# ind_items

secondary_title_index: psychological bulletin
title_index:
       associations between microaggression and adjustment outcomes: a meta-analytic and narrative review.     

full_text_index:
       psychological bulletin  2019 american psychological association 0033-2909/19/ 12.00  2019, vol. 145, no. 1, 45–78 http://dx.doi.org/10.1037/bul0000172  associations between microaggression and adjustment outcomes: a meta-analytic and narrative review p. priscilla lui and lucia quezada  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  southern methodist university microaggression has been considered a form of stressor that negatively affects people with marginalized statuses. research shows variability in how microaggression is measured, and the extent to which it is associated with adjustment outcomes. a new cube model was proposed to conceptualize microaggression across social groups, interpersonal and group-level interactions, and categories of incidents. synthesizing findings from published and unpublished studies, this study was aimed to examine the relations between microaggression and adjustment outcomes. meta-analyses quantified the study-level correlations between microaggression and various adjustment outcomes, and estimated the degree to which methodological and individual factors explained between-study variability. using 72 independent study samples (n 18,718), omnibus analysis with a random-effects model showed a statistically significant summary correlation between microaggression and adjustment outcomes (r .20 (95% ci [.16 –.23]), p .001). between-study variability (q 319.86, p .001, 2 .01, i2 77.80%) was explained by gender, race, and publication status. except for gender microaggression, racial, lgbtq, and health status microaggressions were associated with adjustment outcomes. microaggression was relatively more strongly associated with internalizing problems, stress/negative affect, and positive affect/adjustment than with externalizing problems and physical symptoms. adjustment outcomes were more closely linked to interpersonal microaggression than group microaggression, and to microassault than microinsult and microinvalidation. narrative reviews showed that very few studies tested whether microaggression predicted adjustment outcomes above and beyond overt discrimination and individual difference factors, and examined the indirect mechanisms that may link microaggression to adjustment outcomes. limitations to the scope of this research synthesis and future research directions are discussed.  public significance statement microaggression is a subtle form of discrimination. similar to research on overt discrimination, this meta-analysis shows a robust and small bivariate correlation between adjustment outcomes and racial, lgbtq, and health status microaggressions. correlations are larger (a) when adjustment outcomes focus on internalizing problems, stress and negative affect, and positive adjustment and affect, (b) when microaggression is measured at the interpersonal level and in terms of microassault, and (c) in samples with more men, and with asian, black, and hispanic americans.  keywords: disability, intersection, people of color, prejudice, sexual minority supplemental materials: http://dx.doi.org/10.1037/bul0000172.supp  microaggression is characterized as “subtle, stunning, often automatic, and nonverbal exchanges which are ‘put downs’” of  people from minority and marginalized statuses (pierce, carew, pierce-gonzalez, & wills, 1977, p. 65). microaggression research  p. priscilla lui and lucia quezada, department of psychology, southern methodist university. lucia quezada is now at the department of counseling and clinical psychology, teachers college, columbia university. the southern methodist university mcnair scholars program provided funding to lucia quezada during part of this research project. we thank akihito kamata for his statistical consultation, and all of the researchers who shared effect size information with us. p. priscilla lui is grateful that materials shared at the institute of education sciences’ 2018 metaanalysis training institute have enhanced the quality of our analyses. this project was preregistered with the prospero international prospec-  tive register of systematic reviews. prospero citation is: p. priscilla lui, lucia quezada. associations between microaggression and adjustment outcomes: a meta-analytic and narrative review. prospero 2017 crd42017081373. available from http://www.crd.york.ac.uk/ prospero/display_record.php?id crd42017081373. data used for analyses are available on the open science framework online repository at https://osf.io/2uez9/. correspondence concerning this article should be addressed to p. priscilla lui, department of psychology, southern methodist university, p.o. box 750442, dallas, tx 75275-0442. e-mail: plui@smu .edu 45  
  lui and quezada  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  46  primarily has focused on racism, sexism, and homophobia/heterosexism that target people of color, women, and people in the lesbian, gay, bisexual, transgender, queer, and genderqueer (lgbtq) community, respectively (sue, 2010). qualitative and quantitative research with adolescents and adults has shown that racial and lgbtq microaggressions are associated with adjustment outcomes such as self-esteem, perceived stress, negative and positive affect, and depression and anxiety symptoms (e.g., hu & taylor, 2016; hughes, del toro, harding, way, & rarick, 2016; ong, burrow, fuller-rowell, ja, & sue, 2013). microaggression also is associated with poor therapeutic alliance and clinical outcomes among clients seeking professional psychological help (e.g., owen et al., 2011; shelton & delgado-romero, 2011). to date, there has been only one narrative review on lgbtq microaggression and racial microaggression, respectively (nadal, whitman, davis, erazo, & davidoff, 2016; wong, derthick, david, saw, & okazaki, 2014). as shown in these reviews, evidence regarding the direct relations between microaggression and adjustment outcomes has been mixed. it also is unclear whether microaggression is distinct from overt discrimination as a correlate of adjustment outcomes. to our knowledge, no research synthesis has examined the extent to which adjustment outcomes are associated with microaggressions targeting various social groups. additionally, research on microaggression recently has been criticized for its emphasis on experiential reality over empirical reality, because many studies relied on qualitative methods (e.g., focus groups and individual interviews) and because of the inconclusive findings about microaggression’s causal influence on adjustment outcomes (lilienfeld, 2017a, 2017b). in spite of these remaining empirical questions and criticisms, there continues to be an increase in the number of studies on microaggression as it relates to adjustment outcomes. to further advance this research program, there is a critical and timely need to synthesize and review studies on microaggression and adjustment outcomes. broadly, adjustment can be conceptualized as an outcome used in many psychological studies (seaton, 2009). a complete view of psychological adjustment includes the presence or absence of psychological symptoms (e.g., anxiety and depression) as well as indicators of positive functioning (e.g., self-esteem and subjective well-being), whereas physical health adjustment includes outcomes that reflect diseases, self-rated health, and physiological responses (e.g., elevated blood pressure) that may precede diseases (mays, cochran, & barnes, 2007; rasmussen, scheier, & greenhouse, 2009). as the first meta-analytic review in this area, we aimed to examine the associations between microaggression and various psychological and physical adjustment outcomes.  what is microaggression? microaggression has been conceptualized to elicit stress and negative emotional responses because cumulative exposures to insidious slights and invalidations— even if they are innocuous— can result in psychological burden and in turn maladjustment (pierce et al., 1977). discrimination experiences that are uncontrollable, unpredictable, and ambiguous may be more stressful than those that are easily recognized and clearly attributable to certain group biases (williams & mohammed, 2009). for example, indirect communications of racism have been reported to be more harmful than direct communications of racism (leets & giles,  1997). to best investigate how microaggression may be associated with adjustment outcomes, it is critical to understand microaggression in the context of discrimination and other related constructs, the existing taxonomy of microaggression, and the psychological processes that may underlie the microaggression experiences.  microaggression in the context of stereotypes, prejudice, and overt discrimination to understand the complex definition of microaggression, it is helpful to consider the triad of stereotypes, prejudice, and discrimination. stereotypes are beliefs and opinions that people hold about any given group members’ characteristics and behaviors (ellemers, 2018). these stereotypes may or may not accurately describe the groups on average and are often exaggerated and erroneously applied to all members from the social group (kite & whitley, 2016). some stereotypic images (e.g., gender) may be universal across countries, whereas others (e.g., racial and religion-based stereotypes) may be distinctive to cultural contexts (fiske, 2017). although negative stereotypes are associated with how people treat members of the said social groups, prejudice is more closely linked to intergroup behaviors. prejudice constitutes attitudes or emotions people have toward members of any given social groups. discrimination, then, is the differential treatment of people because of their social group memberships, and it can manifest at the individual, institutional, or cultural levels (williams & mohammed, 2009). there has been some discourse that challenges findings from the microaggression research program, and in turn questions the robustness of the (causal) associations between microaggression and adjustment outcomes. this is an issue that has not faced the study of overt discrimination (reid & foels, 2010). there has been a long history of psychological research on the possible impact of discrimination on adjustment outcomes. more traditionally, studies have focused on overt discrimination. overt discrimination is the outright, blatant differential treatment of minoritized people, based on certain personal characteristics or group affiliations that are deemed inferior to those of the dominant groups (korous, causadias, & casper, 2017). these explicit, old-fashioned forms of discriminatory incidents are consciously intended to harm minoritized groups. examples of overt discrimination include lynching, group segregation, and the use of inappropriate slurs. hate crimes registered by the federal bureau of investigation (fbi) likely reflect the most egregious acts of overt discrimination. over the past 20 years, there has been a 30% decrease in single-bias hate crimes reported by the u.s. department of justice (fbi, 1997, 2017). relatedly, the growing body of work on discrimination has focused on microaggression, given the fact that discriminatory acts against racial, sexual orientation, and gender minorities in the u.s. and other countries have become less blatant, public, and extreme (cf. lilienfeld, 2017a; sue, 2010). although stereotypes and prejudices that underlie microaggression have been shown to be correlated with those that underlie overt discrimination (mcconahay, 1986), research has supported the practical distinctions between microaggression and overt discrimination (swim, aikin, hall, & hunter, 1995). relatedly, much research has intentionally focused on microaggression alone, and little work has considered the roles of microaggression and overt discrimination on adjustment outcomes simultaneously.  
  microaggression and adjustment outcomes  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  conceptualization and taxonomy of microaggression similar to overt discrimination, microaggression can be motivated by prejudices toward people in various social groups, including race and ethnicity, gender, sexual orientation and gender identity, religion, age, ability and health status, and appearance (kite & whitley, 2016), as well as immigration or adoption statuses. despite the unique lived experiences among people across marginalized statuses, there seem to be shared cognitive processes and consequences associated with discrimination (pascoe & smart richman, 2009). according to statistics from 2016, single-bias hate crimes in the united states were most commonly motivated by racial, religious, sexual orientation, and gender identity discrimination (fbi, 2017). within these broad social groups, black/ african americans, jews and muslims, gay men, and transgender people were the most frequent targets, respectively. nevertheless, the prevailing taxonomy put forth by sue, capodilupo, et al. (2007) has enlisted categories and examples that characterize everyday microaggression experiences that can be generalized to different social groups. categories of microaggression. sue’s original taxonomy is the only conceptual model that currently exists in categorizing microaggression into lower-level domains: microinsult, microinvalidation, and microassault.1 microinsults are “communications that convey rudeness and insensitivity” to people’s social identities (sue, capodilupo, et al., 2007, p. 274). these communications also can take the form of exceptionalizing stereotypes— complimentary but nonetheless negative stereotypic views of people (tran & lee, 2014). microinvalidations are “communications that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality” of minoritized people (sue, capodilupo, et al., 2007, p. 274). unlike microinsults and microinvalidations that are often implicit derogations that convey hidden prejudicial and demeaning messages, microassaults are explicit attacks that are “meant to hurt [people from marginalized groups] through name-calling, avoidant behavior, or purposeful discriminatory actions” (sue, capodilupo, et al., 2007, p. 274). within these broad categories, qualitative research has summarized many examples of microaggression. racial microaggression can be broken down into ascription of intelligence, second class citizen, pathologizing cultural values or communication styles, assumption of criminal status, alien in own land, color blindness, myth of meritocracy, and denial of individual racism (sue, capodilupo, et al., 2007). for example, blacks may be watched, monitored, or followed in department stores because of the assumptions that they are criminals (sue, capodilupo, & holder, 2008), or that white americans’ opinions are valued more than asian americans’ because asians are considered second class citizens in the united states (sue, bucceri, lin, nadal, & torino, 2007). lgbtq microaggression examples include the use of heterosexist or transphobic language, endorsement of heteronormative or gender-conforming culture and behaviors, assumption of universal lgbtq experience, exoticization, discomfort around or disapproval of the lgbtq experience, denial of reality of heterosexism or transphobia, and assumption of sexual pathology or abnormality (e.g., oversexualization and undersexualization; see nadal et al., 2016 and platt & lenzen, 2013 for summary). in a therapeutic context, assuming that people’s lgbtq status is the root cause of all presenting problems, and minimizing or overidentifying with  47  clients’ lgbtq experiences also can constitute examples of microaggression (shelton & delgado-romero, 2011). finally, despite increasingly greater gender equality in recent decades, women still are more likely to be excluded, mistreated, or subscribed to stereotypic gender expectations than men (foster, 2009). women may be considered to be less intelligent or capable than men, and are more likely to be viewed as sexual objects (sue, 2010). these messages can be demoralizing and engender a sense of “otherness” and psychological distress among women. social levels. as indicated in sue, capodilupo, et al. (2007) conceptual framework for microaggression, and consistent with research on discrimination more broadly (kite & whitley, 2016), microaggression can manifest at the interpersonal, organizational, institutional, and cultural levels. interpersonal microaggression refers to subtle derogations and putdowns that are communicated face-to-face at a personal level. microaggression at the organizational, institutional, and cultural levels refers to devaluation, underrespect, and inequalities that harm the marginalized groups collectively; it also tends to be communicated in the broader environmental contexts. two examples of microaggression at the group level include only men being featured in portraits hanging in corporate office spaces, and people of color portrayed as less intelligent than white americans in the media. survey research shows that interpersonal and noninterpersonal discrimination can be distinguished from each other, and they can exert nuanced effects on self-esteem: being discriminated individually is related to poorer self-esteem, but being discriminated as a group is related to higher levels of self-esteem (armenta & hunt, 2009; bourguignon, seron, yzerbyt, & herman, 2006). an integrated cube model. based on this knowledge base and inspired by the cube model for competency development (rodolfa et al., 2005), we designed a three-dimensional microaggression cube to illustrate the complex ways in which microaggression can manifest in people’s daily lives across group memberships, categories of microaggression, and social levels. as shown in figure 1, group membership, social levels, and categories are orthogonal dimensions. each microaggression incident can be identified as one point in this cube. we considered group microaggression as an overarching level that would subsume organizational, institutional, and cultural microaggressions. the contrast between interpersonal and group microaggressions is consistent with the distinction between direct and environmental microaggressions in primary studies (molero, recio, garcia-ael, fuster, & sanjuan, 2013; nadal, 2011; sue, capodilupo, et al., 2007; torresharding, andrade, & romero diaz, 2012; woodford, chonody, kulick, brennan, & renn, 2015).  study design and measurement of microaggression building on much qualitative research on microaggression during this research program’s earliest years (e.g., constantine, 2007; sue, bucceri, et al., 2007; see nadal et al., 2016 and wong et al., 2014 for review), more recent quantitative research has used 1 from a conceptual standpoint, microassault likely should not be considered a category of microaggression because it represents explicit, often conscious derogations that are meant to hurt people of marginalized statuses (wong et al., 2014). in explaining the manifestations of microaggression, kite and whitley (2016) only discussed microinsult and microinvalidation, and did not address microassault.  
  lui and quezada  48  microaggression category dimension  social level dimension  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  social group dimension  group levels  figure 1. a cube showing the three orthogonal dimensions of microaggression manifestations: social group membership, category, and social level. per sue’s taxonomy, microaggression categories include microinsult, microinvalidation, and microassault, although microassault may be a domain of overt discrimination. group membership includes, but is not limited to, these seven social identities. see the online article for the color version of this figure.  recall-based or daily diary survey methods to examine this construct (e.g., ong et al., 2013; torres-harding & turner, 2015). a small number of experimental studies have manipulated in vivo individuals’ exposures to microaggression to measure their emotional and physiological reactions (e.g., hughey, rees, goss, rosino, & lesser, 2017). early research has measured simply racial prejudices that underlie overt discrimination (e.g., “it is a bad idea for blacks and whites to marry one another”) and microaggression (e.g., “over the past few years blacks have gotten more economically than they deserve”; mcconahay, hardee, & batts, 1981, p. 568). other research includes denial of discrimination, antagonism toward minority people’s needs, and resentment about special favors for historically minoritized groups as content areas of microaggression (swim et al., 1995). more recently developed measures of overt or subtle discrimination have focused on the behavioral manifestations of negative attitudes toward people of minority status(es). since sue, capodilupo, and colleagues (2007) published their seminal piece on racial microaggression in the american psychologist, the taxonomy outlined in that article remained the only one available to date. in an attempt to better identify, quantify, and ultimately rectify subtle discrimination, development of many self-report measures of microaggression has relied on this prevailing taxonomy as a theoretical foundation. a number of scales have been constructed to measure subtle discrimination motivated by racist, heterosexist, or sexist attitudes, and a combination of these biases. these measures include the racial microaggressions scale (torres-harding et al., 2012) and the homonegative microaggressions scale (wright & wegner, 2012). there has been one published measure, the multidimensional scale of perceived discrimination (molero et al., 2013), that has been developed to assess general microaggression among people across marginalized group memberships (i.e., ethnic minority immigrants, stigmatized health  status, and lgbtq individuals). similar to the case of overt discrimination, the existence of group-specific and general measures indicates that microaggression can take unique forms and manifestations across social groups, yet, there are sufficient similarities in these experiences that transcend social groupings. no research synthesis has examined how these self-report measures function in assessing microaggression, and whether they yield robust results concerning the associations between microaggression and adjustment outcomes. thus, it would be important to review the psychometric properties of existing microaggression scales, and explore the extent to which using different measures explains the mixed findings concerning the associations between microaggression and adjustment outcomes.  conceptual frameworks linking microaggression to adjustment outcomes as implied by the definition of microaggression, its possible consequences can be largely subjective. unlike overt discrimination where there is a general consensus about the deliverers’ ill-intent as well as the psychological and physical harm endured by the receivers—and therefore is “normatively stressful” (lazarus & folkman, 1984, p. 14)—people who experience microaggression can interpret the incident differently and in turn experience various emotional reactions (harris, 2008; reid & foels, 2010). microaggression may seem harmless and benign, yet can still yield negative consequences to its receivers (o’keefe, wingate, cole, hollingsworth, & tucker, 2015; wang, leu, & shoda, 2011). for example, among american indian patients with diabetes, research showed a stronger association between depression symptoms and past-year hospitalization among those who experienced more racial microaggression incidents (walls, gonzalez, gladney, & onello, 2015).  
  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  microaggression and adjustment outcomes  the minority stress framework (meyer, 2003; myers, lewis, & parker-dominguez, 2003) and a biopsychosocial perspective can help conceptualize the possible psychological mechanisms that link microaggression to adjustment outcomes. cumulative exposures to injustice can tax people’s capacity and resources to cope, and in turn elicit physical and psychological pressure or tension (meyer, 2003). among people of marginalized statuses, experiences with prejudices, feelings of exclusion, expectations of rejection, and daily hassles of dealing with these issues can create stress (calabrese, meyer, overstreet, haile, & hansen, 2015; huebner & davis, 2007). even though microaggression incidents may not take the shape and form as cataclysms, the inadvertent stimulus-andresponse relation categorically marks microaggression experiences as stressors (lazarus & folkman, 1984). the minority stress framework conceptualizes discriminationrelated stressors along the continuum ranging from distal events (objective conditions) to proximal appraisals (intrapersonal subjective experiences; meyer, 2003). microaggression is by definition ambiguous; hence, microaggression incidents may yield feelings of hassles, annoyances, and helplessness, and burden the individuals’ psychological resources to cope (sue, 2010; sue, capodilupo, et al., 2007). unlike the case with overt discrimination, people who experience microaggression incidents are not afforded the clear attributions of differential treatments to the deliverers’ prejudices. rather, receivers of microaggression may have to contend with (a) how they know for certain that discrimination has taken place (e.g., “what just happened?”), (b) whether they have misinterpreted these incidents as cases of microinsult or microinvalidation (e.g., “is it me?”), and (c) how to handle the situation (e.g., “do i bring this to the deliverers’ attention?”). the daily hassles and psychological burden can arise from the catch-22 processes that underlie a microaggression stimulus. when appraised as “taxing or exceeding [their] resources,” microaggression may negatively affect people’s adjustment outcomes (lazarus & folkman, 1984). consistent with the minority stress framework, smith and colleagues (2011) offered a battle fatigue perspective to explain the psychological (e.g., frustration, apathy), behavioral (e.g., increased maladaptive coping, increased commitment to spirituality), and physiological (e.g., headaches, high blood pressure, sleep disturbance) stress responses that may arise from dealing with microaggression. although the “active ingredients” associated with microaggression stresses are conceptualized as daily hassles, one study has suggested that racial microaggression can elicit nonspecific traumatic stress symptoms that are common in exposures to overt discrimination (torres & taknint, 2015). other research that explicitly studies the psychological mechanisms has found that microaggression (or generally minority stressors) predict poor adjustment via cultural mistrust, expectations of rejection, selfstigma, and rumination (kim, kendall, & cheon, 2017; timmins, rimes, & rahman, 2017).  possible moderators in the relations between microaggression and adjustment outcomes microaggression has been called into question as a robust source of sociocultural stressor, possibly because of some inconsistent results documenting its associations with various measures of adjustment outcomes. such inconsistencies likely have resulted  49  from between-study methodological differences and betweenindividual and group differences.  adjustment outcomes previous meta-analyses have shown that (racial) discrimination is negatively associated with adjustment outcomes, but the correlations are relatively the strongest for internalizing psychological problems (e.g., depression and traumatic stress) when compared to externalizing problems and health risk behaviors (e.g., alcohol use and smoking), positive psychological adjustment (e.g., self-esteem and subjective well-being), and physical health (e.g., cardiovascular problems and cortisol output; pascoe & smart richman, 2009). to the extent that microaggression has been theorized to exert psychological burden, it stands to reason that microaggression also would be more closely associated with internalizing problems, negative affect, psychological distress, and positive affect and overall adjustment, than externalizing problems and physical symptoms.  social groups, social levels, and categories of microaggression microaggression targeting specific social groups has tended to be studied separately, with the exception of a few studies that have examined lgbtq microaggression or gender microaggression among people of color (e.g., balsam, molina, beadnell, simoni, & walters, 2011; lewis, mendenhall, harwood, & browne huntt, 2016; thomas, 2015). there is no compelling theoretical or empirical rationale for speculating that any particular single-bias microaggression would be more closely related to adjustment outcomes. consistent with the minority stress framework, however, people with multiple marginalized statuses may be exposed to cumulative prejudices and therefore particularly prone to experiencing microaggression and consequent stresses (calabrese et al., 2015). for example, whereas any person of color may experience microinsult or microinvalidation because of racism, women of color may experience additional derogations because of longstanding sexism in many cultural contexts. in addition, people with multiple marginalized statuses may be taxed with the added burden to decipher the reasons behind microaggression incidents (i.e., “was i mistreated because of my race or my gender?”). in terms of methodological factors, it remains unclear whether adjustment outcomes would be differentially associated with microaggression occurring at the interpersonal and group levels, and with microinsult, microinvalidation, and microassault. because of the direct and personal nature, it is possible that microaggression at the interpersonal level is more stressful than microaggression at the group level. for example, results from a narrative review show that alcohol-related outcomes are consistently associated with racial, lgbtq, gender, and age/physical appearance discrimination at the interpersonal level, but not at the systemic/structural levels (gilbert & zemore, 2016). microassault has been questioned as a form of microaggression because of its explicit and intentional nature (lilienfeld, 2017a; wong et al., 2014), but it is unclear whether it would be more or less closely related to adjustment outcomes than microinsult and/or microinvalidation. on the one hand, should microassault resemble old-fashioned overt discrimination, microassault may be more closely associated with traumatic stress symptoms and in turn be  
  lui and quezada  50  more detrimental to adjustment outcomes. on the other hand, microinsult and microinvalidation can manifest in many forms of slights and derogations and likely are more insidious and frequent in everyday lives; the cumulative nature of these microaggression categories may make them more stressful than microassault.  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  publication status finally, there has been an increase in the number of quantitative studies on racial microaggression since 2010 (wong et al., 2014). this likely results from the development of more reliable and valid measures of microaggression. it is also possible that there had been more time to allow quantitative research to appear in peerreviewed journals. as a result, we intended to explore whether published and unpublished studies differed in the associations between microaggression and adjustment outcomes, and whether these effects shifted over time.  the present investigation the goals of the present investigation were to synthesize research pertaining to the associations between various types of microaggression and adjustment outcomes. to describe the distribution of study effects, we conducted a meta-analysis to quantify a summary correlation and examine the variability across samples. we used both meta-analytic and narrative review approaches to explore the extent to which these associations were related to studies’ methodological characteristics and participant factors. findings from this investigation were expected to identify gaps in this literature and in turn help advance the field. based on the conceptual framework of microaggression (sue, capodilupo, et al., 2007), existing narrative reviews (nadal et al., 2016; wong et al., 2014), and research syntheses concerning overt discrimination (e.g., pascoe & smart richman, 2009), we expected that there would be a small-to-moderate correlation between microaggression and adjustment outcomes. there have been numerous meta-analytic reviews concerning the link between perceived overt discrimination and psychological adjustment and physical health outcomes (jones, peddie, gilrane, king, & gray, 2016; jones et al., 2017; lee & ahn, 2012; pascoe & smart richman, 2009); our quantitative estimate would allow us to determine whether psychological and physical adjustment outcomes were more or less closely related to microaggression than overt discrimination. additionally, we expected the relations between microaggression and adjustment outcomes to be stronger for internalizing problems than externalizing problems and physical health symptoms, and that microaggression at the interpersonal level would be more closely linked to adjustment outcomes than at the group level. comparing the study effects across adjustment outcomes and microaggressions targeting different social groups can unveil the complexity of this form of subtle discrimination. finally, we hypothesized that there would be a stronger correlation between microaggression and adjustment outcomes in studies focusing on people with multiple marginalized social group memberships (e.g., lgbtq people of color) than people with one marginalized group membership. in addition to these a priori moderators, we also explored other methodological and individual characteristics such as microaggression categories and measures, age, gender, race, and lgbtq identifications as possible moderators. findings would shed light on factors that contributed to the between-study vari-  ability, and help inform new research questions surrounding microaggression. considering that this was the first research synthesis on microaggression and adjustment outcomes, we included both published and unpublished completed studies from various countries.2 this not only presented a comprehensive review of all available research to date, but also provided an opportunity to test possible publication bias that might favor larger and statistically significant findings.  method procedures in terms of literature searches, inclusion and exclusion criteria, coding parameters, and overall data analytic plan were preregistered with prospero international prospective register of systematic reviews.  literature search and screening we used a number of literature search methods to identify relevant research reports.3 across these methods, we collected research records and managed them using zotero, and then exported the search database into ms excel for screening and coding purposes. first, a computerized literature search was conducted using psycinfo and google scholar. we collected research reports from peer-reviewed journal articles, book chapters, and unpublished master’s theses/doctoral dissertations available from these search engines. keywords used in these searches were microaggressionⴱ, subtle discrimination, covert discrimination, and subtle racism. searches were conducted on june 1–2, 2017, and yielded 687 records. second, during june 2017 and again february 2018, we conducted backward searches to identify other articles cited in narrative reviews and articles that were already retrieved. third, we manually searched research records that were available online but not yet in print in major diversity-focused journals. these journals were asian american journal of psychology, cultural diversity and ethnic minority psychology, hispanic journal of behavioral sciences, journal of black psychology, journal of counseling psychology, journal of latino/a psychology, journal of lgbt youth, psychology of men and masculinity, and psychology of sexual orientation and gender diversity. the manual searches added 15 research records to our ms excel spreadsheet. fourth, we conducted auxiliary searches during july and august,  2 we had initially included only studies that examined microaggression among marginalized groups in the u.s., because historical, sociopolitical, and intergroup contexts differ across countries. at the request of a reviewer, we added non-u.s. studies to capture a broader research synthesis on this topic. 3 there are a number of methods for identifying published and unpublished sources of information in research syntheses. the most common sources of published data are peer-reviewed journals from search engines, edited books, references from previous reviews, and manual searches of printed journals (swift & wampold, 2018). sources of unpublished materials vary: “grey literature” is typically represented in doctoral dissertations/master’s theses, and “grey information” can be reflected in conference proceedings, working papers by researchers, unpublished data, government documents, and social media posts (adams et al., 2017).  
  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  microaggression and adjustment outcomes  2018 to identify unpublished, grey information.4 we systematically identified 30 researchers as experts in this content area. these researchers had been primary or senior authors of published research articles that were collected during the primary searches. among individuals whom we contacted, one e-mail message was undelivered, and nine researchers provided a response. three of these nine researchers reported that they had unpublished data available for sharing. finally, we solicited grey information on the listserv of the society for the psychological study of culture, ethnicity, and race. our auxiliary searches added four research articles possibly eligible for the meta-analysis. all of these search efforts yielded 706 articles spanning 1960 –2018 for further considerations.5 inclusion criteria for the initial screening were: peer-reviewed articles, book chapters, or master’s theses/doctoral dissertations that were written in english, employed a quantitative or mixedmethods design that yielded effect size information linking microaggression and adjustment outcomes. we included studies in which authors operationalized microaggression as a subtle form of discrimination (e.g., administered a scale measuring self-reported experiences with microaggression, or subjected participants to microaggression incidents in a controlled laboratory environment), and measured individual adjustment outcomes. whereas broad, nonspecific scales assessing unfair treatment or discrimination (e.g., the everyday discrimination scale) were not considered theory-driven measures of microaggression, validated survey instruments (e.g., the racial microaggressions scale or the sexual orientation microaggression inventory) or other scales constructed for a specific study were deemed appropriate as long as the authors operationalized them as measures of microaggression. similarly, we included any individual adjustment outcomes with the intent of capturing all relevant research reports. studies that only examined the relations between microaggression and interpersonal adjustment (e.g., social support, quality of relationships, and therapeutic alliance) were excluded. screening occurred at two stages, first using article titles and abstracts, and second by carefully reviewing the full research reports. in cases where multiple research articles used the same group of participants, we included the first available article to avoid duplicating samples in our meta-analysis. additionally, in cases where the same dataset was used in both a published research report and an unpublished dissertation, we coded information from both sources. two coders independently screened all research records obtained from the literature database for their suitability to be included in this study. the intercoder reliability was adequate (91.67% proportion of agreement; .80 accounting for agreement by chance). disagreements regarding the exclusion of research reports were resolved through discussion. seventy-three research reports met our inclusion criteria, but 10 of them did not contain zero-order effect size information for coding. we contacted the corresponding authors of these articles via e-mail, and requested that they provide us with the relevant effect sizes. a total of 72 independent study samples from 65 research reports contained sufficient study and effect size information to be included in our meta-analysis. figure 2 summarizes the procedures in the literature search and screening based on the preferred reporting items for systematic reviews and metaanalyses (prisma) checklist.  51  coding a detailed coding scheme was developed collaboratively by the authors, and finalized through an iterative trial coding process (lipsey & wilson, 2001; wilson, 2009). the coding scheme included qualitative and numeric information in an excel spreadsheet. the coding protocol allowed flexibility in recording study information that was inconsistently reported across articles (e.g., some studies reported the percentages of lesbians and gays separately, but other studies reported the percentage of lgbt individuals altogether). we coded the following study-level information: title of research report, author(s), year of publication/research report, publication status, grant funding source(s), country of sampling, study design, measures of microaggression, and measures of adjustment outcomes. we also coded a number of participant-level information, including sample size, sample mean age, percentage of women, percentage(s) of transgender and lgb participants, percentage of foreign-born participants, and education attainment. most studies in this literature reported zero-order correlations. in addition to pearson’s correlation coefficients linking adjustment outcomes and microaggression, we also coded other effect size indicators such as mean differences in participants’ adjustment outcome scores in a microaggression condition versus a control condition. the second author coded all research reports and entered them into the excel spreadsheet. throughout the screening process, a random sample of the studies (10% of the included research reports) were selected and double coded by the first author, and any discrepancies were discussed and resolved among the authors to ensure intercoder reliability (wilson, 2009). the first author then transformed the same information from the excel coding protocol into a comprehensive meta-analysis (cma) v3 data file (borenstein, 2014).  data analysis overall effect size estimation and identification of heterogeneity. we conducted analyses using information in the cma data file. to compute a weighted mean correlation between microaggression and adjustment outcomes, all effect sizes retrieved from the research reports or their authors were coded in such a way that positive associations indicated that greater microaggression experiences were linked to greater adjustment problems. the effect sizes linking microaggression and positive affect and positive adjustment outcomes were reverse coded in estimating the omnibus summary effect size. various types of effect sizes were first converted into z scores for calculations, which were then converted back into pearson’s r coefficient for interpretation. we used a random-effects model to calculate the weighted mean correlation (lipsey & wilson, 2001). additionally, we tested between-study heterogeneity in several ways. first, cochran’s q was computed to show the distribution of observed correlation effects in the meta-analysis and determine whether the betweenstudy variability was greater than what would be expected from sampling error. second, 2 was computed to quantify the between4 although not specified in our preregistered research plan, we were recommended by a reviewer to survey grey information by soliciting unpublished data from experts in this field and relevant academic listservs. 5 readers interested in the list of recruited research reports can request this information from the first author.  
  lui and quezada  52 primary search: 687 records of peerreviewed journal articles, book chapters, theses/dissertations identified through computerized database searches  additional search: 15 articles identified through other sources (i.e., online-first publications, studies cited in alreadyidentified articles or narrative reviews)  auxiliary search: 4 unpublished studies identified by contacting content experts and soliciting grey information on an academic listserv  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  initial screening: 127 peer-reviewed journal articles, doctoral dissertations, and unpublished manuscripts passed initial screening after review of the study titles and abstracts  secondary screening: 73 research articles passed secondary screening after careful review of the full manuscripts and details about the study 63 articles reported effect sizes for meta-analysis 10 articles did not report zero-order effect sizes  duplicated records and studies that were unrelated to covert discrimination or microaggression were excluded.  studies that did not measure both adjustment and microaggression were excluded.  studies without usable zero-order effect size information were excluded. inclusion for meta-analysis: 72 independent samples (across 65 research reports) with effect size information  figure 2. prisma flowchart summarizing the processes involved in literature search, screening, and inclusion to the present research synthesis and meta-analysis.  study variance of the true effect sizes. was expressed in the same standardized correlation scale as the summary effect. third, we estimated i2 to indicate the proportion of variance in the observed effect sizes that would be attributable to any true effect variations in the population. i2 value of 25%, 50%, and 75%, respectively suggests a low, moderate, and high proportion of dispersion in the observed correlations that would remain should sampling error be removed (borenstein, higgins, hedges, & rothstein, 2017). lastly, we computed a prediction interval to evaluate the dispersion of the true effect sizes (borenstein, hedges, higgins, & rothstein, 2009). larger prediction interval would indicate that the true correlation varies widely from one study to the next. dependence of within-study effects and sensitivity analysis. each study sample could generate multiple effect sizes concerning the relations between microaggression and adjustment outcomes, and therefore these within-study effects were dependent from each other. for example, studies tended to include multiple adjustment outcomes (e.g., depression, health risk behavior, and self-esteem) using the same sample. selecting one effect size indicator from each study sample could resolve the dependency issue (lipsey & wilson, 2001), but this strategy might introduce biased selection and risk skipping out on valuable information about the association of interest. in a standard univariate meta-analysis, within-study effect sizes would be averaged into one synthetic arithmetic-mean study-level estimate without considering the fact that within-study effects were correlated with each other. this conventional strategy could underestimate the standard error of these estimates and possibly overestimate the precision of study-level effects (borenstein et al., 2009; hedges, 2009; hedges, tipton, & johnson, 2010; marin-martinez & sanchez-meca, 1999). because the correlational structure underlying within-study effects was unknown like in most studies, we conducted a series of multivariate meta-  analyses with robust variance estimation (rve) to explore how the summary effect size might be affected when the correlation among within-study effects ( ) ranged from 0.0 to 1.0 (hedges et al., 2010). the variance-adjusted composite study-level effects were compared against those from the univariate meta-analysis in a series of sensitivity analyses. moderation analyses. we used a mixed-effects model to test the extent to which different participant and study-level variables accounted for the between-study variability in the correlations between microaggression and adjustment outcomes. a mixedeffects model assumes that there are systematic common effects across subgroups of studies (e.g., internalizing vs. externalizing problems) and that the effects within subgroups follow a normal distribution (borenstein et al., 2009; lipsey & wilson, 2001). meta-regression analyses were used to examine the extent to which study methodological and participant factors explained between-study variability. we conducted meta-regression analyses using metafor and clubsandwich packages in r, which computed standard errors using rve. given that we were interested in whether each possible moderating variable would explain some portion of the between-study variability, we examined one variable in each meta-regression model. additional sensitivity analyses and tests of publication bias. similar to any research syntheses, the presence of publication bias poses a risk to the validity of our results (rothstein, 2008). assuming that statistically significant or larger effect sizes are usually more likely to be published than nonsignificant or smaller effect sizes,6 a number of analyses were used to detect publication 6 there also have been examples showing that unpublished studies yielded larger effect sizes than published studies (e.g., pallini et al., 2018).  
