Abstract
People with disabilities (PWD) encounter societal barriers that impact their well-being, particularly due to stigma and systemic discrimination. Whether a disability is congenital or acquired can shape how individuals experience these challenges, influencing their psychological adjustment and coping mechanisms. Stigma, enacted by others and internalized by PWD, can undermine the emotional, social, and physical health of PWD, limiting their ability to flourish. Disability severity adds further nuance to these experiences, influencing the challenges PWD face in accessing resources and social inclusion. This study examined how disability onset moderates the effects of stigma and disability severity on well-being, using the PERMA model. In total, 221 participants with either congenital or acquired disabilities were assessed for overall well-being, negative emotions, health, and loneliness. Hierarchical regression analyses revealed that enacted stigma and self-stigma were associated with poorer well-being outcomes, including higher negative emotions, poorer health, and greater loneliness. Disability onset moderated the relationship between self-stigma and well-being, with individuals with acquired disabilities showing stronger negative associations between self-stigma and well-being and health. These findings underscore the importance of addressing both stigma and disability severity in rehabilitation counseling, particularly by tailoring select interventions to the onset of disability. Implications for rehabilitation counseling practitioners are discussed.
People with disabilities (PWD) navigate a world shaped by systemic barriers and societal exclusion, which impact nearly every aspect of their lives, including access to health care, interpersonal relationships, and personal fulfillment. Despite advances in understanding and addressing these barriers, PWD continue to encounter significant social and environmental challenges that undermine their well-being. These challenges arise not from the disabilities themselves, but from societal attitudes, stigma, and a lack of accessible resources and opportunities (Nevala et al., 2015; Vornholt et al., 2013). Stigma, in particular, has a profound effect on both mental and physical health, contributing to feelings of alienation, reduced self-worth, and increased emotional distress (Lalvani, 2015; Picco et al., 2016). While past research has largely focused on the negative consequences of disability-related exclusion and discrimination, there is a growing interest in understanding the positive dimensions of well-being among PWD and how rehabilitation professionals can further support their well-being (Chou et al., 2013; Qin et al., 2025; Seligman, 2011).
Disabilities can be broadly categorized into congenital, which are present at or shortly after birth, and acquired, which develop later in life due to injury, illness, or trauma (Bogart, 2014; Mackelprang et al., 2021). Both forms of disability onset present unique challenges and adaptation processes for individuals, with research suggesting that the onset of disability can influence how one experiences stigma and well-being (Hutchinson et al., 2018). Those with congenital disabilities may demonstrate greater adaptability over time, having lived with their disability since birth, whereas individuals with acquired disabilities often face the additional challenge of reconciling their new identity with a life previously lived without that adjustment (Bishop, 2005; Bogart et al., 2019). This transition can prompt a profound shift in identity and possibly lead to a deep sense of loss. These individuals may also struggle with societal biases and ableist views that they previously held, causing further incongruence with their self-concept. This distinction between congenital and acquired disabilities is critical for understanding how individuals cope with stigma and the strategies they employ to maintain or enhance their well-being.
Disability severity provides further nuance to these experiences, influencing both the level of support needed and the challenges encountered in daily life. Disability severity refers to the extent to which a disability affects an individual’s functional abilities, with more severe disabilities typically requiring greater levels of support and accommodation (Friedman, 2019). Research shows that individuals with more severe disabilities face heightened challenges related to social inclusion, employment, and quality of life, often due to systemic factors such as insufficient supports and limited access to opportunities (Carter et al., 2012). For instance, individuals with severe disabilities are less likely to be employed, and when employed, they are often placed in segregated or low-wage positions with fewer opportunities for advancement (Carter et al., 2012). In terms of well-being, those with severe disabilities frequently report lower levels of autonomy, social integration, and choice (Friedman, 2019). These compounded challenges highlight the importance of understanding how severity interacts with stigma and other factors to shape the well-being of PWD.
