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Graduate Student Journal of Psychology          Copyright 2011 by the Department of Counseling and Clinical Psychology 

2011, Vol. 13               Teachers College, Columbia University 

25 

 

 

Predictors of Attitudes Toward Psychological Counseling Among  

Lebanese College Students 
 

Hussein Wehbe 
Teachers College, Columbia University 

 
The study investigated the effects of social stigma, self-stigma, and willingness to self-disclose 

personal distress on attitudes towards psychological counseling among Lebanese college students. 

One hundred twenty-five participants enrolled in an introductory psychology course were surveyed. 

Questionnaire packets included questions pertaining to demographic characteristics and four scales 

assessing attitudes towards counseling, social stigma, self-stigma, and self-disclosure.  Contrary to 

previous findings in the literature, our study found that students expressed favorable attitudes 

towards counseling.  Results also indicated that social stigma and self-stigma were negatively 

correlated with attitudes towards counseling, whereas comfort with self-disclosure had no 

relationship with attitudes showing inconsistency with past reviews.  Among the three factors 

hypothesized to impact attitudes towards counseling, only self-stigma had significant predictive 

power.  The results and limitations of the study are discussed, and several implications and future 

directions for further research are identified. 

 

 

Many people in need of psychological counseling 

underutilize available mental health services (Shaffer, Vogel, 

& Wei, 2006).  In order to serve more effectively those who 

need psychological services, practitioners in the Lebanese 

community would benefit from a comprehensive 

understanding of factors that influence one’s decision to seek 

psychological help.  Possible factors that may influence one’s 

decision include: social stigma, self-stigma, and reluctance to 

self-disclose personally distressing information (Shaffer et al., 

2006; Komiya, Good, & Sherrod, 2000).

   

 

Social Stigma 

Public stigma labels counseling as being socially 

unacceptable (Vogel, Wade, & Haake, 2006; Komiya et al., 

2000).  Thus, an individual may avoid seeking treatment and 

express unfavorable attitudes towards psychological services 

in an attempt to reduce possible social stigma (Vogel, Wade, 

& Ascheman, 2009).  Research suggests that people tend to 

view individuals who seek mental health treatment less 

favorably than treatment nonseekers (Sibicky & Dovidio, 

1986).  Individuals who seek psychological treatment for 

depression are often described as being emotionally unstable, 

responsible for their own symptoms, and lacking self-

confidence; however, depressed individuals who seek 

treatment for their condition are viewed more negatively than 

treatment nonseekers who also suffer from depression.  Vogel 

and colleagues (2009) developed the five item Social Stigma 

for Receiving Psychological Help Scale in order to investigate 

the degree to which social stigma is associated with treatment 

seeking behavior and prevents people from seeking mental 

                                                 
Hussein Wehbe, Department of Counseling and Clinical 

Psychology, Teachers College, Columbia University. 

Correspondence concerning this article should be addressed to 
Hussein Wehbe, 145 West 55th Street, New York, NY 10019. Email: 

hmw2120@columbia.edu. 

health services.  The results of their survey showed that 

individuals with mental health disorders were not willing to 

seek psychological help as a result of perceived social stigma 

(Vogel et al., 2009). 

 

Self-Stigma 

Self-stigma refers to internalized stigma that individuals 

may have toward themselves due to being labeled as 

incompetent and socially unacceptable (Vogel et al., 2006).  

The concept of self-stigma suggests that people may have 

negative attitudes towards seeking help because if they admit 

they have mental health problems they internalize the stigma 

and label themselves as being inadequate, weak, or inferior 

(Vogel et al., 2006).  Studies have shown that individuals 

with mental health problems internalize negative perceptions 

of themselves (Link, 1987; Link & Phelan, 2001).  Vogel and 

colleagues (2006) conducted a study among college students 

to investigate how aspects of one’s self-esteem (i.e., self-

regard, self-confidence, satisfaction with oneself and one’s 

abilities, and overall sense of worth as a person) are subject to 

change if a person considers seeking psychological help.  

Using the Self-Stigma of Seeking Help Scale (SSOSH; Vogel 

et al., 2006), the authors found that study participants 

believed that seeking help from a psychologist or other 

mental health professionals would negatively affect one’s 

self-regard, self-satisfaction, self-confidence, and self-worth. 