  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  microaggression and adjustment outcomes  bias (borenstein et al., 2009; greenhouse & iyengar, 2009; sutton, 2009). to the extent that microaggression is a subtle form of discrimination, and often discussed in the context of— or in contrast to— overt discrimination, we only recruited research reports on microaggression to synthesize and evaluate empirical evidence on this topic. although experimental and correlational research tended to yield effect sizes using different metrics, the exclusion of experimental studies in this meta-analysis would limit our coverage of this synthesis. including correlational and experimental research would present an opportunity to evaluate the state of the science. we intentionally and systematically collected completed studies across various outlets (e.g., peer-reviewed journals, edited books, theses/dissertations, and unpublished data from expert researchers). we included unpublished data because many individuals who conduct research during graduate training may not be interested in pursuing a research career and submitting their work for publication, and because dissemination of results in peerreviewed journals can take a long time. to quantify how our research procedures could affect our results, we used several exploratory data analytic techniques. first, we used moderation analysis to test whether published and unpublished studies differed in their study-level effect sizes. second, we used a stem-and-leaf plot, funnel plots of precision, and forest plots to visualize the distribution of study effect sizes. the studylevel correlations between microaggression and adjustment outcomes were sorted into numeric order. the typical values, shape of the distribution, and any gaps or atypical values were identified in the stem-and-leaf plot (greenhouse & iyengar, 2009; lipsey & wilson, 2001). the fisher’s z-scores and precision (inverse of the standard errors) for each study sample were displayed in a funnel plot. symmetry in the funnel plot would signal that sampling error was random, and that larger effect sizes were no more likely to be published than smaller effect sizes. given the subjective nature of these graphical assessments, we used other statistical tests to evaluate the degree to which this meta-analysis might be affected by publication bias. third, we used the fail-safe n approaches to determine how many missing studies would reduce the overall effect size to a trivial correlation. both classical and orwin’s methods were implemented to estimate the number of file-drawer studies required to nullify the summary effect between microaggression and adjustment outcomes. finally, the egger’s linear regression test and the duval and tweedie’s trim-and-fill test were used to quantify the possible impact of publication bias on our meta-analytic findings. the egger’s test uses precision to predict the standardized effect size, as reflected by the slope of the regression line on the funnel plot. if the intercept (b0) of the regression line is not statistically significantly different from zero, the test suggests no publication bias. by contrast, if the regression intercept is statistically significantly different from zero, a positive value indicates that larger studies are associated with larger effects. the egger’s test has been shown to have low power for small or medium-sized meta-analyses; therefore, we considered p .10 per convention (rothstein, 2008). the trim-and-fill test uses an iterative procedure to estimate effects from hypothetically missing studies to create a symmetrical funnel plot and yield a new, adjusted effect size (van assen, van aert, & wicherts, 2015). using cumulative analyses, we inspected  53  the graphical presentation of study effects to detect possible mechanisms for publication bias. we organized forest plots by sample size, chronological order of publication, and with the one-studyremoved method. corresponding shifts in the effect size estimates would suggest publication bias when small samples and/or more recently published studies were added to the database, and/or when any influential studies were removed from the meta-analysis.  results sample characteristics table 1 summarizes details of each study sample included in this meta-analysis, and table 2 summarizes descriptive statistics of our study samples. studies were identified in peer-reviewed journals, a thesis/dissertation depository, and shared with us during 2017–2018. our 72 independent study samples yielded a total of 349 coded effect size indicators. on average, each study yielded 4.97 effect size estimates (mode 2). the present data came from 18,718 participants (n ranged from 51 to 1,207) and included participants with a median mage of 24.73 years. the median percent of women in these samples was 61.5%. many samples recruited college students (undergraduate or graduate students); this may be a function of convenience sampling, as well as purposive sampling to examine microaggression occurring in higher education (e.g., clark, mercer, zeigler-hill, & dufrene, 2012; torres, driscoll, & burrow, 2010). approximately two-thirds of the study samples were published in peer-reviewed journals. most studies took place in the united states (k 62), and others in india, the netherlands, south africa, and spain (k 10). racial microaggression was the most frequently studied motivation for subtle discrimination (e.g., ajayi & syed, 2014; hu & taylor, 2016; thai, lyons, lee, & iwasaki, 2017; torres et al., 2010), followed by lgbtq microaggression (e.g., kulick, wernick, woodford, & renn, 2017; swann, minshew, newcomb, & mustanski, 2016; woodford, joslin, pitcher, & renn, 2017). there were five study samples examining health status microaggression (e.g., conover, 2015; perez-garin, molero, & bos, 2015) and only one examining gender microaggression (prather, 2015). finally, three study samples considered microaggression among people with multiple marginalized identities (racial/gender microaggression, lewis & neville, 2015; racial/lgbtq microaggression, balsam et al., 2011 and thomas, 2015).  weighted mean correlation figure 3 shows the univariate effect size estimates and their 95% confidence intervals of our 72 study samples, as well as the weighted mean correlation between microaggression and adjustment outcomes. using the standard meta-analysis approach, we found a statistically significant summary effect, r .20 (95% ci [.16, .23]), z 12.23 p .001. table 3 summarizes these statistics with 3 decimal places. consistent with our hypothesis, the summary correlation between microaggression and adjustment outcomes fell in the small range. the confidence intervals showed that the true association between microaggression and adjustment outcomes was unlikely to be zero, and the narrow confidence intervals showed precision in this summary effect size estimate.  between-study heterogeneity as expected, the present data showed a statistically significant and large degree of between-study variability, q(71) 319.86, p .001,  
  lui and quezada  54  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  table 1 characteristics and effect size information of study samples included in the meta-analysis (k 72) study  n  mage  %f  ctry  race  lgbtq  pub  design  ajayi and syed (2014) balsam, molina, beadnell, simoni, and walters (2011) bowleg et al. (2016) choi, lewis, harwood, mendenhall, and huntt (2017) clark, mercer, zeigler-hill, and dufrene (2012-s1) clark et al. (2012-s2) conover (2015) deitz (2015) demianczyk (2015) estrada (2016) fay (2015) garcia (2013) greenfield (2015) helm (2013) hernandez (2014) hollingsworth et al. (2017) hu and taylor (2016) huynh (2012)  295  18.02  61.7  usa  m  n/a  y  c  racial  imabi  bsi/swls  .16ⴱ  297 578  33.00 28.83  50.2 .0  usa usa  m b  lgbtq n/a  y y  c c  racial/lgbtq racial  lgbt-pcms bmes  cesd/pss phq-9  .16ⴱ .23ⴱ  353  21.00  46.0  usa  a  n/a  y  c  racial  rmhes  cesd  .44ⴱ  87 313 833 233 418 86 243 139 347 234 681 135 449 360  26.64 26.64 34.30 42.30 21.51 38.00 39.46 34.47 28.45 nr 20.10 19.45 31.97 17.18  84.0 84.0 52.7 48.5 69.1 57.0 100.0 85.6 65.1 68.4 71.7 56.3 69.9 57.0  usa usa usa usa usa usa usa usa usa usa usa usa usa usa  m m m m m h b m nr b m b m m  n/a n/a n/a lgb n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a  y y n n n n n n n n n y y y  c c c c c c c c c c c c c c  racial racial health status lgbtq racial racial racial racial racial racial racial racial racial racial  imabi imabi ams hms rems rmas imabi rems mas rems rmas rmas rmas ema  bsi bsi/pss cesd/pss pwbs/swls bai/bdi/rapi/staxi hp/pss gad-7/phq-9 rses atlfb/cage-aid bdi/rses bsi/panas/swls hdsq-ss cesd/pss cesd/physical complaints/ pss/staxi  .22ⴱ .08 .26ⴱ .16ⴱ .13ⴱ .10 .24ⴱ .05 .07 .25ⴱ  .02 .06 .28ⴱ .20ⴱ  280 281  20.3 19.43  63.7 66.9  usa usa  m a  n/a n/a  n n  c c  racial racial  ema sabra2  bmi/happiness/osdus/pms assist/cses/dass/qol  .15ⴱ .20ⴱ  170 71  31.65 31.65  13.7 13.7  sa sa  n/a n/a  n/a n/a  y y  c c  racial racial  srs srs  psi psi  .24ⴱ .28ⴱ  447  nr  nr  usa  n  n/a  y  c  racial  mds  pain/smoking  .13ⴱ  77 190 143  17.61 17.61 20.12  .0 100.0 76.2  nl nl usa  n/a n/a m  lgb lgb n/a  y y y  c c c  lgbtq lgbtq racial  somi somi rems  dml dml mhi  .42ⴱ .32ⴱ .24ⴱ  156  19.61  67.3  usa  a  n/a  y  c  racial  rems  mhi  .28ⴱ  111 349  22.50 23.09  45.0 56.7  usa usa  m w  lgbtq lgbtq  y y  c c  lgbtq lgbtq  lgbqmcs lgbqmcs  phq-9 phq-9  .26ⴱ .25ⴱ  72 210 126 158 472 164 213 170  12.10 37.69 30.20 23.90 22.70 23.00 23.00 46.96  68.1 100.0 79.0 70.3 43.4 62.8 58.2 34.7  usa usa usa usa usa usa usa eg  b b b a a b h n/a  n/a n/a n/a n/a n/a n/a n/a n/a  y y y n n n n y  c c c c c c c c  racial racial/gender racial racial racial racial racial health status  dle rems grms imabi aarms r28rems r28rems r28rems mspd  cesd/rses mhi dass swls/panas audit/k6/phq-4 audit/k6/phq-4 audit/k6/phq-4 hads  .32ⴱ .25ⴱ .28ⴱ .13ⴱ .26ⴱ .12 .13 .37  111  43.99  66.7  eg  n/a  n/a  y  c  health status  mspd  panas/sf-36  .20ⴱ  72 115  42.73 20.80  65.3 100.0  eg usa  n/a b  n/a n/a  y n  c c  health status racial  mspd imabi  panas dass/srs  .28ⴱ .24ⴱ  385 175  21.37 46.00  83.0 66.9  usa usa  b h  n/a n/a  y n  c c  racial racial  imabi rems  bsi/panas/pss bsi/stai  .24ⴱ .33ⴱ  506  24.83  74.1  usa  m  n/a  y  c  racial  rems  mhi   .09ⴱ  277 77 405  24.8 25.00 19.65  75.5 71.4 61.48  usa usa usa  m b m  n/a n/a n/a  y n y  c c c  racial racial racial  rems imabi rmas  randsf panas/swls cesd/hdsq-ss   .04 .14ⴱ .17ⴱ  152 213 81 328 142 320  18.14 43.03 19.63 30.80 19.32 30.00  42.8 40.0 100.0 72.9 63.0 52.5  usa eg usa usa usa nl  a n/a m m b n/a  n/a n/a n/a n/a n/a n/a  y y n n n y  c c e c c c  racial health status gender racial racial racial  other mspd n/a rems dle other  panas/physical symptoms panas/pwbs/slds bp/hr/panas mhi/srph cesd/pss swls  .32ⴱ .16ⴱ .03  .11ⴱ .03 .12ⴱ  497  nr  50.0  usa  m  t  y  c  lgbtq  lgbqmcs/other  rses  huynh, majeno, and gilleno’neel (2018) jackson (2015) jackson, van de vijver, and burckard (2011-s1) jackson et al. (2011-s2) johnson-jennings, belcourt, town, walls, and walters (2014) kaufman, baams, and dubas (2017-s1) kaufman et al. (2017-s2) kim (2017) kim, kendall, and cheon (2017) kulick, wernick, woodford, and renn (2017-s1) kulick et al. (2017-s2) lanier, sommers, fletcher, sutton, and roberts (2017) lewis and neville (2015) liao, weng, and west (2016) lin (2011) lui (2018-s1) lui (2018-s2) lui (2018-s3) magallares et al. (2017) magallares, benito de valle, irles, and jauregui-lobera (2014) magallares, luna, garriga, botella-carretero, and morales (2016) marks (2015) mercer, zeigler-hill, wallace, and hayes (2011) moore (2012) nadal, griffin, wong, hamit, and rasmus (2014) nadal, griffin, wong, davidoff, and davis (2017) nealious (2016) o’keefe et al. (2015) ong, burrow, fuller-rowell, ja, and sue (2013) perez-garin et al. (2015) prather (2015) rivera (2012) roberts (2013) schaafsma (2011) seelman, woodford, and nicolazzo (2017)  social group  ma measure  adjustment measure  r  .29ⴱ  
  microaggression and adjustment outcomes  55  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  table 1 (continued) study  n  mage  %f  ctry  race  lgbtq  pub  design  social group  ma measure  adjustment measure  r  sohi and singh (2015) swann, minshew, newcomb, and mustanski (2016) thai, lyons, lee, and iwasaki (2017) thomas (2015) timmins, rimes, and rahman (2017) torres and taknint (2015) torres, driscoll, and burrow (2010) torres, yznaga, and moore (2011) wegner (2014) whicker (2016) williams (2014) wilson (2014) woodford, kulick, sinco, and hong (2014) woodford, chonody, kulick, brennan, and renn (2015) woodford, paceley, kulick, and hong (2015) woodford, joslin, pitcher, and renn (2017) wright and wegner (2012) yoo, steger, and lee (2010-s1) yoo et al. (2010-s2)  214  23.52  50.9  in  n/a  n/a  y  c  racial  rmas  mhc-sf  .24ⴱ  363  nr  .0  usa  m  lgb  y  c  lgbtq  somi  aseba-asr  .19ⴱ  87 99  23.83 33.00  59.8 45.5  usa usa  a b  n/a lgb  y n  c c  racial racial/lgbtq  rems lgbt-pcms  cses/rses swls  .20 .29ⴱ  1207 113  28.50 34.00  31.2 59.3  usa usa  m h  t n/a  y y  c c  lgbtq racial  gsmms rems  gad-7/ons-wb/phq-9 cesd/pss  .35ⴱ .34ⴱ  107  30.44  87.9  usa  b  n/a  y  c  racial  other  cesd/pss  .34ⴱ  397 302 179 268 51  31.20 30.76 34.56 36.1 24.65  74.6 45.0 .0 75.4 52.9  usa usa usa usa usa  h m m b b  n/a lgb lgb n/a n/a  y n n n n  c c c c e  racial lgbtq lgbtq racial racial  prsl hms hms rems n/a  bsi rses dass/swls mhi/phq-9 bp/hr  .24ⴱ .10ⴱ .27ⴱ .04 .17  299  24.00  57.2  usa  m  lgb  y  c  lgbtq  lgbqmcs  gad/pss  .27ⴱ  580  23.00  54.0  usa  m  lgb  y  c  lgbtq  lgbqmcs  phq-9  .27ⴱ  187  21.00  54.5  usa  m  lgb  y  c  lgbtq  emas  gad-7/rses  .16ⴱ  152 120 155 193  23.00 34.00 nr 20.00  nr 44.0 nr 45.6  usa usa usa usa  m m a a  t lgb n/a n/a  y y y y  c c c c  lgbtq lgbtq racial racial  emas hms sabra2 sabra2  phq-9 rses rses dass   .23ⴱ .37ⴱ .23ⴱ .30ⴱ  note. nr not reported. n/a not applicable. %f percent of women in the sample. ctry study’s country of origin: eg spain, in india, nl netherlands, sa south africa, usa united states. race racial groups in the sample (only applicable to u.s. studies): a asian americans, b black/african americans, h hispanic/latinx americans, m multiple groups or unspecified, n native american/american/indians, w white/euro american. lgbtq sexual orientation or gender identity of participants in the sample: (only applicable to lgbtq microaggression studies): lgb cisgender lesbian, gay, or bisexual individuals, t transgender individuals, lgbtq lesbian, gay, bisexual, transgender, or queer individuals. pub published (y) or unpublished (n) research data. design correlational survey (c) or experimental research design (e). social group microaggression motivated by gender, health status, lgbtq, and/or racial biases. ma measure methods of measuring or manipulating experiences with microaggressions: ams ableist microaggressions scale; aarms asian american racial microaggressions scale; bmes black men’s experiences scale; dle daily life experiences scale; ema ethnic microaggression scale; emas distal and proximal environmental microaggression scale; grms gender microaggression scale; gsmms gender and sexual minority microaggressions scale; hms homonegative microaggression scale; imabi inventory of microaggressions against black individuals; lgbqmcs lgbq microaggression on campus scale; lgbt-pcms lesbian, gay, bisexual, transgender-people of color microaggression scale; mas microaggression scale; mds microaggression distress scale; mspd multidimensional scale of perceived discrimination; prsl perceived racism scale for latinos; rems racial and ethnic microaggression scale; rmas racial microaggression scale; rmhes racial microaggression in higher education scale; sabra2 subtle and blatant racism scale for asian americans; somi sexual orientation microaggression inventory; srs subtle racism scale. adjustment measure: atlfb alcohol timeline follow-back; aseba-asr achenbach system of empirically based assessment-adult self-report; assist alcohol, smoking and substance involvement screening test; audit alcohol use disorder identification test; bai beck anxiety inventory; bdi beck depression inventory; bmi body mass index; bp mean arterial pressure; bsi brief symptom inventory; cage-aid cage adapted to include drugs; cdi children’s depression inventory; cesd center for epidemiologic studies-depression scale; cses collective self-esteem scale; dass depression anxiety stress scale; dml depressive mood list; hads hospital anxiety and depression scale; hdsq-ss hopelessness depressive symptoms questionnaire-suicidality scale; hp hypertension ratings; hr heart rate; hscl hopkins symptom checklist; k6 kessler psychological distress scale; mhc-sf mental health continuum-short form; mhi mental health inventory; mwa multidimensional well-being assessment; ons-wb uk office of national statistics well-being measure; osdus ontario student drug use survey; panas positive affect and negative affect schedule; pdsq psychiatric diagnostic screening questionnaire; phq-4/phq-9 patient health questionnaire; pms profile of mood states, anxiety and depression subscales; psi physical symptoms inventory; pss perceived stress scale; pss-sr post-traumatic stress disorder symptom scale-self report; pwbs psychological well-being scale; qol world health organization quality of life scale; rand-sf rand short form health survey; rapi rutgers alcohol problem index; rses rosenberg self-esteem scale; sf-36 short form-36; slds satisfaction with life domains scale; srs sexual risk survey; srph self-reported global physical health; stai state-trait anxiety inventory; staxi state-trait anger expression inventory; swls satisfaction with life scale. r study-level univariate correlation between microaggression and adjustment outcomes. ⴱ p .05.   2 .013, i2 77.80% (see table 3). the q statistic rejected the null hypothesis that all studies shared a common true effect size. the i2 statistic indicated that a large proportion of the observed variance in the relation between microaggression and adjustment outcomes was attributable to variances in the true effects rather than sampling error. the prediction interval for the correlation of interest was .03 to .40: results from 95% of any future studies examining the bivariate associations between microaggression and adjustment outcomes would fall into this range. given the large prediction interval, it was important to identify for  whom and under what condition would microaggression be more and less closely associated with adjustment outcomes.  sensitivity analysis for effect size (non)dependence table 3 also summarizes the results from rve meta-analyses of the present data using ranging from 0.0 to 1.0. as expected, there was evidence that the univariate meta-analysis underestimated the between-study variance. our sensitivity analyses did not affect the summary correlation between microaggression and adjustment  
  lui and quezada  56  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  table 2 summary of descriptive information about the 72 study samples included in the meta-analysis sample characteristics  details  k n (range) median mage median % women data from published sources countries  72 18,718 (51–1,207) 24.73 years 61.5% 61.9% united states (k 62) spain (k 4) netherlands (k 3) south africa (k 2) india (k 1) racial (k 49) lgbtq (k 15) health status (k 5) gender (k 1) racial/lgbtq (k 2) racial/gender (k 1)  social groups being affected by microaggressiona  note. k number of studies. n sample size. a one study produced effect size indicators for both racial microaggression and racial/lgbtq microaggression.  outcomes, and the confidence and prediction intervals around the true effects were similar across plausible values of intercorrelations among within-study effects. overall, findings showed that the omnibus weighted mean correlation was not sensitive to the dependence of within-study effects.  moderator analyses study design. all but two studies used a correlational design to examine the relations between microaggression and adjustment outcomes. experimental studies manipulated participants’ exposure to microaggression in the laboratory to examine its effects on self-reported psychological or physiological responses (prather, 2015; wilson, 2014). experimental studies tended to examine event-specific consequences of microaggression (i.e., immediate responses to the treatment conditions), whereas correlational studies tended to examine global consequences (i.e., overall psychological or physical health outcomes; see sellers & shelton, 2003). our analysis did not reveal a statistically significant effect size difference between experimental and correlational studies (q 1.15, p .28). furthermore, the summary effect and its confidence intervals did not differ when we constrained our analysis to correlational studies only (k 70). to the extent that historical and sociopolitical contexts, and attitudes toward various marginalized groups can differ across countries, we limited our analysis to include only u.s. studies (k 62) and found very similar results, r .19 (95% ci [.15, .22]), z 10.69, p .001, q(61) 301.36, i2 79.76%, prediction intervals ranged from .05 to .40. in sum, the weighted mean correlation between microaggression and adjustment outcomes did not differ by research design; thus, we conducted subsequent analyses using all 72 study samples. adjustment outcomes. to evaluate whether the associations of interest differed by adjustment outcomes, we calculated the weighted mean correlations separately (see table 4). microaggression was statistically significantly correlated with all psychological adjustment but not physical adjustment. higher levels of microag-  gression were associated with greater internalizing problems (e.g., depression and anxiety; k 44), externalizing problems/health risk behaviors (e.g., alcohol use, smoking, gambling; k 8), self-reported stress/negative affect (e.g., psychological distress, anger; k 32), as well as lower levels of positive affect/adjustment (e.g., self-esteem, subjective well-being; k 29). microaggression was not associated with physical symptoms (e.g., selfreported somatization, heart rate; k 14). our univariate moderation analysis showed marginally significant effect size differences across adjustment outcomes. consistent with our hypothesis, the average association between microaggression and adjustment outcomes was the largest for internalizing problems, and the smallest for physical symptoms and externalizing problems/health risk behaviors. social groups, social levels, and microaggression categories in our integrated cube model. table 5 summarizes separate meta-analyses by social groups, social levels at which microaggression takes place, and categories of microaggression. with the exception for gender microaggression, racial, lgbtq, health status, racial/lgbtq, and racial/gender microaggressions were all statistically significantly correlated with adjustment outcomes. because racial and lgbtq microaggressions were the most frequently studied motivations, we constrained our analysis to those 64 study samples and found no statistically significant moderation effect by social group membership (q 2.29, p .13). most studies considered interpersonal-level microaggression alone (k 71), and only nine studies considered group-level microaggression, thus we conducted separate meta-analyses for interpersonal- and group-level microaggressions. consistent with our hypothesis, interpersonal microaggression yielded larger effects than group-level microaggression. with regard to microaggression categories, we coded various examples of microaggression incidents into microinsult, microinvalidation, and microassault based on sue’s taxonomy (2007). some measures already contained separate subscales for these categories, whereas others contained subscales that covered multiple examples (e.g., exoticization/assumptions of similarities; nadal, 2011). in the event that scales measured group-level microaggression or contained multiple examples, we coded those (sub)scales into the overall/unspecified category. most study samples included overall microaggression alone (k 54), whereas many others measured multiple categories of microaggression (k 17). to avoid conducting a standard univariate meta-analysis that might be biased by the intercorrelations among within-study effect sizes, and to allow optimal statistical power to consider microaggression category as a moderator, we conducted separate meta-analyses to estimate the summary effects concerning microinsult, microinvalidation, and microassault. studies that examined microinsult and microinvalidation yielded similar summary effects that were smaller than studies that examined overall/unspecified microaggression. by contrast, microassault yielded the largest summary effects than all other categories of microaggression. measurement of microaggression. table 6 presents a brief narrative review of all measures used to assess microaggression in our meta-analyzed studies. except for the distal and proximal environmental microaggression scale assessing lgbtq microaggression (which showed acceptable internal consistency reliability for research purposes), all established measures showed excellent to adequate reliability (cronbach’s alpha). there were more  
  microaggression and adjustment outcomes  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  study  statistics for each study  ajayi & syed (2014) balsam et al. (2011) bowleg et al. (2016) choi et al. (2017) clark et al. (2012-s1) clark et al. (2012-s2) conover (2015) deitz (2015) demianczyk (2015) estrada (2016) fay (2015) garcia (2013) greenfield (2015) helm (2013) hernandez (2014) hollingsworth et al. (2017) hu & taylor (2016) huynh (2012) huynh et al. (2018) jackson (2015) jackson et al. (2011-s1) jackson et al. (2011-s2) johnson-jennings et al. (2014) kaufman et al. (2017-s1) kaufman et al. (2017-s2) kim (2017) kim et al. (2017) kulick et al. (2017-s1) kulick et al. (2017-s2) lainer et al. (2017) lewis & neville (2015) liao et al. (2016) lin (2011) lui (2018-s1) lui (2018-s2) lui (2018-s3) magallares et al. (2014) magallares et al. (2016) magallares et al. (2017) marks (2015) mercer et al. (2011) moore (2012) nadal et al. (2014) nadal et al. (2017) nealious (2016) o'keefe et al. (2014) ong et al. (2013/2017) perez-garin et al. (2015) prather (2015) rivera (2012) roberts (2013) schaafsma (2011) seelman et al. (2017) sohi & singh (2015) swann et al. (2016-s2) thai et al. (2017) thomas (2015) timmins et al (2017) torres & taknint (2015) torres et al (2010) torres et al. (2011) wegner (2014-s2) whicker (2016) williams (2014) wilson (2014) woodford et al. (2014) woodford et al. (2015a) woodford et al. (2015b) woodford et al. (2017) wright & wegner (2012) yoo et al. (2010-s1) yoo et al. (2010-s2)  correlation  lower limit  upper limit  z-value  0.158 0.141 0.230 0.439 0.218 0.084 0.255 0.155 0.129 0.099 0.240 0.050 0.071 0.246 -0.022 0.058 0.283 0.202 0.150 0.198 0.240 0.280 0.125 0.420 0.320 0.240 0.284 0.263 0.247 0.321 0.248 0.280 0.128 0.259 0.115 0.125 0.196 0.284 0.370 0.235 0.236 0.327 -0.087 -0.041 0.136 0.168 0.323 0.159 0.029 -0.110 0.030 0.120 0.285 0.236 0.193 0.200 0.287 0.354 0.337 0.339 0.240 0.102 0.270 0.035 0.169 0.272 0.270 0.158 -0.230 0.372 0.230 0.297 0.195  0.044 0.061 0.151 0.351 0.008 -0.027 0.191 0.027 0.033 -0.115 0.118 -0.117 -0.035 0.122 -0.097 -0.112 0.196 0.101 0.033 0.083 0.093 0.050 0.033 0.216 0.186 0.079 0.133 0.081 0.146 0.096 0.117 0.111 -0.029 0.173 -0.038 -0.010 0.010 0.056 0.232 0.054 0.139 0.188 -0.173 -0.158 -0.091 0.072 0.173 0.025 -0.227 -0.216 -0.135 0.010 0.202 0.105 0.092 -0.011 0.095 0.304 0.163 0.159 0.145 -0.011 0.129 -0.085 -0.124 0.164 0.193 0.015 -0.375 0.207 0.075 0.163 0.164  0.267 0.219 0.306 0.520 0.410 0.193 0.318 0.278 0.222 0.304 0.355 0.215 0.175 0.363 0.053 0.225 0.366 0.299 0.263 0.308 0.377 0.482 0.215 0.589 0.442 0.389 0.422 0.429 0.343 0.514 0.371 0.434 0.279 0.341 0.264 0.255 0.369 0.484 0.493 0.401 0.328 0.454 -0.000 0.078 0.349 0.261 0.459 0.287 0.282 -0.002 0.194 0.227 0.363 0.359 0.290 0.394 0.459 0.402 0.491 0.497 0.331 0.212 0.401 0.154 0.435 0.374 0.344 0.295 -0.073 0.517 0.374 0.421 0.225  2.719 3.437 5.616 8.811 2.031 1.485 7.517 2.370 2.633 0.904 3.796 0.584 1.317 3.819 -0.570 0.668 6.146 3.868 2.514 3.342 3.164 2.373 2.649 3.851 4.535 2.896 3.610 2.803 4.691 2.762 3.651 3.191 1.604 5.738 1.472 1.815 2.060 2.424 5.020 2.535 4.704 4.459 -1.966 -0.673 1.176 3.407 4.089 2.323 0.221 -1.993 0.354 2.147 6.506 3.490 3.708 1.857 2.898 12.836 3.680 3.598 4.859 1.762 3.674 0.575 1.131 4.807 6.654 2.161 -2.859 4.227 2.887 4.220 12.234  57  correlation and 95% ci p-value 0.007 0.001 0.000 0.000 0.042 0.138 0.000 0.018 0.008 0.366 0.000 0.560 0.188 0.000 0.569 0.504 0.000 0.000 0.012 0.001 0.002 0.018 0.008 0.000 0.000 0.004 0.000 0.005 0.000 0.006 0.000 0.001 0.109 0.000 0.141 0.069 0.039 0.015 0.000 0.011 0.000 0.000 0.049 0.501 0.240 0.001 0.000 0.020 0.825 0.046 0.723 0.032 0.000 0.000 0.000 0.063 0.004 0.000 0.000 0.000 0.000 0.078 0.000 0.565 0.258 0.000 0.000 0.031 0.004 0.000 0.004 0.000 0.000 -0.70  -0.35  0.00  0.35  figure 3. forest plot summarizing the mean study-level correlations (pearson’s r) between microaggression and adjustment outcomes and their 95% confidence intervals (k 72). squares represent effect size estimates from individual study samples, and the diamond represents the weighted mean effect size estimated in a random-effects model. see the online article for the color version of this figure.  0.70  
  lui and quezada  58  table 3 effect size estimates from standard and robust variance estimation meta-analyses (k 72)  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  rve measure  standard   .0   .2   .4   .6   .8   1.0  r 95% ci z  2 q i2 prediction interval  .195ⴱ [.164, .225] 12.234 .013 319.858 77.803 [ .032, .403]  .196ⴱ [.166, .226] 12.400 .016 1431.722 95.041 [ .056, .424]  .196ⴱ [.166, .226] 12.557 .015 668.246 89.375 [ .047, .418]  .197ⴱ [.167, .226] 12.574 .014 500.928 85.826 [ .038, .412]  .197ⴱ [.166, .227] 12.418 .014 421.967 83.174 [ .039, .412]  .197ⴱ [.166, .227] 12.314 .014 374.495 81.041 [ .039, .412]  .197ⴱ [.166, .228] 12.261 .014 333.466 78.708 [ .039, .412]  note. rve robust variance estimation. 95% ci 95% confidence intervals around the weighted mean correlation. all analyses were computed in a random-effects model. p .05.  ⴱ  measures of racial and lgbtq microaggressions than other types of microaggressions. in terms of racial microaggression, the most frequently used measures were the original racial and ethnic microaggressions scale (rems; k 12), the inventory of microaggressions against black individuals (imabi; k 8), and the racial microaggressions scale (rmas; k 6). among other measures of racial microaggression, the perceived racism scale for latinos (prsl; k 1), the subtle and blatant racism scale for asian americans (sbra2; k 2), and the racism and life experiences scale (rles; k 1) contained subscales tapping both subtle and overt discrimination. in terms of lgbtq microaggression, the most frequently used measures were the lgbq microaggression on campus scale (lgbqmcs; k 5) and the homonegative microaggressions scale (hms; k 4). to examine whether the choice of measures affected the relations between adjustment outcomes and racial microaggression, and lgbtq microaggression, we conducted separate metaregression analyses with rve correction ( .70). in each metaregression, measures were dummy coded and the most frequently used scale was treated as the reference group. as shown in table 7, various survey measures did not explain between-study variability in the correlations between adjustment outcomes and racial microaggression, f 1.30, p .31 and lgbtq microaggression, f .60, p .58. participant factors. table 7 also summarizes the metaregression results concerning moderation by participant factors. tested as a continuous variable in a meta-regression model, sample mean age did not explain the between-study variations in effect  sizes (b .002, f .98, p .33). gender was examined as a continuous variable using study-level percentage of women in a meta-regression model. percentage of women statistically significantly explained the between-study variability in the effects (b .001, f 4.54, p .05). each one percent decrease in women in the samples corresponded with an increase in the studylevel effect size by approximately .0013 standard unit of correlation, suggesting that the associations between microaggression and adjustment outcomes might be stronger in studies with more men than women. we also explored whether college student status moderated the association between microaggression and adjustment outcomes. results did not show that college student status explained between-study variability in the effect size estimates, f .05, p .83. considering racial (or racial/lgbtq, racial/gender) microaggression in the united states, many studies contained samples with racially diverse participants (k 30). there were more samples with exclusively black americans (k 15), asian americans (k 9), and hispanic americans (k 5) than native americans/ american indians (k 1) or white americans (k 2). racial group membership statistically significantly moderated the relation between racial microaggression and adjustment outcomes, f 7.33, p .003. compared with white americans, the correlation effects were larger in studies that focused on asian americans, followed by black and hispanic americans. considering studies that focused on lgbtq (or racial/lgbtq) microaggression, there were more studies on cisgender lgb individuals (k 10) than transgender individuals (k 3) and nonspecified lgbtq individ-  table 4 weighted mean correlations between microaggressions and five adjustment outcomes adjustment outcome  k  r  95% ci  z  p  q(df)   2  i2  internalizing problems externalizing problems/health risk behaviors (di)stress/negative affect positive adjustment/positive affect physical symptoms  44 8 32 29 14  .240ⴱ .123ⴱ .187ⴱ  .171ⴱ .087  [.202, .278] [.054, .190] [.113, .258] [ .208, .133] [ .087, .175]  11.847 3.488 4.931 8.706 1.912   .001  .001  .001  .001 .056  209.970ⴱ (43) 64.926 (7) 408.133ⴱ (31) 71.087ⴱ (28) 74.684ⴱ (13)  .014 .006 .042 .006 .022  79.521 64.926 92.404 60.612 82.593  note. weighted mean correlations computed using standard univariate meta-analysis. k number of study samples. 95% ci 95% confidence intervals around the weighted mean correlation effect. one study produced effect size indicators for both racial microaggression and racial/lgbtq microaggression. moderation analyses using a mixed-effects model showed that the difference in effect size estimates across adjustment outcomes was marginally significant (q 10.60, p .06). ⴱ p .05.  