Well-being itself is a multidimensional concept, encompassing various aspects of an individual’s physical, emotional, and social life (Kern et al., 2014). For PWD, well-being extends beyond mere physical health to include emotional resilience, social support, and the ability to find meaning and purpose in life despite the societal barriers and challenges they may encounter (I. Brown et al., 2013; Costanza et al., 2007; Opoku et al., 2019). The importance of fostering well-being among PWD has been increasingly recognized in rehabilitation counseling and psychology, as enhancing well-being can lead to improved quality of life, greater autonomy, and increased participation in social and professional activities (Chou et al., 2013; Woodgate et al., 2020).
A framework that has gained prominence in the study of well-being is Seligman’s (2011) PERMA Theory of Well-being. The PERMA model conceptualizes well-being as comprising five key elements: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment. These elements are viewed as essential to human flourishing and provide a comprehensive framework for understanding well-being across diverse populations, including PWD (Butler & Kern, 2016). The PERMA model allows for a multidimensional assessment of well-being, capturing not only emotional and mental health but also factors related to social connection, purpose, and achievement (Seligman, 2011). Research applying the PERMA framework to PWD has shown that fostering these five elements can mitigate the negative effects of stigma and promote resilience in the face of adversity (Ginis et al., 2017; Moriña & Biagiotti, 2022). Positive emotion, the first element of the PERMA model, is essential for psychological resilience and emotional well-being. Encouraging positive emotions such as gratitude, hope, and happiness can help PWD manage stress and cope with the challenges they face (Lestari & Fajar, 2020). Engagement, or the experience of deep involvement in meaningful activities, promotes a sense of competence and mastery, which is particularly beneficial for PWD as they navigate their daily lives (Labbé et al., 2019). Relationships, another core component, emphasize the importance of social support and connectedness, which are crucial for mitigating the isolating effects of disability (Wilson et al., 2017). Meaning, defined as a sense of purpose and value in life, allows individuals to find fulfillment and satisfaction, even in the face of limitations (Butler & Kern, 2016). Finally, accomplishment, or the pursuit and achievement of goals, fosters self-esteem and confidence, which are vital for maintaining well-being amid stigma and other social barriers (Moriña & Biagiotti, 2022).
Despite the growing application of the PERMA model to understanding well-being among PWD, limited research has explored how factors such as stigma, disability onset, and severity interact with the model’s dimensions to influence overall well-being. Stigma, both enacted and internalized, remains a significant barrier to well-being, as it undermines individuals’ sense of belonging and self-worth and can perpetuate widespread acceptance of stereotypes and prejudices (Pescosolido & Martin, 2015; Ross et al., 2019; Rössler, 2016). Moreover, individuals with congenital and acquired disabilities may experience stigma differently, with congenital disabilities often associated with long-standing societal biases, while acquired disabilities may prompt shifts in identity and self-perception (Bogart et al., 2019; Campbell & Stramondo, 2017; Hutchinson et al., 2018). Understanding how these factors intersect with the dimensions of the PERMA model is critical for developing interventions aimed at improving the well-being of PWD.
The present study aims to address these gaps by examining how disability onset moderates the effects of stigma and severity on key well-being outcomes, including overall well-being, negative emotion, health, and loneliness. Guided by the PERMA model, this study explores whether the onset of disability (congenital or acquired) influences how severity and stigma affect the well-being of PWD. Specifically, the purpose of the study was to investigate the differential impact of enacted stigma, self-stigma, and disability severity on the various dimensions of well-being, while also assessing the moderating role of disability onset. We further explored the associations between disability onset, disability visibility, stigma, and disability severity. By applying the PERMA model to a diverse sample of PWD, this study seeks to contribute to the growing body of literature on positive psychology and well-being in disability contexts. This inquiry holds significant relevance for rehabilitation counseling practitioners, as it shifts the focus from deficit-based models of disability to strength-based frameworks that prioritize flourishing and resilience. Understanding how stigma, severity, and disability onset interact to shape multiple dimensions of well-being can help rehabilitation professionals develop more targeted, culturally responsive, and client-centered interventions. In addition, the study provides an empirical application of the PERMA framework in disability research, offering new directions for evaluation beyond symptom reduction.