 

Self-Disclosure 

Studies have shown that the desire to avoid disclosing 

personal issues or painful feelings may affect treatment 

seeking decisions (Vogel et al., 2006).  In a study of college 

students’ attitudes toward self-disclosure, Vogel and Wester 

(2003) found that comfort with self-disclosing distressing 

information was highly associated with a willingness to seek 

psychological help.  Vogel and colleagues (2006) measured 



WEHBE 

 

26 

 

the degree to which a person is comfortable self-disclosing 

personally distressing information using the Distress 

Disclosure Index (DDI).  Results indicated that the desire to 

self-disclose personally distressing information significantly 

predicted attitudes toward seeking professional help (Vogel et 

al., 2006).  Komiya and colleagues (2000) examined the 

effects of emotional openness on seeking psychological help 

in a sample of college students.  Results indicated that 

discomfort with expressing emotions accounted for a large 

percentage of the variance in negative attitudes towards 

psychological help. 

 

Mental Health in the Arab Society 

Arab college students are prone to developing 

psychological distress, including symptoms of anxiety, 

distress, and depression, as a result of the abrupt transition to 

college life (Al-Krenawi, Graham, Al-Bedah, Kadri, & 

Sehwail, 2009).  Problems such as moving away from home, 

dealing with academic demands, attaining appropriate study 

habits and making vocational decisions are a few examples 

that accompany such a transition (Al-Krenawi et al., 2009).  

Arab college students, however, tend to avoid making contact 

with professional services (Al-Krenawi et al., 2009).  Al-

Krenawi and Graham (2005) found that mental health patients 

in the Arab population tend to express their psychological 

problems in terms of physical symptoms, thereby avoiding 

the stigma attached to mental illness. 

The present study seeks to explore Lebanese college 

students’ attitudes towards psychological distress. The 

primary aim of the study is to investigate the factors involved 

in predicting attitudes towards counseling among Lebanese 

college students.  This study will extend the work of previous 

research by examining the comparative effects of three 

predictor variables (social stigma, self-stigma, and comfort 

with self-disclosure) on attitudes towards psychological 

counseling.  No prior research has been conducted in 

Lebanon with respect to the social stigma, self-stigma or self-

disclosure.  As a result, this study will investigate which 

variable possesses the strongest predictive power in 

predicting attitudes towards counseling among Lebanese 

college students. 

Based on the findings reported in the literature, it was 

hypothesized that: (1) Lebanese college students would 

endorse high levels of negative attitudes towards 

psychological counseling; (2) negative attitudes towards 

psychological counseling would be predicted by high levels 

of social stigma and self-stigma; (3) positive attitudes towards 

counseling would be predicted by high levels of self-

disclosure; and (4) the reluctance to self-disclose personally 

distressing emotions would account for significant and unique 

variance in predicting psychological help seeking behavior. 

 

Method 

 

Participants  

Participation was entirely voluntary.  The criterion for 

participation was that the subject be Lebanese and at least 17 

years of age.  One hundred and twenty-five students were 

initially surveyed, of which 17 (13.6 %) were non-Lebanese 

(i.e., Jordanian, Palestinian, Columbian, Cypriot, Canadian, 

American, Brazilian, and French).  The final sample consisted 

of 108 participants (59 males and 49 females) of Lebanese 

origin aged 17-22 years (see Table 1). 

 

Instruments  

Attitudes Toward Seeking Professional Psychological 

Help Scale–Short Form.  The measure consists of ten items 

rated from 1 (strongly disagree) to 5 (strongly agree) that 

were summed; lower scores reflected negative attitudes 

towards counseling (five items are reverse-scored).  A sample 

item is “If I believed I was having a mental breakdown, my 

first inclination would be to get professional attention.”  The 

internal consistency for this scale was α = .84 in a college 

sample (Vogel et al., 2009). 

Stigma of Seeking Professional Psychological Help 

Scale (SSPPH).  The SSPPH consists of five items rated from 

1 (strongly disagree) to 5 (strongly agree) that assess 

perceptions of the societal stigma associated with seeking 

professional help, with higher scores reflecting greater 

perceptions of social stigma.  A sample item is “People will 

see a person in a less favorable way if they come to know that 

he/she has seen a psychologist.” The SSPPH correlated with 

attitudes toward seeking counseling and had a reported 

internal consistency of α = .73 in college samples (Vogel et 

al., 2009). 