  microaggression and adjustment outcomes  59  table 5 weighted mean correlations between microaggression and adjustment outcomes across social groups, social levels, and categories of microaggression  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  variable social group racial lgbtq health status gender racial/lgbtq intersection racial/gender intersection social level interpersonal group microaggression category overall/unspecified microinsult microinvalidation microassault  k  mean r  95% ci  z  p  q(df)   2  i2  49 15 5 1 2 1  .175ⴱ .232ⴱ .252ⴱ .029 .230ⴱ .248ⴱ  [.138, .212] [.167, .295] [.186, .316] [ .227, .282] [.134, .321] [.117, .371]  9.117 6.855 7.274 .221 4.615 3.651   .001  .001  .001 .825  .001  .001  202.376ⴱ (48) 70.612ⴱ (14) 7.274 (4) — .492 (1) —  .013 .013 .002 — — —  76.282 80.173 24.808 — — —  71 9  .199ⴱ .155ⴱ  [.168, .230] [.062, .246]  12.280 3.245   .001 .001  322.854ⴱ (70) 44.430ⴱ (8)  .014 .016  78.318 81.994  66 18 13 2  .198ⴱ .141ⴱ .142ⴱ .231ⴱ  [.166, .231] [.092, .190] [.075, .207] [.156, .303]  11.692 5.529 4.127 5.925   .001  .001  .001  .001  323.949ⴱ (65) 41.812ⴱ (17) 43.943ⴱ (12) .784 (1)  .015 .006 .011 —  79.935 59.342 72.692 —  note. weighted mean correlations computed using standard univariate meta-analysis. k number of study samples. 95% ci 95% confidence intervals around the weighted mean correlation effect. moderation analyses using a mixed-effects model showed statistically nonsignificant differences in the summary effects across social groups (q 9.98, p .13), social levels (q 1.09, p .58), and categories of microaggression (q 4.40, p .11). ⴱ p .05.  uals (k 2). there was not a statistically significant difference in the relation between lgbtq microaggression and adjustment outcomes across lgbtq subgroups, f .13, p .89.  exploratory analyses: microaggression versus overt discrimination quantitative results. among all study samples that assessed the relations between microaggression and adjustment outcomes, only 12 contained effect size information on the bivariate correlations between overt discrimination and adjustment outcomes. using this subset of studies, we calculated and compared the weighted mean correlations between adjustment outcomes and microaggression, and between adjustment outcomes and overt discrimination. the summary effect for microaggression was .24 (95% ci [.19, .29]), z 9.34, p .001, whereas the summary effect for overt discrimination was also .24 (95% ci [.18, .30]), z 7.72, p .001. only two of these research reports (k 4) contained multivariate analyses that estimated the relations between adjustment outcomes and microaggression when overt discrimination was accounted for (i.e., lui, 2018; yoo, steger, & lee, 2010). the dearth of quantitative information did not afford us the opportunity to meta-analyze the associations between microaggression and adjustment outcomes while statistically controlling for overt discrimination. rather, we conducted a narrative review to explore the distinctive relations between adjustment outcomes and these two types of discrimination experiences. narrative review. seven of these samples considered microaggression and overt discrimination targeting racial minorities, whereas another four samples considered microaggression and overt discrimination targeting lgbtq people. racial microaggression tended to be statistically significantly correlated with overt racial discrimination (rs ranged from .46 to .81). lgbtq microaggression also tended to be statistically significantly correlated with overt lgbtq discrimination (rs ranged from .13 to .65).  adolescents of color with higher levels of cultural mistrust and preparation for racial bias were found to report greater overt discrimination and microaggression (ajayi & syed, 2014). yoo and colleagues (2010) reported that neither overt nor subtle racism measured by the subtle and blatant racism scale for asian american college students predicted depression symptoms or stress when their regression models accounted for racial exclusion and rejection, stigmatization and devaluation, work/school discrimination, and unfair treatment and aggression. only overt— but not subtle—racism statistically significantly predicted anxiety above and beyond all these other common racial discrimination variables. controlling for everyday racial discrimination, neither racial microaggression nor overt discrimination subscales measured by the black men’s experiences scale (bmes) predicted depression in a sample of low-income or unemployed black men (bowleg et al., 2016). although the study by donovan and colleagues (2013) was not included in our meta-analysis because we were unable to obtain relevant effect size information, these researchers found mixed results pertaining to the unique contribution of microaggression to psychological adjustment outcomes over and above overt discrimination: racial microaggression predicted depression, but not anxiety symptoms, above and beyond overt discrimination and social desirability among black women. lui (2018) found that the incremental validity of racial microaggression over and above overt discrimination varied by racial groups and adjustment outcomes. among asian americans, microaggression statistically significantly predicted psychological distress, alcohol consumption, and alcohol-related problems even after controlling for overt discrimination and individual differences in neuroticism. among hispanic americans, microaggression predicted negative affect above and beyond overt discrimination and neuroticism, but only overt discrimination explained the variance in psychological distress. among black americans, neither microaggression nor overt discrimination predicted psychological distress, negative affect, and alcohol use outcomes once neuroticism was accounted for.  
  lui and quezada  60  table 6 summary of basic psychometric properties of survey measures used to assess racial, lgbtq, health status, racial/lgbtq, racial/gender, and general microaggressions measure and description  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  racial microaggression asian american racial microaggressions scale (aarms; lin, 2011): the aarms is a 49-item scale specifically constructed to measure the experiences of racial microaggression among asian americans. items include, “you were not given proper credit for something that you did/said,” and “someone assumed that you are smart.” respondents are prompted to rate the frequency of encountering each of the incidents on a scale of 1 (never) to 6 (almost all the time).  cronbach’s  evidence for validity  .90  a principal axis factoring analysis yielded a four-factor solution: asian inferior status, assumptions of model minority, alien in own land, and aberrant sexual stereotypes. the aarms scores were positively correlated with the asian american racism related stress inventory (aarrsi) scales (r .23 to .64), and demonstrated criterionrelated validity (r .14 to .35 with negative affect). exploratory and confirmatory factor analyses supported a three-factor solution underlying the scale scores: overt discrimination, positives, and microaggressions. the microaggressions subscale scores showed construct validity with racial discrimination (r .46), and criterion-related validity with depression (r .23). not available; the dle has been used in many studies.  black men’s experiences scale (bmes; bowleg et al., 2016): the bmes is a 12-item scale that assesses black men’s racial experiences. three items measure racial microaggression, including “how often have white people seemed uncomfortable when they pass you on the street?” respondents rate the frequency of having the respective experiences on a scale of 1 (never) to 6 (always).  .80  daily life experiences subscale, racism and life experiences scale (harrell, 1994): the dle consists of 20 items that assess the frequency of which people experience racial microaggression. sample items include “being treated rudely or disrespectfully” and “being mistaken for someone else of your same race.” items are rated on a scale of 0 (never) to 5 (once a week or more) over the past year. ethnic microaggression scale (ema; huynh, 2011, 2012): the ema is a 12-item measure that assesses people’s experiences with various microaggression events in the past year. items include “someone tells you that racism does not exist anymore” and “you are asked ‘what you are.’” items are rated on a scale of 0 (0 times/ never) to 5 (almost everyday/all the time) for frequency, and 1 (this event made me feel good) to 5 (this event upset me extremely) for the degree of which microaggression bothered respondents.  .94–.97  inventory of microaggressions against black individuals (imabi; mercer et al., 2011): the imabi is a 14-item scale of racial microaggression developed specifically for black americans. the scale is intended to capture both microinsults and microinvalidations. the imabi assesses seven aspects of racial microaggression: ascription of intelligence, assumption of inferior status, assumption of criminality, assumed superiority of white cultural values, assumed universality of the ethnic minority experience, denial of individual racism/colorblindness, myth of meritocracy. sample items include “i was treated like i was of inferior status because of my racial/ethnic background” and “someone reacted negatively to the way i dress because of my racial/ethnic background.” respondents rate the frequency of which they experience each incident over the past year on a scale of 0 (this has never happened to me) to 4 (this event happened and i was extremely upset). microaggressions scale (mas; chae & walters, 2009): the mas is a 10-item scale that measures both overt and subtle discriminations in the past year, and has been developed for native americans specifically. the mas is a modified version of the microaggressions distress scale (mds; unpublished).  .66–.71 (ed) .71–.76 (drr) .71–.72 (nt)  .94  .97  confirmatory factor analysis supported a threefactor solution: emphasis on differences (ed), denial of racial reality (drr), and negative treatment (nt). the frequency of microaggression was correlated with the frequency of peer and adult discrimination. the ema scales demonstrated concurrent validity, as evident by their correlations with depressive (r .24) and somatic symptoms (r .28). factor analysis supported that a single factor underlies the imabi scores. the imabi was correlated with perceived stress (r .38), negative affect (r .21), racial identity public regard (r .29), and global psychological symptoms index (r .30).  not available  
  microaggression and adjustment outcomes  61  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  table 6 (continued) measure and description  cronbach’s  evidence for validity  perceived racism scale for latinos (prsl; collado-proctor, 1999): the prsl is a 34-item scale that assesses frequency of overt discrimination events experienced in the work-academic places, and public and healthcare settings. the prsl also includes a subscale measuring specifically covert discrimination. the scale was modified from the original prs (mcneilly et al., 1996) to capture latino/as’ experiences. items are rated on a scale of 1 (never) to 5 (several times a day). racial and ethnic microaggression scale (rems; nadal, 2011): the rems is a 45-item scale that measures people’s experiences with racial microaggression over the past six months. items include “someone assumed that i would have a lower education because of my race,” “i was told that i should not complain about race,” and “i observe that someone of my race portrayed positively in movies.” items are rated on a scale of 1 (i did not experience this event in the past six months) to 5 (i experienced this event 10 or more times in the past six months). there is a shortened, revised version of the rems. the revised 28-item racial and ethnic microaggressions scale (r28rems; forrest-bank, jenson, & trecartin, 2015) has been validated across asian, black, and hispanic groups with similar factor structure and psychometric properties as the original rems. racial microaggressions scale (rmas; torres-harding, andrade, & romero diaz, 2012): the rmas is a 32-item scale that measures people of color’s experiences with racial microaggression. sample items include “i am mistaken for being a service worker or lowerstatus worker simply because of my race,” “other people treat me like a criminal because of my race,” and “other people ask me where i am from, suggesting that i don’t belong.” items are rated on a scale of 0 (never) to 3 (often/frequently) for frequency, and 0 (not at all) to 3 (high level) for how stressful, upsetting, or bothersome the incident is. racial microaggression in higher education scale (rmhes): the rmhes is a 14-item scale that measures the frequency of racial microaggression experiences among people in a higher education setting (choi et al., 2017). items include “i have experienced someone making offensive jokes to me on this campus because of my race.” respondents rate the frequency to which they experience these incidents in the past year on a scale from 0 (never) to 5 (once a week or more). subtle and blatant racism scale for asian americans (sabr-a2; yoo et al., 2010): the sabr-a2 is a 10-item scale that measures perception of blatant and subtle racism among asian americans. items tapping subtle racism include “in america, i am viewed with suspicion because i’m asian” and “in america, i am faced with barriers in society because i’m asian.” items are rated on a scale of 1 (almost never) to 5 (almost always).  .92  not available; the prsl has been used validly in other studies (e.g., torres, driscoll, & voell, 2012).  .93 .85–.89 (subscales)  principal components analysis and confirmatory factor analysis (with less than adequate fit) showed that the scale items could be reduced to six components: assumption of inferiority (ai), second-class citizen/assumptions of criminality (sc/ac), microinvalidations (mi), exoticization/assumptions of similarity (e/as), environmental microaggressions (em), and workplace and school microaggressions (wsm). the rems was positively correlated with the dle (r .70).  .95 .78–.89 (subscales)  exploratory and confirmatory factor analyses showed that a six-factor solution was adequate: invisibility, criminality, low-achieving/undesirable culture, sexualization, foreigner/not belonging, and environmental invalidations. the rmas demonstrated construct validity (r .15 to .69 with schedule of racist events subscales).  subtle racism scale (srs; duckitt, 1991): the srs is a 10-item scale that measures modern racist attitudes toward blacks held by south african whites. items tapping subtle racism include “the large scale extension of political rights to blacks will inevitably lead to chaos” and “although black living conditions should be improved, it is crucial for the stable development of the country that whites retain political control.” there is no specific information about how items are rated. the srs also has a 4-item abbreviated version.  .92  not available  .83  principal axis factor analysis and confirmatory factor analysis suggested a two-factor solution: blatant racism and subtle racism. subtle racism demonstrated construct validity (r .53. to .72 with the brief perceived ethnic discrimination questionnaire-community version), and criterion-related validity (r .23 with selfesteem and r .26. to .33 for internalizing symptoms). exploratory factor analysis showed that the 10item scale data were unidimensional. the srs demonstrated criterion-related validity (r .83 with interracial behavioral intent and r .80 with social distance with other group members).  .91 .86 (4-item version)  (table continues)  
  lui and quezada  62 table 6 (continued)  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  measure and description lgbtq microaggression distal and proximal environmental microaggression scale (emas; woodford, paceley, kulick, & hong, 2015): the emas is a scale designed to measure exposure to environmental microaggression based on sexual orientation biases. sample items include “i’ve heard politicians oppose equal rights and protections for lgbq people” and “i saw people holding signs with religiously based anti-lgbq messages.” items are rated on a scale from 0 (never) to 5 (very frequently) over the past year. gender and sexual minority microaggressions scale (gsmms; timmins et al., 2017): the gsmms is a 12-item scale developed to measure experiences of anti-lgbt microaggression. items include, “people suggesting that your sexual orientation or gender identity is just a phase, a choice or not real.” participants respond to each of the items by rating the frequency of the incident occurring in the past year, on a scale of never to all of the time. homonegative microaggressions scale (hms; wright & wegner, 2012): the hms is a 45-item scale that measures the experiences of microaggressions among lesbian, gay, or bisexual people over the past six months, and throughout the lifetime. sample items are “how often have people changed the subject/topic when reference to your sexual orientation comes up?” and “how often has someone done something else to make you feel like your values or communication style are wrong or bad?” items are rated on a scale from hardly ever/never to consistently for frequency, and from not at all to a great deal for the extent to which homonegative microaggression incidents have bothered them. lgbq microaggressions on campus scale (lgbqmcs; woodford, chonody, et al., 2015): the lgbqmcs is a 45-item scale developed to measure microinvalidations, microinsults/microassaults, and environmental microaggression experienced by college students of lesbian, gay, bisexual, and queer identities. items include, “someone said or implied that all lgbq people have the same experiences,” “people have said that being lesbian, gay, bisexual, or queer is a sin,” and “i heard someone say ‘that’s so gay’ to describe something as negative, stupid, or uncool.” scale items are rated on a scale of 0 (never) to 5 (very frequently) over the past year.  sexual orientation microaggression inventory (somi; swann et al., 2016): the somi is a 26-item scale that measures the microaggression experiences among lgbtq people. sample items are “you were told, ‘you’re not really gay’ and “a family member expressed disappointment about you being gay, lesbian, or bisexual.” items are rated on a scale from not at all to about every day.  health status ableist microaggressions scale (ams; conover, 2015): the ams is a 20-item measure constructed to measure people’s lifetime experiences with microaggression based on disability. items include “people don’t see me as a whole person because i have a disability,” and “people ask me about my disability at inappropriate times or places.” items are rated from 0 (never) to 5 (very frequently).  cronbach’s  evidence for validity  .68 (d) .65 (p)  the emas reportedly was shown to consist of two factors in an exploratory factor analysis: distal environmental microaggressions (d) and proximal environmental microaggressions (p).  .85  the gsmms has been reported to demonstrate convergent and discriminant validity: it correlates with lifetime victimization (r .42) and experiences with harassment, rejection, and discrimination in the past year (r .65) because of lgbtq biases.  .94–.96 (frequency) .96 (impact)  current and past frequency scores, and the impact scores of the hms demonstrated construct validity. hms was correlated with experiences of gay and lesbian oppression (r .60 to .75), perceived prejudice (r .46 to .56) and perceived discrimination (r .39 to .52). the hms also demonstrated criterion-related validity as evident by its correlations with self-esteem and negative feelings toward lgb identity.  .94 (im) .81 (em)  initial principal components analysis and principal axis factor analysis did not support the three-factor solution. a confirmatory factor analysis suggested that a two-factor solution that consisted of interpersonal microaggression (im) and environmental microaggression (em). the lgbqmcs demonstrated construct validity, evident by its correlations with sexual orientation victimizations (r .13 to .56) and low levels of social acceptance on campus (r .09 to .10). the lgbqmcs also showed adequate criterion-related validity (r .25 to .29 with depression symptoms). exploratory factor analyses suggested a fourfactor solution, but the confirmatory factor analysis showed that a bifactor structure was the best fitting model. analyses indicated that the general factor but not the specific factors reliably predicted the item indicators. the somi showed convergent and discriminant validity, and demonstrated both criterion-related validity with internalizing symptoms both concurrently and predictively. finally, somi showed incremental validity over and above lgbt victimization when predicting internalizing symptoms.  not available  .92  exploratory and confirmatory factor analyses yielded a four-factor solution: helplessness, minimization, denial of personhood, and otherization. the ams showed criterionrelated validity, evident by its correlations with perceived stress (r .23) and depression symptoms (r .28).  
  microaggression and adjustment outcomes  63  table 6 (continued) measure and description  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  racial/lgbtq lgbt people of color microaggressions scale (lgbt-pcms; balsam et al., 2011): the lgbt-pcms is an 18-item scale measuring microaggression associated with both racism and heterosexism that are unique to the experiences of lgbt people of color (poc). to examine both frequency and perceived distress, items are rated on a scale of 0 (did not happen/not applicable to me) to 5 (it happened and it bothered me extremely).  racial/gender gendered racial microaggression scale (grms; lewis & neville, 2015): the grms is a 25-item scale that measures both the frequency of microaggression based on sexist biases toward black women, and people’s stress appraisal in the context of these microaggression experiences. sample items are, “unattractive because of size of butt,” “my comments have been ignored,” and “someone assumed i was sassy and straightforward,” and “someone has told me to calm down.” items are rated on a scale of 0 (never) to 5 (once a week or more) for frequency in their life time, and from 0 (not at all stressful) to 5 (extremely stressful) for stressfulness. general microaggression multidimensional scale of perceived discrimination (mspd; molero, recio, garcia-ael, fuster, & sanjuan, 2013): the mspd is a 20item scale that measures perceived discrimination across different marginalized and stigmatized groups in spain. sample items tapping subtle discrimination include “spanish society mistrusts _____ (marginalized group membership)” and “even though there is no express[ed] rejection, people treat me differently when they see i am ____.” items are rated on a 5-point likert scale indicating respondents’ degree of agreement. the mspd was validated in five distinct stigmatized groups, including latin american immigrants in spain, romanian immigrants in spain, people with hiv, gay men, and lesbian women.  overall, microaggression was correlated with, but distinct from, overt discrimination. the degree of overlap in these variables’ variances differed across samples and measures. in the small number of studies available for a narrative review, (racial) microaggression inconsistently predicted adjustment outcomes over and above overt discrimination.  narrative review: indirect relations between microaggressions and adjustment outcomes consistent with the minority stress theory (myers, lewis, & parker-dominguez, 2003) and the conceptualization of the impact of microaggression (sue, capodilupo, et al., 2007), 15 correlational studies hypothesized indirect relations linking microaggression and adjustment outcomes via some kinds of stress- or emotion-related factors.7 all of these studies focused on either racial or lgbtq microaggression. except for one longitudinal study (torres et al., 2010), all samples yielded cross-sectional data. lgbtq microaggression. three studies examined the roles of possibly mediating variables linking experiences with lgbtq microaggression and psychological distress. in a large sample of transgender individuals, timmins and colleagues (2017) reported  cronbach’s  evidence for validity  .92  principal components analysis suggested three components: lgbt racism, poc heterosexism, and lgbt relationship racism. the lgbt-pcms was correlated with stigma sensitivity, internalized homonegativity, superiority, and outness (r .03 to .42), and lgbt discrimination (r .20 to .45). the scale scores also showed criterion-related validity, evident by associations with depression (r .08. to .24) and perceived stress (r .06. to .22).  .92–.93 (total) .74–.88 (subscales)  an exploratory factor analysis showed a fourfactor solution: assumptions of beauty and sexual objectification, silenced and marginalized, strong black woman, and angry black woman. the grms demonstrated construct validity by correlating with both rems scores and scores from the schedule of sexist events (r .04 to .64). the grms also showed criterion-related validity associating with mental health outcomes (r .15 to .32).  .79 (sgd) .84 (sid)  confirmatory factor analysis supported a fourfactor structure for the mspd: subtle group discrimination (sgd), subtle individual discrimination (sid), blatant group discrimination (bgd), and blatant individual discrimination (bid). the sgd and sid subscales demonstrated construct validity with stigma consciousness (r .49 to .55), and showed criterion-related validity, evident by their associations with affect balance (r .14 to .22) and selfacceptance (r .10 to .20).  statistically significant indirect relations between a latent factor of transphobic prejudice (i.e., microaggression, heterosexist discrimination, and victimization) and psychological distress (i.e., wellbeing, depression, and anxiety) via rumination, self-stigma, and personal expectations of rejection. among ethnically diverse sexual minority and gender queer individuals, deitz (2015) found that lgbtq microaggression was indirectly related to psychological well-being by way of internalized heterosexism and expectations of rejection. furthermore, among college students who identified as lesbian, gay, bisexual, and queer, woodford and colleagues (2014) found that lgbtq microaggression statistically significantly predicted psychological distress by way of lower levels of self-acceptance. racial microaggression. fifteen correlational study reports hypothesized that racial microaggression would predict adjustment outcomes indirectly. two studies reported statistically significant 7 marks (2015) proposed a model linking psychosocial adversities associated with overt racism and microaggression to psychological distress, and in turn sexual risk behaviors; however, the study did not specifically test an indirect pathway.  
  lui and quezada  64  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  table 7 summary of meta-regression analyses in the associations between microaggression and adjustment outcomes categorical moderator  k  b/r  se  p  racial microaggression measure rems (reference) imabi rmas other lgbtq microaggression measure lgbqmcs (reference) hms other college student status no (reference) yes u.s. race groupa white american (reference) asian american black american hispanic american native american/american indian multiple (reference) lgbtq groupb lgb (reference) lgb/t transgender publication status published (reference) unpublished  49 12 8 6 23 15 5 4 6 72 45 27 59 2 9 15 5 1 30 15 10 2 3 72 46 26  continuous moderator mean age % women  f(df)  .115/.115ⴱ .081/.196 .025/.140 .089/.204  .049 .054 .064 .023  .044 .158 .709 .108  .269/.269ⴱ  .051/.218  .049/.220  .01 .060 .061   .001 .423 .443  .188/.188ⴱ .006/.194  .021 .028   .001 .828  .191/.191 .062/.253 .031/.222 .026/.218  .066/.125  .042/.150  .064 .069 .067 .082 .064 .068  .106 .432 .687 .763 .417 .599  .250/.250ⴱ  .015/.235  .065/.185  .028 .034 .154   .001 .681 .699  .216/.216ⴱ  .064/.149ⴱ  .020 .028   .001 .026  k  b  se  p  f(df)  68 69  .002  .001ⴱ  .002  .001  .374 .047  .958 (24.0) 4.500ⴱ (19.2)  1.300 (15.0)  .598 (7.3)  .048 (52.7) 7.33ⴱ (10.4)  .127 (3.32)  5.270ⴱ (50.3)  note. b intercept for the reference group or slope for comparison groups in each meta-regression model. r weighted mean correlation for each group. hms homonegative microaggression scale; imabi inventory of microaggressions against black individuals; lgbqmcs lgbq microaggression on campus scale; rems racial and ethnic microaggression scale; rmas racial microaggression scale. racial microaggression measure was tested as a moderator among studies examining the association between racial microaggression and adjustment outcomes only. lgbtq microaggression measure was tested as a moderator among studies examining the association between lgbtq microaggression and adjustment outcomes only. a u.s. race group was tested as a moderator among u.s. studies examining racial, racial/lgbtq, and racial/gender microaggressions only. b lgbtq group was tested as a moderator among studies examining lgbtq and racial/lgbtq microaggressions only. ⴱ p .05.  indirect associations between racial microaggression and suicidal ideations via depression symptoms among college students of color (e.g., o’keefe et al., 2015). specifically, interpersonal and environmental microaggression incidents that implied perceived invisibility and low-achievement/undesirable culture predicted african americans’ suicidal ideation through their perceived burdensomeness on others (hollingsworth et al., 2017). other studies focused more specifically on self-reported stress symptoms and negative affect as possible mediators linking racial microaggression and adjustment outcomes. torres and colleagues found that racial microaggression indirectly predicted depression symptoms via traumatic stress among latinx americans (torres & taknint, 2015), and via general perceived stress among african americans (torres et al., 2010). examining psychological distress as a possible intervening factor, lui (2018) found that racial microaggression predicted alcohol consumption and related problems among asian americans, and negative affect among both  asian and hispanic americans. furthermore, state anger mediated the relations between racial microaggression and somatic symptoms in a sample of asian and latinx american adolescents (huynh, 2012). among asian american college students, jackson (2015) found that people’s appraisal of microaggression (i.e., perceived harm or loss) explained the indirect associations between lifetime racial microaggression and depression. racial microaggression also predicted gambling— but not alcohol use— partially through anxiety symptoms (jackson, 2015). additionally, some studies examined how interpersonal relationships and environmental factors function as a mediator linking microaggression and adjustment outcomes. among graduate students of ethnic minority and majority statuses, racial microaggression was unrelated to emotional distress via either perceived autonomy or belongingness (clark et al., 2012). kim and colleague’s (2017) study found support for the indirect pathway linking racial microaggression to psychological well-being via cultural mistrust  
  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  microaggression and adjustment outcomes  publication bias our meta-regression analysis showed that study samples from published research reports yielded larger correlations than those from unpublished sources, f 5.27, p .03 (see table 7). as shown in the stem-and-leaf plot (see figure 4), there were no noticeable gaps or atypical values across samples. the study-level correlations generally followed the shape of a normal curve with a slight negative skew. the mode of the correlations fell in the range of .20-.29. as seen in figure 5, the funnel plot of precision did not show a severe degree of asymmetry. classic fail-safe n indicated  -.1 -.0 .0 .1 .2 .3 .4  1 249 3345678 002233334456666667779 00002334444445556667778888899 022234457 24  figure 4. stem-and-leaf plot of univariate correlation effect size estimates across 72 study samples.  40  30  precision (1/std err)  among asian american college students. similarly, school belonging explained the covariance between racial microinvalidation and poor health, happiness, and psychological distress in another sample of asian american college students (huynh, majeno, & gillen-o’neel, 2018). among lgbt/two-spirit individuals of american indian/alaska native backgrounds, johnson-jennings, belcourt, town, walls, and walters (2014) reported that racial microaggression predicted bodily pain intensity and impairments, and in turn smoking status. despite the supporting evidence on possible mechanisms that link racial and lgbtq microaggressions to adjustment outcomes via proximal predictors, this body of literature could benefit from clearer differentiation of mediation and moderation models. for example, one study mentioned a “mediation” relation between racial microaggression and psychological adjustment outcomes in the article; yet, the authors specified and tested a moderation model (i.e., whether racial identity intensified the negative relations between microaggression and adjustment outcomes; nealious, 2016). research also could be more systematic in theorizing and analyzing indirect associations concerning microaggression and adjustment outcomes. for example, a study reported that racial microaggression predicted well-being by way of deteriorated congregation support, but not church leader support (kim, 2017). another study tested indirect relations linking lifetime racial microaggression to adjustment outcomes by way of dispositional coping strategies (jackson, 2015). theoretically, it was unclear why racial microaggression would cause people to receive less care and support from the congregation or employ different types of coping strategies, and in turn lead to poor adjustment outcomes. furthermore, one study tested a mediation model using path analysis; although the bivariate relation between racial microaggression and perceived stress, and the bivariate relation between perceived stress and depression symptoms were statistically significant, the study did not systematically estimate whether the indirect path was robust (roberts, 2013).  65  20  10  0 -2.0  -1.5  -1.0  -0.5  0.0  0.5  1.0  1.5  2.0  fisher's z  figure 5. funnel plot showing the precision of the associations between microaggression and adjustment outcomes using all 72 studies included in this meta-analysis.  that 2,161 hypothetically missing studies would be needed to nullify our weighted mean correlation estimate to a statistically nonsignificant p value. the orwin’s fail-safe n indicated that 71 studies with study-level effects of .001 would be needed to reduce the overall weighted mean correlation to .10. egger’s test (b0 .06, t .08, p .94 two-tailed) did not show a statistically significant likelihood of publication bias (using both the conventional p .10 and more rigorous p .05). whereas no relevant studies might be missing to the right of the computed summary effect size (i.e., larger than r .20), the trim-and-fill test under a random-effects model indicated that 15 studies were potentially missing to the left of this summary effect. the adjusted correlation between microaggression and adjustment outcomes with these imputed studies would result in a slightly smaller summary effect (r’ .16; 95% ci [.15, .17]). the 72 observed and 15 trimmed-and-then-imputed study-level effects are shown in a new funnel plot (see figure 6). finally, our cumulative analyses did not reveal systematic patterns of effect size suppression. as illustrated in figure 7, samples with larger sizes are displayed first. with the addition of smaller samples (i.e., decreasing precision of individual studies), the summary effect size was unaffected (see figure 7). we also did not see shifts in the summary effect size as more recent studies became available in this body of literature (see figure 8). when we removed each study sample from the meta-analysis, the weighted mean correlation between microaggression and adjustment outcomes did not change (see figure 9), meaning the summary effect was not heavily influenced by any specific study. collectively, there was no strong evidence for the presence of publication bias in this body of work. we did not identify any specific mechanisms for which smaller (or larger) effects were suppressed. even though the observed and adjusted summary  
  lui and quezada  66  studies (r .20) and adjusted effect with observed and imputed studies (r .16) fell in the small range. our correlation estimates linking microaggression and adjustment outcomes are comparable to the correlation estimates linking perceived discrimination to health outcomes (pascoe & smart richman, 2009; see supplemental table 1 for direct comparisons across adjustment outcomes).  40  precision (1/std err)  30  advancing the conceptualization of microaggression  20  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  10  0 -2.0  -1.5  -1.0  -0.5  0.0  0.5  1.0  1.5  2.0  fisher's z  figure 6. funnel plot of precision showing both observed and imputed studies on the associations between microaggression and adjustment outcomes to illustrate the possible impact of publication bias. open circles indicate the 72 observed studies in this meta-analysis, and the open diamond represents the observed correlation estimate. filled circles represent 15 imputed studies, and the filled diamond represents the adjusted correlation estimate should the meta-analysis include these imputed studies.  effects both fell in the small range, it would require many studies to nullify the present results. lastly, the inclusion of unpublished studies was shown to contribute to a more realistic estimation of the associations between microaggression and adjustment outcomes.  discussion this is the first comprehensive research synthesis that examines the associations between racial, lgbtq, gender, and health status microaggressions and adjustment outcomes. given the growing interest in academic and public discourse on microaggression, a critical review of this body of work is timely and important. using both meta-analytic and narrative review approaches, we have quantified the precision and dispersion across available studies examining the relations between microaggression and adjustment outcomes, and have identified methodological and individual factors that explained between-study heterogeneity. additionally, our narrative reviews contribute to the literature by (a) summarizing the psychometric properties of available measures of microaggression, and (b) highlighting the research progress and gaps with regard to the incremental validity of microaggression over and above overt discrimination, and possible pathways underlying the relations between microaggression and adjustment outcomes. overall, our meta-analysis shows a statistically significant summary correlation between microaggression and adjustment outcomes. using jacob cohen’s benchmarks for interpreting correlation coefficients, our summary effect estimated with all observed  one specific contribution of this study is the proposal of a three-dimensional cube model and the generation of new evidence that helps advance our conceptualization of microaggression. our cube model highlights the complexity surrounding microaggression, and encourages researchers and practitioners to take into account people’s social group membership, social level(s) at which microaggression takes place, and the categories of microaggression. our findings suggest that with the exception of gender microaggression, racial, lgbtq, and health status microaggressions targeting marginalized social groups are associated with adjustment outcomes with similar effect sizes. revisiting categories of microaggression. our preliminary results on the associations between adjustment outcomes and microassault, microinsult, and microinvalidation call into question the existing taxonomy of microaggression. by definition, microassaults represent the least ambiguous stimuli, whereas microinvalidations represent the most ambiguous stimuli, in intergroup interactions. as suggested in sue’s framework (2007), microaggression incidents are stressful to people of marginalized statuses because of the catch-22 psychological processes and the frequent and cumulative nature of daily hassles. following this logic, it would be reasonable to expect microinvalidation, followed by microinsult, to be more stressful than microassault. quite the contrary, microassault shows larger correlations with adjustment outcomes than both microinsult and microinvalidation. a recent experimental study examines how people’s emotional reactions differ across microaggression incidents with varying degree of ambiguity. the study finds that people experience more negative and less positive affect when the incidents seem more blatant (tao, owen, & drinane, 2017). along with the fact that microassault may be conceptually akin to overt discrimination (lilienfeld, 2017a), whether microassault belongs in the same nomological network of microaggression remains an open question. group variations. our results also shed light on some nuances by social group memberships. by examining racial differences, we demonstrate that racial minorities of asian, black, and hispanic american backgrounds possibly are more negatively affected by microaggression than their white american and native american/ american indian counterparts. within the u.s. context, blacks in particular have been targets of overt and subtle discrimination for decades. contrary to our expectations, samples with more men yielded larger effect size estimates than samples with fewer men. this moderation effect does not support the notion that people with intersectional identities and multiple marginal statuses (e.g., racial minority women) would be distinctively affected by microaggression. it is possible that women are more used to gender bias and general discrimination than men, thus experiences of microaggression are less closely linked to women’s adjustment outcomes.  
