Toward a multimodal model of internalized epilepsy stigma

This work elaborates the theoretical foundations of the RISE ABOVE program and presents a Multimodal Model of Internalized Stigma among people with epilepsy (PWE). The model integrates established behavioral science theories-including stress and coping, self-efficacy, learned helplessness, and cognitive-behavioral frameworks-to explain how stigma-related triggers, appraisals, and maladaptive cognitive-emotional-behavioral cycles culminate in self-reinforcing internalized stigma that may intersect with other stigmatized aspects of identity. In contrast to the psychoanalytic and post-rationalist perspectives proposed by Di Gennaro, Grammaldo, and Tomasini, our model offers concrete, evidence-informed pathways for intervention through conscious self-regulation and coping skill development. RISE ABOVE applies this framework through structured self-management exercises that enhance understanding of internalized stigma, strengthen stress management and psychological flexibility, and empower adaptive responses to stigma-related challenges. Prior findings demonstrate reductions in perceived stigma and improvements in psychosocial outcomes following RISE ABOVE completion, supporting the model's utility for informing stigma-focused interventions.