Self-Stigma of Seeking Help Scale (SSOSH).  The 10-

item SSOSH assesses threats to one’s self-evaluation for 

seeking psychological help (e.g., “I would feel inadequate if I 

went to a therapist for psychological help”).  Items are rated 

from 1 (strongly disagree) to 5 (strongly agree) and higher 

scores reflect perceptions of self-stigma associated with  

treatment seeking.  The SSOSH has shown good internal  

 

Table 1 

 

Frequencies of Demographic Variables 

Demographic Variables N % 

Gender   

Male 59 54.6 

Female 49 45.4 

Age    

17 2 1.9 

18 39 36.1 

19 37 34.3 

20 19 17.6 

21 9 8.3 

22 2 1.9 

Year in University   

Freshman 4 3.7 

Sophomore 50 46.3 

Junior 38 35.2 

Senior 12 11.1 

Graduate 4 3.7 



LEBANESE COUNSELING ATTITUDES 

 

27 

 

consistency, with Cronbach α ranging from α =.86 to α = .90 

in college samples (Vogel et al., 2006). 

 Distress Disclosure Index (DDI).  The DDI is a 12-item 

questionnaire measuring comfort with the self-disclosure of 

distressing emotions (e.g., “When I feel upset, I usually 

confide in my friends”). Items are rated on a 5-point Likert-

type scale ranging from 1 (strongly disagree) to 5 (strongly 

agree), with six items being reverse-scored.  Items are 

summed up so that higher scores reflect a greater willingness 

to disclose personally distressing emotions.  The DDI has 

been found to have good internal consistency (Cronbach α = 

.93) in college samples (Vogel et al., 2006). 

 

Procedure 

Sixty-three students enrolled in an introductory 

psychology course were given two questionnaire packets, one 

for themselves and one to give to a friend of the same age 

range (17-22 years) also enrolled in the same college.  Each 

packet had (1) a consent form informing participants of the 

purpose of the study, that their participation was voluntary, 

and ensuring confidentiality and anonymity of their 

responses; (2) a demographic questionnaire, assessing socio-

demographic information on the participants’ gender, age, 

nationality, and year and major in university; (3) the Attitudes 

Toward Seeking Professional Psychological Help Scale–Short 

Form (Vogel et al., 2009); (4) the Stigma of Seeking 

Professional Psychological Help Scale (SSPPH; Vogel et al., 

2009); (5) Self-Stigma of Seeking Help Scale (SSOSH; Vogel 

et al., 2006), and (6) the Distress Disclosure Index (DDI; 

Vogel et al., 2006).  The students were asked to return the 

packets the next day to the researcher in exchange for course 

credit.  All measures were administered in English.  

 

Statistical Analysis  

We first conducted preliminary statistical analyses to test 

for accuracy of entry and outliers, normal distribution of the 

study variables, and multicollinearity problems.  We then 

calculated the means and standard deviation for each scale’s 

total scores.  To assess the relationship between the study 

variables we conducted a correlation matrix.  A stepwise 

multiple regression was then conducted to evaluate which 

variables (i.e., social stigma, self-stigma, self-disclosure, and 

general attitudes) would significantly predict attitudes 

towards psychological counseling.  Statistical analyses were 

performed using the SPSS statistical software package for 

Microsoft Windows (version 14.0, SPSS Inc, Chicago, IL, 

USA).  

 

Results 

 

Prior to analysis, the data was examined for accuracy of 

entry and outliers.  No univariate outliers were detected from 

the analysis (Z scores >│3.26│) (Tabachnick & Fidell, 2001). 

Reliability analyses of all the scales and items yielded high 

alpha coefficients for the self-disclosure and self-stigma 

scales and a good alpha coefficient for the general attitudes 

scale (see Table 2).  The reliability analysis for the social 

stigma scale reported unreliable results; therefore, any results  

associated with the social stigma scale should be interpreted 

with caution.  Given that several predictors were fitted into a 

model to predict an outcome variable, the statistical design 

that was implemented was a multiple regression analysis.  

The data was plotted and the assumption of normality was 

met.  Also, according to Tabachnick and Fidell (2001), since 

we were interested in the overall correlation and the 

individual predictors, our sample N should be larger than both 

(50 + 8m) and (104 + m), where m is the number of 

predictors.  In this case our sample was larger than both (50 + 

8(3)) = 74 and (104+3) = 107.  Hence, the assumption of ratio 

of cases to independent variable (IV) was met. 

