Trans MST APA 2015 Slides

TEACHERS COLLEGE
COLUMBIA UNIVERSITY
Resilience and Collective Action: Exploring Buffers Against
Minority Stress for Transgender Individuals
Aaron S. Breslow, Melanie E. Brewster, Brandon L. Velez, Stephanie
Wong, Elizabeth Geiger, & Blake Soderstrom
Citation:
Breslow, A. S., Brewster, M. E., Velez, B. L., Wong, S., Geiger,
E., Soderstrom, B. (2015). Resilience and collective action:
Exploring buffers against minority stress for transgender
individuals. Psychology of Sexual Orientation and Gender
Diversity, 2, 3.
For questions, please contact:
Aaron Samuel Breslow
Counseling & Clinical Psychology
Teachers College, Columbia University
Email: asb2233@tc.columbia.edu

TEACHERS COLLEGE
COLUMBIA UNIVERSITY
The present study aimed to extend the minority stress framework and calls for attention
to stress-ameliorating processes with national data from 552 transgender adults. Specifically,
the present study examined the relations of minority stressors (i.e., anti-transgender
discrimination, expectations of rejection, and internalized transphobia) and potential mental
health promoters (i.e., resilience and collective action) with psychological distress.
Results offered support for the applicability of the minority stress model – including recent
expansions positing meditation patterns (Hatzenbuehler, 2009) – with transgender populations.
As expected, each minority stressor was related positively with psychological distress; in terms
of the mental health promoters, resilience, but not collective action, was related negatively
with psychological distress. Additionally, expectations of rejection (though not transphobia)
mediated the link of anti-transgender discrimination with higher psychological distress.
Regarding moderated mediation patterns, the results offered some support for resilience
and collective action as moderators. Strategies for developing individual (e.g., resilience building
strategies) and group-level (e.g., engagement in collective action) interventions targeted toward
transgender individuals who experience discrimination are discussed.
ABSTRACT

TEACHERS COLLEGE
COLUMBIA UNIVERSITY
Minority stress theory posits that individuals who embody socially stigmatized identities
report poorer psychological functioning and compromised well-being as a result of contending
with discrimination (Brooks, 1981; Meyer, 1995, 2003; Moritsugu & Sue, 1983). It was not until
recently that limited studies began to expand this theoretical framework to include transgender
people, which is alarming considering transgender people often face multiple manifestations of
discrimination, including violence and harassment (Lombardi, Wilchins, Priesing, & Malouf,
2002); economic and employment discrimination (Brewster, Velez, DeBlaere, & Moradi, 2012;
Brewster, Velez, Mennicke, & Tebbe, 2014; Mizock & Mueser, 2014); and culturally incompetent
health care (Bradford, Reisner, Honnold, & Xavier, 2013; Lombardi, 2007). Transgender people
also often experience disproportionately high rates of psychological distress (Budge,Adelson, &
Howard, 2013).
This study aims to build concomitantly on current conceptualizations of minority stress
and resilience through a large-scale, national study with transgender participants. The current
research expands upon recent extensions of minority stress theory (Hatzenbuehler, 2009) by
examining potential pathways through which proximal stressors (i.e., expectation of rejection,
internalized transphobia) may mediate the links between distal stressors (i.e., anti-transgender
discrimination) and psychological outcomes.
INTRODUCTION

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PRESENT STUDY: PROCEDURE
Procedure
• Participants recruited online through websites, mailing lists, apps, message boards, and
venues for people of trans experience. Survey hosted on Qualtrics.com.
Participants
Gender ID:
• 45% of the sample identified as men of transgender experience (e.g., transgender
man, FtM), 16% as women of transgender experience (e.g., transgender woman, MtF),
and 39% opted to write in a preferred gender identity descriptor (e.g., gender queer,
gender non-binary, gender nonconforming, gender fluid, trans*).
Race:
• 74% of the sample identified as White, 11% as Multi-racial, 3% as Hispanic/Latino, 3%
as African American/Black, 3% as Asian American/Pacific Islander, 1% as Native
American, and 1% as other races or ethnicities.
Sexual Orientation:
• 32% of the sample identified as queer, 14% as pansexual, 11% as bisexual, 9% as
“mostly straight or heterosexual,” 8% as gay or lesbian, 7% as heterosexual, and 5% as
“mostly gay or lesbian.” 10% identified as another sexual orientation