Method
Procedures and Sampling
Institutional Review Board approval was secured prior to data collection. Participant recruitment was conducted via Prolific, a well-known platform for crowdsourcing research participants. Participants were eligible to participate if they were residing in the United States and reported having a disability or a chronic health condition. Those who met the inclusion criteria were directed to a consent form and after providing consent, participants proceeded to complete a survey hosted on Qualtrics. Participants who completed the survey were compensated $6 via Prolific.
In line with recommendations for creating valid attention checks, we steered clear of biased questions that might test participants’ memory (e.g., recalling information presented earlier in the survey) or lead to ambiguous interpretations of the survey questions, focusing instead on ensuring engagement and attentiveness to instructions. A total of 260 participants began the study; however, eight participants provided partial responses with more than 80% missing data and were excluded from the analysis. To ensure data quality, we examined their responses to attention-check questions. These checks included verifying consistency in answers to basic factual questions, like age, and adherence to specific instructions within the questions (e.g., Because of my disability, I often find myself staying alone. [Please choose “sometimes 3” for this question]). As a result of this screening, 31 responses were deemed invalid and excluded, resulting in a final sample size of 221 participants. The data and materials supporting the findings of this study may be available upon request.
Measures
Disability Onset, Severity, and Visibility
Participants provided information about the onset, severity, and visibility of their disability. Disability onset was assessed with the question: “Was your disability or health condition present at or shortly after birth?” to which participants responded with either “yes, my condition was present at or shortly after birth (congenital)” or “no, my condition developed later in life (acquired).” Severity was measured by asking participants to rate the extent to which their disability or condition affects their daily life, with the question: “How would you rate the severity of your disability or health condition (how significant it affects your daily life)?” Responses were provided on a 5-point Likert scale ranging from “very mild” to “very severe,” with higher scores indicating greater perceived severity. Finally, participants were asked about the visibility of their disability using the item: “Based on your own experience, would you describe your disability or health condition as apparent or non-apparent?” Those who selected “apparent” indicated that their condition is clearly visible or noticeable to others, while those selecting “non-apparent” described their condition as not readily noticeable to others. The use of single-item, self-report measures for severity and disability is supported by prior research showing that single-item measures, while limited in depth, can be valid tools in health research for efficiently capturing core perceptions of health status and functional impact (DeSalvo et al., 2006; Fisher et al., 2016). While we acknowledge that visibility is often fluid, context-dependent, or experienced along a spectrum, the binary framing was intended to capture participants’ dominant perception of their condition’s visibility in most social contexts.
Stigma
The Stigma Scale for Chronic Illness (SSCI; Rao et al., 2009) is a widely validated tool designed to assess the impact of stigma among people with chronic illness. This 24-item instrument evaluates stigma using a 5-point Likert scale (1 = never, 5 = always), and it can be analyzed either as a unidimensional construct or divided into two subscales: enacted stigma and self/internalized stigma. The enacted stigma subscale comprises 11 items (e.g., “Because of my illness, I was treated unfairly by others”), whereas the self/internalized stigma subscale includes 13 items (e.g., “I felt embarrassed about my illness”). Higher scores indicated higher levels of enacted stigma and self-stigma. The SSCI has demonstrated strong psychometric properties, including high internal consistency reliability (α = .97), robust factor structure supporting both a general stigma factor and subdomains, and convergent validity with psychological distress and performance status (Rao et al., 2009). Excellent internal consistency was observed in this study for items in the enacted stigma subscale (α = .94) and the self-stigma subscale (α = .93) with the current sample.