The total means and standard deviations of the scales are 

presented in Table 3.  The total means of attitudes towards 

counseling, social stigma and self-disclosure were above 

average (given the range from 1, strongly disagree, to 5, 

strongly agree).  The mean score for items above a midpoint 

score of 3 suggests high levels of favorable attitudes towards 

psychological counseling, high levels of perceived social 

stigma associated with counseling, and greater willingness to 

self-disclose personally distressing emotions to a counselor 

among the students in the investigated sample.  The mean for 

self-stigma was around midpoint suggesting that on average, 

participants expressed no opinion on the items pertaining to 

self-stigma.  The fact that participants expressed high levels 

of favorable attitudes towards counseling contradicted our 

first hypothesis and demonstrated inconsistency with the 

study conducted by Al-Krenawi and colleagues (2009). 

The Pearson correlations between the variables are 

displayed in Table 4.  Significant negative correlations were 

found between self-stigma and attitudes, social stigma and 

attitudes, and self-disclosure and self-stigma; the correlation 

between self-stigma and attitudes was the highest.  

Table 2 

 

Reliabilities of Scales 

Scale  Number of Items Cronbach’s α 

Self-Stigma   10 .83 

Self-Disclosure   12 .92 

General Attitudes    10 .74 

Social Stigma    5 .67 

 

Table 3 

 

Means and Standard Deviations of All Variables 

 M SD N 

General Attitudes 31.04 5.92 108 

Social Stigma 14.10 3.81 108 

Self Stigma 24.63 6.85 108 

Self-Disclosure 40.88 10.09 108 



WEHBE 

 

28 

 

Nonsignificant negative correlations were found between 

self-disclosure and social stigma, (p > .05), and self-

disclosure and general attitudes, (p > .05).  A significant 

positive correlation was found between self-stigma and social 

stigma.  Higher perceptions of self-stigma related to seeking 

psychological services were associated with lower levels of 

willingness to disclose personally distressing emotions (p < 

.01).  Furthermore, higher perceptions of social stigma were 

associated with higher perceptions of self-stigma associated 

with seeking counseling (p < .01).  

To test for multicollinearity problems we followed 

recommendations by Field (2005), and scanned a correlation 

matrix of all of the predictor variables to see if there were 

variables that correlated with each other very highly (r > .80).  

We also looked at the variable inflation factor (VIF), which 

according to Myers (1990) if above 10 is considered a 

potential sign for multicollinearity.  Finally, we looked at the 

tolerance values, given that values below 0.1 are a potential 

sign for multicollinearity (Field, 2005).  The values of the 

correlation matrix were all below r = .75 and both the 

tolerance and VIF coefficients indicated that the assumptions 

of singularity and absence of multicollinearity were met.  The 

Durbin-Watson statistics indicated that the assumption of 

independence of errors was met.   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The stepwise regression revealed a good fit of the 

variance explained.  The results indicated that the overall 

model was significant R
2 

= .405, F(106) = 72.23, p < .05, 

indicating that these predictors (social stigma, self-stigma, 

and self-disclosure) accounted for 40.5 % of the variance in 

attitudes towards psychological counseling. Examining the 

Standardized Beta coefficients (β), self-stigma was the best 

predictor of attitudes towards psychological counseling in the 

investigated sample (see Table 5).  Both social stigma and 

self-disclosure were excluded from the model.   

Discussion 

 

The purpose of this study was to investigate the roles of 

social stigma, self-stigma, and self-disclosure in predicting 

attitudes towards psychological counseling among Lebanese 

college students.  All of the aforementioned variables were 

assessed through four different scales as previously 

mentioned.  The study showed that among the three predictor 

variables, only social stigma and self-stigma showed a 

significant predictive power, with self-stigma being the 

variable with the greatest effect.   

The findings from our correlation analysis illustrated that 

higher perceptions of self-stigma and social stigma were 

associated with higher levels of negative attitudes towards 

counseling, while self-disclosure showed no significant 

relationship with such attitudes.  Regression analysis found 

only one strong predictor among the variables measured.  

Contrary to our hypothesis, self-stigma appeared to be the 

only strong predictor of negative attitudes towards 

counseling.  