  microaggression and adjustment outcomes  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  study  timmins et al. (2017) conover (2015) hernandez (2014) woodford et al. (2015a) bowleg et al. (2016) nadal et al. (2014) seelman et al. (2017) lui (2018-s1) hu & taylor (2016) johnson-jennings et al. (2014) demianczyk (2015) o'keefe et al. (2014) torres et al. (2011) mercer et al. (2011) swann et al. (2016-s2) huynh (2012) choi et al. (2017) kulick et al. (2017-s2) greenfield (2015) rivera (2012) schaafsma (2011) clark et al. (2012-s2) wegner (2014-s2) woodford et al. (2014) balsam et al. (2011) ajayi & syed (2014) jackson (2015) huynh et al. (2018) nadal et al. (2017) williams (2014) fay (2015) helm (2013) deitz (2015) sohi & singh (2015) lui (2018-s3) perez-garin et al. (2015) lewis & neville (2015) yoo et al. (2010-s2) kaufman et al. (2017-s2) woodford et al. (2015b) whicker (2016) moore (2012) jackson et al. (2011-s1) magallares et al. (2017) lui (2018-s2) lin (2011) kim et al. (2017) yoo et al. (2010-s1) ong et al. (2013/2017) woodford et al. (2017) kim (2017) roberts (2013) garcia (2013) hollingsworth et al. (2017) liao et al. (2016) wright & wegner (2012) marks (2015) torres & taknint (2015) kulick et al. (2017-s1) magallares et al. (2014) torres et al (2010) thomas (2015) clark et al. (2012-s1) thai et al. (2017) estrada (2016) kaufman et al. (2017-s1) nealious (2016) lainer et al. (2017) magallares et al. (2016) jackson et al. (2011-s2) wilson (2014) prather (2015)  cumulative statistics  cumulative correlation (95% ci)  lower upper point limit limit  z-value p-value  0.354 0.307 0.201 0.219 0.221 0.172 0.188 0.197 0.206 0.199 0.193 0.191 0.194 0.197 0.197 0.197 0.212 0.214 0.207 0.192 0.189 0.184 0.181 0.185 0.183 0.182 0.183 0.182 0.174 0.170 0.172 0.174 0.174 0.176 0.174 0.174 0.176 0.179 0.182 0.181 0.183 0.186 0.188 0.191 0.190 0.189 0.190 0.191 0.193 0.187 0.187 0.185 0.183 0.181 0.182 0.185 0.186 0.188 0.189 0.189 0.191 0.192 0.193 0.193 0.192 0.194 0.194 0.195 0.196 0.197 0.196 0.195 0.195  12.836 5.823 1.805 2.640 3.347 2.341 2.930 3.462 4.012 4.178 4.354 4.644 5.076 5.495 5.821 6.164 6.464 6.846 6.765 5.961 6.070 6.094 6.163 6.490 6.707 6.888 7.125 7.287 6.960 6.882 7.138 7.395 7.546 7.783 7.881 8.030 8.272 8.531 8.791 8.925 9.159 9.408 9.615 9.855 9.915 9.993 10.212 10.397 10.622 9.879 10.056 9.989 9.956 9.938 10.124 10.329 10.481 10.676 10.840 10.960 11.147 11.312 11.431 11.539 11.564 11.734 11.788 11.938 12.074 12.208 12.268 12.234 12.234  0.304 0.207 -0.017 0.057 0.093 0.028 0.063 0.086 0.107 0.106 0.107 0.111 0.120 0.128 0.132 0.136 0.149 0.154 0.148 0.130 0.129 0.126 0.124 0.130 0.130 0.131 0.133 0.133 0.126 0.122 0.126 0.129 0.129 0.132 0.132 0.132 0.135 0.138 0.142 0.142 0.145 0.148 0.150 0.154 0.153 0.152 0.155 0.156 0.158 0.150 0.152 0.149 0.147 0.146 0.148 0.151 0.152 0.154 0.156 0.156 0.158 0.160 0.160 0.161 0.160 0.162 0.162 0.164 0.165 0.166 0.166 0.164 0.164  0.402 0.400 0.402 0.369 0.342 0.308 0.307 0.303 0.302 0.287 0.275 0.268 0.266 0.265 0.261 0.258 0.273 0.272 0.264 0.253 0.248 0.242 0.237 0.239 0.235 0.232 0.231 0.229 0.222 0.217 0.218 0.219 0.218 0.219 0.216 0.215 0.216 0.219 0.221 0.220 0.221 0.224 0.225 0.228 0.226 0.225 0.226 0.226 0.228 0.222 0.223 0.220 0.218 0.216 0.217 0.219 0.220 0.222 0.222 0.222 0.224 0.225 0.225 0.224 0.223 0.226 0.225 0.226 0.227 0.227 0.227 0.225 0.225  67  0.000 0.000 0.071 0.008 0.001 0.019 0.003 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 -0.70  -0.35  0.00  0.35  0.70  figure 7. cumulative forest plot summarizing the associations between microaggression and adjustment outcomes, in which study samples are displayed by descending sample sizes (i.e., most precise to least precise) to illustrate the potential impact of publication bias. see the online article for the color version of this figure.  
  lui and quezada  68 study  cumulative statistics  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  lower upper point limit limit torres et al. (2010) 0.339 yoo et al. (2010-s1) 0.275 yoo et al. (2010-s2) 0.284 balsam et al. (2011) 0.235 jackson et al. (2011-s1) 0.231 jackson et al. (2011-s2) 0.232 lin (2011) 0.217 mercer et al. (2011) 0.217 schaafsma (2011) 0.205 torres et al. (2011) 0.209 clark et al. (2012-s1) 0.208 clark et al. (2012-s2) 0.198 huynh (2012) 0.197 moore (2012) 0.206 rivera (2012) 0.190 wright & wegner (2012) 0.200 garcia (2013) 0.193 helm (2013) 0.195 ong et al. (2013/2017) 0.202 roberts (2013) 0.195 ajayi & syed (2014) 0.192 hernandez (2014) 0.182 johnson-jennings et al. (2014) 0.178 magallares et al. (2014) 0.178 nadal et al. (2014) 0.168 o'keefe et al. (2014) 0.167 wegner (2014-s2) 0.164 williams (2014) 0.159 wilson (2014) 0.159 woodford et al. (2014) 0.164 conover (2015) 0.167 deitz (2015) 0.167 demianczyk (2015) 0.165 fay (2015) 0.167 greenfield (2015) 0.164 jackson (2015) 0.165 lewis & neville (2015) 0.167 marks (2015) 0.169 perez-garin et al. (2015) 0.168 prather (2015) 0.166 sohi & singh (2015) 0.168 thomas (2015) 0.170 torres & taknint (2015) 0.173 woodford et al. (2015a) 0.176 woodford et al. (2015b) 0.176 bowleg et al. (2016) 0.177 estrada (2016) 0.176 hu & taylor (2016) 0.179 kim et al. (2017) 0.181 liao et al. (2016) 0.182 magallares et al. (2016) 0.184 nealious (2016) 0.183 swann et al. (2016-s2) 0.183 whicker (2016) 0.185 choi et al. (2017) 0.191 hollingsworth et al. (2017) 0.189 kaufman et al. (2017-s1) 0.192 kaufman et al. (2017-s2) 0.194 kim (2017) 0.195 kulick et al. (2017-s1) 0.196 kulick et al. (2017-s2) 0.197 lainer et al. (2017) 0.198 magallares et al. (2017) 0.201 nadal et al. (2017) 0.197 seelman et al. (2017) 0.199 thai et al. (2017) 0.199 timmins et al. (2017) 0.202 woodford et al. (2017) 0.197 huynh et al. (2018) 0.196 lui (2018-s1) 0.197 lui (2018-s2) 0.196 lui (2018-s3) 0.195 0.195  0.159 0.159 0.197 0.136 0.153 0.162 0.154 0.166 0.154 0.164 0.166 0.154 0.157 0.165 0.130 0.140 0.134 0.140 0.147 0.141 0.141 0.126 0.126 0.128 0.113 0.116 0.115 0.111 0.112 0.117 0.122 0.122 0.122 0.126 0.123 0.125 0.128 0.130 0.131 0.129 0.131 0.134 0.137 0.141 0.141 0.143 0.142 0.146 0.148 0.150 0.151 0.151 0.152 0.154 0.159 0.157 0.160 0.162 0.163 0.165 0.166 0.168 0.170 0.166 0.168 0.168 0.171 0.165 0.164 0.166 0.165 0.164 0.164  0.497 0.384 0.367 0.329 0.306 0.299 0.279 0.268 0.255 0.253 0.248 0.241 0.236 0.247 0.249 0.259 0.250 0.250 0.255 0.247 0.242 0.235 0.229 0.228 0.221 0.218 0.213 0.207 0.206 0.210 0.213 0.211 0.208 0.209 0.205 0.204 0.206 0.207 0.205 0.203 0.204 0.206 0.209 0.212 0.210 0.211 0.209 0.212 0.213 0.215 0.216 0.215 0.214 0.215 0.223 0.221 0.224 0.226 0.226 0.227 0.227 0.228 0.231 0.228 0.229 0.229 0.233 0.229 0.227 0.228 0.227 0.225 0.225  cumulative correlation (95% ci)  z-value p-value 3.598 4.518 6.177 4.590 5.703 6.411 6.605 8.064 7.785 8.991 9.650 8.597 9.561 9.663 6.076 6.404 6.332 6.759 7.117 6.963 7.279 6.378 6.639 6.846 5.997 6.279 6.417 6.391 6.489 6.760 7.061 7.251 7.460 7.726 7.775 8.026 8.277 8.472 8.654 8.635 8.878 9.076 9.281 9.549 9.709 10.038 10.086 10.343 10.565 10.770 10.930 11.008 11.268 11.493 11.298 11.274 11.434 11.649 11.834 12.009 12.272 12.428 12.608 12.214 12.471 12.586 12.460 11.721 11.845 12.111 12.162 12.234 12.234  0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 -0.70  -0.35  0.00  0.35  figure 8. cumulative forest plot summarizing the associations between microaggression and adjustment outcomes, in which study samples are displayed by years of publication (i.e., least recent to most recent) to illustrate the potential impact of publication bias over time. see the online article for the color version of this figure.  0.70  
  microaggression and adjustment outcomes study  statistics with study removed  69  correlation (95% ci) with study removed  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  lower upper point limit limit z-value p-value ajayi & syed (2014) balsam et al. (2011) bowleg et al. (2016) choi et al. (2017) clark et al. (2012-s1) clark et al. (2012-s2) conover (2015) deitz (2015) demianczyk (2015) estrada (2016) fay (2015) garcia (2013) greenfield (2015) helm (2013) hernandez (2014) hollingsworth et al. (2017) hu & taylor (2016) huynh (2012) huynh et al. (2018) jackson (2015) jackson et al. (2011-s1) jackson et al. (2011-s2) johnson-jennings et al. (2014) kaufman et al. (2017-s1) kaufman et al. (2017-s2) kim (2017) kim et al. (2017) kulick et al. (2017-s1) kulick et al. (2017-s2) lainer et al. (2017) lewis & neville (2015) liao et al. (2016) lin (2011) lui (2018-s1) lui (2018-s2) lui (2018-s3) magallares et al. (2014) magallares et al. (2016) magallares et al. (2017) marks (2015) mercer et al. (2011) moore (2012) nadal et al. (2014) nadal et al. (2017) nealious (2016) o'keefe et al. (2014) ong et al. (2013/2017) perez-garin et al. (2015) prather (2015) rivera (2012) roberts (2013) schaafsma (2011) seelman et al. (2017) sohi & singh (2015) swann et al. (2016-s2) thai et al. (2017) thomas (2015) timmins et al (2017) torres & taknint (2015) torres et al. (2010) torres et al. (2011) wegner (2014-s2) whicker (2016) williams (2014) wilson (2014) woodford et al. (2014) woodford et al. (2015a) woodford et al. (2015b) woodford et al. (2017) wright & wegner (2012) yoo et al. (2010-s1) yoo et al. (2010-s2)  0.196 0.196 0.194 0.190 0.195 0.197 0.194 0.196 0.196 0.196 0.194 0.197 0.197 0.194 0.199 0.197 0.193 0.195 0.196 0.195 0.194 0.194 0.196 0.193 0.193 0.194 0.194 0.194 0.194 0.194 0.194 0.194 0.196 0.194 0.196 0.196 0.195 0.194 0.192 0.195 0.194 0.193 0.199 0.198 0.196 0.195 0.193 0.196 0.196 0.200 0.197 0.196 0.193 0.194 0.195 0.195 0.194 0.192 0.193 0.193 0.194 0.196 0.194 0.197 0.195 0.194 0.194 0.196 0.200 0.193 0.195 0.194 0.195  0.165 0.165 0.163 0.161 0.164 0.166 0.163 0.165 0.165 0.165 0.163 0.166 0.166 0.163 0.169 0.166 0.162 0.164 0.165 0.164 0.163 0.163 0.165 0.162 0.162 0.163 0.163 0.163 0.163 0.163 0.163 0.163 0.165 0.163 0.165 0.165 0.164 0.163 0.162 0.164 0.163 0.162 0.170 0.168 0.165 0.164 0.162 0.165 0.166 0.170 0.166 0.165 0.162 0.163 0.164 0.164 0.163 0.162 0.162 0.162 0.163 0.165 0.163 0.167 0.164 0.163 0.163 0.165 0.171 0.162 0.164 0.163 0.164  0.226 0.227 0.225 0.220 0.225 0.227 0.225 0.226 0.227 0.226 0.225 0.227 0.227 0.225 0.228 0.227 0.224 0.226 0.226 0.226 0.225 0.225 0.227 0.223 0.224 0.225 0.224 0.225 0.225 0.224 0.225 0.224 0.226 0.225 0.227 0.227 0.226 0.225 0.223 0.225 0.225 0.224 0.228 0.228 0.226 0.226 0.224 0.226 0.227 0.229 0.227 0.227 0.224 0.225 0.226 0.225 0.224 0.221 0.224 0.224 0.225 0.227 0.224 0.228 0.226 0.224 0.224 0.226 0.229 0.223 0.225 0.224 0.225  12.096 12.064 11.951 12.245 12.119 12.228 11.905 12.116 12.121 12.211 12.034 12.275 12.262 12.034 12.838 12.262 11.983 12.026 12.111 12.054 12.061 12.101 12.124 12.071 12.031 12.074 12.047 12.079 12.001 12.087 12.041 12.063 12.168 11.971 12.183 12.162 12.120 12.099 12.043 12.091 11.996 12.034 13.126 12.574 12.181 12.054 12.041 12.117 12.268 12.950 12.307 12.153 11.978 12.047 12.034 12.130 12.076 12.342 12.055 12.057 11.991 12.191 12.043 12.339 12.174 12.008 11.957 12.125 12.984 12.051 12.074 12.031 12.234  0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 -0.25  -0.13  0.00  0.13  0.25  figure 9. one-study-removed forest plot indicating the change in the weighted mean correlation estimate with each respective study being left out of the database for meta-analysis. see the online article for the color version of this figure.  
  70  lui and quezada  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  self-reported microaggression and the roles of negative emotionality and attribution experiences with discrimination— especially microaggression—are inherently subjective (major & dover, 2016). selfreported microaggression and its consequences could be influenced by a number of factors: accurate accounts of these events, biased attributions, cultural interpretations of social groups’ shared experiences, and/or personal, familial, and cultural worldviews (hobfoll, 1998). not only do individual differences affect how people respond to microaggression incidents, situational factors and role differences also influence how microaggression is perceived. for example, racial identification has been shown to be associated with the extent to which people report discrimination, and their levels of distress associated with discriminatory acts (sellers & shelton, 2003). experimental research also has shown that compared with observers of the same interpersonal scenarios, receivers of gender-specific prejudices are more likely to attribute an event as discriminatory and label it as harmful (swim, scott, sechrist, campbell, & stangor, 2003). negative emotionality. negative emotionality reflects individual differences in the propensity to perceive the world as distressing and threatening (watson, clark, & harkness, 1994). our meta-analysis shows that microaggression is more closely linked to internalizing problems, psychological distress and negative affect, and positive adjustment and affect. many of these studies on internalizing problems have focused on depression symptoms, which are highly associated with maladaptive rumination styles (aldao, nolen-hoeksema, & schweizer, 2010). perhaps microaggression experiences elicit depression when people brood over the accumulated experiences of microinsult and microinvalidation. in a dutch sample of lgbtq youth, rumination has been shown to connect microaggression to depression symptoms (kaufman, baams, & dubas, 2017). as laid out in sue’s conceptual framework, microaggression carries psychological burden because these experiences can deplete receivers’ energy in efforts to make sense of the situational ambiguity and to decipher their responses (sue, capodilupo, et al., 2007). thus, it is conceivable that people would ruminate more in the context of microaggression than overt discrimination, which in turn predict poorer adjustment outcomes. our findings about the different summary effects across adjustment outcomes suggest that individual difference variables such as negative emotionality can influence the observed associations between microaggression and adjustment outcomes. research with gay or bisexual men has shown that neuroticism explains 40% of the variance in the relations between antigay discrimination and depression symptoms; still, there remains a robust correlation between lgbtq and racial discrimination and health-related outcomes even after controlling for neuroticism and hostility (huebner, nemeroff, & davis, 2005; lui, 2018). to the extent that negative emotionality/neuroticism, the proneness to experience negative feelings and stress, is more closely linked to internalizing problems than externalizing problems and health risk behaviors (castellanos-ryan et al., 2016), this personality trait may explain microaggression’s larger correlations with internalizing problems and stress-related outcomes. people with greater negative emotionality likely are more sensitive to possible incidents of microaggression, and in turn more reactive to the stresses associated with them by way of cognitive vulnerability (lakdawalla & hankin,  2008). reciprocally, cumulated exposure to microaggression also can cause people to develop higher levels of negative emotionality over time (sutin, stephan, & terracciano, 2016). attribution. in addition to negative emotionality, attribution style also may function as a risk factor for maladjustment, and account for the relations between microaggression and adjustment outcomes. one main challenge associated with microaggression research and its conceptualization lies in the ambiguity of the deliverers’ ill-intent, the disparate perceptions by those of the receiver and observer roles, as well as the uncertainty about the receivers’ subjective feelings of harm from the observers’ perspective. racial microaggression has been found to be more closely linked to anxiety for people who have high levels of uncertainty intolerance (liao, weng, & west, 2016). perception of subtle discrimination also has been found to be related to people’s attributional complexity (reid & foels, 2010). people who have a more complex thinking style are more likely to consider situational cues in attributing the reasons behind other’s behaviors than people who have lower levels of attributional complexity (fletcher, danilovics, fernandez, peterson, & reeder, 1986). in our review, no correlational studies have differentiated actual exposure to microaggression, perception of microaggression, and attribution to why any microaggression incidents have occurred. nevertheless, acknowledging what shapes people’s perception and attribution of microaggression can help elucidate the appraisal process that underlies the associations between microaggression and adjustment outcomes.  microaggression across cultural contexts we found no evidence for cultural differences in the relations between microaggression and adjustment outcomes. the current body of research was derived primarily from the united states, thus our ability to test cross-national differences was rather limited. in non-u.s. studies, four samples considered racial microaggression, two considered lgbtq microaggression, and four considered health status microaggression. previous work has suggested that there are greater cross-cultural similarities in intergroup relationships across gender and age groups because these group stereotypes share universal biological and social foundations (fiske, 2017). by contrast, there are fewer cross-cultural similarities in intergroup relationships across race, ethnicity, and religions; microaggression targeting racially, ethnically, and religiously marginalized groups are more likely to be influenced by within-country historical and sociocultural contexts (fiske, 2017). although our summary effects and moderation results likely are generalizable to countries outside of the united states, there is a greater need to examine how specific national and cultural contexts—including sociopolitical climate and relationships between the privileged and marginalized groups— can influence the conceptualization of this construct, and its associations with adjustment outcomes.  challenges with the present research synthesis despite the present contributions, results from this research synthesis should be interpreted in the context of the following constraints and limitations. first, there are substantially fewer studies on gender and health status microaggressions than racial  
  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  microaggression and adjustment outcomes  and lgbtq microaggressions. there also are only two (unpublished) studies using an experimental approach to simulate microaggression experiences in a controlled laboratory setting. as a result, results involving gender and health status microaggressions and experimental data may be less precise than those involving racial and lgbtq microaggressions and survey data. similarly, most studies have considered single-bias microaggressions; it remains unclear whether multi-bias microaggressions are experientially different from single-bias microaggressions. second, as shown in our narrative review, there are many self-report survey measures of microaggression. most scale scores have demonstrated high internal consistency reliability, and therefore we do not expect that the observed correlations between microaggression and adjustment outcomes to be underestimated. still, these questionnaires vary a great deal in their structural and construct validity. limited by the feasibility of testing the extent to which individual measures contribute to between-study variability in the omnibus summary effect, we are only able to explore whether the most commonly used measures of racial microaggression and lgbtq microaggression yield different correlations. third, study samples included in our meta-analysis tend to be normatively adjusted. evident in our screening process, quantitative studies using clinical samples tend to focus on the relations between microaggression and therapeutic alliance (constantine, 2007; owen et al., 2011). given that therapeutic alliance is not considered an individual-level psychological outcome, our data do not allow us to examine how microaggression may be associated with adjustment outcomes among people in the clinical setting. additionally, many studies have examined the frequency in which people experience microaggression (choi, lewis, harwood, mendenhall, & huntt, 2017; lewis & neville, 2015; timmins et al., 2017), and in many cases participants have reported relatively low frequencies of microaggression and low levels of adjustment problems. it is unclear whether our findings are generalized to people under heightened distress (e.g., in the clinical setting or in severely disadvantaged situations). fourth, our meta-analytic approach has allowed us to estimate effect sizes aggregated at the study/sample level. as in most meta-analyses, these findings may or may not reflect the relations between microaggression and adjustment outcomes experienced by different individuals or subgroups. for example, research has shown that people have different attitudes toward gay men, lesbian women, bisexual individuals, and trans individuals (gazzola & morrison, 2014; vaughn, teeters, sadler, & cronan, 2017). whereas it is useful to examine the relations between adjustment outcomes and overall lgbtq microaggression, it is unclear how these associations may play out differently across lgbtq subgroups and the extent to which these meta-analytic effects can explain individuals’ experiences. finally, even though unpublished materials— especially grey information—typically represent only a small number of studies in meta-analyses (bellefontaine & lee, 2014) and that published research does not always yield larger effect sizes, we sought to include published and unpublished data in this research synthesis. still, there may be grey materials on this topic not represented in our investigation. future research syntheses should continue to use a pragmatic approach that supports empirically justified boundaries of a research topic and considers the potentially valuable insight from grey materials (adams, smart, & huff, 2017).  71  research gaps and recommendations for future directions the present findings suggest several critical directions for future research. first, more research is needed to focus on improving the conceptualization and measurement of microaggression. typical to many constructs in psychology and social sciences, microaggression represents an open concept with loose boundaries concerning a “nomological network of convergent and discriminant correlates” (lilienfeld, 2017a, p. 143). to some extent, existing survey questionnaires often contain items that measure everyday unfair treatment and overt discrimination that can be easily attributed to prejudice toward a social group. some questionnaires also measure minority-focused experiences that may or may not be “aggressive” per se (see table 6 for sample scale items). as discussed in another narrative review (wong et al., 2014), it remains an open question as to whether (racial) microassault should be considered a category of microaggression. in our meta-analyses, studies that measured microassault yielded larger correlations than studies that measured microinsult and microinvalidation. although these differences are very tentative given the small number of samples in each category, they nonetheless call into question the argument that everyday microaggressions are more stressful than overt discrimination. the word microaggression at face value implies an “aggressive” ill-intention that underlies (non)verbal slights and put-downs. at the same time, microaggression has been defined to include conscious or unconscious, sometimes well-intended behaviors. unlike overt discrimination, however, microaggression poses as an ambiguous stimulus during interpersonal or group-level interactions. the very nature of this ambiguity has made this research program challenging. in a statement addressing the use of racial slurs, for example, the alliance of colonial era tribes indicated that “degrading an american indian name or historic tribal reference by using it as an insult is making a racial slur, whether knowingly or unknowingly. the right to determine if it is a slur belongs to those who have been insulted, not the one who made the insult” (acet, 2017). to what extent is microaggression a matter that lies in the eye of the beholder, and to what extent does intentionality matter in determining the constitutions of microaggression? the field needs to contend with whether differences exist in the relations between adjustment outcomes and actual exposures to microaggression, and between adjustment outcomes and perceived microaggression. similarly, future research could benefit from better distinctions between interpersonal- and group-level microaggressions. the broader discrimination literature has conceptually distinguished systemic/institutional discrimination from interpersonal discrimination, and has shown their differential relations with mental health outcomes (gilbert & zemore, 2016; williams & mohammed, 2013). other research also has suggested that sources of discrimination (e.g., from authority figures, peers, or society at large) can have differential impact on people’s adjustment outcomes (benner & graham, 2013). having found a weaker association between group-level microaggression than interpersonal microaggression in this study, more investigations should examine whether slights and derogations manifested in the media or in different cultural institutions should be considered microaggression under the same nomological network. with much of the early research focusing on the nuances of its experiential reality (sue,  
  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  72  lui and quezada  2017), improved conceptualization—and subsequently operationalization— of microaggression can benefit from sophisticated statistical approaches such as factor analyses and differential item functioning. second, there should be a greater emphasis to rule out possible extraneous factors in the relations between microaggression and adjustment outcomes, or examine the degree to which microaggression predicts adjustment outcomes while accounting for the influences of individual difference variables. reactions to microaggression (or any other stressors) inevitably vary by individuals’ (lazarus & folkman, 1984; meyer, 2003) prior experiences with discrimination, personality, and cognitive appraisal, but these factors do not necessarily negate the subjectively stressful nature of microaggression. for instance, negative emotionality has been shown to function as predispositions for psychopathology and health problems (lakdawalla & hankin, 2008), yet it has been largely neglected in microaggression research (huebner et al., 2005; lilienfeld, 2017a). additionally, we have yet to see strong and consistent evidence from our narrative reviews that would support the notion that microaggression and overt discrimination predict adjustment outcomes above and beyond each other. with improved conceptualization and operationalization of microaggression, research would have a better chance in differentiating it from overt discrimination, and examining the extent to which microaggression is associated with adjustment outcomes over and above overt discrimination and other minority stressors. third, only a handful of cross-sectional studies and one longitudinal study have examined the pathways by which microaggression experiences are associated with psychological adjustment thus far. in addition to some concerns with regard to the differentiations between mediation and moderation models in this body of work, it is important to note that cross-sectional data are limited in their capacity for making reliable conclusions about indirect associations (lui, 2018; maxwell & cole, 2007) linking microaggression and adjustment outcomes. building on the rich, nuanced findings from qualitative research as well as the conceptual frameworks on microaggression (sue, 2010) and minority stress (meyer, 2003), the microaggression literature will continue to benefit from using sophisticated quantitative survey and experimental methods to uncover the mechanisms that link adjustment outcomes to the perceptions of microaggression (lau & williams, 2010). for example, research has made strides in elucidating how overt discrimination might affect mental and physical health by way of stress responses and health risk behaviors (pascoe & smart richman, 2009). it is possible that microaggression is linked to adjustment outcomes through multiple mechanisms as well. on the one hand, microaggression receivers’ emotionality and attribution may affect how they identify and react to ambiguous intergroup interactions. individual differences in racial vigilance can heighten people’s stress responses to situationally induced discrimination (sawyer, major, casad, townsend, & mendes, 2012). on the other hand, microaggression may give rise to negative affect and subjective feelings of stress. feelings of stress may then adversely affect internalizing problems such as depression, and health outcomes such as sleep quality (huynh, 2012; huynh & gillen-o’neel, 2016), and promote the use of health risk behaviors as maladaptive coping methods (williams & mohammed, 2009). cumulative stresses associated with microaggression also may elicit a sense of burdensomeness (hollingsworth et al., 2017), yield  greater allostatic load among people of minority statuses, and lead to poorer health outcomes (duru, harawa, kermah, & norris, 2012; fredriksen-goldsen et al., 2014; geronimus, hicken, keene, & bound, 2006). future research can measure physiological responses to assess how microaggression may burden the allostasis and affect health. researchers also may examine motives behind health risk behaviors that link microaggression to externalizing problems. longitudinal studies—including those that use a daily diary approach—will be valuable in teasing out the directions in which microaggression is associated with adjustment outcomes. building on research that focuses on between-person analyses, studies that focus on within-person change can further elucidate the mechanisms underlying these associations of interest. lastly, researchers are encouraged to consider people as active agents who make sense of, and best adjust to, their environments and interpersonal relationships (fredriksen-goldsen et al., 2014; lui & zamboanga, 2018a, 2018b). individuals vary in their awareness and cognitive appraisals of, responses to, and coping strategies against, microaggression (sellers & shelton, 2003). some people may consider a microinvalidation incident as an attack that contains hidden demeaning messages, others may brush it off as the deliverer’s ignorance about minority’s lived experiences (harris, 2008). people’s tendencies to recognize microaggression incidents and interpret them as harmful aggression may depend on the centrality of their social identity. for example, affirming to one’s ethnic identity, however, has been shown to buffer the associations between discrimination and self-esteem among mexican americans (umana-taylor, wong, gonzales, & dumka, 2012). alternatively, people who carry greater cultural mistrust and have experienced higher levels of discrimination are at greater risk for depression (ajayi & syed, 2014). in addition, racial identity has been shown to not only promote black americans’ anticipation for racial discrimination, but also intensify the negative association between discrimination and depression symptoms (hoggard, byrd, & sellers, 2015; seaton, upton, gilbert, & volpe, 2014).  conclusions in this research synthesis, we proposed a cube model to help conceptualize microaggression in terms of social group memberships, and social levels, and categories. compared with previous meta-analyses linking overt discrimination to adjustment outcomes, our results showed similar summary effects linking microaggression to adjustment outcomes. except for gender microaggression, we found robust correlations linking racial, lgbtq, and health status microaggressions and psychological adjustment outcomes associated with internalizing and externalizing problems, stress and negative affect, positive adjustment, and positive affect. across categories of microaggression, microassault was more closely associated with adjustment outcomes than microinsult and microinvalidation. microaggression occurring at the interpersonal level was more strongly correlated with adjustment outcomes than microaggression occurring at the group levels. studies with asian, black, and hispanic americans were found to yield larger effects than studies with white americans. results highlighted research gaps pertaining to microaggression’s incremental validity above and beyond overt discrimination and negative emotionality in predicting adjustment outcomes. future investigations should illuminate the pathways by which microaggression may be related to  
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  this document is copyrighted by the american psychological association or one of its allied publishers. this article is intended solely for the personal use of the individual user and is not to be disseminated broadly.  78  lui and quezada  ioral medicine, 32, 20 – 47. http://dx.doi.org/10.1007/s10865-0089185-0 williams, d. r., & mohammed, s. a. (2013). racism and health i: pathways and scientific evidence. american behavioral scientist, 57, 1152–1173. http://dx.doi.org/10.1177/0002764213487340 wilson, d. b. (2009). systematic coding. in h. cooper, l. v. hedges, & j. c. valentine (eds.), the handbook of research synthesis and metaanalysis (pp. 159 –176). new york, ny: russell sage foundation. ⴱ wilson, m. (2014). neurocognitive and whole-system reactions to covert racial discrimination-induced stress (doctoral dissertation). retrieved from proquest dissertations & theses global. (umi no. 3643392) wong, g., derthick, a. o., david, e. j. r., saw, a., & okazaki, s. (2014). the what, the why, and the how: a review of racial microaggressions research in psychology. race and social problems, 6, 181–200. http:// dx.doi.org/10.1007/s12552-013-9107-9 ⴱ woodford, m. r., chonody, j. m., kulick, a., brennan, d. j., & renn, k. (2015). the lgbq microaggressions on campus scale: a scale development and validation study. journal of homosexuality, 62, 1660 –1687. http://dx.doi.org/10.1080/00918369.2015.1078205 ⴱ woodford, m. r., joslin, j. y., pitcher, e. n., & renn, k. a. (2017). a mixed-methods inquiry into transⴱ environmental microaggressions on college campuses: experiences and outcomes. journal of ethnic & cultural diversity in social work, 26, 95–111. http://dx.doi.org/10 .1080/15313204.2016.1263817  ⴱ  woodford, m. r., kulick, a., sinco, b. r., & hong, j. s. (2014). contemporary heterosexism on campus and psychological distress among lgbq students: the mediating role of self-acceptance. american journal of orthopsychiatry, 84, 519 –529. http://dx.doi.org/10.1037/ ort0000015 ⴱ woodford, m. r., paceley, m. s., kulick, a., & hong, j. s. (2015). the lgbq social climate matters: policies, protests, and placards and psychological well-being among lgbq emerging adults. journal of gay & lesbian social services, 27, 116 –141. http://dx.doi.org/10.1080/ 10538720.2015.990334 ⴱ wright, a. j., & wegner, r. t. (2012). homonegative microaggressions and their impact on lgb individuals: a measure validity study. journal of lgbt issues in counseling, 6, 34 –54. http://dx.doi.org/10.1080/ 15538605.2012.648578 ⴱ yoo, h. c., steger, m. f., & lee, r. m. (2010). validation of the subtle and blatant racism scale for asian american college students (sabra(2)). cultural diversity and ethnic minority psychology, 16, 323–334. http://dx.doi.org/10.1037/a0018674  received december 15, 2017 revision received september 1, 2018 accepted september 7, 2018 䡲  e-mail notification of your latest issue online! would you like to know when the next issue of your favorite apa journal will be available online? this service is now available to you. sign up at https://my.apa.org/portal/alerts/ and you will be notified by e-mail when issues of interest to you become available!  