PERMA Model of Well-Being
The PERMA Profiler (Butler & Kern, 2016) is a concise measure grounded in Seligman’s (2011) PERMA theory of well-being, which conceptualizes well-being as a multidimensional construct encompassing five domains: positive emotion, engagement, relationships, meaning, and accomplishment. The 23-item instrument includes 15 items assessing these five domains, along with eight additional items evaluating overall well-being, negative emotion, loneliness, and self-perceived physical health. Responses are rated on an 11-point Likert scale, ranging from 0 (never, not at all, or terrible) to 10 (always, completely, or excellent). In this study, overall well-being, negative emotion, loneliness, and health were examined. Negative emotion and health were calculated as the average of their three respective items (e.g., “How satisfied are you with your current physical health?”). Loneliness was assessed using a single item (e.g., “How lonely do you feel in your daily life?”), and overall well-being was determined by averaging the 15 core PERMA items and one general happiness item (e.g., “Taking all things together, how happy would you say you are?”). Loneliness was included in the validation study by Butler and Kern (2016), where it demonstrated strong inverse correlations with the Relationships subscale and significant associations with depression, anxiety, and life satisfaction. The authors note that single-item measures of loneliness are commonly used in large-scale research and effectively capture meaningful variance in social and emotional functioning. The PERMA Profiler has been validated across diverse international samples, with confirmatory factor analyses showing excellent fit and strong convergent validity with related constructs such as life satisfaction and self-efficacy (Butler and Kern, 2016).
Statistical Analyses
Data were screened for missing values and distribution characteristics. Skewness statistics (±1) and kurtosis statistics (±3) were within the normal range. Associations between congenital-acquired status, visibility, stigma, and severity were examined using Chi-squared tests and one-way analysis of variance (ANOVA). For chi-square analyses, each cell contained at least five data points. Linearity between independent (continuous) variables and dependent variables was confirmed. The nature of the disability (i.e., congenital versus acquired) were coded into two dummy variables for the ease of interpretation. Multicollinearity among independent variables was assessed, with the variance inflation factor (VIF) revealing no issues (VIFenacted stigma = 2.07; VIFself-stigma = 2.07; VIFseverity = 1.31; VIFcongenital-acquired = 1.03). Homoscedasticity was confirmed through visual inspection of studentized residuals against predicted values for all independent variables and each dependent variable. Hierarchical regression analyses were employed to test interactions. In cases where no significant interaction emerged, multiple regression analyses were conducted without the interaction terms.
Results
The final dataset contained 221 participants. Most participants identified as either cisgender women (47.1%) or cisgender men (42.5%), with the remaining participants identifying as transgender, non-binary, or another gender-expansive identity. The majority were White (73.8%), followed by smaller groups of Black or African American, Latina/o/x, Asian, multiracial, and other racial identities. In terms of disability, most participants had acquired disabilities (82.8%), reported their disability as non-apparent (81.0%), and indicated their disability as moderate (46.4%). Additional demographics are presented in Table 1.
Participant Demographics.
The chi-square analysis indicated a significant association between visibility and disability onset, χ2(1) = 4.71, p = .03 with a small effect size, φ = 0.15. People with acquired conditions were more likely to report their condition as non-apparent opposed to those with congenital disabilities. Subsequent analyses compared the differences in enacted stigma and self-stigma between people with congenital versus acquired disabilities. No significant difference was found between groups, Fenacted stigma (1, 219) = .00, p = .97; Fself-stigma (1, 219) = 2.20, p = .14. The severity of disabilities was also compared between the groups. One-way ANOVA showed no significant difference, F(1, 219) = 1.54, p = .22. Finally, we explored whether the congenital or acquired nature of one’s disability moderated the effects of stigma and severity on PERMA factors. Findings are summarized in Table 2.
Moderated Regression Analysis of the Interaction Between Congenital-Acquired Disability Onset and Stigma (Enacted and Self) and Severity, on PERMA and Related Outcomes.
Note. the results reported were from hierarchical analyses, with interaction terms introduced at the second step. “Onset” refers to the dummy coded variable—disabilities as congenital or acquired, with congenital conditions coded as “1.”