Research has shown that social stigma and self-stigma 

are important factors of negative attitudes towards 

counseling.  Previous studies have found that individuals may 

decide not to seek help, even when they are experiencing 

emotional pain, because of the belief that labels such as 

“unreliable” or “emotionally unstable” would be applied to 

them and that such a decision would be a sign of weakness or 

an acknowledgment of failure (Vogel et al., 2006).   

Our findings are largely consistent with previous 

research.  First, previous studies have found that participants’ 

attitudes towards psychological treatment were significantly 

associated with the social stigma and that participants’ self-

stigma impacted psychological help seeking behavior (Vogel 

et al., 2009; 2006).  However, findings pertaining to self-

disclosure were inconsistent with Vogel et al.’s (2006) study 

in which the desire to self-disclose personally distressing 

information significantly predicted attitudes toward seeking 

professional help.  Results were also inconsistent with the 

study by Komiya and colleagues (2000) in which discomfort 

with expressing emotions accounted for a large percentage of 

the variance in negative attitudes towards psychological help.   

 

Limitations  

Despite the importance of these findings, some 

limitations should be noted.  First, a major limitation in the 

study lies in the procedure.  As previously mentioned, 

participants were given two questionnaire packets and were 

asked to complete one packet, and give the other to a friend.  

There is a possibility that participants failed to abide by the 

instructions of the study, and instead filled out both 

questionnaires.  There is also the possibility that participants 

shared answers with their friends in an attempt to express 

similar views on the presented scales.   

Second, we cannot generalize the results to the whole 

Lebanese college population.  In the study at hand, the sample 

size was not sufficiently large.  A small sample size (N = 108) 

is probably not large enough to draw meaningful conclusions 

Table 4 

 

Correlations between Scales 

Scales 
Social 

Stigma 

Self-

Stigma 

Self-

Disclosure 

General 

Attitudes 

Social Stigma 1    

Self Stigma .42** 1   

Self-

Disclosure 

-.06 -.28** 1  

Attitudes -.36*** -.64*** .156 1 

*p < .05.  **p < .01. *** p < .001 

 

Table 5 

 

Standardized β Coefficients for the Predictor Variables 

Model Standardized β Coefficient Sig. 

Self-Stigma -.64 .000 

Social Stigma -.12 .15 

Self-disclosure -.02 .76 



LEBANESE COUNSELING ATTITUDES 

 

29 

 

and implications.  Moreover, low reliability for the social 

stigma scale was revealed. 

A disadvantage of relying on survey methods is that they 

are dependent on self-report and do not measure behavior 

directly.  As a result, social desirability and demand 

characteristics may shape participants’ responses regardless 

of assurances of confidentially and anonymity.  For instance, 

on items measuring attitudes, respondents may wish to deny 

unfavorable attitudes towards mental health services to 

present themselves in a positive light, as open minded 

individuals, especially considering that they were enrolled in 

a psychology course.  As students with background 

knowledge in psychology, it is far more likely for them to be 

biased. 

 

Implications and Recommendations for Future Research  

In order to reach individuals who typically avoid 

psychological treatment, mental health education in school 

settings, work environments, and within institutions could be 

the optimal solution.  Educating the public about mental 

health services will help combat the adverse effects of stigma.  

Psychologists and other health care providers may also reach 

individuals who typically avoid psychological treatment by 

using alternative means to implement psychoeducational 

goals such as broad-based advertisements (print, radio, and 

TV).  Such efforts would be directed towards those who 

might not seek help for psychological distress because of the 

social stigma or self-stigma related to psychological treatment 

(Vogel et al., 2006).   

Based on the aforementioned findings, several 

suggestions could be made for future research.  Evidence was 

presented in this study on how social stigma and self-stigma 

are associated with seeking psychological help.  However, 

further research may examine potential mediating effects of 

personality.  Future investigations may also choose to 

examine the results of educational programs targeted toward 

reducing stigma (e.g., media efforts).  Another consideration 

for future research is to consider implementing longitudinal 

studies that integrate psychoeducation with ongoing 

investigations of attitudes towards counseling and mental 

health services in general.  Such an approach will help in 

reducing stigma and increasing willingness to seek counseling 

services.  This type of design can assess how effective a 

psychoeducational model is over time. 

 

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