       


secondary_title_index: journal of ethnic &amp; cultural diversity in social work
title_index:
       spiritual microaggressions: understanding the subtle messages that foster religious discrimination     

full_text_index:
       journal of ethnic & cultural diversity in social work  issn: 1531-3204 (print) 1531-3212 (online) journal homepage: https://www.tandfonline.com/loi/wecd20  spiritual microaggressions: understanding the subtle messages that foster religious discrimination david r. hodge to cite this article: david r. hodge (2019): spiritual microaggressions: understanding the subtle messages that foster religious discrimination, journal of ethnic & cultural diversity in social work, doi: 10.1080/15313204.2018.1555501 to link to this article: https://doi.org/10.1080/15313204.2018.1555501  published online: 14 jan 2019.  submit your article to this journal  article views: 3  view crossmark data  full terms & conditions of access and use can be found at https://www.tandfonline.com/action/journalinformation?journalcode wecd20  
  journal of ethnic & cultural diversity in social work https://doi.org/10.1080/15313204.2018.1555501  original article  spiritual microaggressions: understanding the subtle messages that foster religious discrimination david r. hodge school of social work, arizona state university, phoenix, az, usa and program for research on religion and urban civil society, university of pennsylvania, philadelphia, pa, usa abstract  keywords  social workers have an ethical duty to recognize and support each person’s spiritual identity and ameliorate diverse forms of religious bias. these ethnical mandates are increasingly salient in light of recent federal bureau of investigation data indicating that jews, muslims, christians, and other people of faith are frequent victims of hate crimes. these discriminatory actions do not occur in a vacuum, but are legitimized by widely disseminated, subtly detrimental messages—commonly referred to as microaggressions. to assist social workers in identifying and counteracting these negative messages, this article delineates seven types of spiritual microaggressions that are frequently encountered in societal discourse. it concludes by offering some suggestions to help create a society that upholds and defends each person’s spiritual integrity and well-being.  spirituality; religion; jews; muslims; hate crimes  social workers have an ethical calling to ameliorate diverse forms of religious bias (national association of social workers [nasw], 2017). per the international federation of social workers’ (2018) statement of ethical principles, social workers have an ethical duty to recognize and support each person’s spiritual identity in tandem with challenging spiritual discrimination and institutional oppression. to foster the creation of a more socially just society as called for in these ethics codes, it is necessary to identify and eliminate societal inequities that foster unequal treatment based upon people’s spirituality. these ethnical mandates are increasingly salient in light of current societal trends (husain & howard, 2017). according to recent federal bureau of investigation (fbi, 2015, 2016) data, religious hate crimes increased 18% over the past year. after race/ethnicity, religion now represents the single largest category of bias. religious hate crimes exceed those based upon gender, disability, and sexual orientation—combined. religious hate crimes do not occur in isolation, but rather reflect attitudes that flow from structural power differentials (sue, 2010a). in other contact david r. hodge davidhodge@asu.edu school of social work, arizona state university, mail code 3920, 411 n. central avenue, suite 750, phoenix, az 85004-2163, usa.  2019 taylor & francis group, llc  
  2  d. r. hodge  words, hate crimes are the small, visible manifestation of more pervasive patterns of prejudice. these biases, which are often unconsciously held, are reinforced by others who share similar sentiments (yancey & williamson, 2014). widely disseminated, implicitly detrimental messages—commonly referred to as microaggressions—subtly serve to legitimize negative sentiments toward targeted groups (sue, 2010b). in turn, these spiritual microaggressions function to create a societal milieu that fosters acts of violence against people of faith. despite the prevalence of religious hate crimes, a paucity of scholarly attention has examined the topic of spiritual microaggressions (husain & howard, 2017; nadal, issa, griffin, hamit, & lyons, 2010). the lack of content is particularly concerning in light of studies that have repeatedly demonstrated that most social workers have received little, if any, training in spirituality during their graduate educations (canda & furman, 2010; oxhandler, parrish, torres, & achenbaum, 2015; sheridan, 2009). it is difficult to see how social workers can fulfill their ethical mandate to ameliorate religious discrimination and support people’s spiritual well-being without some exposure to content on this subject. accordingly, the present article addresses this gap in the profession’s literature by familiarizing readers with spiritual microaggressions. the article begins by providing an overview of the general concept of microaggressions. this lays the foundation for the subsequent section that defines spiritual microaggressions. to assist social workers in understanding the subtle messages that foster religious discrimination, the next section reviews seven overlapping categories of spiritual microaggressions. the article concludes by offering some suggestions to help create a society that upholds and defends each person’s spiritual integrity and well-being. microaggressions: an introduction microaggressions can be defined as short, commonplace exchanges that convey implicitly denigrating messages to people based upon their membership in a particular group (sue, 2010b). the term was originally created to describe subtle, derogatory messages directed toward african-americans in television programing (pierce, carew, pierce-gonzalez, & wills, 1977). pierce and colleagues (1977) contend that the framing of black americans in this culture-shaping venue communicated subtle messages that fostered bias toward african-americans at the macro level. in subsequent scholarship, the concept was broadened to incorporate a wide variety of populations (gonzales, davidoff, nadal, & yanos, 2015). it should be mentioned that the increased visibility of microaggressions has sparked questions about their utility (haidt, 2017). for example, lilienfeld (2017a) argues that the conceptual boundaries of microaggressions  
  journal of ethnic & cultural diversity in social work  3  are too fluid and the construct is insufficiently empirically grounded. defenders have emphasized the importance of utilizing different types of scholarship as a way to achieve a more just society (sue, 2017). a full exposition of the critiques and counter-critiques is beyond the scope of this article. interested readers are encouraged to obtain and read the underlying sources (e.g., lilienfeld, 2017a, 2017b; sue, 2017). three different types of microaggressions are commonly posited to exist: microinsults, microassaults, and microinvalidations (sue, 2010b; young, anderson, & stewart, 2015). microinsults are subtle snubs that express insulting messages to members of a target group (pierce et al., 1977). for instance, singling out an african-american male for his articulate speech implicitly communicates that members of this group are not typically wellspoken (kaskan & ho, 2016). microassaults represent more overt attempts to marginalize people through labeling, name-calling, or other forms of discriminatory messages that are intended to intimidate, threaten, and dehumanize members of a specific group. examples include using racial epithets, neglecting to provide services, and displaying pictures of a kkk hood/noose. microinvalidations contradict, nullify, or otherwise invalidate people’s perceptions of reality. an example would be discounting someone’s account of individually experienced bias. as this content implies, microaggressions come in various forms. in addition to verbal aggressions, behavioral and environmental microaggressions also exist (sue, 2010a). as indicated by the examples just provided, verbal microaggressions employ interpersonal speech to communicate derogatory, hostile, or negative messages of various types toward members of a particular group. with behavioral microaggressions, actions implicitly express a demeaning message (e.g., physically recoiling when encountering or interacting with someone who is a member of a target group). with environmental microaggressions, the messages are transmitted through the institutional structures of society. depictions in television programming, educational curricula, news media, films, and other culture-shaping forums implicitly convey messages about the groups featured or excluded (signorielli, 2004). for example, a university where the administrative personnel are comprised almost exclusively of european-americans implicitly conveys a number of covert, hostile messages to african-americans and other people of color, such as “people of your group are unwelcome” and “if you chose to come here, you can only advance so far” (sue, 2010b). environmental microaggressions are especially pernicious since they foster a societal milieu that facilitates the expression of verbal and behavioral microaggressions at the interpersonal level (torres-harding & turner, 2015). environmental microaggressions—regardless of whether they are expressed as microinsults, microassaults, or microinvalidations—serve to shape perceptions at the macro level. thus, relative to verbal and behavioral  
  4  d. r. hodge  microaggressions, environmental microaggressions are particularly concerning due to their culture-shaping influence. it is important to note that microaggressions are group specific (robinson & rubin, 2016). unique societal dynamics shape the messages that are aimed at various cultural groups. microaggressions aimed at african-americans differ from those aimed at women, which in turn differ from those aimed at people coping with disabilities. for instance, sexually explicit pictures of women in the workplace serve as a culturally distinct microaggression that serves to objectify females (kaskan & ho, 2016). among the different groups that can be singled out for microaggressions are spiritual groups (ahluwalia & alimchandani, 2013; husain & howard, 2017; nadal et al., 2010; rosik, teraoka, & moretto, 2016).  spiritual microaggressions spiritual microaggressions can be understood as common verbal, behavioral, and environmental snubs, slights, or insults aimed at people based upon their membership in a particular spiritual group, faith tradition, or religion (sue, 2010b). it should be noted that the concept of spirituality, as well as its relationship to religion, is contested in academic discourse (koenig, king, & carson, 2012). in this article, spirituality is viewed as a broader, more encompassing construct relative to religion (canda & furman, 2010). spirituality is commonly defined as an individual’s subjective relationship with god (wuthnow, 2007), or more broadly the sacred or transcendent (hodge, 2015). understood in this manner, spirituality is an individually oriented construct. in keeping with the social nature of human beings, spirituality is typically expressed in, and informed by, a social group that is animated in some sense by spirituality. in the united states this social group is typically a specific religion, which can be understood as a culturally shared set of beliefs, values, and practices that have been developed over time by those who share similar understandings of the transcendent (praglin, 2004). thus, spiritual microaggressions in the united states are typically aimed at people based upon their membership in a particular religion (rosik et al., 2016). in this sense, spiritual microaggressions are analogous to racial microaggressions, which can be defined as slights that seek to disenfranchise individuals based upon their membership in a racial group (ong, burrow, fuller-rowell, ja, & sue, 2013). like racial groups, each religious group has a unique history and culturally shared value system (richards & bergin, 2014). thus, insults targeting muslims may differ from those aimed at jews in the same way that slights aimed at african-americans tend to differ from those aimed at asian-americans (nadal et al., 2010). since the insults target people based upon their expression of spirituality, however, they are viewed  
  journal of ethnic & cultural diversity in social work  5  as spiritual microaggressions in much the same way that insults that target people on their racial identity are considered racial microaggressions. to be clear, however, not all spiritual microaggressions are based upon membership in a particular religion. in the same way that some generic racial microaggressions exist, some spiritual microaggressions target individuals based solely upon their spirituality, apart from any membership in a specific religious tradition. for example, some spiritual microaggressions target people based upon a pan-religious spirituality, a generic belief in god, or a nonreligious spirituality. this being said, it should be noted that spiritual microaggressions, like other forms of microaggressions, are a group-based phenomenon (sue, 2010b). thus, some type of social group with a distinctive worldview is either directly or indirectly referenced. in a manner similar to racial microaggressions, spiritual microaggressions stem from worldview power differentials (sue, 2010a). power flows from the ability to define reality, typically through culture-shaping forums such as education, television, films, and news media. people with a secular worldview dominate these and other postindustrial knowledge sector professions (gouldner, 1979; smith, 2003). for example, elite institutions such as harvard, once run by devout puritan christians, are now populated by people with a secular worldview (kendrick, 2006; marsden, 1994). as a result of their dominance in these culture-shaping forums, secular attitudes and beliefs are infused throughout society at a macro level (sue, 2010b). the beliefs and biases of secular people are framed as normative (bolce & de maio, 2008). as such, these perceptions exist outside the conscious awareness of many members of society. the values disseminated through reality-defining forums function to shape understandings of how the world should be ordered for most societal members. consequently, perpetrators are often unaware of the potentially pernicious nature of their microaggressions as the dominant secular narrative serves to legitimize negative sentiments in popular discourse. in turn, these sentiments help fuel a societal milieu that fosters discriminatory acts against people of faith (fbi, 2015, 2016). examples of spiritual microaggressions to identify spiritual microaggressions, it can be helpful to have some understanding of the various types of microaggressions that commonly manifest in societal discourse. in the following content, seven overlapping categories of spiritual microaggressions are delineated (see figure 1). in broad relief, the subtle messages that foster religious discrimination can be grouped in the following categories: messages that endorse stereotypes, assume homogeneity, pathologize, disparage, and exoticize spirituality, presuppose secularism, and, finally, deny the existence of spiritual prejudice. although most of the  
  6  d. r. hodge  endorsing stereotypes moving right after a muslim woman wearing a hijab sits next to you on a park bench. (you are a violent threat to everyone around you) commenting, "i really jewed him down!" (the jewish people can be essentialized as nothing but a derogatory stereotype) assuming homogeneity asking a muslim, “what is the islamic perspective on that topic?" (no diversity of thought exists among muslims) remarking, “you have blond hair. how can you be jewish?” (everyone within judaism is the same) pathologizing spirituality exclaiming, “that’s crazy!” after an american indian shares her belief in spirit guides. (your beliefs represent a form of psychopathology) wearing clothing featuring the phrase, “recovering catholic.” (catholicism is a form of disease) disparaging spirituality television characters using the term “god” in a profane manner. (the central object of your spirituality is nothing but an emotional expletive) labeling a person a “fundamentalist.” (you are a bigot, hateful, and potentially a terrorist) exoticizing spirituality staring or pointing at a jew wearing a yarmulke or skullcap. (you are outside the mainstream of society) asking excessive questions about the five ks commonly practiced by sikhs. (your beliefs and practices are alien or foreign) presupposing secularism universities that do not include any visible muslims among faculty and administrators. (you are not welcome here) textbooks that omit or obscure the contributions of people of faith. (people of faith did not, do not, and should not exist) television programming that typically features secular people, values, and reasoning. (secularism is the norm, people of faith are outside the societal mainstream) denying the existence of spiritual prejudice "i am not anti-semitic. i have a jewish friend." (i am incapable of bias) "people of faith can't experience structural bias since most people believe in god." (your understanding of your lived reality is inferior to my understanding of your reality)  figure 1. spiritual microaggressions: overlapping types, examples, and underlying messages.  examples used to illustrate these categories seek to disenfranchise people based upon their membership in a specific religious group, some examples are also provided in which people are targeted based solely upon their spirituality, apart from membership in a specific religious tradition.  
  journal of ethnic & cultural diversity in social work  7  endorsing stereotypes  spiritual microaggressions in this category consist of messages that play on over-generalized beliefs about spiritual groups. stereotypes emerge about essentially all subordinate populations (farley, 2011). for example, common stereotypes attributed to african-americans include incompetence, criminality, and intellectual inferiority (holder, jackson, & ponterotto, 2015). similar stereotypes exist about religious groups. for example, traditional muslims are frequently associated with violence and terrorism (aronian, 2012), jews with frugality and trickery (nadal et al., 2010), and christians with intolerance and extremism (kinnaman & lyons, 2007, 2016). an example of a behavioral microinsult might occur when a muslim wearing a hijab sits down on a city park bench and the individual sitting next to her immediately gets up and leaves (husain & howard, 2017). this behavior implicitly conveys the message to the women that she is not safe, that she represents a dangerous threat to one’s physical well-being. as is the case with many microinsults, however, some degree of ambiguity exists about the message conveyed (sue, 2010b). the individual may have had an appointment and needed to leave at just that time, or perhaps wanted to move to a bench with a different view. furthermore, the individual may not even be fully cognizant of reasons underlying the move. the victim must guess at the reasons that prompted the sudden move. this ambiguity can cause a significant degree of psychological stress for victims as they must sort through the various options (gonzales et al., 2015). not all spiritual microaggressions are cloaked in ambiguity. take, for instance, a supervisor who comments to one of his salesman after he concludes negotiations with a buyer, “you really jewed him down.” this verbal microassault communicates the message that jewish people are not fully human by playing on derogatory stereotypes about members of this population. as is the case with many other microaggressions, the perpetrator may have intended the comment in a positive manner. in this case, the supervisor likely wanted to be supportive and encouraging, complementing his salesman on a job well done. yet, irrespective of the intent, the underlying message communicated about the jewish people is disparaging.  assuming homogeneity  this type of spiritual microaggression conveys the message that every individual in a given spiritual tradition affirms the same beliefs and practices. the spiritual microaggressions that fall into this category are similar to those discussed earlier, but differ in an important manner. stereotypes tend to be based on uninformed prejudice of some type while spiritual homogeneity is based on an accurate understanding of religious beliefs. microaggressions in  
  8  d. r. hodge  this category reflect the assumption that no flexibility exists within a given religious belief system (nadal et al., 2012). in other words, the message is conveyed that every person who ascribes to a given religion holds the same beliefs and values. spiritual microaggressions in this category can take many forms (dupper, forrest-bank, & lowry-carusillo, 2015). for example, asking a muslim, “what is the islamic perspective on that subject?” sends the message that a single islamic perspective exists on the subject at hand. this verbal microinsult also implies that the individual should be a representative of this perspective just because they are a muslim. another form of this spiritual microaggression is manifested in the question, “you have blond hair so how can you be jewish?” this statement implicitly communicates that everyone within judaism is identical (nadal et al., 2010). another variation is seen in the following statement: “you’re latino, so you must be catholic.” in this instance, the verbal microinsult conflates faith and ethnicity, and implicitly sends the message that people must be a member of a given religion due to their ethnicity. pathologizing spirituality  this category of microaggressions is characterized by communication that pathologizes people based upon their spirituality. these messages subtly equate spiritual beliefs and practices with abnormality, deviance, or sickness. an analogous example drawn from racial microaggressions would be statements that express the sentiment that african-american culture is defective. in the area of spirituality, many people believe in what might be called spirit guides, supernatural beings that have a nonmaterial existence (stark, 2008). exclaiming “that’s crazy!” when an american indian reports such a belief would be an example of a verbal microassault that falls into this category. another example consists of clothing featuring the phrase “recovering catholic,” which represents a play on the phrase “recovering alcoholic.” catholicism is equated with alcoholism, which is commonly understood to be a disease. the implicit message is that catholics are suffering from a type of disease, much like alcoholics. such environmental microassaults can be profoundly hurtful to catholics and facilitate the creation of a discriminatory social milieu. another example of an environmental microassault occurs when students are asked to read key texts by freud (1927/1964) and ellis (1980). these influential theorists are the founders, respectively, of the psychoanalytic and cognitive behavioral therapy movements. both thinkers argued that devout faith was a type of mental illness. spirituality often functions as an individual’s most important social identity (newport, 2012). stating this identity represents a form of pathology is damaging. such texts reduce people to  
  journal of ethnic & cultural diversity in social work  9  subhuman status, essentially depicting them as a form of mental illness that should be eradicated through counseling. although freud’s and ellis’s views find little support in the empirical research (koenig et al., 2012), similar perspectives frequently appear in academic scholarship (larson, milano, & lu, 1998; richards & davison, 1992; watson, morris, & hood, 1992) as well as in popular discourse (dawkins, 2008; harris, 2005; hitchens, 2009).  disparaging spirituality  messages fall into this category if they involve mocking, denigrating, or otherwise disparaging people who are members of a faith. overlap exists between this category and those previously discussed. for example, suggesting someone’s spirituality represents a form of pathology can be considered a belittling or mocking message, as might occur with clothing displaying the message “recovering catholic.” this category captures aggressions that do not fall into other categories, but are disparaging. for example, a common microinsult that falls under this banner consists of referring to a deity (e.g., god) in a profane manner (hyers & hyers, 2008). such environmental microinsults appear frequently in fictional television programming (skill, robinson, lyons, & larson, 1994). for muslims, jews, and many other spiritual people, god is commonly viewed as a supreme being worthy of reverence. the use of god’s name in a profane manner is offensive. the message communicated through such usage is that the central object of one’s spiritual life is an emotional expletive (skill et al., 1994). another common microinsult is referring to someone as a “fundamentalist.” this is analogous to referring to women as “bitches” or japanese-americans as “japs” (sue, 2010b). in the same way that the latter two labels represent an assault on one’s identity based upon, respectively, gender and race, the use of “fundamentalist” represents an assault on one’s identity based upon their spirituality (sayyid, 1997). the term “fundamentalist” has been constructed in mainstream discourse to connote bigotry, hatred, militancy, and terrorism (hunsberger, 1995). the underlying message is that devout jews, muslims, and other people of faith should be viewed as a type of social “other,” as illegitimate people whose beliefs place them outside the bounds of acceptable discourse (bolce & de maio, 2008).  exoticizing spirituality  this form of microaggression is evidenced by messages that communicate that particular forms of spirituality are bizarre, foreign, or unusual (nadal et al., 2010). the distinguishing characteristic in this category is the unusualness of spiritual beliefs and practices. these messages can be directed at all  
  10  d. r. hodge  people of faith but they are frequently targeted toward those whose appearance differs from secular norms. examples of behavioral microinsults in this category can include staring at a jew wearing a yarmulke or skullcap, pointing at a muslim wearing a hijab, gawking at a sikh wearing a turban, or even smirking at a catholic’s ashes on ash wednesday. the underlying sentiment communicated by these actions is that individuals who express their spirituality in these forms are outside the mainstream of society; that they are deviant, non-normal, or exotic. the same implicit message of foreignness can also be communicated verbally by, for example, asking questions about certain spiritual practices. examples that can elicit such inquires include the islamic practice of fasting during ramadan by muslims, jewish kosher diets, speaking in tongues by pentecostal christians, the five k’s of sikhism, and the temple garments worn by latter-day saints, sometimes referred to as mormon underwear. asking questions about these and other spiritual customs can potentially transmit the message that such practices are alien and bizarre. it is important to note that intent is not necessarily a relevant factor. even sincere, well-intentioned attempts to understand a person’s beliefs can—in certain circumstances— implicitly frame the spiritually committed person as an alien in the larger secular culture. presupposing secularism  macroaggressions in this category reflect the assumption that secular values are normative, expected, or the standard (rosik et al., 2016). the dynamic is similar to that discussed earlier regarding universities and television programing (pierce et al., 1977). university campuses and television content populated by european-americans fosters a climate in which white perceptions of reality serve as the standard against which others are implicitly judged. likewise, universities that do not include visible professors of faith communicate similar environmental microinsults to students of faith (gross & simmons, 2009). an academic department without, for example, orthodox jews, muslims, or evangelical christians implicitly communicates that students from these faith traditions are unwelcome, may be uncomfortable if they decide to pursue a degree, and can only progress so far up the academic ladder. these messages are reinforced by k–12 textbooks that tend to either omit or fail to draw attention to the contributions of people of faith (bellitto, 1996; boyer, 1996; hillocks, 1978; oppewal, 1985; sewall, 1995; vitz, 1986, 1998). such selective framing transmits a number of environmental microinsults, such as people of faith do not exist, have never existed, and should not exist in the future. a comparable set of environmental microinsults are communicated through fictional television programing, which tends to frame secular people  
  journal of ethnic & cultural diversity in social work  11  positively and religious people infrequently and, when depicted, with a negative bias (clarke, 2005; lichter, lichter, & rothman, 1994; lind, 2014; skill & robinson, 1994; skill et al., 1994). such programming communicates the message that secular people and values represent normality—the way the world should be ordered—while people of faith represent abnormality, or people who are outside the societal mainstream. similar environmental microinsults are communicated in other culture-shaping forums including corporate advertising (maguire, sandage, & weatherby, 1999; maguire & weatherby, 1998), films (powers, rothman, & rothman, 1996), film reviews (moore, 2014), and popular periodicals (perkins, 1984; woodward, 2005). in addition to environmental microinsults, it should be noted that interpersonal microaggressions also exist in this category. for example, exhibiting surprise when a jew or muslim declines a meal containing bacon might be an example of a behavioral microinsult (husain & howard, 2017). alternatively, consider a person who asks his hindu colleague to refrain from praying before eating a meal in a public setting. this verbal microinsult sends several negative messages such as you should avoid being yourself in public, being a spiritual person in public is inappropriate, and only secular forms of expression are acceptable in public forums. denying prejudice  this category of microaggressions is characterized by denying the existence of spiritual prejudice (nadal et al., 2010). this includes denials at both the micro and macro levels. the former includes negating experiences of personal bias while the latter includes rejecting the existence of systemic bias. consider, for instance, the following statement offered to invalidate a report of personal bias: “i am not anti-semitic. i have a jewish friend.” this statement implies that the person cannot be prejudiced; that the individual is incapable of bias. a similar message is transmitted by the following response: “i don’t see your religion; i see only you as a person.” this response implicitly sends the message that the person’s spiritual identity is not a relevant factor in interpersonal interactions. a microinvalidation that discounts systemic bias is illustrated by the statement, “people of faith can’t experience bias in america since most people believe in god.” this comment disregards the experiential reality of many people of faith who, as implied earlier, experience structural bias in many culture-shaping venues (yancey, 2011), including television programming, perhaps the most powerful culture-shaping medium (clarke, 2005; grigg, 2007; lichter et al., 1994; lind, 2014; skill & robinson, 1994; skill et al., 1994). several disparaging messages are communicated by this microinvalidation, including the assumption that the speaker’s understanding of  
  12  d. r. hodge  the victim’s lived reality is superior to the victim’s understanding of his or her own reality. implications for social work education and practice as noted in the introduction, spiritual microaggressions can have significant consequences. at one end of the continuum, a small but growing body of research links microaggressions with a variety of negative health outcomes (ong et al., 2013; robinson & rubin, 2016; torres-harding & turner, 2015). at the other end of the continuum, they help create an environment that fuels and legitimizes hate crimes against people of faith (fbi, 2016). the growing prevalence of such crimes underscores the importance of efforts to create a society that upholds and defends each person’s spiritual integrity and well-being. toward that end, a key strategy is highlighting the issue of spiritual microaggressions in diverse settings (husain & howard, 2017). currently, very little awareness exists regarding spiritual microaggressions. to address the problem, it is first necessary to recognize its existence. raising awareness about spiritual microaggressions empowers people to acknowledge their reality and implement strategies to counteract the negative effects (guzman, trevino, lubuguin, & aryan, 2010). efforts might be focused on those groups who are most often victimized. fbi (2016) data indicate the most frequent victims of hate crimes are, in declining order, jews, muslims, and christians, followed by members of other religious groups. just over half (51.3%) of offenses were aimed at jews while muslims recorded the biggest increase in hate crimes on a yearover-year basis (lichtblau, 2016). these data suggest that attention, at least initially, might center on highlighting the effects of microaggressions that target jews and muslims, although work is needed on this topic across essentially all religious groups. research can also play an important role in this process. as alluded to earlier, little research has been conducted on spiritual microaggressions. studies might investigate the various types of spiritual microaggressions that are most pronounced regarding different religious groups. the relationship between microaggressions and health outcomes might also be examined (husain & howard, 2017). highlighting the basic human rights that apply to people of faith can also be helpful. in keeping with that goal, social workers might review the human rights that address religion in the united nations’ (1948/1998) universal declaration of human rights in classrooms and other settings. disseminating information about the basic human rights that safeguard diverse expressions of spirituality can help foster a more inclusive, civil society.  
  journal of ethnic & cultural diversity in social work  13  in direct-practice settings, a spiritual assessment should typically be conducted (hodge, 2015). such an assessment lays the foundation for subsequent clinical work with people of faith while also providing a window into the adverse effects of discrimination on client functioning. identifying such discrimination and its effects positions practitioners to tailor therapeutic strategies accordingly. conclusion spiritual microaggressions are antithetical to the social work profession’s values of inclusion, equity, and equality. these subtle, often covert, messages embedded in common phrases function to legitimize discriminatory actions that target jews, muslims, christians, and other people of faith in an increasingly polarized society. to help social workers identify and address these aggressions, this article provides an overview of seven common manifestations of spiritual microaggressions. by understanding the subtle messages that foster religious discrimination, social workers are better positioned to fulfill their ethical mandate to ameliorate religious discrimination and support clients’ spiritual well-being. put differently, this article helps facilitate movement toward more ethical, client-centered service provision. disclosure statement no potential conflict of interest was reported by the author.  references ahluwalia, m. k., & alimchandani, a. (2013). a call to integrate religious communities into practice: the case of sikhs. the counseling psychologist, 41(6), 931–956. doi:10.1177/ 0011000012458808 aronian, k. j. (2012). discrimination against muslim american adolescents. the journal of school nursing, 28(3), 206–213. doi:10.1177/1059840511432316 bellitto, c. m. (1996). incomplete pictures: religion in high-school textbooks on european history. social studies, 87(6), 274–280. doi:10.1080/00377996.1996.10114500 bolce, l., & de maio, g. (2008). a prejudice for the thinking classes: media exposure, political sophistication, and the anti-christian fundamentalist. american politics research, 36(2), 155–185. doi:10.1177/1532673x07309601 boyer, p. (1996). in search of the fourth “r”: the treatment of religion in american history textbooks and survey courses. the history teacher, 29(2), 195–216. doi:10.2307/ 494740 canda, e. r., & furman, l. d. (2010). spiritual diversity in social work practice: the heart of helping (2nd ed.). new york, ny: oxford university press. clarke, s. h. (2005). created in whose image? religious characters on network television. journal of media and religion, 4(3), 137–153. doi:10.1207/s15328415jmr0403_2 dawkins, r. (2008). the god delusion. new york, ny: houghton mifflin company.  