Indicates that the slope coefficient is significant at .05 level. **Indicates that the slope coefficient is significant at .01 level.
Enacted Stigma
A hierarchical regression reported no significant moderator effect of disability onset (p = .15). Therefore, the interaction term was dropped from the model. This new regression model revealed that there was a significant negative relationship (b = −0.05, SE = 0.01) between overall well-being (i.e., PERMA) and enacted stigma (p < .01). There was no significant difference in the overall well-being between individuals with acquired and congenital disabilities (p=.12). Hierarchical analyses revealed no significant moderating effects of disability onset on negative emotion (p = .50), health (p = .43), or loneliness (p = .06). When the interaction terms were removed, regression analyses identified enacted stigma as a significant predictor of negative emotion (b = 0.11, SE = 0.02, p < .01), health (b = −0.04, SE = 0.02, p = .02), and loneliness (b = 0.16, SE = 0.02, p < .01). However, disability onset did not significantly predict these outcomes.
Self-Stigma
Results of hierarchical regression indicated significant interaction effects between self-stigma and disability onset for overall well-being (ΔR2 = .03, p = .01) and for health (ΔR2 = .02, p = .03). Simple slopes analysis indicated a significant negative association between self-stigma and overall well-being in individuals with acquired disabilities (b = −0.08, SE = 0.01, p = .02), which was not observed in those with congenital disabilities (b = 0.00, SE = 0.03, p = 1.00). Similarly, a significant negative relationship was found between self-stigma and health in people with acquired disabilities (b = −0.06, SE = 0.01, p < .01), but this relationship was not significant in individuals with congenital disabilities (b = −0.01, SE = 0.03, p = .67).
The interaction term did not reach significance for either negative emotion (p = .09) or loneliness (p = .11). When the interaction term was excluded, multiple regression revealed a significant positive association between negative emotion and self-stigma (b = 0.10, SE = 0.01, p < .01), as well as between loneliness and self-stigma (b = 0.13, SE = 0.02, p < .01). In both cases, individuals with acquired and congenital disabilities exhibited similar levels of negative emotion (p = .61) and loneliness (p = .37).
Severity
Significant interactions were observed for overall well-being (ΔR² = 0.05, p < .01), negative emotion (ΔR² = 0.08, p < .01), and health (ΔR² = 0.07, p < .01), but not for loneliness (p = .54). Simple slopes analyses indicated a significant negative relationship between overall well-being and severity in individuals with acquired disabilities (b = −1.01, SE = 0.16, p < .01). This relationship was not present in individuals with congenital disabilities (b = 0.53, SE = 0.40, p = .18). For negative emotion, there was a significant positive relationship with severity among those with acquired disabilities (b = 1.10, SE = 0.21, p < .01), whereas a significant negative relationship was found for individuals with congenital disabilities (b = −1.34, SE = 0.51, p < .01). In terms of health, a significant negative relationship with severity was observed for those with acquired disabilities (b = −1.18, SE = 0.19, p < .01), and a significant positive relationship was found for those with congenital disabilities (b = 1.00, SE = 0.47, p = .03). After the interaction term was removed, a significant positive association was found between loneliness and severity (b = 0.74, SE = 0.28, p < .01). Moreover, there was no significant difference in the levels of loneliness between individuals with acquired and congenital disabilities (p = .32).
