal pf Organizational Behavior,
15, 393-398.

90

Schwartz, A. J., & Reifler, C. B. (1984). Quantitative
aspects of college mental health: Usage rates, prevalence
and incidence, suicide. Psychiatric Annals, aa, 681-688.

Shapiro, S., Skinner, E. A., Kessler, L. G., Von Korff,
M., German, P. S., Tischler, G. L., Leaf, P. J., Benham, L.,
Cottler, L., & Regier, D. A. (1984). Utilization of health
and mental health services: Three epidemiologic catchment

area sites. Archives of general Psychiatsy, 21, 971-978.

Shedler, J., Mayman, M., & Manis, M. (1993). The
illusion of mental health. American Psychologist, as, 1117-
1130.

Sibicky, M., & Dovidio, J. F. (1986). Stigma of
psychological therapy: Stereotypes, interpersonal reactions,
and the self-fulfilling prophecy. Journal of Counseling
Psychology, gg, 148-154.

Socall, D. W., & Holtgraves, T. (1992). Attitudes
toward the mentally ill: The effects of label and beliefs.

The Sociological Quarterly, gg, 435-445.

Spector, P. E. (1994). Using self-report questionnaires
in OB research: A comment on the use of a controversial

method. Journal of Organizational Behavior, gs, 385-392.

Taylor, S. E., & Lobel, M. (1989). Social comparison
activity under threat: Downward evaluation and upward
contacts. Psychological Review, gs, 569-575.

Thompson, J. R., & Bentz, W. K. (1975). The health
opinion survey for assessing psychiatric disorder among

college students. Journal of American College Health
Association, as, 84-87.

Thompson, J. R., Bentz, W. K., & Liptzin, M. B. (1973).
The prevalence of psychiatric disorder in an undergraduate

population. Journal of American College Health Association,
gs, 415-422.

Tracey, T. J., Leong, F. T., & Glidden, C. (1986). Help
seeking and problem perception among Asian Americans.

Journal of Counseling Psychology, gg, 331-336.

Watson, D., & Clark, L. A. (1984). Negative
affectivity: The disposition to experience aversive
emotional states. Psycholpgical Bulletin, gs, 465-490.

91

Watson, D., Clark, L. A., & Tellegen, A. (1988).
Development and validation of brief measures of positive and
negative affect: The PANAS scales. Journal of Personality
and Social Psychology, 54. 1063-1070.

Wheeler, L., & Miyake, K. (1992). Social comparison in

everyday life. Journal of Personality and Social Psychology,
as, 760-773.

Wills, T. A. (1981). Downward comparison principles in
social psychology. Psychological Bulletin, gs, 245-271.

Wills, T. A. (1983). Social comparison in coping and
help-seeking. In B. DePaulo, A. Nadler, & J. Fisher (Eds.),

New Directions in Helping: Help-seeking (Vol. 2, pp. 109-
141). New York: Academic Press.

Wood, J. V., Saltzberg, J. A., Neale, J. M., Stone, A.
A., & Rachmiel, T. B. (1990). Self-focused attention, coping
responses, and distressed mood in everyday life. Journal of

Personality and Social Psychology, ss, 1027-1036.

Zuckerman, M., & Lubin, B. (1965). Multiple Affect
Adjective Checklist: Today form. San Diego, CA: Educational
and Industrial Testing Service.

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