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Measures
Experience of anti-trans discrimination was assessed with a trans-inclusive modified version of
the Heterosexist Harassment Rejection and Discrimination Scale (Syzmanski et al., 2005)
Internalized transphobia was assessed with the Transgender Congruence Scale (Kozee et al.,
2012)
Expectations of Rejection was assessed with the Public subscale of the Collective Self-Esteem
Scale (CSES; Luhtanen & Crocker, 1992)
Collective action was assessed with the assessed using a modified version of the Involvement in
Feminist Activities Scale (IFAS; Szymanski, 2004)
Resilience was assessed with the six-item Brief Resilience Scale (BRS; B. W. Smith et al., 2008).
Psychological distress was assessed with the Hopkins Symptom Checklist-21 (HSCL-21; Green,
Walkey, McCormick, & Taylor, 1988)
PRESENT STUDY: PROCEDURE

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PRESENT STUDY: RESULTS
Descriptive statistics, Cronbach’s alphas, and bivariate correlations for the variables of
interest and the demographic covariates are reported in Table 1. Correlations were
characterized as small (r = .10), medium (r = .30), or large (r = .50) using Cohen’s benchmarks.
Consistent with hypotheses:
• Anti-transgender discrimination, internalized transphobia, and expectations of
rejection yielded significant small to medium positive correlations with psychological
distress.
• Resilience yielded a significant large negative correlation with psychological distress.
• The correlation of collective action with psychological distress was nonsignificant.
Consistent with prior research exploring demographic correlates of psychological distress,
age, education, household income, employment status, and perceived social class, each yielded
significant small negative correlations with psychological distress. Thus, these demographic
variables were included as covariates in subsequent analyses to provide more stringent tests of
the hypotheses.

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Tests of Mediation
Figure 2. Path model of direct and indirect relations of variables of interest with
psychological distress as the criterion. Values reflect standardized coefficients. Dashed line
signifies nonsignificant paths. The lengths of age (-.13**), education level (-.06), household
income (.03), employment status (-.09*), and social class (-.10*) with psychological distress
were also estimated but were not shown for the sake of parsimony.
* p < .05 *** p < .001.

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Table 1
Descriptive Statistics, Cronbach’s Alphas, and Bivariate Correlations
Note. a
18.00-71.00 is the observed rage of Age
* p < .05 ** p < .01 *** p < .001
Variable 1 2 3 4 5 6 7 8 9 10 M SD
Possible
Range
α
1. Discrimination — 2.30 0.86 1.00-6.00 .89
2. Internalized Transphobia .09* — 2.77 1.29 1.00-7.00 .78
3. Expectations of Rejection .35*** .18*** — 4.43 1.31 1.00-6.00 .75
4. Collective Action .21*** – .19*** .05 — 3.83 1.60 1.00-7.00 .94
5. Resilience – .22*** – .17*** – .24*** .05 — 2.90 0.94 1.00-5.00 .91
6. Distress .42*** .11** .27*** .07 – .52*** — 2.36 0.64 1.00-4.00 .92
7. Age – .21*** – .07 – .03 .13** .19*** – .25*** — 26.42 9.85 18.00-71.00a
—
8. Education Level – .21*** .01 – .03 .20*** .19*** – .23*** .47*** — 4.06 1.64 1.00-7.00
—
9. Household Income – .12** .00 – .06 .03 .11* – .12** .21*** .14** — 2.39 1.69 1.00-7.00
—
10. Employment Status – .09* – .02 – .10* .16** .24*** – .20*** .31*** .40*** .17** — 1.97 0.85 1.00-3.00
—
11. Social Class – .16*** .00 – .05 .07 .09* – .14** – .03 .11** .50** .06 2.55 0.89 1.00-5.00
—