Discussion
This study applied the PERMA model to PWD and examined how disability onset moderated the impacts of stigma and disability severity on well-being, specifically assessing their influence on overall well-being, negative emotion, health, and loneliness. The findings uncovered multifaceted insights into the experiences of individuals with disabilities. The analysis revealed a pronounced negative association between enacted stigma and overall well-being, highlighting the harmful repercussions of societal attitudes and discrimination on well-being of PWD. Specifically, higher enacted stigma was linked to poorer well-being, increased negative emotion, diminished health outcomes, and greater loneliness. These findings are consistent with prior research showing that societal discrimination and stigmatization can severely undermine the mental and emotional well-being of PWD (Pescosolido & Martin, 2015; Van Alboom et al., 2021). Importantly, disability onset did not moderate the relationship between enacted stigma and well-being. Despite differences in how disabilities are acquired (congenital or acquired later in life) and the lack of notable disparities in well-being between these two groups suggests that the harmful effects of enacted stigma are pervasive, regardless of when the disability is acquired. These findings reinforce the notion that social stigma operates as a broad determinant of well-being, with consistent negative effects across psychological, physical, and social domains. For rehabilitation counselors and professionals, this emphasizes the need to target external, systemic sources of stigma when addressing client well-being. This result expands on earlier studies by demonstrating that enacted stigma impacts people with both congenital and acquired disabilities similarly, contradicting assumptions that individuals with congenital disabilities might be less affected due to long-term adaptation (Bogart et al., 2019). Furthermore, while enacted stigma significantly predicted well-being-related outcomes, the lack of interaction effects suggests that interventions aimed at reducing stigma must be broadly applied, rather than tailored solely to congenital or acquired disabilities.
In addition to self-stigma predicting overall well-being, negative emotion, health, and loneliness for all participants, the results for self-stigma also demonstrated a significant interaction with disability onset for overall well-being and health. Specifically, individuals with acquired disabilities exhibited a stronger negative association between self-stigma and overall well-being and health compared with those with congenital disabilities, highlighting the detrimental impact of internalized societal attitudes on their well-being and indicating potential barriers to accessing healthcare services or managing their conditions effectively. That self-stigma had a stronger negative effect on well-being and health for those with acquired disabilities suggests that the adjustment to a new identity may heighten vulnerability to internalized stigma. These findings align with research by Chalker and colleagues (2023), who also observed that internalized stigma is associated with lower well-being among individuals with disabilities, particularly veterans. Similarly, R. L. Brown and Batty (2021) found that internalized stigma contributes to declines in both self-rated physical health and functioning over time. The current study expands upon these findings by highlighting that individuals with acquired disabilities may face unique challenges related to identity and adjustment, resulting in a stronger impact of self-stigma on their well-being and health outcomes. Furthermore, the relationships among self-stigma, well-being, and health were not significant among those with congenital disabilities, suggesting potential differences in coping mechanisms or resilience factors between the two groups. This observation emphasizes the distinct psychological hurdles that individuals acquiring disabilities later in life may encounter, such as challenges related to identity, self-worth, and adjustment to altered circumstances. Interestingly, no differences were found for negative emotion or loneliness when comparing congenital and acquired disabilities, suggesting that self-stigma’s emotional and social effects may be consistent across disability types. However, self-stigma still predicted greater negative emotion and loneliness overall, indicating that internalized societal attitudes have pervasive emotional consequences for all PWD. These findings reinforce the need for interventions aimed at reducing self-stigma, particularly for individuals with acquired disabilities, as they may be more vulnerable to the negative effects on well-being and physical health.
The severity of a disability adds another layer of complexity to these outcomes, particularly when considering the differences between congenital and acquired disabilities. Disability severity significantly interacted with disability onset in predicting overall well-being, negative emotion, and health, but not loneliness. Specifically, severity had a negative relationship with well-being for those with acquired disabilities, but no significant relationship was observed for those with congenital disabilities. This may reflect long-term adaptation processes or differences in expectations and coping strategies. This finding highlights the distinct challenges faced by individuals with acquired disabilities, who may experience greater declines in well-being as their condition becomes more severe. These results align with prior research, which suggests that individuals who acquire disabilities later in life often face more difficulties adapting to their condition and managing its impact on their overall quality of life (Friedman, 2019). In terms of negative emotion, severity was positively associated with negative emotions among individuals with acquired disabilities, while a significant negative relationship was found for those with congenital disabilities. This contrast suggests that individuals with congenital disabilities may have developed greater emotional resilience over time, which buffers them against the emotional toll of increasing disability severity. Similarly, for health, severity was negatively associated with health outcomes for those with acquired disabilities, but positively associated for those with congenital disabilities. These findings expand upon previous research by showing that individuals with congenital disabilities might benefit from long-term adaptation strategies, allowing them to better maintain health despite the severity of their condition (Bogart et al., 2019). While the interaction term for loneliness was not significant, a positive association between severity and loneliness was identified when the interaction term was removed. This suggests that as disability severity increases, individuals—regardless of whether their disability is congenital or acquired—are more likely to experience feelings of loneliness, which supports previous research on the social isolation experienced by PWD (Rossetti & Keenan, 2018).
