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Volume 2, Issue 1

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Ending Self-Stigma for Posttraumatic Stress Disorder (ESS-P): Initial Outcomes

Research Publication:

Drapalski, A.L., Aakre, J., Brown, C.H., Romero, E., Lucksted, A. (2020). The Ending Self Stigma for posttraumatic stress disorder program: Results of a pilot randomized trial. Journal of Traumatic Stress. Advanced online publication.

Self-stigma, or internalized stigma, is the belief that negative stereotypes and assumptions about mental health conditions are true and reflective of oneself. Self-stigma can interfere with an individual’s mental health recovery through decreased hope and motivation, increased isolation and interference with pursuing goals and seeking treatment. Many Veterans with posttraumatic stress disorder (PTSD) experience self-stigma. However, current treatments for Veterans with PTSD generally do not focus on addressing it as part of care. This pilot, or initial, study attempted to examine a 9-session, small group intervention called Ending Self-Stigma for Veterans with PTSD (ESS-P) designed to teach different tools to help Veterans cope with both external and internalized stigma. These tools include: education on stigma and myths about PTSD; cognitive-behavioral strategies for stigmatizing thoughts; bolstering personal strengths; and strategies for increasing connections with others and responding to stigma and discrimination. Veterans with a diagnosis of PTSD either participated in ESS-P or received information about stigma/self-stigma in addition to participating in their usual care. Overall, the Veterans reported finding ESS-P supportive and reported using many of the skills taught in the group. Veterans that participated in ESS-P also showed a greater reduction in self-stigma and depressive symptoms and gains in sense of social belonging when compared to those who received the written information. Further refinement of the ESS-P intervention and testing with a larger group of Veterans are needed.

What Can Providers Do?

  • Educate yourself on the myths and facts about PTSD (Visit the National Center for PTSD website).
  • Inform yourself about stigma/self-stigma (see the Ending Self Stigma webpage).
  • Remind yourself that negative stereotypes you hear about PTSD and treatment are inaccurate.
  • If stigma is affecting you or your loved one, you may want to talk your friends, family, other Veterans, health providers and/or counselors.
  • Know that you are not alone. Many Veterans experience symptoms and seek treatment for PTSD.
  • Take time to recognize your values and strengths, and to take care of yourself.
  • Invest in yourself, in what you need to grow and in ways you want to, to reach your goals.
  • Strengthen your positive connections with others to fight the negative effects of stigma.

What Can Veterans and their Families Do?

  • Discuss stigma and self-stigma and explore its impacts with the Veterans with whom you work. How does it impact: Their self image? Their thoughts about treatment? How they view their relationships and interact with others?
  • Consider incorporating strategies to address stigma/self-stigma into your work with Veterans. For examples of ways to do this see the EASEing Self Stigma webpage.
  • Contact Dr. Amy Drapalski for more information or if you are interested in offering ESS-P at
  • Sign up for VISN 5 MIRECC resources to receive updates on ESS-P and other stigma-related resources.
VISN 5 MIRECC Link Home Page