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secondary_title_index: the journal of academic librarianship
title_index:
       racial microaggressions in academic libraries: results of a survey of minority and non-minority librarians     

full_text_index:
       available online at www.sciencedirect.com  sciencedirect behavior therapy 52 (2021) 709 – 719 www.elsevier.com/locate/bt  microaggressions are a form of aggression monnica t. williams university of ottawa most efforts to understand microaggressions have examined affected group members, but little work has been done to understand the motivations and characteristics of offenders. the purpose of this study was to determine whether microaggressions are best conceptualized as a form of aggression, as per common definitions advanced in social psychology, by examining correlations between propensity to commit microaggressions and aggressive tendencies. this cross-sectional study was conducted using mturk prime to survey a sample of white and black adults across the united states (n 610). measures administered included the cultural cognitions and actions scale (ccas) to assess the likelihood of committing microaggressions, buss–perry aggression questionnaire (bpaq), inventory of hostility and suspicious thinking (ihs), overt–covert aggression inventory (ocai), and the positive and negative affectivity schedule (panas). the ccas was found to be highly and significantly positively correlated with all three measures of aggression. there was a significant negative correlation between black participants’ ratings of microaggressive interactions being racist and white participants’ likelihood of engaging in those same interactions. there was a significant positive correlation between negative affectivity and the propensity of white participants to commit microaggressions. in a regression predicting microaggressive propensity from aggressive tendencies, the bpaq was highly significant, whereas negative affectivity was not. findings indicate that microaggressions represent aggression and  romar muir, terence ching, and jamilah george provided assistance in the initial stages of this project, and destiny printz helped with data collection. an early version of this work was presented at the 53rd annual convention of the association of behavioral and cognitive therapies in atlanta, georgia. the work was funded by the pi’s research fund at the university of connecticut. the university had no involvement in the study design, data collection, analysis/interpretation of data, writing of the paper, or the decision to submit the paper for publication. address correspondence to monnica t. williams, ph.d., university of ottawa, school of psychology, 136 jean-jacques lussier, vanier hall, ottawa, ontario, k1n 6n5, canada; e-mail: monnica.williams@uottawa.ca. 0005-7894/ 2021 association for behavioral and cognitive therapies. published by elsevier ltd. all rights reserved.  hostility on the part of offenders and a form of aggressive behavior that is generally socially unacceptable. future research should explore the relationship between the many forms of microaggressions and aggression among different groups.  keywords: microaggressions; ethnic differences; aggression; hostility; affect  as blatant expressions of prejudice have declined over the last several decades (charlesworth & banaji, 2019; krysan & moberg, 2016; madon et al., 2001), increasing attention has been paid to how more subtle forms of prejudice may be enacted in everyday interpersonal interactions, which has generated increasing interest in the concept of racial microaggressions. microaggressions were originally conceptualized by pierce (1970) as a way to describe unacknowledged racism experienced by african americans, and it was further popularized by sue et al. (2007), who proposed a taxonomy of microaggressions. since that time, research has demonstrated that many ethnoracial groups experience microaggressions regularly, including african americans (chae et al., 2011; donovan et al., 2013; torres et al., 2010), asian americans (lin, 2010; ong et al., 2013), and hispanic americans (huynh, 2012; yosso et al., 2009). an increasing number of studies document not only the widespread occurrence of racial microaggressions but also that these experiences are distressing and contribute to a chronically stressful and oppressive environment for many people of color, with negative psychological consequences (lui & quezada, 2019; williams, 2020c). studies have found associations between microaggressions and symptoms of depression (ayalon & gum, 2011; donovan et al., 2013; huynh, 2012; torres et al., 2010), general psychological distress and negative emotions (chae et al., 2011; smith et al., 2011), decreased life satisfaction (ayalon & gum, 2011), alcohol use and substance use disorders  
  710  williams  (blume et al., 2012; clark et al., 2015), anxiety (blume et al., 2012; liao et al., 2016), and even suicidal ideation (o'keefe et al., 2015). thus, from a public health perspective, microaggressions represent a grave concern. microaggressions also pose a barrier to mental health care when committed by mental health providers and have been implicated as a cause of mental health disparities (dovidio & casados, 2019; sue et al., 2007; williams, 2020a). to date, most efforts to understand microaggressions have examined affected group members, but little work has been done to understand the characteristics of offenders who engage in microaggressive behaviors. such findings could provide a better understanding of the psychology of those delivering microaggressions and inform efforts to develop cognitive-behavioral therapy (cbt) and educational interventions to reduce the frequency of these acts (e.g., social skills training protocols, diversity workshops).  are microaggressions offensive? because microaggressions are common, many people are so acclimated to them that they do not regard them as offensive or even notice them at all (e.g., alabi, 2015). to determine whether microaggressions are considered offensive, kanter et al. (2017) developed several racially charged scenarios along with a series of microaggressive behaviors that people might commit in these situations. the scenarios were created based on the reports of black students who participated in focus groups about their experiences on campuses at three different predominately white institutions—for example, one scenario was as follows: “a friend of yours has wanted you to meet a friend, saying they think you will like the person. you meet this person oneon-one. he turns out to be a tall, fit-looking black man who says he is a law student. he seems very smart and he has a very sophisticated vocabulary. you like his personality” (kanter et al., 2017; michaels et al., 2018). after each scenario, white participants were provided a series of potential actions or statements one might make in that situation, including those that would be considered microaggressive (e.g., “did you get into school through a minority scholarship?”). respondents were asked to report how likely they would be to say or do for each response (or something similar) on a 5-point scale. to explore the degree to which the items would be experienced as microaggressive, black students were given the same scenarios and items and asked to rate how racist they would rate each item on a similar scale. out of 51 items that authors predicted black students would deem as microag-  gressions, 96% were in fact considered potentially or definitely racially objectionable by 30% or more of the black students. subsequent studies indicated that most white students found the microaggressions objectionable as well (williams, 2020b). in a related study, a very strong correlation was found between the black student scores on items they considered racist and whether or not white students would say or do the microaggression (r .93, p .001), and although white students denied they would commit most microaggressions, more admitted having microaggressive thoughts (michaels et al., 2018). that indicates there is some degree of agreement between black and white students as to what microaggressions are, and it shows that people of color and white people alike largely interpret microaggression negatively. however, a limitation of that study was the relatively small sample size (n 64) and all participants were students from a single university in new england. it could be that college students are more aware and sensitized to the concept of microaggressions, due to vigorous ongoing social justice conversations occurring in these settings, and younger cohorts tend to be less prejudiced in general (charlesworth & banaji, 2019).  are microaggressions aggressive? in social psychology, aggression is most commonly defined as a behavior intended to harm another person who does not wish to be harmed, and violence is aggression that has harm as its goal (allen & anderson, 2017; bushman & huesmann, 2010). this may include physical aggression, but it can also include verbal aggression, relational aggression, ostracization, and avoidant behavior (warren et al., 2011). in fact, being ostracized or excluded is so aversive that it can even trigger aggression in targets (ren et al., 2018). because microaggressions are believed to be mostly unintentional (or even well-intentioned) and harms may be considered small, microaggressions have not traditionally been considered a form of violence or aggression (lilienfeld, 2017). there are many disciplines that have a broader conceptualization of this and consider all forms of racism to be violence and aggression, and this is seen in peace and conflict studies, education, feminism, global health, racial/ethnic studies, and sociology (williams, 2020b). kanter et al. (2017) found that white students who reported that they were more likely to microaggress were also more likely to endorse color-blind, symbolic, and modern racist attitudes—linking microaggressions to racial animus. nonetheless, some scholars have questioned whether the term “microaggression” is appropriate given that it has not yet been established that  
  microaggressions and aggression microaggressions are correlated to aggression. it has even been suggested that the term be replaced with a more innocuous alternative, such as “culturally insensitive faux pas” (lilienfeld, 2017), and at least one scholar exhorts institutions of higher learning to “discourage faculty and administrators from even using the term” (haidt, 2017, p. 177). whether or not microaggressions are a form of aggression is not simply an academic matter. if microaggressions are benign cultural errors, then eliminating them may simply be a matter of teaching targets how to politely educate those who microaggress (e.g., lilienfeld, 2017). on the other hand, if microaggressions are aggressive acts, these behaviors would be an important focus for therapeutic interventions. further, those who experience microaggressions would be wise to recognize these signals of danger being emitted by offenders and exercise caution (williams, 2020b), because if microaggressions do reflect hostile and aggressive tendencies, it may be socially dangerous for victims to confront offenders. given that most individuals recognize that microaggressive behaviors are unacceptable, and as such they are more likely to think about them than do them (e.g., michaels et al., 2018), it would make sense that those who are more temperamentally aggressive would be less likely to suppress these urges. mekawi and todd (2018) examined this issue in their study of the acceptability of microaggressions (microinsults and microinvalidations, specifically). they found that the degree to which participants maintained that microaggressions were acceptable was positively associated with how likely they would be to commit these microaggressions. using the three-item verbal aggression and hostility subscale of the short version of the buss–perry aggression questionnaire (bpaq; diamond & magaletta, 2006), the study did not find strong or consistent correlations between various types of microaggressions and verbal aggression or hostility. there were, however, some methodological weaknesses in the study, such as using a highly abbreviated measure of aggression that may have failed to fully capture the aggression construct. further, mixing white and students of color in that analysis could pose a problem, given that there may be differences in how microaggressions are perceived by people in different ethnoracial groups (e.g., alabi, 2015). microaggressions are highly context dependent, and a behavior by an ingroup member may be perceived differently than the same behavior from an outgroup member— for example, the question, “where are you from?” may be perceived as an attempt at social connection when asked by someone from the same ethnic group but may be experienced as a means of othering when  711  coming from someone of a different ethnic group. therefore, it might be beneficial to examine this issue separately in white people and people of color. classical theories about aggression often situate the cause of aggressive behavior within the context of negative affect (e.g., frustration, pain, anger; watson et al., 1988). it is clear that negative affect increases aggression, and as such can be a causative or contributing factor (e.g., donahue et al., 2014). as such, it makes sense that people who are more aggressive would also have more negative affect. it has been generally accepted that positive affect, which includes feeling good about oneself and others, is incompatible with aggression (jhangiani & tarry, 2014). however, some research implicates positive affect as an important correlate and cause of aggression, orthogonal to negative affect (chester, 2017). aggressing against outgroup members can be socially rewarding—for example, historically, the lynching of african americans was often an enjoyable social event for spectators, with the degree of violence positively correlated to the size of the crowd (leader et al., 2007). as such, more research is warranted to help determine the degree to which microaggressions are truly aggressive, and also how much of this can be explained by affective states.  purpose of this study the purpose of this study is to determine whether microaggressions are best conceptualized as a form of aggression, based on common definitions advanced in social psychology (e.g., bushman & huesmann, 2010). because prior research connects microaggressions to racism, i predict that most people will recognize that these behaviors are socially unacceptable, and as such there will be a negative correlation between the likelihood of microaggressions being committed by white actors and how racist these behaviors are deemed by observers of color. further, it is hypothesized that more aggressive individuals are more likely to commit microaggressions. therefore, one expects to see positive correlations between aggressive tendencies and the likelihood of committing microaggressions, as well as positive correlations between microaggression propensity and negative affect. due to the conflicting nature of the literature, no predictions are made about the relationship of positive affectivity to the propensity to commit microaggressions, and so this facet of the analysis is exploratory.  methods participants recruitment for this study was conducted online through amazon mechanical turk (mturk) prime.  
  712  williams  table 1  demographics of sample  gender male female other/nonbinary race white black ethnicity hispanic non-hispanic nativity united states other marital status married never married divorced/separated/widowed living with partner language fluency english bilingual english/spanish bilingual english/other other household income, annual less than 20,000  20,000– 39,999  40,000– 59,999  60,000– 79,999  80,000– 99,999  100,000– 150,000 more than 150,000 education high school or less part college or 2-year degree graduated, 3- to 4-year degree graduate/professional degree  n  percentage  313 296 1  51.3% 48.5% 0.2%  322 288  52.8% 47.2%  101 509  16.6% 83.4%  591 19  96.8% 3.2%  211 257 49 93  34.6% 42.1% 8.0% 15.2%  577 23 8 2  94.6% 3.8% 1.3% 0.4%  90 168 137 100 62 50 13  13.1% 27.5% 22.5% 16.4% 10.2% 8.2% 2.1%  62 233 260 54  10.2% 38.2% 42.8% 8.9%  eligibility criteria included over 18 years of age; identify as african american/black, european american/white, asian american, or latino american/hispanic; spent most of childhood in the united states; and able to read and speak english. only eligible turk workers were able to view the posted recruitment invitation and, if they accepted the invitation, they were then able to complete the consent form and online battery containing the study surveys. the participant population of mturk has similar demographics to the general u.s. population in geographical location and gender distribution (huff & tingley, 2015), and the use of turk prime offers more control over who participates in the study and sample representativeness (litman et al., 2017). the study was approved by the university of  connecticut’s irb. average compensation was  6.00 an hour. the online battery took approximately 1 hour to complete. a total of 844 diverse participants were enrolled— however, only participants who identified as white or black were included (whether or not they were of hispanic ethnicity), leaving n 610, with a mean age of 35.7 (sd 10.7). sexual orientation was assessed with an open-ended question to maximize flexibility in responding, and 75.1% identified as heterosexual (although 9.2% mistakenly wrote in their gender). the remaining demographics are shown in table 1.  measures a comprehensive demographics form was administered to gather data that included race, hispanic versus non-hispanic ethnicity, age, gender, language fluency, nativity, income, length of time living in the united states, marital status, and educational attainment. the remaining measures are listed below. all measures were delivered online via qualtrics, with individual items randomized by section. cultural cognitions and actions scale (ccas) the ccas (kanter, williams, et al., 2020) measures one’s likelihood of engaging in racial microaggressions, with an emphasis on black–white interactions. the 20-item ccas has four factors: negative attitudes (hostility, microassaults), colorblindness (deflection of differences, microinvalidations), objectifying (exoticizing statements), and avoidance (exclusion, distancing). each factor comprises a subscale with five items assessing microaggression likelihood across seven specific common social contexts. participants answer questions about how they might respond in each situation. the scenarios included interacting with a young woman with african-style dress and braided hair; talking about racial current events (e.g., police brutality); listening and singing along to rap music with mixed-race friends; and giving directions to a black man in the participant’s neighborhood. after each scenario, participants were provided with a series of potential statements one might make in that situation and asked to report how likely they would be to think or say/do for each response (or something similar) on a 5point scale (1 very unlikely to 5 very likely). the scale can be summed for a total score, or each subscale can be examined separately. the ccas has shown good concurrent validity in that people with higher scores have more racist attitudes (kanter et al., 2017), and scores change in the predicted direction after participating in a diversity workshop (williams et al., 2020).  
  microaggressions and aggression predictive validity of the ccas has been demonstrated in laboratory experiments (kanter, williams, et al., 2020). white participants who had taken the ccas engaged in real-time interactions about race-related current events with a white confederate while a black research assistant observed the conversation via a live video feed. an independent, mixed-race team of coders reviewed the video recordings of the interactions and rated the amount of microaggressive and supportive (i.e., nonracist) behavior displayed by the participants in the interactions. there was a high degree of correlation between ccas scores and commission of microaggressions for two of the three scenarios presented (r .56** and .62***). additionally, the ccas demonstrated good internal consistency in the white college student sample, and reliability was good in our sample as well (αwhite .90). most black participants (n 226) were given a slightly different version of the ccas (the ccas-r), with modified prompts to ascertain the extent to which they would perceive racism within each vignette (e.g., kanter et al., 2017; williams, 2020b). items were rated from 1 (very racist) to 5 (very positive; nonracist, understanding, sensitive). the ccas-r had good reliability for black participants in this study (αblack .91). buss–perry aggression questionnaire the bpaq (buss & perry, 1992) is a 29-item survey that measures hostile behavior and aggression. the questionnaire contains four domains: physical aggression, verbal aggression, anger, and hostility. the bpaq is considered a gold standard for understanding the construct of aggression and has been validated in multiple languages and cultures (e.g., gerevich et al., 2007). men typically score higher than women (archer, 2004). items are summed for a total score, with two items reverse scored. reliability was good in our sample (α .95). overt-covert aggression inventory (ocai) the ocai (miyazaki et al., 2003) is a 10-item measure of both overt and covert hostility. the ocai was originally developed in japan to account for the fact that anger in japanese people may manifest differently from other cultural groups. items are scored on a scale of 1–5 (never to always). reliability was good in our sample (α .87). inventory of hostility and suspicious thinking (ihs) the ihs (tellawi et al., 2016) is a 19-item scale designed to measure symptoms of interpersonal suspicion and hostility. it assesses feelings of being talked about, bitterness, suspicion of others, and unusual thinking. a few items overlap with the bpaq. the questionnaire has been shown to be  713  correlated with mental health problems, such as anxiety and psychosis (huppert et al., 2002). reliability was good in our sample (α .95). positive and negative affectivity schedule (panas) the panas (watson et al., 1988) is designed to measure affect in different situations. the instrument measures the presence and absence of both positive affect (panas-positive) and negative affect (panas-negative). items are rated from 1 to 5, with higher numbers indicating greater agreement. participants are asked to rate items based on how they feel “in general,” “now,” or over a specified period of time to assess affect. for this study, most participants were asked to rate their feelings over the past 2 weeks. reliability was good in our sample (αpos .91, αneg .81). a subset of participants was queried about their affect “in general” rather than the last 2 weeks (n 84), to obtain a score that reflected a more trait-like form of affectivity, and reliability was good (αpos .88, αneg .89).  data analysis item-level descriptives and correlations to determine the acceptability of racial microaggressions, we examined the frequency of each individual response to the ccas and ccas-r, as per the methodology described in michaels et al. (2018). we focused this part of the analysis on black and white participants only to maximize the contrast between two of the most highly privileged and stigmatized ethnoracial identities in the united states. we then conducted pearson’s correlations between the black and white scores for the 20 items to ascertain the degree of agreement. we also report means and standard deviations for white participants to elucidate which type of microaggressions are most common. analyses of aggression and affect to determine whether microaggressions represent a form of aggression, we used pearson correlations to examine the correlation between the ccas and three different measures of aggression, as well as affect for white participants. we also examined the correlation of the ccas to additional demographic variables that might influence findings (age, education, income, gender, hispanic ethnicity). correlations of the bpaq and ccas subscales were examined to provide more nuanced data about the constructs under study. the bpaq was utilized in these more detailed analyses because it is considered a gold-standard measure and has been most widely used to study the construct of aggression in the literature. to better understand the most prominent predictors of committing microaggressions, we conducted linear regressions, predicting the ccas in white  
  714  williams  table 2  acceptability of microaggressions from the cultural cognitions and actions scale  scenario  microaggressive item  1. meeting a black female with african-style dress and braided hair  "i've always wanted to go to africa." "why do black women wear their hair in these sorts of styles?” "can i touch your hair?" 2. discussion about white privilege "everyone suffers. not just black at diversity training people." "i am not a racist." "a lot of minorities are too sensitive." 3. study session talking about various "all lives matter, not just black lives." current events and racial political issues "i don't think of black people as black." stay quiet so you don't offend anyone. "everyone can succeed in this society, if they work hard enough." "black people should work harder to fit in to our society." 4. a lost black man asking for directions check that your wallet/purse is secure. in neighborhood make sure not to make eye contact and just keep walking. cross the street to avoid him. 5. doing karaoke with friends and song say the n-word loudly every time you with n-word comes up hear it. leave the room to avoid an uncomfortable situation. 6. watching news about police brutality "i would be pretty scared—that guy looks with diverse friends at sports bar like a thug." "the real problem is a lack of good role models in the black community." 7. talking to racially ambiguous lab "where are your parents from?" mate about science project "i'm not racist, but i really want to know what race you are."  black (n 226)  white (n 322)  rating as racist % 43.4 64.6  unlikely to mean (sd) say/do % 88.5 1.39 (0.88) 91.9 1.28 (0.78)  50.4 38.1  92.2 48.8  1.28 (0.80) 2.70 (1.48)  22.1 74.8 51.3 37.6 47.3 36.3  62.4 78.6 59.6 73.0 41.0 57.8  2.24 (1.42) 1.72 (1.16) 2.36 (1.46) 1.89 (1.19) 2.90 (1.46) 2.42 (1.47)  82.3  83.9  1.50 (0.94)  75.2 64.2  69.3 77.3  2.01 (1.20) 1.85 (1.13)  73.0 76.5  79.2 88.8  1.76 (1.09) 1.43 (0.83)  10.6  60.9  2.30 (1.35)  85.4  86.6  1.48 (0.89)  62.8  77.6  1.76 (1.08)  38.1 49.1  80.7 90.7  1.71 (1.12) 1.38 (0.86)  note. sd standard deviation.  participants from the bpaq and negative affectivity. the regression was conducted with both panasnegative variables (“past 2 weeks” and “in general”) separately.  results microaggression acceptability table 2 lists the microaggressions included in the 20item ccas. included are the percentage of black participants finding the microaggressive statement objectionable in the context of the scenarios listed (i.e., rated as “a little racist” or “very racist”), the percentage of white participants who reported that they were “unlikely” or “very unlikely” to say or do each item, and the mean score for white participants. notably, white participants were unlikely to commit most microaggressions, but avoidant and color-blind statements were the most highly endorsed. despite some variability, there was a significant correlation between black participants’ ratings of  microaggressive interactions being racist and white participants’ unlikelihood of engaging in those same interactions, r .488 (p .03). this means that the more racist the behavior was deemed by black participants, the less white participants endorsed a likelihood of doing the behavior.  microaggressions and aggression the relationship between the ccas and several of the demographic variables was examined in the white sample (n 322). there was no correlation between the ccas and age (as a continuous variable), income category (as an ordinal variable with eight levels), education (as an ordinal variable with seven levels), or gender (as a binary variable). however, there was a small but significant correlation with hispanic ethnicity (as a binary variable), r .111, p .046. next, the correlations between the ccas and measures of aggression and affect were examined  
  715  microaggressions and aggression table 3  correlations between the ccas and measures of aggression and affect for white participants  buss–perry aggression questionnaire (bpaq) overt–covert aggression inventory (ocai) inventory hostility suspicious thinking (ihs) panas- negative (last 2 weeks) panas-positive (last 2 weeks)  ccas  bpaq  ocai  ihs  panas-neg  .464*** .428*** .369*** .231*** -.005  .811*** .761*** .508*** -.254***  .725*** .501*** -.193***  .651*** -.289***  -.419***  note. n 322–238. ccas cultural cognitions and actions scale. *p .05, **p .01, ***p .001 (two-tailed).  (see table 3). all three measures of aggression were robustly positively correlated with the ccas. negative affect was moderately positively correlated, and positive affect was uncorrelated. to better understand how aggression and affect might contribute to committing microaggressions, the ccas subscales for the white participants were examined, as well as correlations between measures of aggression and affect, including the bpaq subscales (see table 4). in examining the total measures of aggression, the largest correlations for each ccas subscale occur with the bpaq, followed by the ocai and the ihs, respectively. all full measures of aggression were moderately positively correlated with all ccas subscales (rs .229–.391, p .001). the panas-positive was slightly negatively correlated with the ccas avoidance scale, and the panas-negative was modestly positively correlated to all scales except ccas colorblindness.  predicting microaggressions we conducted a linear regression, predicting the ccas total score from the total bpaq and the panas-negative (n 239). the overall model was  significant, f(2, 235) 31.10, p .001, r2 .21, and the bpaq was the only significant independent variable, s .46, t 6.81, p .001. those participants who were queried about their affect “in general” on the panas-negative rather than the last 2 weeks (n 85) were also examined. when exploring the model with the more trait-like panas-negative, the results did not differ greatly, f(2, 81) 12.72, p .001, r2 .24, and the bpaq remained significant (s .50, t 4.81, p .001) while the panas-negative was not.  discussion microaggressions are aggressive microaggressions appear to represent a discrete form of subtle relational aggression. the propensity to commit microaggressions was significantly correlated with three separate measures of aggression, including the full version of the bpaq and all four of its subscales. although negative affectivity was also positively correlated with microaggressiveness, this relationship disappeared when aggression was factored into a regression. notably, wyckoff (2016) found that anger and not negative affect predicts the desire to aggress, which is in line  table 4  means and correlations between the ccas subscales and measures of aggression and affect  ccas subscale mean (sd) buss–perry aggression questionnaire bpaq physical aggression bpaq verbal aggression bpaq anger bpaq hostility overt–covert aggression inventory inventory hostility and suspicious thinking panas-negative (last 2 weeks) panas-positive (last 2 weeks)  ccas 1 negative attitudes  ccas 2 colorblindness  ccas 3 objectification  ccas 4 avoidance  7.89 (3.88) .396*** .364*** .333*** .201*** .428*** .337*** .271*** .164* .015  11.59 (5.46) .298*** .282*** .304*** .135* .315*** .268*** .229*** .117 .084  7.04 (3.58) .391*** .357*** .327*** .214*** .424*** .374*** .332*** .208** .045  10.82 (4.30) .388*** .286*** .290*** .282*** .387*** .380*** .340*** .248*** -.182**  note. n 322, except for the panas scales, where n 238. sd standard deviation; ccas cultural cognitions and actions scale; bpaq buss–perry aggression questionnaire; panas positive and negative affectivity schedule. *p .05, **p .01, ***p .001 (two-tailed).  
  716  williams  with current findings. additionally, prior research has found that anger increases dominance-seeking and antagonistic behaviors (cabral & de almeida, 2019). in this study, aggressive anger was more strongly correlated to all four categories of microaggressions (negative/hostile attitudes, colorblindness, objectifying, and avoidance), more so than negative affect, although aggressive hostility showed the strongest correlations across microaggression categories. there was no support for the notion that positive affect contributes to microaggression propensity; there was only a small correlation between positive affect and racially avoidant behavior, which was in the opposite direction. the item-level examination of microaggressions by race, as per the ccas, indicates that the majority of white people would not commit most microaggressions presented, and large proportions of black people agree that microaggressions are racist. these findings build on previous student studies (kanter et al., 2017; michaels et al., 2018) but this time in a large nationwide sample. further, there is significant agreement between black and white participants that indicates some awareness of the respective unacceptability of the various types of offenses. this is consistent with earlier work (michaels et al., 2018) and the findings of mekawi and todd (2018), who found that across racial groupings, microaggressions are considered largely unacceptable among college students. most white people report they will not commit most microaggressions, perhaps because they recognize the aggressive nature of the behavior. however, this fact alone should not lead one to the conclusion that microaggressions are a minor problem. even if only 1 in 10 people will commit a specific microaggression, when a person of color is in a common mixed-group situation with 10 other people (e.g., a class, group activity, social event), he or she can expect to experience the microaggression at least once. this is consistent with studies that find people of color experience microaggressions frequently (suarez-orozco et al., 2015). according to our findings, avoidant and colorblind microaggressions are most frequent. how is it that microaggressions constitute a form of aggression? if we conceptualize microaggressions as isolated unintended individual events, it seems counterintuitive that they represent hostility or aggression. it is important to understand, however, that microaggressions represent a pattern of behavior that functions to reinforce a social hierarchy whereby outgroup members are cast in a subordinate position (williams, 2020b). aggressors may not have a clear awareness of how their actions are  a part of this larger system of oppression— however, when offenders commit microaggressions, the aggression is directed toward the target and symbolically the target’s entire group. although it has been assumed that microaggressions are largely unintentional (e.g., sue et al., 2007, 2009), the evidence does not support this theory. on the contrary, the data we do have seem to indicate that racial microaggressions are a deliberate assertion of dominance, motivated by underlying bias (kanter et al., 2017). those who are prone to commit microaggressions are higher in aggressive tendencies that are not explained by negative affect. taken together, this contradicts the common assumption that microaggressions represent accidental acts committed by benevolent people who should simply be given the benefit of the doubt (e.g., haidt, 2017). it also suggests that mere education about the harmful effects of microaggressions on targets may not be sufficient to bring about behavior change. this is because when people act aggressively they are generally focused on their own goals for the interaction (controlling the situation) rather than understanding the needs, perspectives, or feelings of the target (e.g., sue et al., 2009). hostility often occurs due to the perception of threat or fear, and aggression increases feelings of power and temporarily relieves anxiety (green, 1986). research indicates that those who are socially anxious are more likely to engage in relational but not overt aggression against targets (dewall et al., 2010; loudin et al., 2003). learning about how microaggressions harm others would be expected to increase social anxiety and avoidance rather than reduce reliance on stereotypes or foster interracial connection (kanter et al., 2019). this could explain the connection among aggression, hostility, and microaggressions—for example, in the case of interracial interactions, white actors may feel fear and anxiety in the presence of black people, where fears are automatically activated by the presence of the racialized person due to stereotypes of danger (kanter et al., 2019). notably, characteristics of african americans are tethered to pathological stereotypes about being aggressive, loud, criminal, confrontational, and angry (madon et al., 2001; williams et al., 2012). therefore, it makes sense that the expression of these anxieties would be interpersonal acts of aggression to bolster feelings of control over the interaction and thereby mitigate fear. one could predict that interventions that correct pathological stereotypes through a combination of education and disconfirming experiences with outgroup members will reduce fears and the subsequent commission of these acts. such an approach  
  microaggressions and aggression has been utilized successfully with undergraduates and medical students in workshop interventions designed to reduce microaggressions through education about microaggressions paired with exercises focused on interracial connection (kanter, rosen, et al., 2020; williams et al., 2020). likewise, in a therapeutic setting, clients who endorse or demonstrate microaggressive behaviors may benefit from cbt interventions focused on reducing cognitive distortions and improving prosocial behaviors in interracial interactions. interventions may include education to correct pathological stereotypes (e.g., “actually, the data show that most black people are not poor. . . .”), socratic questioning (e.g., “do you imagine that all black people feel that way?”), challenging of assumptions (e.g., “what if we ask that person rather than assume?”), behavioral experiments (e.g., “let’s see what happens when you express concern to your co-worker about his experience of racism”), and exposures to reduce interracial anxiety (e.g., spending prolonged amounts of time in mostly black spaces). it would be expected that these approaches will reduce pathological stereotypes, thereby reducing anxiety and fear, thereby reducing the urge to control interracial situations, and ultimately reducing the commission of microaggressions.  limitations and future directions although the present study included a large, national sample of diverse adults, amazon mturk has some shortcomings; notably data are less representative than national probability samples (huff & tingley, 2015), though the use of turk prime permits more specificity in selecting respondent demographics (litman et al., 2017). it should also be noted that many of the issues endemic to turk workers are not different from the shortcomings of traditional undergraduate samples (e.g., lack of interest, fatigue, and low incentives), and turk prime does impose on participants some level of accountability for the quality of their responses more so than undergraduates who may receive credit regardless. in terms of assessing the acceptability of microaggressions in our white participants, we used their reported likelihood of engaging in the microaggression as a proxy for its acceptability. future studies might put a sharper point on this by directly asking white participants how racist various microaggressions seem to them. further, the measures and analyses herein were focused on black–white racism. future studies should focus on other ethnoracial groups to better understand these issues more broadly. although microaggressions may stem from racism in concert with underlying aggressive tendencies, it seems likely that some portion of  717  microaggressive behavior is caused by other factors as well, such as deficits in emotional intelligence, high anxiety or a fearful disposition, or a lack of exposure to other cultures. these possibilities should be further explored. fears rooted in pathological stereotypes may be maintained by self-segregation and a limited eurocentric worldview. future studies should examine cultural knowledge and cross-cultural experience as predictive factors. cultural intelligence may account for additional variance in scores, and measures like the cultural intelligence scale (van dyne et al., 2012) could be helpful in determining this. finally, this study only examined racial microaggressions. there are many other types of microaggressions that are a source of problematic interactions, including those impacting sexual and gender minorities, gender microaggressions, religious microaggressions, and ableist microaggressions. additional studies should examine aggression as a predictor of these behaviors.  conclusion the term “microaggressions” was originally coined by african american psychiatrist chester pierce (1970) in response to daily indignities he experienced from white offenders. white american psychologist scott lilienfeld (2017) called for a change in the name of microaggressions, to “shed the unmerited implication that microaggressions are aggressive in nature and perhaps intent” (p. 161). the findings of this study indicate that calls for a change of terminology were premature and are, in fact, unfounded. what pierce observed 50 years ago is still true today. racial microaggressions do appear to represent a discrete form of aggression and should be recognized as such. conflict of interest statement the authors declare that there are no conflicts of interest.  references alabi, j. 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       measuring discrimination resource david r. williams june 2016  table of contents i. the everyday discrimination scale ............................................................................................................ 2 a. the original and still recommended scale .......................................................................................... 2 b. everyday discrimination scale (short version) alpha .77 ................................................................. 3 c. expanded everyday discrimination scale ............................................................................................. 3 ii. major experiences of discrimination ....................................................................................................... 4 a. major experiences of discrimination (nsal and sash version) .......................................................... 4 b. major experiences of discrimination (abbreviated version) ............................................................... 5 iii. work discrimination ............................................................................................................................... 5 a. chronic work discrimination and harassment (yes study) ................................................................. 5 b. chronic work discrimination and harassment (abbreviated) ............................................................ 6 iv. heightened vigilance scale ..................................................................................................................... 7 a. from das and yes study ...................................................................................................................... 7 b. heightened vigilance scale (abbreviated) (4 items, alpha .72) ........................................................ 7 v. appendix a: publications by david r. williams on racism and discrimination ...................................... 8 vi. appendix b: selected studies that have used the everyday discrimination scale in other countries 15 vii. appendix c: other versions of major experiences of discrimination scale ....................................... 18 a. major experiences of discrimination: original 6 item version........................................................... 18 b. major experiences of discrimination: 9 item version from the midus study................................... 19 c. major experiences of discrimination (expanded 19 item version) .................................................... 20 e.  coping with discrimination ............................................................................................................. 23  e. coping with discrimination – nsal study (abbreviated)................................................................... 24  1  