Implications for Practice
The findings of this study have important implications for rehabilitation counseling practitioners, as they underscore the critical role of stigma and disability severity in shaping well-being outcomes for PWD. Given the pervasive negative impact of both enacted and internalized stigma on well-being, rehabilitation counselors should prioritize interventions that directly target stigma reduction. This may involve helping clients reframe negative societal attitudes, fostering resilience against internalized stigma, and creating safe spaces for individuals to discuss their experiences without fear of judgment. For individuals with acquired disabilities, it is particularly important to address the challenges of identity reconstruction and adjustment to the new reality of living with a disability. Group counseling and peer support programs that encourage open conversation about stigma can be particularly effective in reducing both enacted and self-stigma, improving well-being outcomes in the process. Evidence-based approaches such as narrative enhancement and cognitive therapy (NECT) have been shown to reduce internalized stigma and improve self-esteem and functioning among PWD (Yanos et al., 2012). In addition to these clinical approaches, rehabilitation counselors should consider implementing or referring clients to stigma reduction programs such as psychoeducational campaigns (Corrigan et al., 2012), indirect social contact (Hammer & Stutts, 2025), and community-based educational models (Hepperlen et al., 2021; Smythe et al., 2020) which have shown promise in reducing disability-related stigma. These interventions can be tailored for various populations and settings and may include school- or community-based educational sessions, media representations of counter-stereotypical narratives, and participatory action methods such as photovoice projects. These approaches not only shift public attitudes but also provide disabled individuals with opportunities to reclaim and reshape their identities, fostering empowerment and inclusion.
Within rehabilitation counseling settings, these stigma-reduction strategies can be adapted in several practical ways. For example, NECT principles can be introduced into group counseling planning for clients navigating disability identity and adjustment. Individual counselors might use brief interventions to help clients identify and reframe internalized stigma during case conceptualization and treatment planning. Contact-based strategies (e.g., inviting peer mentors with disabilities to share lived experiences in pre-employment workshops) can be embedded into vocational rehabilitation services to reduce stigma-related barriers. Counselors can also use intake assessments to explore clients’ experiences of stigma and tailor interventions accordingly, especially for those with newly acquired disabilities or high levels of visibility-related concerns.
In addition to addressing stigma, rehabilitation counselors can apply the PERMA model of well-being to guide assessment, treatment planning, and intervention strategies. For example, counselors might assess each PERMA domain during intake or progress monitoring to identify which aspects of well-being may need targeted support. Intervention strategies can be framed around these domains; for example, helping clients with high self-stigma strengthen relationships or engagement to improve resilience. The PERMA framework also provides a strengths-based lens that counselors can use when working with clients who are adjusting to disability onset or navigating the emotional impact of severity, allowing for more holistic and comprehensive treatment planning.
Practitioners must also be mindful of the distinct differences in how individuals with congenital versus acquired disabilities experience and cope with severity. Those with acquired disabilities may require more intensive emotional and psychological support if they perceive their disability, or environmental barriers, has having a significant effect on their daily life. Rehabilitation counselors can integrate strategies that promote resilience, foster emotional regulation, and build coping mechanisms tailored to the individual’s stage of disability onset. For those with congenital disabilities, the focus might be more on sustaining long-term health and well-being strategies, given their longer experience with disability and the resilience they may have developed over time.