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Table 2
Tests of Collective Action as a Moderator of Prediction-Mediator, Mediator-Criterion, and Prediction-Criterion Links
Note. Confidence Intervals (CI) reflect standardized scores. Degrees of Freedoms (df) reflect the fact that 30 of the participants were excluded
from the analysis because of missing data for the demographic covariates.
* p < .05 ** p < .01 *** p < .001
Predictor Variables B β CI t R2
F df
Mediator: Internalized Transphobia
Discrimination .20 .13 (.05, .22) 3.09** .06 11.29*** (3, 518)
Collective Action – .18 – .22 (– .31, – .14) – 5.25***
Discrimination x Collective Action – .07 – .07 (– .15, .01) – 1.80
Mediator: Expectations of Rejection
Discrimination .53 .35 (.27, .44) 8.27*** .12 23.43*** (3, 518)
Collective Action – .02 – .03 (– .11, .05) – 0.67
Discrimination x Collective Action – .01 – .01 (– .09, .07) – 0.19
Criterion: Distress
Age – .01 – .13 (– .22, – .04) – 2.84** .26 14.95*** (12,509)
Education Level – .03 – .07 (– .17, .02) – 1.57
Household Income .01 .03 (– .06, .12) 0.62
Employment Status – .08 – .10 (– .19, – .02) – 2.41*
Social Class – .08 – .11 (– .20, – .02) – 2.32*
Discrimination .20 .27 (.18, .36) 6.00***
Internalized Transphobia .04 .08 (.00, .16) 1.98*
Expectations of Rejection .08 .16 (.07, .24) 3.73***
Collective Action .03 .08 (– .00, .17) 1.94
Discrimination x Collective Action .03 .07 (– .01, .15) 1.72
Internalized Transphobia x Collective Action .03 .10 (.02, .18) 2.53*
Expectations of Rejection x Collective Action – .02 – .08 (– .16, .01) – 1.80

TEACHERS COLLEGE
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Table 3
Tests of Resilience as a Moderator of Prediction-Mediator, Mediator-Criterion, and Prediction-Criterion Links
Note. Confidence Intervals (CI) reflect standardized scores. Degrees of Freedoms (df) reflect the fact that 30 of the participants were excluded
from the analysis because of missing data for the demographic covariates.
* p < .05 ** p < .01 *** p < .001
B β CI t R2
F df
Mediator: Internalized Transphobia
Discrimination .07 .05 (– .04, .13) 1.05 .03 4.77** (3, 518)
Collective Action – .20 – .14 (– .23, – .06) – 3.29**
Discrimination x Resilience – .01 – .01 (– .09, .07) – 0.22
Mediator: Expectations of Rejection
Discrimination .46 .31 (.23, .39) 7.41*** .16 33.62*** (3, 518)
Collective Action – .27 – .19 (– .27, – .11) – 4.72***
Discrimination x Resilience .14 .09 (.01, .17) 2.29*
Criterion: Distress
Age – .01 – .11 (– .19, – .02) – 2.56* .39 27.02*** (12,509)
Education Level – .01 – .03 (– .11, .05) – 0.69
Household Income .01 .03 (– .05, .11) 0.76
Employment Status – .02 – .03 (– .10, .05) – 0.68
Social Class – .06 – .08 (– .16, .01) – 1.83
Discrimination .18 .25 (.17, .32) 6.25***
Internalized Transphobia .00 .00 (– .07, .07) 0.04
Expectations of Rejection .04 .07 (– .00, .15) 1.92
Resilience – .28 – .41 (– .49, – .34) – 10.99***
Discrimination x Resilience – .03 – .03 (– .11, .04) – 0.90
Internalized Transphobia x Resilience – .01 – .03 (– .09, .04) – 0.78
Expectations of Rejection x Resilience .03 .05 (– .03, .13) 1.22