  i. the everyday discrimination scale a. the original and still recommended scale   source: williams, d.r., yu, y., jackson, j.s., and anderson, n.b. “racial differences in physical and mental health: socioeconomic status, stress, and discrimination.” journal of health psychology. 1997; 2(3):335-351.    studies of validity and reliability o krieger n., smith k., naishadham d., hartman c., barbeau e.m. “experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health.” social science & medicine. 2005; 61(7):1576-1596. o taylor t.r., kamarck t.w., shiffman s. “validation of the detroit area study discrimination scale in a community sample of older african american adults: the pittsburgh healthy heart project.” international journal of behavioral medicine. 2004; 11:88–94.    measure: in your day-to-day life, how often do any of the following things happen to you? 1. you are treated with less courtesy than other people are. 2. you are treated with less respect than other people are. 3. you receive poorer service than other people at restaurants or stores. 4. people act as if they think you are not smart. 5. people act as if they are afraid of you. 6. people act as if they think you are dishonest. 7. people act as if they’re better than you are. 8. you are called names or insulted. 9. you are threatened or harassed. recommended response categories for all items: almost everyday at least once a week a few times a month a few times a year less than once a year never    follow-up question (asked only of those answering “a few times a year” or more frequently to at least one question.): what do you think is the main reason for these experiences? (check more than one if volunteered). recommended options 1. your ancestry or national origins 2. your gender  2  
  3. your race 4. your age 5. your religion 6. your height 7. your weight 8. some other aspect of your physical appearance 9. your sexual orientation 10. your education or income level other possible categories to consider 1. a physical disability 2. your shade of skin color (nsal) 3. your tribe (sash) other (specify) _____________________________  b. everyday discrimination scale (short version) alpha .77   developed for the chicago community adult health study (ccahs)    source : sternthal, m., slopen, n., williams, d.r. “racial disparities in health: how much does stress really matter?” du bois review, 2011; 8(1): 95-113.    measure: in your day-to-day life how often have any of the following things happened to you? 1. you are treated with less courtesy or respect than other people. 2. you receive poorer service than other people at restaurants or stores. 3. people act as if they think you are not smart. 4. people act as if they are afraid of you. 5. you are threatened or harassed. follow-up question at end of scale and response categories: the same as the original scale.  c. expanded everyday discrimination scale   a 10th item was added to the original scale: “you are followed around in stores.”    this scale was used in the national survey of american life (nsal) and the south african study of stress and health study (sash)  3    source: williams, d.r., gonzalez, h.m., williams, s., mohammed, s.a., moomal, h, stein, d.j. “perceived discrimination, race and health in south africa: findings from the south africa stress and health study.” social science and medicine, 2008; 67: 441-452.  ii. major experiences of discrimination a. major experiences of discrimination (nsal and sash version)   adapted from 1995 das and midus    source: williams, d.r., gonzalez, h.m., williams, s., mohammed, s.a., moomal, h, stein, d.j. “perceived discrimination, race and health in south africa: findings from the south africa stress and health study.” social science and medicine, 2008; 67: 441-452.    questionnaire in the following questions, we are interested in the way other people have treated you or your beliefs about how other people have treated you. can you tell me if any of the following has ever happened to you: 1. at any time in your life, have you ever been unfairly fired? 2. for unfair reasons, have you ever not been hired for a job? 3. have you ever been unfairly denied a promotion? 4. have you ever been unfairly stopped, searched, questioned, physically threatened or abused by the police? 5. have you ever been unfairly discouraged by a teacher or advisor from continuing your education? 6. have you ever been unfairly prevented from moving into a neighborhood because the landlord or a realtor refused to sell or rent you a house or apartment? 7. have you ever moved into a neighborhood where neighbors made life difficult for you or your family? 8. have you ever been unfairly denied a bank loan? 9. have you ever received service from someone such as a plumber or car mechanic that was worse than what other people get? follow-up questions after each item: 1. what do you think was the main reason for this experience? a. your ancestry or national origins b. your gender c. your race d. your age e. your religion f. your height g. your weight h. some other aspect of your physical appearance i. your sexual orientation  4  
  j. your education or income level 2. when was the last time this happened? a. past week b. past month c. past year d. more than a year ago 3. how many times has this happened during your lifetime?  b. major experiences of discrimination (abbreviated version)   adapted from nsal for the ccahs study    source: sternthal, m.j., slopen, n., williams, d.r. “racial disparities in health.” du bois review: social science research on race, 2011; 8: 95-113.    measure: in the following questions, we are interested in your perceptions about the way other people have treated you. can you tell me if any of the following has ever happened to you: 1. at any time in your life, have you ever been unfairly fired from a job or been unfairly denied a promotion? 2. for unfair reasons, have you ever not been hired for a job? 3. have you ever been unfairly stopped, searched, questioned, physically threatened or abused by the police? 4. have you ever been unfairly discouraged by a teacher or advisor from continuing your education? 5. have you ever been unfairly prevented from moving into a neighborhood because the landlord or a realtor refused to sell or rent you a house or apartment? 6. have you ever been unfairly denied a bank loan? use same follow-up questions as for the full scale  iii. work discrimination a. chronic work discrimination and harassment (yes study)    developed for the yes study adapted from 2 sources: o mcneilly, m.d., anderson, n.b., armstead, c.a., clark, r., corbett, m., robinson, e.l., pieper, c.f. & lepisto, e.m. “the perceived racism scale: a multidimensional assessment of the experience of white racism among african americans.” ethnicity and disease. 1996; 6 (1,2), 154-166.  5  
  bobo, l, suh sa. surveying racial discrimination: analyses from a multiethnic labor market. prismatic metropolis: inequality in los angeles. (l. d. bobo, m. l. oliver, j. h. johnson, a. valenzuela, eds.). 2000; 527-564., new york: russell sage foundation measure: here are some situations that can arise at work. please tell me how often you have experienced them during the last 12 months. 1. how often are you unfairly given the jobs that no one else wants to do? 2. at work, when different opinions would be helpful, how often is your opinion not asked for? 3. how often are you watched more closely than others? 4. how often does your supervisor or boss use racial or ethnic slurs or jokes? 5. how often does your supervisor or boss direct racial or ethnic slurs or jokes at you? 6. how often do your coworkers use racial or ethnic slurs or jokes? 7. how often do your coworkers direct racial or ethnic slurs or jokes at you? 8. how often do you feel that you have to work twice as hard as others work? 9. how often do you feel that you are ignored or not taken seriously by your boss? 10. how often do others assume that you work in a lower status job than you do and treat you as such? 11. how often has a coworker with less experience and fewer qualifications gotten promoted before you? 12. how often have you been unfairly humiliated in front of others at work? o    response scale for all items: once a week or more.........1 a few times a month.........2 a few times a year.........3 less than once a year.........4 never.....................5  b. chronic work discrimination and harassment (abbreviated)     developed for the ccahs study source: sternthal, m., slopen, n., williams, d.r. “racial disparities in health: how much does stress really matter?” du bois review, 2011; 8(1): 95-113. measure: here are some more situations that can arise at work. please tell me how often you have experienced them during the past 12 months. discrimination (3 items, alpha .73) 1. how often do you feel that you have to work twice as hard as others to get the same treatment or evaluation?  6  
  2. how often are you watched more closely than other workers? 3. how often are you unfairly humiliated in front of others at work? harassment (3 items, alpha .84) 1. how often do your supervisor or coworkers make slurs or jokes about racial or ethnic groups? 2. how often do your supervisor or coworkers make slurs or jokes about women? 3. how often do your supervisor or co-workers make slurs or jokes about gays or lesbians? response scale for all items: once a week or more.........1 a few times a month.........2 a few times a year.........3 less than once a year.........4 never.....................5  iv. heightened vigilance scale a. from das and yes study    source: das and yes study in dealing with these day-to-day experiences that you just told me about, how often do you: 1. think in advance about the kinds of problems you are likely to experience? 2. try to prepare for possible insults before leaving home? 3. feel that you always have to be very careful about your appearance to get good service or avoid being harassed? 4. carefully watch what you say and how you say it? 5. carefully observe what happens around you? 6. try to avoid certain social situations and places? response scale for all items: very often.........1 fairly often.........2 not too often.........3 hardly ever.........4 never .........5  b. heightened vigilance scale (abbreviated) (4 items, alpha .72)    developed for the chicago community adult health study measure:  7  
  in your day-to-day life, how often do you do the following things: 1. you try to prepare for possible insults from other people before leaving home. 2. feel that you always have to be very careful about your appearance (to get good service or avoid being harassed). 3. carefully watch what you say and how you say it. 4. try to avoid certain social situations and places. response scale for all items: almost every day.........1 at least once a week.........2 a few times a month.........3 a few times a year.........4 less than once a year.........5 never.........6  v. appendix a: publications by david r. williams on racism and discrimination 1. conceptual/review papers on racism, discrimination and health             williams, d.r., lavizzo-mourey, r., and warren, r.c. “the concept of race and health status in america.” public health reports. 1994 109(1):26-41. williams, d.r. and collins, c. “u.s. socioeconomic and racial differences in health: patterns and explanations.” annual review of sociology. 1995 21:349-386. king, g. and williams, d.r. “race and health: a multidimensional approach to african american health.” benjamin c. amick, sol levin, diana chapman walsh, and alvin r. tarlov (eds.), society and health. oxford: oxford university press. 1995 pp. 93-130. williams, d.r. “racism and health: a research agenda.” ethnicity and disease, 1996 6(1,2):1-6. williams, d.r. “the health of the african american population.” silvia pedraza and ruben g. rumbaut (eds.), origins and destinies: immigration, race and ethnicity in america. 1996 wadsworth. pp. 404-416. williams, d.r. “race and health: basic questions, emerging directions.” annals of epidemiology. 1997 7(5):322-333. clark, r., anderson, n.b., clark, v.r., and williams, d.r. “racism as a stressor for african americans: a biopsychosocial model.” american psychologist. 1999 54:805-816. williams, d.r. “race, socioeconomic status, and health: the added effects of racism and discrimination.” annals of the new york academy of sciences. 1999 896:173-188. williams, d.r., and williams-morris, r. “racism and mental health: the african american experience.” ethnicity and health. 2000 5: 243-268.  8                     williams, d.r. and neighbors, h., "racism, discrimination & hypertension: evidence & needed research", ethnicity & disease. 2001 11:800-816. williams, d.r. & collins, c. "racial residential segregation: a fundamental cause of racial disparities in health." public health reports, 2001. 116 (september/october 2001): 404-416. schulz, a.j., williams, d.r., israel, b.l., and lempert, l.b. “racial and spatial relations as fundamental determinants of health in detroit.” milbank quarterly, 2002 80(4): 677707. williams, d.r., neighbors, h.w., and jackson, j.s. “racial/ethnic discrimination and health: findings from community studies.” american journal of public health, 2003 93(2): 200-208. wyatt, s.b., williams, d.r., calvin, r., henderson, f., walker, e., and winters, k. racism and cardiovascular disease in african americans: evidence and implications for the jackson heart study. american journal of medical sciences, 2003 325(6):315-331. williams, d.r. “race, health, and health care.” st. louis university law journal, 2003 48(1): 13-35. williams, d.r., “racism and health.” 2004 pp. 69-80 in whitfield, keith e., (ed.), closing the gap: improving the health of minority elders in the new millennium. washington, d.c., the gerontological society of america. williams, d.r., and collins, c. “reparations: a viable strategy to address the enigma of african-american health.” american behavioral scientist, 2004 47 (7):977-1000. williams, d.r. “discrimination and health.” in anderson, n.b. (ed.), encyclopedia of health and behavior, vol. 1, thousand oaks, ca: sage publications, 2004 254-259. williams, d.r. “the health of u.s. racial and ethnic populations.” journal of gerontology: series b, 2005 60b(special issue ii):53-62. williams, d.r., and mohammed, s.a. (2007). “racial harassment/discrimination.” 2007 pp. 321-326 in george fink (ed.), encyclopedia of stress, 2nd edition, volume 3. oxford, academic press. ahmed, a., mohammed, s., williams, d.r., “racial discrimination & health: pathways & evidence.” indian journal of medical research, 2007 126:21-30. paradies, y. , williams, d.r. “racism and health.” in kris heggenhougen and stella quah (eds.) encyclopedia of public health, 2008 vol. 5 pp. 474-483, san diego, ca: academic press. williams, d.r., mohammed, s.a. “discrimination and racial disparities in health: evidence and needed research.” journal of behavioral medicine, 2009 32:20-47. williams, d.r., mohammed, s.a., leavell, j., collins, c. "race, socioeconomic status and health: complexities, ongoing challenges and research opportunities.” annals of the new york academy of sciences, 2010 1186:69-101. albert, m.a., williams, d.r., “discrimination: an emerging target for cvd risk reduction?” invited commentary. american journal of epidemiology, 2011 173(11): 1240-1243. williams, d.r. "miles to go before we sleep: racial inequities in health." journal of health and social behavior, 2012,53(3): 279-295. pmid: 22940811. pmcid: pmc3712789. white, k., haas, j., williams, d. r. “elucidating the role of place in health care disparities: the example of racial/ethnic residential segregation.” health services research. 2012, 47(3 pt 2): 1278-99. pmid: 22515933. pmcid: pmc3417310.  9                 williams, d.r., mohammed, s.a. “racism and health i: pathways and scientific evidence.” american behavioral scientist. 2013, 57(8) 1152–1173. pmid: 24347666 pmcid: pmc3863357 williams, d.r., mohammed, s.a. “racism and health ii: a needed research agenda for effective interventions.” american behavioral scientist. 2013, 57(8) 1200–1226. pmid: 24347667 pmcid: pmc3863360 williams, d.r. "pathways to promote racial healing and equity in the american south: opportunities for community philanthropy." kelly, paula j. (ed.), pathways to racial healing and equity in the american south: a community philanthropy strategy. little rock, ar: the university of arkansas clinton school of public service. 2013, pp 48-59. earnshaw, v. a., bogart, l.m., dovidio, j.f., williams, d.r. “stigma and racial/ethnic hiv disparities: moving toward resilience.” american psychologist. 2013,68(4):225-236. pmid: 23688090. pmcid: pmc3740715. lewis, t., williams, d.r., tamene, m., clark, c.r. "self-reported experiences of discrimination and cardiovascular disease." current cardiovascular risk reports , 2014, 8:365. pmid: 24729825. pmcid: pmc3980947. williams, d.r., wyatt, r. "racial bias in health care and health." journal of the american medical association. 2015, 314(6): 555-556. pmid: 26262792. williams, d. r., priest, n. “racismo e saude: um corpus crescente de evidencia internacional (racism and health: a growing body of international evidence).” sociologias. 2015, 17(40):124-174. lewis, t.t., cogburn, c.d., williams, d.r. “self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues.” annual review of clinical psychology. 2015, 11:407-40. pmid: 25581238. priest, n., esmail, a., kilne, r., rao, m., coghill, y., williams, d.r. “promoting equality for ethnic minority nhs staff- what works?” british medical journal 2015, 351:h3297. pmid: 26157106. pmcid: pmc4707526. purdie-vaughns, v., williams, d.r. “stand-your-ground is losing ground for racial minorities’ health.” social sciences & medicine. 2015, 147:341-3. pmid: 26552751. williams d. r., priest, n., anderson, n. "understanding associations between race, socioeconomic status and health: patterns and prospects." health psychology. 2016, 35(4): 407-11. pmid: 27018733. pmcid: pmc4817358. slopen, n., lewis, t. t., williams, d. r. “discrimination and sleep: a systematic review.” sleep medicine. 2016 feb;18:88-95. pmid: 25770043. pmcid: pmc4699868. williams, d. r., purdie-vaughns, v. “needed interventions to reduce racial/ethnic disparities in health.” journal of health politics, policy and law. 2016, 41(4):627-651. pmid: 27127267.  2. empirical publications on racism, discrimination and health    collins, c. and williams, d.r. “examining the black-white adult mortality disparity: the role of residential segregation.” proceedings of the 1995 public health conference on records and statistics. dhhs pub. no. (phs) 1995 96-1214:320-325. jackson, j.s. brown, t.n., williams, d.r., torres, m., sellers, s.l., and brown, k. “racism and the physical and mental health status of african americans: a thirteen-year national panel study.” ethnicity and disease, 1996 6(1,2):132-147.  10                      williams, d.r., yu, y., jackson, j.s., and anderson, n.b. “racial differences in physical and mental health: socioeconomic status, stress, and discrimination.” journal of health psychology. 1997 2(3):335-351. forman, t.a., williams, d.r., and jackson, j.s. “race, place, and discrimination.” in carol gardner (ed.), perspectives on social problems. jai press. 1997 9:231-261. williams, d.r., yu, y. and jackson, j.s. “discrimination, race, and health.” 1998 proceedings of the public health conference on records and statistics and data user’s conference, july 28-31, 1997, united states government printing office, washington, d.c., cd rom #1. ren, x.s., amick, b., williams, d.r. “racial/ethnic disparities in health: the interplay between discrimination and socioeconomic status.” ethnicity and disease. 1999 9(2):151-165. kessler, r.c., mickelson, k., and williams, d.r. “the prevalence, distribution, and mental health correlates of perceived discrimination in the united states.” journal of health and social behavior. 1999 40(3):208-230. collins, c., and williams, d.r. “segregation and mortality: the deadly effects of racism.” sociological forum. 1999 14(3):495-523. williams, d.r., spencer, m., and jackson, j.s. “race stress and physical health: the role of group identity” r.j. contrada and r.d. ashmore (eds.), self, social identity and physical health: interdisciplinary explorations. 1999 new york: oxford university press. pp. 71-100. brown, t.n., williams, d.r., jackson, j.s., neighbors, h.w., torres, m., sellers, s.l., and brown, k.t. “being black and feeling blue: the mental health consequences of racial discrimination”. race & society. 2000 2:117-131. schulz, a., williams, d., israel, b., becker, a., parker, e., james, s., and jackson, j. “unfair treatment, neighborhood effects, and mental health in the detroit metropolitan area”. journal of health and social behavior. 2000 41:314-332. williams, d.r. “race, stress, and mental health: findings from the commonwealth minority health survey.” in c. hogue, m.a. hargraves and k.s. collins (eds.), minority health in america: findings and policy implication from the commonwealth fund minority health survey. 2000 johns-hopkins university press, baltimore, md. pp. 209243. guthrie, b.j., young, a.m., williams, d.r., boyd, c.j., and kintner, e.k., “african american girls’ smoking habits and day-to-day experience with racial discrimination. nursing research, 2002 51(3): 183-190. jackson, j.s., williams, d.r., and torres, m. “perceptions of discrimination, health and mental health: the social stress process.” 2002 socioeconomic conditions, stress and mental disorders: toward a new syn of research and public policy. online. internet. available: http://www.mhsip.org/pdfs/jackson.pdf. schulz, a.j., gravlee, c.c., williams, d.r., israel, b., mentz, g., rowe, z. “discrimination, symptoms of depression, and self-rated general health among african american women in detroit: longitudinal results from eastside village health worker partnership.” american journal of public health, 2006 96(7):1265-1270. borrell, l. n., kiefe, c.i., williams, d.r., diez-roux, a.v., gordon-larsen, p. “self-reported health, perceived racial discrimination, and skin color in african americans in the cardia study.” social science and medicine, 2006 63:1415-27.  11                    richman, l.s., kohn-wood, l.p., williams, d.r., “the role of discrimination and racial identity for mental health service utilization.” journal of social and clinical psychology, 2007 26(8): 960-981. oyserman, d., uskul, a.k., yoder, n., nesse, r.m., williams, d.r., “unfair treatment and self-regulatory focus.” journal of experimental and social psychology, 2007 43:505512. williams, d.r., gonzalez, h.m., williams, s., mohammed, s.a., moomal, h, stein, d.j. “perceived discrimination, race and health in south africa: findings from the south africa stress and health study.” social science and medicine, 2008 67: 441-452. tynes, b., giang, m.t., williams, d.r., and thompson, g.n. “online racial discrimination and psychological adjustment among adolescents.” journal of adolescent health, 2008 43:565-569. haas, j.s., earle, c.c., orav, j.e., brawarsky, p., neville, b.a., williams, d.r. “racial segregation and disparities in cancer stage for seniors.” journal of general internal medicine, 2008 23(5):699-705. haas, j. s., earle, c. c., orav, j. e., brawarsky, p., keohane, m., neville, b. a., williams, d. r. "racial segregation and disparities in breast cancer care and mortality." cancer, 2008 113(8): 2166-2172. sims, m., wyatt, s.b., gutierrez, m.s., taylor, h. s., williams, d. r. “development and psychometric testing of a multidimensional instrument of perceived discrimination among african americans in the jackson heart study.” ethnicity & disease, 2009 winter;19(1):56-64. moomal, h., jackson, p.b., stein, d.j., herman, a., myer, l., seedat, s., madela-mntla, e., williams, d.r. “perceived discrimination and mental health disorders: the south african stress and health study.” south african medical journal, 2009 99(5):383-389. hunte, h., williams, d.r. “the association between perceived discrimination and obesity in a population based multiracial/ethnic adult sample.” american journal of public health, 2009 99(7):1285-1292. friedman, e.m., williams, d.r., singer, b.h., ryff, c.d. “chronic discrimination predicts higher circulating levels of e-selectin in a national sample: the midus study.” brain behavior and immunity, 2009 23:684-692. shariff-marco, s., gee, g.c., breen, n., willis, g., reeve, b.b., grant, d., ponce, n.a., krieger, n., landrine, h., williams, d.r., alegria, m., mays, v.m., johnson, t.p., brown, e.r. “a mixed-methods approach to developing a self-reported racial ethnic discrimination measure for use in multiethnic health surveys.” ethnicity & disease, 2009 19(autumn):447-453. surkan, p.j., mukerjee, j.s., williams, d.r., eustache, e., louis, e., jean-paul, t., lambert. w., scanlan, f.c., oswald, c.m. smith fawzi, m.c. “perceived discrimination and stigma towards children affected by hiv/aids and their hiv-positive caregivers in central haiti,” aids care, 2010 22(2):803-815. shariff-marco, s., breen, n., landrine, h., reeve, b.b., krieger, n., gee, g.c., williams, d.r., mays, v.m., ponce, n.a., alegria, m. “measuring everyday racial/ethnic discrimination in health surveys.” du bois review, 2011 8(1): 159-177. sternthal, m., slopen, n., williams, d.r. “racial disparities in health: how much does stress really matter?” du bois review, 2011 8(1): 95-113.  12                       rooks, ronica., xu, y., holliman, b., williams, d.r. “discrimination and mental health among black and white adults in the yes health study.” race and social problems, 2011 3(3):182-196. kim, s.s., williams, d.r.” perceived discrimination and self-rated health in south korea: a nationally representative survey.” plos one. 2012 7(1): e30501. krieger, n., waterman, p.d., kosheleva, a., chen, j.t., carney, d.r., smith, k.w., bennett, g.g., williams, d.r., freeman, e., russell, b., thornhill, g., mikolowsky, k., rifkin, r., samuel, l. “exposing racial discrimination: implicit & explicit measures-the my body, my story study of 1005 us-born black & white community health center members.” plos one. 2011 6(11):e27636. reeve, b. b., willis, g., shariff-marco, s. n., breen, n., williams, d. r., gee, g. c., alegria, m., takeuchi, d. t., stapleton, m. and levin, k. y. "comparing cognitive interviewing and psychometric methods to evaluate a racial/ethnic discrimination scale." field methods 2011, 23(4): 397-419. williams, d.r., haile, r., mohammed, s.a., herman, a., sonnega, j., jackson, j.s., stein, d.j. “perceived discrimination and psychological well-being in the u.s. and south africa.” ethnicity and health. 2012,17(1-2): 111-33. pmid: 22339224. pmcid: pmc3468317. williams, d.r., john, d., oyserman, d., sonnega, j., mohammed, s.a., jackson, j.s. “research on discrimination and health: an exploratory study of unresolved conceptual and measurement issues” american journal of public health. 2012, 102(5): 975-978. pmid: 22420798. pmcid: pmc3329155. williams, d.r., haile, r., mohammed, s.a., herman, a., sonnega, j., jackson, j.s., stein, d.j. “perceived discrimination and psychological well-being in the u.s. and south africa.” ethnicity and health. 2012, 17(1-2): 111-33. pmid: 22339224. pmcid: pmc3468317. “research on discrimination and health: an exploratory study of unresolved conceptual and measurement issues.” american journal of public health. 2012, 102(5): 975-978. pmid: 22420798. pmcid: pmc3329155. sims, m., diez-roux, a. v., dudley, a., gebreab, s., wyatt, s. b., bruce, m. a., james, s. a., robinson, j. c., williams, d. r. and taylor, h. a. "perceived discrimination and hypertension among african americans in the jackson heart study." american journal of public health. 2012,102: suppl 2: s258-265. pmid: 22401510. kim, s.s., williams, d.r.” perceived discrimination and self-rated health in south korea: a nationally representative survey.” plos one. 2012,7(1): e30501. pmid: 22272357. pmcid: pmc3260296 kim, s.-s., chung, y., subramanian, s. v. and williams, d. r. "measuring discrimination in south korea: underestimating the prevalence of discriminatory experiences among female and less educated workers?" plos one 2012,7(3): e32872. pmid: 22427901. pmcid: pmc3299710. borrell, l. n., kiefe, c. i., diez-roux, a. v., williams, d. r. and gordon-larsen, p. racial discrimination, racial/ethnic segregation and health behaviors in the cardia study. ethnicity and health. 2013, 18:3, 227-243, pmid: 22913715. pmcid: pmc3523091. duncan, d., kawachi, i., white, k. and williams, d.r. "the geography of recreational open space: influence of neighborhood racial composition and neighborhood poverty." journal of urban health. 2013,90(4):618-31. pmid: 23099625. pmcid: pmc3732687 krieger, n., waterman, p.d., kosheleva, a., chen, j.t., smith, k.s., carney, d.r., bennett, g., williams, d.r., thornhill, g., freeman, e. “racial discrimination & cardiovascular disease  13                  risk: my body my story study of 1005 us-born black and white community health center participants (us).” plos one, 2013, 8(10):e77174. brewer l.c., carson k.a., williams d.r., allen a., jones c.p., cooper l.a. “association of race consciousness with the patient-physician relationship, medication adherence, and blood pressure in urban primary care patients.” american journal of hypertension. 2013, 26(11). pmid: 23864583. pmcid: pmc3790452. slopen, n. & williams, d.r. "discrimination, other psychosocial stressors, and selfreported sleep duration and difficulties." sleep 2014, 37(1): 147-156a. pmid: 24381373. pmcid: pmc3865350. lewis, t., williams, d.r., tamene, m., clark, c.r. "self-reported experiences of discrimination and cardiovascular disease." current cardiovascular risk reports. 2014, 8:365. pmid: 24729825. pmcid: pmc3980947. garnett, b.r., masyn, k.e., austin, s.b., miller, m., williams, d.r.,viswanath, k. "the intersectionality of discrimination attributes and bullying among youth: an applied latent class analysis. journal of youth and adolescence. 2014, 43(8): 1225-39. pmid: 24318776. tynes, b.m., rose, c.a., hiss, s., umana-taylor, a. j., mitchell, k., williams, d.r. “virtual environments, online racial discrimination, a diverse, school-based sample of adolescents.” international journal of gaming and computer-mediated simulations. 2014,6(3), 1-6. dutra, l. m., williams, d. r., kawachi, i., okechukwu, c. a. "racial and non-racial discrimination and smoking status among south african adults 10 years after apartheid." tobacco control. 2014 nov, 23(e2):e114-21. pmid: 24789604. pmcid: pmc4214915. umana-taylor, a. j., tynes, b., toomey, r. b., williams, d.r., mitchell, k. “latino adolescents’ perceived discrimination in online and off-line settings: an examination of cultural risk and protective factors.” developmental psychology. 2015, 51(1):87-100. pmid: 25546597. pmcid: pmc4752111. garnett, b.r., masyn, k.e., austin, s.b., williams, d.r., viswanath, k. "coping styles of adolescents experiencing multiple forms of discrimination and bullying: evidence from a sample of ethnically diverse urban youth." journal of school health. 2015, 85(2):10917. pmid: 25564979. ong, a.d., williams, d.r., nwizu, u., gruenewald, t. in press. “everyday unfair treatment and multisystem biological dysregulation in african-american adults.” cultural diversity and ethnic minority psychology.  3. publications on vigilance, race and health     hicken, m.t. lee, h., ailshire, j., burgard, s.a., williams d.r. ““every shut eye, ain’t sleep”: the role of racism-related vigilance in racial/ethnic disparities in sleep difficulty.” race and social problems 2013, 5(2):100-112. pmid: 23894254. pmcid: pmc3722054 hicken, m. t., lee, h., morenoff, j., house, j. s. and williams, d. r. "racial/ethnic disparities in hypertension prevalence: reconsidering the role of chronic stress."  14    american journal of public health. 2014, 104(1): 117-123. pmid: 24228644. pmcid: pmc3910029. laveist, t. a., thorpe jr., r.j., pierre, g., mance, g. a., williams, d. r. “the relationships among vigilant coping style, race, and depression.” journal of social issues. 2014, 70(2):241-255. pmid: 24954953. pmcid: pmc4061746.  vi. appendix b: selected studies that have used the everyday discrimination scale in other countries australia runions, k., priest, n., dandy, j. discrimination and psychological adjustment amongst australian children from middle-eastern and asian backgrounds. australian community psychologist. 2011, 23(1), 23-33.  brazil celeste, r. k., goncalves, l. g., faerstein, e., bastos, j. l. the role of potential mediators in racial inequalities in tooth loss: the pro‐saude study. community dentistry and oral epidemiology. 2013, 41(6), 509-516. faerstein, e., chor, d., werneck, g. l., lopes, c. d. s., kaplan, g. race and perceived racism, education, and hypertension among brazilian civil servants: the pro-saude study. revista brasileira de epidemiologia. 2014, 17, 81-87.  canada kim, i. noh, s. racial/ethnic variations in the main and buffering effects of ethnic and nonethnic supports on depressive symptoms among five ethnic immigrant groups in toronto. ethnicity health. 2015, 21(3): 215-232.  china huang, y., chen, j., yang, j., song, k., wang, x., cheng, x., qu, s. evaluation of depressive symptoms in obese patients with or without acanthosis nigricans. hormones. 2015, 14(3), 417-424. yu, n., chan, c., zhang, j. dyadic effects of stigma and discrimination on distress in chinese hiv discordant couples. aids education and prevention. 2016, 28(4), 277-286.  15  
  democratic republic of congo verelst, a., de schryver, m., broekaert, e., derluyn, i. mental health of victims of sexual violence in eastern congo: associations with daily stressors, stigma, and labeling. bmc women's health. 2014, 14(1), 106. verelst, a., de schryver, m., de haene, l., broekaert, e., derluyn, i. the mediating role of stigmatization in the mental health of adolescent victims of sexual violence in eastern congo. child abuse neglect. 2014, 38(7), 1139-1146.  england hatch, s.l., gazard, b., williams, d.r., frissa, s., goodwin, l. selcoh study team, hotopf, m. discrimination and common mental disorder among migrant and ethnic groups: findings from a south east london community sample. soc pyschiatry psychiatr epidemiol. 2016, 51, 689-701. furnham, a. swami, v. an investigation of attitudes toward surveillance at work and its correlates. psychology. 2015, 6, 1668-1675.  england, france, and germany kunst, j. r., sam, d. l., ulleberg, p. perceived islamophobia: scale development and validation. international journal of intercultural relations. 2013, 37(2), 225-237.  france dambrun, michael. gender differences in mental health: the mediating role of perceived personal discrimination. journal of applied social psychology. 2007, 37(5), 1118-1129.  italy tarricone, i., cianconi, p., chierzi, f., marcacci, t., berardi, d. comprendere le cause dell’esordio psicotico dall’ascolto della storia migratoria: il lavoro del bologna transcultural psychitric team (botpt). interventi precoci nelle psicosi. 2013.  macedonia and serbia janevic, t., gundersen, k., stojanovski, j., jankovic, z., nikolic, b., kasapinov, b. discrimination and romani health: a validation study of discrimination scales among romani women in macedonia and serbia. int j public health. 2015, 60(6), 669-677.  netherlands  16  
  ikram, u.z., snijder, m.b., fassaert, t.j.l , schene, a.h., kunst, a.e., stronks, k. the contribution of perceived ethnic discrimination to the prevalence of depression. european journal of public health. 2015, 25(2), 243-248. ikram, u., snijder, m., wit, m. schene, a. stronks, k., kunst, a. perceived ethnic discrimination and depressive symptoms: the buffering effects of ethnic identity, religion and ethnic social network. social psychiatry and psychiatric epidemiology. 2016, 51(5), 679-688. ikram, u.z., snijder, m.b., agyemang, c., schene, a.h., peters, r.j., stronks, k., kunst, a.e. perceived ethnic discrimination and the metabolic syndrome in ethnic minority groups: the healthy life in an urban setting study. psychosomatic medicine. 2016. (in press)  new zealand thayer, z.m. kuzawa, c.w. ethnic discrimination predicts poor self-rated health and cortisol in pregnancy: insights from new zealand. social science medicine. 2015, 128, 36-42.  pakistan sadiq, s., bashir, a. relationship between perceived discrimination and loneliness among transgender: mediating role of coping mechanism. international journal of research studies in psychology. 2014, 3(5).  portugal freitas, d.f., coimbra, s., marturano, e.b., fontaine, a.m. adaptation of the everyday discrimination scale to portuguese youth. psicologia: refl exao e critica. 2015, 28(4), 708-717. freitas, d.f., d'augelli, a.r., coimbra, s., fontaine, a.m. discrimination and mental health among gay, lesbian, and bisexual youths in portugal: the moderating role of family relationships and optimism. journal of glbt family studies. 2016, 12(1), 68-90.  south africa moomal, h., jackson, p. b., stein, d. j., herman, a., myer, l., seedat, s., williams, d. r. perceived discrimination and mental health disorders: the south african stress and health study. samj: south african medical journal. 2009, 99(5), 383-389. williams, d. r., gonzalez, h. m., williams, s., mohammed, s. a., moomal, h., stein, d. j. perceived discrimination, race and health in south africa. social science medicine. 2008, 67(3), 441-452. williams, d.r., haile, r., mohammed, s., herman, a., sonnega, j., jackson, j., stein, d. perceived discrimination and psychological well-being in the usa and south africa. ethnicity health. 2012m 17(1-2), 111-133.  17  
  uganda amone-p’olak, k., ovuga, e., jones, p.b. the effects of sexual violence on psychosocial outcomes in formerly abducted girls in northern uganda: the ways study. bmc psychology. 2015, 3(46).  vii. appendix c: other versions of major experiences of discrimination scale a. major experiences of discrimination: original 6 item version   developed for the 1995 detroit area study (das)    source: williams, d.r., yu, y., jackson, j.s., and anderson, n.b. “racial differences in physical and mental health: socioeconomic status, stress, and discrimination.” journal of health psychology. 1997; 2(3):335-351.    source: forman, t.a., williams, d.r., and jackson, j.s. “race, place, and discrimination.” in carol gardner (ed.), perspectives on social problems. jai press. 1997; 9:231-261.    measure: in the following questions, we are interested in your beliefs about the way other people have treated you. 1. do you think you have ever been unfairly fired or denied a promotion? 2. for unfair reasons, do you think you have ever not been hired for a job? 3. have you ever been unfairly stopped, searched, questioned, physically threatened or abused by the police? 4. have you ever been unfairly discouraged by a teacher or advisor from continuing your education? 5. do you think you have ever been unfairly prevented from moving into a neighborhood because the landlord or a realtor refused to sell or rent you a house or apartment? 6. have you ever moved into a neighborhood where neighbors made life difficult for you or your family? for each yes response to the above questions, here are the follow-up questions: 1. what was the main reason? your ethnicity.........1 your gender.........2 your race.........3  18  
  your age.........4 your religion.........5 your physical appearance.........6 your sexual orientation.........7 your income level/social class.........8 other specify __________ 2. did that happen in the last 12 months?  b. major experiences of discrimination: 9 item version from the midus study   adapted from the 1995 das    see http://www.midus.wisc.edu/ for more information    source: kessler, r.c., mickelson, k., and williams, d.r. “the prevalence, distribution, and mental health correlates of perceived discrimination in the united states.” journal of health and social behavior. 1999 40(3):208-230.    questionnaire s13. how many times in your life have you been discriminated against in each of the following ways because of such things as your race, ethnicity, gender, age, religion, physical appearance, sexual orientation, or other characteristics? (if the experience happened to you, but for some reason other than discrimination, enter "0".) # of times in your life 1. you were discouraged by a teacher or advisor from seeking higher education? 2. you were denied a scholarship? 3. you were not hired for a job? 4. you were not given a job promotion? 5. you were fired? 6. you were prevented from renting or buying a home in the neighborhood you wanted? 7. you were prevented from remaining in a neighborhood because neighbors made life so uncomfortable? 8. you were hassled by the police 9. you were denied a bank loan? 10. you were denied or provided inferior medical care? 11. you were denied or provided inferior service by a plumber, car mechanic, or other service provider?    follow-up question for each item: number of times in your life?  19  
  s15. global follow up question after all items: what was the main reason for the discrimination you experienced? (if more than one main reason, circle all that apply.) 1. your age 2. your gender 3. your race 4. your ethnicity or nationality 5. your religion 6. your height or weight 7. some other aspect of your appearance 8. a physical disability 9. your sexual orientation 10. some other reason for discrimination (please specify:) ________________________________________________________________ ________________________________________________________________ s16. overall, how much has discrimination interfered with you having a full and productive life? 1. a lot 2. some 3. a little 4. not at all s17. overall, how much harder has your life been because of discrimination? 1. a lot 2. some 3. a little 4. not at all  c. major experiences of discrimination (expanded 19 item version)      expanded from the 1995 detroit area study and the midus study for the yes health study source: in press williams, d.r., john, d., oyserman, d., sonnega, j., mohammed, s.a., jackson, j.s. “research on discrimination and health: an exploratory study of unresolved conceptual and measurement issues” american journal of public health. questionnaire we are interested in your beliefs about the way other people have treated you. in this section, i am going to ask you about experiences of being treated unfairly. employment first, i will ask you about being treated unfairly at work. can you tell me if each of the following has ever happened to you: 1. at any time in your life, have you ever been unfairly fired?  20  
  2. for unfair reasons, do you think you have ever not been hired for a job? 3. have you ever felt that others at your place of employment unfairly got promotions or pay raises faster than you did? 4. have you ever been unfairly denied a promotion? 5. in addition to what we have talked about, is there any other way you have been treated unfairly at work, for example, prevented from doing something or been hassled or made to feel inferior? housing 6. have you ever been unfairly prevented from moving into a neighborhood because the landlord or a realtor refused to sell or rent you a house or apartment? 7. have you ever moved into a neighborhood where neighbors unfairly made life difficult for you or your family? 8. (if yes) was it so bad that that you moved out? 9. in addition to what we have talked about, have you ever been treated unfairly, prevented from doing something, or been hassled or made to feel inferior in getting into or staying in a neighborhood that you wanted? education 10. have you ever been unfairly discouraged by a teacher or advisor from continuing your education? 11. have you ever been unfairly denied a scholarship? 12. in addition to what we have talked about, have you ever been treated unfairly, prevented from doing something, or been hassled or made to feel inferior by teachers or classmates? police/courts 13. have you ever been unfairly stopped, searched, or questioned by the police? 14. have you ever been unfairly physically threatened or abused by the police? 15. have you ever been unfairly suspected or accused of doing something illegal by the authorities? 16. in addition to what we have talked about, have you ever been treated unfairly, prevented from doing something, or been hassled or made to feel inferior by the police or the courts? other major experiences of unfair treatment 17. have you ever been unfairly denied a bank loan? 18. have you ever been unfairly denied medical care or provided medical care that was worse than what other people get? 19. have you ever unfairly received service from someone such as a plumber or car mechanic that was worse than what other people get? 20. thinking over your entire life, in addition to what we have talked about, have you ever been treated unfairly, prevented from doing something, or been hassled or made to feel inferior in some other aspect of your life? response categories for all of the previous questions are yes/no.  21    follow-up questions: we want to talk in more detail about experiences of unfair treatment you told me about earlier. for each question: h1. you told me that you have been unfairly ________________. h1a. how many times has this happened in your entire life? 1. once 5. more than once (specify): go to h1c. h1b. in what month or year did this happen? (go to h5b) h1c. how many times has this happened in the last year?______________ h1d. in what year did you first have an experience of ___________________? h1e. what do you think was the main reason for this experience? (check more than one if volunteered). 1. your ancestry or national origins 2. your gender 3. your race 4. your age 5. your religion 6. your height or weight 7. some other aspect of your physical appearance 8. your sexual orientation 9. your education or income level 10. a physical disability 11. other (specify) _____________________________ h1f. how certain are you that __________ was the main reason for this experience? absolutely positive pretty sure somewhat doubtful very doubtful h2. think of your worst experience of ____________________. could you tell me more about what happened? (probe: ensure that information is included about the age, gender, and race of the perpetrator). h3. was your worst experience of ________________________ also your very first experience? response categories: yes - go to h4. no h3a. what do you think was the main reason for your worst experience? (check more than one if volunteered). h4. was your worst experience of ____________________ also your most recent experience? response categories: yes - go to h5e. no  22  