The positive association between disability severity and loneliness, regardless of onset, highlights the need for rehabilitation counselors to incorporate social connectedness into their interventions. Helping clients build supportive social networks, whether through family, peer support groups, or community resources, can mitigate the isolating effects of severe disabilities. Rehabilitation counselors can also work with clients to develop communication and social skills that enhance their ability to form and maintain relationships, ultimately improving their sense of belonging and reducing loneliness.
For rehabilitation counselor educators and researchers, the study’s findings underscore the importance of developing training programs and evidence-based interventions that address both stigma and severity-related issues. Rehabilitation counselor training programs should emphasize the complexity of disability experiences and equip future practitioners with the tools to address the nuanced challenges faced by individuals with varying disability onset and severity. In addition, research that continues to explore the intersections between stigma, severity, and well-being can further inform best practices and enhance the effectiveness of rehabilitation counseling interventions.
Limitations and Future Directions
This study has several limitations that should be considered when interpreting the findings. First, participants were recruited through Prolific, an online research recruitment platform, requiring internet access and pre-existing registration. Consequently, the sample may not fully represent individuals with limited digital access or familiarity with technology. Future research should consider alternative recruitment methods to capture a broader spectrum of participants, particularly those who may not engage with online platforms. Second, the demographic composition of the sample was relatively homogenous in some areas, limiting the ability to generalize the findings across diverse sociodemographic groups. Expanding future research to include more varied samples in terms of race, socioeconomic status, and geographical region would enhance the external validity of the findings, allowing for a deeper understanding of how these factors intersect with disability experiences. In addition, this study did not differentiate between disability types in its examination of stigma, despite evidence that stigma may manifest differently across physical, intellectual, and sensory disabilities. Future research should investigate how stigma uniquely affects individuals based on their specific disability type, thereby providing a more nuanced understanding of the intersection between stigma, severity, and well-being. We also recognize that the use of single-item measures for complex constructs such as visibility and severity may have limitations. In particular, the dichotomous visibility item may not fully capture the fluid or context-specific nature of visibility for some individuals. As a result, our ability to interpret the association between visibility and disability onset is constrained, as participants with ambiguous or situational visibility experiences may not have been accurately represented. Future studies may benefit from more nuanced or continuous measures to account for intermediate or situational visibility experiences. For example, visibility could be assessed using Likert-style ratings of perceived visibility across settings (e.g., school, work, public spaces), or through multidimensional tools that consider both how visible a disability is to others and how much effort individuals invest in concealing or disclosing it. Moreover, future research could adopt a more holistic approach to understanding stigma and well-being by including other important factors such as social support, access to healthcare, and environmental barriers. Lastly, the cross-sectional design of this study precludes any causal inferences. Longitudinal studies are needed to explore how the relationships between stigma, severity, and well-being evolve over time. Such research could provide insights into the long-term psychological and health outcomes associated with disability onset and the progression of severity, offering a more dynamic view of well-being across the lifespan.
Conclusion
This study contributes to the growing body of literature on the well-being of PWD, with a particular focus on how stigma and disability severity influence outcomes within the framework of the PERMA model. The findings underscore the pervasive negative effects of both enacted and internalized stigma on well-being, while highlighting the distinct challenges faced by individuals with acquired versus congenital disabilities. For rehabilitation counseling practitioners, these findings emphasize the importance of addressing stigma in therapeutic interventions and tailoring support strategies based on disability onset and severity. Future research should continue to explore these dynamics, incorporating longitudinal designs, more diverse samples, and the addition of social or environmental factors to deepen the understanding of how stigma, severity, and onset affect the lives of PWD. Understanding these dynamics can inform the development of more targeted interventions, empowering practitioners to better support PWD in both counseling and rehabilitation settings, ultimately promoting resilience, inclusion, and flourishing.
Footnotes
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work for this manuscript was funded partially by the School of Education at the University of Wisconsin-Madison.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.