TEACHERS COLLEGE
COLUMBIA UNIVERSITY
The present study expanded prior research on minority stress processes and mental health
promoting variables – conducted primarily with LGB people – to explore the unique experiences of
transgender individuals. Specifically, the study tested the links of three minority stressors (i.e., anti-
transgender discrimination, internalized transphobia, and expectation of rejection) and two variables
posited to promote mental health within marginalized groups (i.e., engagement in collective action
and resilience) with psychological distress.
Additionally, the study examined the applicability of recent conceptualizations of minority stress
theory, which posit that there are proximal minority stressors (i.e., internalized transphobia and
expectation of rejection) which mediate the link of distal minority stress (i.e., anti-transgender
discrimination) with psychological distress (Hatzenbuehler, 2009). Importantly, the study also aimed
to redress a historic lack of focus on variables that may have ameliorative effects on minority stress by
examining the moderating roles of collective action and resilience in the aforementioned mediation
model. Findings from the present research can be used to offer directions for future research, clinical
practice, and resilience-building interventions with transgender people.
DISCUSSION

TEACHERS COLLEGE
COLUMBIA UNIVERSITY
In partial support of our first set of hypotheses, the pattern of correlations among variables of
interest was largely consistent with prior research on minority stress with transgender samples (e.g.,
Bockting et al., 2013). Specifically, higher levels of minority stress (anti-transgender discrimination,
internalized transphobia, and expectations of rejection) were each associated positively with greater
psychological distress, with correlations ranging from small to medium in magnitude.
In further support of our first hypothesis, high levels of resilience were associated strongly with
lower levels of psychological distress. Whereas links between resilience and dimensions of distress –
such as depression or PTSD – have been supported qualitatively with transgender samples (Singh et
al., 2011; Singh & McKleroy, 2011), results from the present study are among the first quantitative
data to support this relation.
Resilience was related negatively with anti-transgender discrimination, internalized transphobia,
and expectations of rejection – adding further support to prior research finding that resilience may
protect marginalized groups from minority stressors (e.g., Singh et al., 2011). Collective action,
contrary to expectation, was not related to psychological distress.
Examination of mediation patterns provided partial support for our second set of hypotheses:
that proximal minority stressors (e.g., internalized transphobia and expectations of rejection) would
mediate relations between distal minority stress (anti-transgender discrimination) and psychological
distress (Brewster et al., 2014; Hatzenbuehler, 2009).
DISCUSSION

TEACHERS COLLEGE
COLUMBIA UNIVERSITY
IMPLICATIONS
These results provide further support for the applicability of the minority stress model
(Meyer, 1995, 2003) amongst transgender people – including patterns of mediation posited in
recent expansions (Hatzenbuehler, 2009). Future studies may benefit from utilizing an
intersectionality framework when exploring the minority stress experiences of transgender
individuals who embody multiple marginalized identities.
Additionally, these findings present helpful suggestions for practice. First, such high levels
of experiences of discrimination – and subsequent links with expectations of rejection,
internalized transphobia, and psychological distress – provide further support for considering
the role of oppression in the lives of transgender clients (Korell & Lorah, 2007).
Third, our results suggest that both individual resilience and group-level coping factors
(e.g., collective action) buffer the link between experiences of discrimination and psychological
distress. In line with such results, we suggest that outreach campaigns not only promote
individual-level resilience, but also encourage transgender-affirming social support and
community involvement. Social interventions targeting minority stressors themselves should
address structural anti-transgender discrimination (Hatzenbuehler, 2014) i.e., unequal access to
health care, gender-based violence, employment discrimination, and criminalization of
transgender individuals.

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