  h5. in what year was your most recent experience of _____________________? h5a. in what month did it happen?___________________________________ h5b. could you tell me more about what happened? (probe: ensure that information is included about the age, gender, and race of the perpetrator). h5c. what do you think was the main reason for this (your most recent experience)? (check more than one if volunteered). h5d. how certain are you that __________ was the main reason for this experience? absolutely positive pretty sure somewhat doubtful very doubtful h5e. how did this experience make you feel? (check all that apply). 1. angry 2. frustrated 3. sad 4. powerless 5. hopeless 6. scared 7. vulnerable 8. humiliated 9. vengeful 10. inferior 11. not surprised/resigned h5f. how stressful was this experience for you? would you say it was: very stressful quite stressful somewhat stressful not at all stressful  e.  coping with discrimination    used in the yes health study adapted from 2 sources: o mcneilly, m.d., anderson, n.b., armstead, c.a., clark, r., corbett, m., robinson, e.l., pieper, c.f. & lepisto, e.m. “the perceived racism scale: a multidimensional assessment of the experience of white racism among african americans.” ethnicity and disease. 1996; 6 (1,2), 154-166. o krieger, n. “racial and gender discrimination: risk factors for high blood pressure?” social science and medicine. 1990; 30 (12), 1273-1281. h6. how did you respond to this experience? please tell me if you did each of the following things a lot, some, or not at all: 1. tried to do something about it.  23  
  2. accepted it as a fact of life. 3. worked harder to prove them wrong. 4. talked to someone about what to do about the situation. 5. didn’t let it get to you; refused to think about it too much. 6. felt that you brought it on yourself. 7. talked to someone about how you were feeling. 8. tried to keep your feelings to yourself. 9. criticized or lectured yourself. 10. increased your efforts to make things work. 11. talked to someone who could do something concrete about the situation. 12. went on as if nothing had happened. 13. expressed anger to the person who caused the problem. 14. tried to forget that it had happened. 15. sought or found spiritual comfort and support. global evaluation h7. how well do you feel you have dealt up to now with this experience and any changes or problems which may have resulted from it? very well quite well somewhat well not too well  e. coping with discrimination – nsal study (abbreviated)     adapted from 2 sources: o mcneilly, m.d., anderson, n.b., armstead, c.a., clark, r., corbett, m., robinson, e.l., pieper, c.f. & lepisto, e.m. “the perceived racism scale: a multidimensional assessment of the experience of white racism among african americans.” ethnicity and disease. 1996; 6 (1,2), 154-166. o krieger, n. “racial and gender discrimination: risk factors for high blood pressure?” social science and medicine. 1990; 30 (12), 1273-1281. how did you respond to this/these experience(s)? please tell me if you did each of the following things. 1. tried to do something about it. 2. accepted it as a fact of life. 3. worked harder to prove them wrong. 4. realized that you brought it on yourself. 5. talked to someone about how you were feeling. 6. expressed anger or got mad. 7. prayed about the situation.  24  
       


title_index: microaggressions._clarification_evidence_and_impact
full_text_index:
       827499  research-article2019  ppsxxx10.1177/1745691619827499williamsmicroaggressions  association for  psychological science  microaggressions: clarification, evidence, and impact  perspectives on psychological science 2020, vol. 15(1) 3 –26  the author(s) 2019 article reuse guidelines: sagepub.com/journals-permissions https://doi.org/10.1177/1745691619827499 doi: 10.1177/1745691619827499 www.psychologicalscience.org/pps  monnica t. williams school of psychology, university of ottawa  abstract in a 2017 article in perspectives on psychological science, scott lilienfeld critiqued the conceptual basis for microaggressions as well as the scientific rigor of scholarship on the topic. the current article provides a response that systematically analyzes the arguments and representations made in lilienfeld’s critique with regard to the concept of microaggressions and the state of the related research. i show that, in contrast to the claim that the concept of microaggressions is vague and inconsistent, the term is well defined and can be decisively linked to individual prejudice in offenders and mental-health outcomes in targets. i explain how the concept of microaggressions is connected to pathological stereotypes, power structures, structural racism, and multiple forms of racial prejudice. also described are recent research advances that address some of lilienfeld’s original critiques. further, this article highlights potentially problematic attitudes, assumptions, and approaches embedded in lilienfeld’s analysis that are common to the field of psychology as a whole. it is important for all academics to acknowledge and question their own biases and perspectives when conducting scientific research. keywords microaggressions, racism, validity, ethnic differences, diversity, education although it is no longer socially acceptable to be openly racist in america (e.g., nadal, 2018), racism continues to be part of the fabric of american life. racism can be defined as beliefs, attitudes, policies, and acts that denigrate or disadvantage individuals or groups because of presumed racial or ethnic-group affiliation (r. clark, anderson, clark, & williams, 1999; schmid, 1996). according to r. clark et al. (1999), the conceptualization of racism can generally be placed into two broad categories: attitudinal (e.g., prejudice) or behavioral (e.g., discrimination); however, it is important to understand that racism is also structural in nature, in that it is woven into nearly all of our social systems, institutions, and policies for the benefit of white americans at the expense of people of color (salter, adams, & perez, 2018). individual and structural racism exist in synergy, each supporting the other. people of color experience racism in many forms, including covert acts of racial discrimination that go unseen and unacknowledged by offenders (e.g., gaertner & dovidio, 2005). chester pierce (1974), a prominent african american harvard-trained psychiatrist, was the first to describe these covert acts as microaggressions in the 1960s. he  defined microaggressions as “black-white racial interactions [that] are characterized by white put-downs, done in an automatic, preconscious, or unconscious fashion” (p. 515). since that time, both popular use and the academic study of microaggressions have grown rapidly (e.g., sue et al., 2007), and the definition has been expanded to describe this phenomenon when it occurs between various groups where there exists stigma and/ or a power imbalance. in contrast to what pierce (1970) called “macroaggressions,” which would include severe acts of racism (e.g., lynchings, beatings, cross burnings), microaggressions are considered small, common, and sometimes ambiguous, yet they are particularly stressful for those on the receiving end given their ubiquity and deniability. scott lilienfeld (2017a,b) has critiqued both the conceptual basis for microaggressions as well as the scientific  corresponding author: monnica t. williams, university of ottawa, school of psychology, 136 jean-jacques lussier, vanier hall, ottawa, ontario, canada, k1n 6n5 e-mail: monnica.williams@uottawa.ca  
  williams  4 rigor of academic scholarship on the topic. in a 2017 article published in this journal, he argued that the microaggression research program rests on five faulty premises: 1. microaggressions are operationalized with sufficient clarity and consensus to afford rigorous scientific investigation. 2. microaggressions are interpreted negatively by most or all minority group members. 3. microaggressions reflect implicitly prejudicial and implicitly aggressive motives. 4. microaggressions can be validly assessed using only respondents’ subjective reports. 5. microaggressions exert an adverse impact on recipients’ mental health. (lilienfeld, 2017b, p. 140) some scholars have supported his critique (e.g., haidt, 2017), and so it is critical that these points be addressed with sound reasoning and current empirical findings. this article will address each premise, using the existing literature base and my own research. specifically, as elaborated in table 1, i argue the following: 1. 2. 3. 4. 5.  microaggressions are well defined. adequate agreement exists regarding what constitutes a microaggression. microaggressions are correlated with valid measures of racism. microaggressions can be validly assessed using respondents’ subjective reports. microaggressions are linked to negative mentalhealth outcomes.  on the basis of pierce’s original descriptions and current scholarship, i define microaggressions as deniable acts of racism that reinforce pathological stereotypes and inequitable social norms. this definition is not based on the conscious intent of the offender or the perception of the target, although i will illustrate how microaggressions are related to racial biases, are offensive to many, and are harmful to victims. lilienfeld also made a number of additional claims and comments that deserve a response, but not all of the issues can be addressed here because of space issues, so in addition to these five major premises, i address a few of his most problematic points in the discussion. specifically, i argue that lilienfeld’s approach to understanding these issues uses a cultural-deficit model, that he endorsed what may amount to suppressing information about microaggressions,1 and that microaggression education can beneficially be taught to students. before examining specific claims, i first address the approach to the scientific process. although ultimately this article is aimed at systematically and carefully deconstructing lilienfeld’s arguments, claims, reasoning, and misrepresentation of the state of microaggression research, it is important for all academics to acknowledge and question their own biases and perspectives when conducting research (barber & silver, 1968; does et al., 2018; orne, 1962). this principle is inherent in statistical approaches for reducing confirmation bias and in the academic encouragement of open discussion and debate (littell, 2008; nickerson, 1998). in responding to lilienfeld’s article, i consciously choose to share my vantage point. note that i approach this issue from my own perspective as a clinical psychologist, psychopathology researcher, disparities  table 1. addressing lilienfeld’s key assertions questioned assertion 1. microaggressions are operationalized with sufficient clarity and consensus to afford rigorous scientific investigation 2. microaggressions are interpreted negatively by most or all minority group members 3. microaggressions reflect implicitly prejudicial and implicitly aggressive motives 4. microaggressions can be validly assessed using only respondents’ subjective reports 5. microaggressions exert an adverse impact on recipients’ mental health.  response microaggressions are well operationalized and can be identified on the basis of pathological ethnic or racial stereotypes, the content of which is dictated by legitimizing myths. the defining features of microaggressions are largely shared among diversity researchers, who have created many validated measures of microaggressions that have been used in several rigorous scientific investigations. it is not necessary for microaggressions to be interpreted negatively by all minorities for the construct to have meaning. nonetheless, the evidence suggests that most people of color agree that most microaggressions (as identified by researchers) are offensive. microaggressions are correlated to multiple indicators of racism, including symbolic racism, color-blind racial attitudes, modern racism, and explicit racial attitudes (feelings thermometer), and they are negatively correlated to positive feelings toward people of color. microaggressions are routinely assessed using validated self-report measures. further, people of color, white people, and diversity experts alike largely agree as to what constitutes undesirable microaggressive behavior. microaggressions are correlated to numerous severe mental-health conditions, including suicidality. correlations remain even after controlling for negative affectivity. several studies have examined the effects of microaggressions proactively to establish cause and effect. thus microaggressions pose an important mental health concern.  
  microaggressions researcher, psychometrician, behaviorist, diversity instructor, university educator, clinical supervisor, target of microaggressions, person of color, american, african american, and woman. some of these identities are stigmatized (e.g., black woman) and some are privileged (e.g., university professor). all of these identities are salient as they inform my approach, perspective, and priorities (does et al., 2018). as part of my african american cultural values and ethnic/racial socialization, i value being clear, direct, and honest. i regularly experience all forms of racism, probably more than most because of the relatively large platform i have to disseminate my antiracism work, but less so than some because of my privileged identities. i am an optimist and believe people can grow and change for the better. all of us carry biases, and challenging ongoing personal work is needed to address these.  racial microaggressions terminology much of the scholarship surrounding microaggressions has focused on marginalized ethnic and racial groups that tend to be the targets of microaggressive behavior. the term started as a way to describe the common experiences of african americans (pierce, 1970; smith, allen, & danley, 2007), but other groups experience frequent microaggressions as well, including asian americans (nadal, vigilia escobar, prado, david, & haynes, 2012; ong, burrow, fuller-rowell, ja, & sue, 2013), hispanic americans (huynh, 2012; yosso, smith, ceja, & solorzano, 2009), native americans/american indians ( jones & galliher, 2015; walls, gonzalez, gladney, & onello, 2015), asian and indigenous canadians (canel-cinarbas & yohani, 2019; d. a. clark, kleiman, spanierman, isaac, & poolokasingham, 2014; poolokasingham, spanierman, kleiman, & houshmand, 2014), and others. arab americans are also subjected to microaggressions, but because individuals of middle eastern descent are not officially recognized as an ethnic minority group, research is sparse, and many instances of discrimination are not documented (awad, 2010). sue et al. (2007) proposed one of the first classification systems for racial microaggressions. this included nine categories, described as (a) assumptions that a person of color is not a true american; (b) assumptions of lesser intelligence; (c) statements that convey colorblindness or denial of the importance of race; (d) assumptions of criminality or dangerousness; (e) denial of individual racism; (f) promotion of the myth of meritocracy; (g) assumptions that one’s cultural background and communication styles are pathological; (h) the experience of being treated as a second-class citizen; and (i) environmental messages of being unwelcome or devalued. these are specific to the types of microaggressions  5 experienced by people in our culture as a result of race or ethnicity. although there are other types of microaggressions (i.e., gender, religious, etc.) and unique intersectional stressors for people with various marginalized identities (e.g., asian american sexual/gender minorities; ching, lee, chen, so, & williams, 2018), the focus of this article is on microaggressions connected to the target’s presumed racial and ethnic group, and so herein microaggressions should be taken to mean ethnoracial microaggressions, unless otherwise indicated. this is because microaggressions against groups that are stigmatized differently have a unique history that changes the nature of the construct in ways requiring a different understanding than what is presented here. in terms of who commits microaggressions, lilienfeld objected to sue et al.’s (2007) use of the term perpetrator in order to avoid any connotation of intentionality or malevolence and instead uses the term deliverer. he also preferred the term recipient over victim, which perhaps diverts attention away from the harm done by the deliverer, given that he openly questioned the mental-health impact of microaggressions. deliverer and recipient are, by lilienfeld’s own admission, awkward, but they are also misleading. consider that the term deliverer may conjure up images of a student driver holding pizza in a cardboard box, a ups carrier with a long-awaited package, or even santa claus with gifts, and yet microaggressions are nothing a child would want to find under a christmas tree. pierce (1970, 1974) describes microaggressions as emotionally damaging “offensive mechanisms,” a type of analogue to the freudian concept of defensive mechanisms, which, like microaggressions, often occur outside conscious awareness. further, pierce (1970) likens the performance of microaggressions to an offensive maneuver one might observe in the sport of football, and consequently he urged people of color to have ready defenses to counter these attacks. therefore, i will use the term offender to refer to those who microaggress, in homage to dr. piece, and also in recognition of the fact that microaggressions are, by nature, offensive in the sense that they are a form of racism (kanter et al., 2017), making the term offender an apt description. given that not all microaggressions are consciously deliberate, some may wonder if offender is an appropriate term. consider the case of an inexperienced driver who unintentionally strikes and injures a pedestrian. even though the accident was unintended, the driver can still be considered culpable and can be convicted for not being careful enough or skilled enough, at which point the driver becomes an offender. the foundational perspective of this article is that microaggressions are real and not simply a subjective experience. consequently, an offender directs a microaggression  
  6 at a specific person or group of people, and in this sense, a microaggression is aimed and launched, but it may or may not strike a victim and cause harm (e.g., the target may not perceive the microaggression— for example, an offender may mutter an unkind phrase under his breath but not loud enough for the target to hear). thus, i will use the term target to refer to the intended recipient of the microaggression. that being said, the term victim is appropriate if the target is harmed by the microaggression. consider, in the example of the inexperienced driver above, that although the injury is unintended, the injured pedestrian is still a victim.  operationalizing microaggressions defining microaggressions although we tend to think of microaggressions as statements, they may take many forms. in addition to negative statements (e.g., “asians are bad drivers”) and seemingly positive statements (e.g., “black people are good at basketball”), they can include actions (e.g., crossing the street to avoid walking past a black man), inaction (e.g., failing to offer aid to a person of color in distress because “someone else will do it”), being unseen (e.g., everyone at a banquet getting served except the lone person of color), being treated as contaminated (e.g., a cashier putting change on the counter rather than in hand to avoid touching the person of color), and environmental assaults (e.g., naming a public park after a confederate civil war leader). a microaggression would not generally involve direct physical harm, although in certain cases it may (e.g., a person of color is tripped in a crowded train station because a white person is taking the right of way). lilienfeld described microaggressions “as subtle snubs, slights, and insults directed toward minorities, as well as to women and other historically stigmatized groups, that implicitly communicate or engender hostility” (p. 139). this is somewhat different from sue et al.’s (2007) definition: “brief, everyday exchanges that send denigrating messages to people of color because they belong to a racial minority group” (p. 273, emphasis added). microaggressions are by definition caused by socially conditioned racial biases and prejudices. lilienfeld’s revision omitted the purported cause of the transgression, leaving us without a sound theoretical basis for the behavior, and so we cannot properly conceptualize it, much less operationalize it. because the cause of microaggressions is not adequately addressed, lilienfeld could assert that they are “open concepts” with “fuzzy boundaries” (p. 143). he implied that when microaggressions occur, they are mostly random behaviors that just happen because offenders are careless or  williams unaware. he urged us to consider that perhaps “certain microaggression items reflect innocuous statements or actions that do not stem from implicit racial biases” (p. 158). at one time, i might have been inclined to give offenders the benefit of the doubt, had i not read about the experiences of pierce (1970) and the demeaning microaggressions he endured from his colleagues and medical students more than 50 years ago. it is noteworthy that the events he described continue to happen today to black faculty, as we encounter more disrespect, patronizing advice, and challenges to our intellectual authority than our white counterparts (e.g., chambers, 2012). for example, carlotta berry, a black engineering professor, describes her microaggressive experiences in a new york times article, noting, in class, i have my derivations questioned, lectures critiqued, grading regarded as too harsh or unfair and my expectations dismissed as too high or difficult. i once had a student who would review notes with me that he had taken on my lecture, then offer tips on how i could improve. it seems he thought he was doing me a favor (berry, 2014, para. 7). given what we know about behavioral conditioning, we would expect that random behaviors that are punished or unreinforced would eventually become extinct (skinner, 1958, 1963; thorndike, 1933). given that people of color are not positively reinforcing others for behaving this way, and at least sometimes expressing their displeasure about it (punishment; e.g., watkins, labarrie, & appio, 2010), we must wonder why such behaviors have persisted since pierce first described them 5 decades ago. microaggressions persist because the underlying cause of these behaviors (racism) reinforces social inequalities and hierarchies that are desirable to the in-group at the expense of the out-group. according to social-dominance theory (pratto, 1999), group-based inequalities are reinforced through intergroup behaviors, including behavioral asymmetry (which applies to microaggressions) and individual discrimination (sidanius & pratto, 2012). these behaviors are justified, both morally and intellectually, by widely shared legitimizing cultural myths (sidanius, pratto, & devereux, 1992), giving rise to false stereotypes that ultimately serve to reinforce and propagate inequality. substantial evidence from social psychology supports the application of social-dominance theory to many forms of discrimination (foels & pratto, 2015), and microaggressions can be examined and understood within this context. further, although microaggressions are sometimes rebuffed by the target, they must often be accepted  
  microaggressions without challenge because of the power differential between the parties. targets learn that should they reject microaggressive actions, they may experience social harm in the form of anger, defensiveness, and/ or denial from the offender (diangelo, 2011; smith et al., 2007; sue et al., 2007). thus targets are typically forced to endure these insults without recourse, which contributes to the perpetuation of the problem.  “microaggressions” and “everyday racism/discrimination” microaggressions overlap with some similar concepts, so one cannot study microaggressions without considering these other close constructs and the related literature base. the concept of “everyday racism” emerged from the work of essed (1991) and her studies of black women in different societies. it describes how racism is transmitted through routine practices that seem normal to the dominant group, ensuring that the racism goes largely unrecognized and unacknowledged (e.g., phillips & lowery, 2018). everyday racism is defined as unacknowledged racism integrated into common situations through cognitive and behavioral practices that activate and perpetuate underlying power relations via familiar schemas in common situations. one example essed describes is the concept of “majority rule,” which may be invoked to legitimize ignoring minority concerns. she notes how minority preferences are often dismissed as something of interest to only a small number of people. by this logic, it becomes possible that no ethnic minority concerns will ever be addressed, because those concerns affect a relatively smaller number of individuals, and yet we unthinkingly defer to majority opinion in many everyday situations. everyday racism is part of a larger system of structural racism that reinforces the underlying racial hierarchy and has a cumulative negative affect on people of color (e.g., salter et al., 2018). essed also describes many situations in which high-achieving black women were hindered in their attempts at educational progress, such as being given a c grade on an excellent paper or being discouraged from taking an advanced course of study— backlash for attempting to upset the social order. everyday racism was followed by the concept of “everyday discrimination,” which largely overlaps with microaggressions and is well studied in terms of impact and outcomes. this describes subjective common discrimination or unfair treatment as a form of stress that is not randomly distributed in society but is strongly related to race (banks, kohn-wood, & spencer, 2006). everyday discrimination can be defined as racially motivated minor daily hassles and recent experiences that often constitute an assault to one’s character (ayalon  7 & gum, 2011). compared with microaggressions, everyday discrimination tends to have a greater focus on discrete discriminatory experiences, sometimes including blatant acts of prejudice, and tends to not include social exclusion or environmental assaults. this construct also sometimes addresses forms of discrimination other than race, such as gender- or disability-related discrimination. like microaggressions, everyday racism and everyday discrimination include covert prejudice, are commonplace, and are rooted in power differentials between groups. therefore, many if not most microaggressions can be conceptualized as manifestations of everyday racism and discrimination. a robust body of literature using national samples has linked everyday discrimination to negative mental and physical health outcomes across racial and ethnic groups (ayalon & gum, 2011; earnshaw et al., 2016).  why some people have difficulty defining microaggressions lilienfeld finds that acts defined as microaggressions seem contradictory at times (e.g., a professor ignoring a student of color is a microaggression, but focusing too much attention on same that student might also be a microaggression). faced with this conundrum, he appeared to write off the whole concept as too unclear to be useful. the issue is that because microaggressions are context dependent (sue et al., 2007), they cannot be defined simply on the basis of the exact behavior performed or the precise words used in a given sentence. for example, a confederate monument might not be a microaggression in a museum but probably would be on a busy public intersection at a southern college campus (e.g., williams, 2019). telling a black student that she is smart might not be a microaggression during office hours, but it might be if said during class with a look of surprise on the instructor’s face. asking an asian american woman where she is from might not be a microaggression if the desire is to form a genuine connection over similar life experiences, but would be if the goal is to draw stereotypical conclusions on the basis of heritage and/or assumed immigrant status. identifying microaggressions requires some discernment, but this is no different than the degree of nuance required to do good psychotherapy or to have harmonious interactions with one’s spouse. in all cases, the same statement may be welcomed in one circumstance and despised in another (e.g., bouton, 1988). this does not invalidate the concept; it simply requires a more sophisticated lens for understanding it. correspondingly, lilienfeld interpreted the prefix “micro” in microaggression to mean that the transgression is “barely visible or at least challenging to detect”  
  williams  8 (p. 158). but “micro” is simply meant to contrast with “macro”: a macroaggression would be a racist act resulting in tangible harm, such as an assault or losing one’s job (e.g., pierce, 1970). however, the meaning of the prefix “micro” can be misunderstood given that white people in our culture have more difficulty identifying and operationalizing microaggressions. they tend not to notice microaggressions levied against their peers of color (alabi, 2015). microaggressions are invisible to many white people because they are socialized not to see racial inequities (phillips & lowery, 2018; underhill, 2018); they usually do not directly experience microaggressions, and as dominant-group members, accurate identification is not necessary to ensure personal safety and well-being. however, those who are motivated to understand them can be sensitized to identify microaggressions when they are happening to others, even if they are not directed at the observer. for example, a white parent who adopts a hispanic child may start to notice microaggressions for the first time as they are leveled against the child or may even start to receive them from others who may be uncomfortable with a multiethnic family (e.g., caballero, edwards, goodyer, & okitikpi, 2012). racism puts people of color at a social disadvantage that can at times lead to severe consequences (e.g., police violence, loss of employment, eviction), and so out of necessity they may learn (from parents, peers, and/or their own experiences) to identify subtle signs of bias in order to most effectively navigate american life. some have argued that this is critical for well-being (e.g., stevenson, 1994), although it is worth noting that this discernment is an acquired skill and is neither inborn nor an exact science (dovidio, kawakami, & gaertner, 2000, 2002; van ryn et al., 2015). groups of people that have lived in the united states longer, for more generations, and/or with darker skin will tend to have more experience with racial bias than new immigrants or those who appear white (e.g., keith, nguyen, taylor, chatters, & mouzon, 2017), and some ethnic groups engage in more ethnic/racial socialization with their children than others do (hughes et al., 2006). more ethnic/racial socialization is correlated both with better identification of subtle racism and improved mental health (brown & tylka, 2010; thai, lyons, lee, & iwasaki, 2017).  microaggressions and pathological stereotypes as noted, microaggressions are not simply cultural missteps or racial faux pas, but function as a form of oppression designed to reinforce the traditional power differential between groups (e.g., sue et al., 2007),  whether or not this was the conscious intention of the offender. consequently, there is an underlying connection between the message embedded in the microaggression and its relationship to pathological stereotypes about the target that reify existing power structures. pathological stereotypes can be defined as false notions about people in oppressed groups that serve to explain and justify disparities (also known as legitimizing myths); social dominance determines the stereotyped content rather than the actual characteristics of group members (williams, gooden, & davis, 2012). therefore, one can predict that microaggressions will reinforce unfair pathological stereotypes about people of color (sue et al., 2007). these cultural ideologies are not restricted to white actors: any person can commit a microaggression. consider that pathological stereotypes are pervasive and arguably part of our social fabric. people of color are subjected to the same pathological stereotypes about various ethnic and racial groups as everyone else, and so they may hold negative views about other ethnic groups or even their own group if they are in an early stage of ethnic-identity development (sue & sue, 2016). although people with a psychological orientation toward group equality may endorse beliefs that attenuate social hierarchies, ethnicidentity development may moderate the extent to which even people of color subscribe to pathological stereotypes (hipolito-delgado, 2016).  intentionality lilienfeld argued that because such actions are not always intentional, and intention is required for aggression, the term microaggression is inaccurate and should be changed. microaggressions are part of an ideological social system that confers benefits to the dominant group at the expense of the subordinate group (bonillasilva, 2004; essed, 1991; phillips & lowery, 2018). as such, they are in fact intentional, although the intentionality may represent individual bias in the offender (conscious or unconscious) or may be the manifestation of the aggressive goals of the dominant group, taught to unwitting actors through observational learning or other social mechanisms. in either case, the social context is required to understand individual behaviors. for example, during the era of legalized segregation, it was common to observe caste behavior, such as black people quietly deferring to whites in public spaces, giving them the right of way on sidewalks and streets. whites grew to expect this behavior, even if not consciously acknowledged, which reinforced feelings of superiority (davis, 1989). it would be a mistake to argue that there was no intention to oppress the black populace embedded in  
  microaggressions these subtle behaviors. blacks deferred because they knew that failure to do so could result in harm. most whites would have denied doing anything harmful, aggressive, or intentional as they went about their daily business because it was simply what they had learned and what they had always done. likewise, even people who may consider themselves unbiased learn that microaggressive statements and actions are an appropriate and harmless way of interacting with people of color, even if not taught this explicitly. further, this behavior is maintained because targets have learned that should they object, they risk suffering some degree of harm, such as invalidation (e.g., sue et al., 2007), anger and defensiveness (e.g., diangelo, 2011), being called neurotic (e.g., lilienfeld, 2017b), or having one’s character attacked (e.g., campbell & manning, 2014). this point is made doubly salient when a person of color is microaggressed against in the form of an unjustified encounter with law enforcement, such as requests for identification, being searched, or being asked to leave a public place, given that targets are powerless to object (e.g., smith et al., 2007). sue et al. (2007) created three classifications of racial microaggressions: microassaults, microinsults, and microinvalidations. the main difference among these terms is that microassults are considered intentional behaviors, whereas microinsults and microinvalidations are not intended to be offensive. in terms of the latter two, microinsults denigrate the target for being a person of color, and microinvalidations are hurtful because they invalidate the thoughts, feelings, or experiences of the target as a person of color. it has been argued that microassaults do not capture the true definition of microaggressions because they are intentionally meant to cause harm whereas the others are not (lilienfeld, 2017b). i do not find these categories especially useful because all microaggressions are meant to cause harm, either by the individual or society at large, and this is what makes them all forms of aggression. further, it often cannot be known how much of a given microaggression was intentional (the offender wanted to harm the target purely because the individual was a person of color) versus quasi-intentional (the offender came up with a reason other than race to aggress, although it was actually motivated by racial hostility) versus “good intentions” (the offender meant to be helpful but was actually being patronizing). it has been hypothesized that most microaggressions fall in in the “good intentions” category, but this is impossible to know because nearly all offenders profess good intentions. even those who espouse overtly racist views often simultaneously deny negative feelings or bad intentions toward others. consider that while supporting school segregation, alabama governor george  9 wallace denied hostility toward people of color, justifying legally codified racism because “white people felt it was the best interest of both races; it was not an antagonism toward black people, and that’s what some people can’t understand” (crossely, 1986). these are not so different from the claims of white supremacist and hate groups today. white nationalist leader david duke, a former ku klux klan grand wizard, asserts that he does not hate black people; rather he represents “the very opposite of racism,” and wants only to defend his white heritage (duke, 2011; “rights for white people,” 2017). many people of color report that they endure racial slurs from white friends or colleagues who believe they are using these terms affectionately (e.g., harwood, huntt, mendenhall, & lewis, 2012). so subjective inferences about harmful intent are not particularly useful, as even those committing overt racist behaviors may tether actions to purported good intentions. in all cases, whether intentional, quasi-intentional, or unintended, microaggressions reinforce social hierarchies and are racially offensive, explained away as valid, and frustrating to victims. therefore, microaggressions need not be defined in terms of conscious intentionality.  are microaggressions truly aggressive? in social psychology, aggression is most commonly defined as a behavior intended to harm another person who does not wish to be harmed, and violence is defined as aggression that has extreme physical harm as its goal (allen & anderson, 2017; bushman & huesmann, 2010). because microaggressions are believed to be often unintentional (or even well intentioned) and harms are often small, under this definition they are not automatically considered a form of violence or aggression. however, there are many disciplines that have a broader conceptualization of these terms and consider all forms of racism to be violence and aggression. in the journal aggression & violent behavior, lee (2015) proposes a definition of violence based on the one provided by the world health organization: the intentional reduction of life or thriving of life in human beings by human beings through physical, structural, or other means of force, that either results in or has a high likelihood of resulting in depravation, maldevelopment, psychological harm, injury, death, or extinction of the species. (lee, 2015, p. 202) racism can fit this definition because it encompasses multifaceted behaviors by the dominant group that are forced on subordinate racial groups, leading to many  
  10 well-documented harms. microaggressions also fit this definition because they are a form of racism that leads to negative mental- and physical-health outcomes (described further in the sections “microaggressions are caused (at least in part) by racial biases” and “microaggressions exert an adverse impact on mental health”). so, although this may not fit the most common socialpsychology definitions, the term would apply within many other academic disciplines, including peace and conflict studies, education, feminism, global health, racial/ethnic studies, and sociology. it is not that one discipline has a better definition or is more correct; rather, one discipline has a very specific definition and others are using such terms more broadly. because the study of microaggressions arose out of african american mental health, it makes sense that the terminology is more closely aligned with some of these other disciplines. the foundations of the aggression versus microaggression literatures are qualitatively different and to equate them because of pierce’s choice of terminology may be unwarranted. the term microaggression has been used to describe subtle racism for over 5 decades within multicultural psychology and is perhaps equally legitimate as the current definition of aggression within social psychology. that being said, the meaning of the term microaggression may be debated or shift over time; if so, that should be because those invested in continuing pierce’s work (i.e., people of color and diversity researchers) have made that decision on the basis of their research and the utility of the construct (e.g., minikel-lacocque, 2013; wong, derthick, david, saw, & okazaki, 2014). such important decisions are not to be made by detractors who have invested little in the work and may not fully understand the problem or its impact. pierce, who invented the term, intended microaggressions to be an umbrella for all types of covert racism. microaggressions are transactional; as such, both sides of the transaction are important and should be fully appreciated. the language should not be changed simply because offenders object to being considered aggressors without considering the perspectives of the targets as well. freeman and stewart (2019) argue that the term microaggression is fair and balanced because the term “micro” reflects the perspective of the offender (small offense) and “aggression” reflects the perspective of the victim (aggressive act). on the other side of the coin, some people object to the term “microaggression” because they feel the prefix “micro” minimizes the experience of harm. finally, one must consider the aggression that often results when a target attempts to reject a microaggression, making them afraid to confront offenders. fear of reprisal may not only perpetuate microaggressions but  williams also lead to coerced behavior on the part of targets. for example, imagine a situation in which several students are attending office hours for a difficult computer science class. after one of the students shares what a hard time she is having, the professor points to an asian american student who is waiting for help and suggests they work together, saying, “i bet kevin can help you out.” suppose kevin is also really struggling in the class, feels embarrassed to be doing poorly, and now feels tremendous stress and anxiety having been volunteered as a tutor. imagine kevin says to the professor that he is not comfortable helping the other student and also feels a bit stereotyped by the whole thing. the professor could recognize the misstep and apologize, or he could get angry, defensive, and even covertly retaliate against the student. imagine kevin has experienced angry retaliation in the past for pointing out a microaggression, so he decides it is just too risky and opts to help the other student rather than risk the possible harms of sharing how this affected him. he might even neglect other academic needs in order to meet the professor’s stereotyped expectations. so, it is not simply that microaggressions are unwanted and offensive, it is also that targets are not truly free to reject them (e.g., minikel-lacocque, 2013). lilienfeld called for more research to determine whether the commission of microaggressions is correlated to aggressive tendencies in offenders. if we accept that racism is a form of violence, then more research is not necessary to classify microaggressions as a form of aggression. however, to determine whether microaggressions are correlated to conventional psychological conceptualizations of aggression, lilienfeld suggested that researchers administer measures of aggression along with measures of microaggression likelihood to potential offenders. given that most people seem to recognize that microaggressive behaviors are unacceptable (michaels, gallagher, crawford, kanter, & williams, 2018; kanter et al., 2017), it would make sense that those who are more temperamentally aggressive would be less likely to suppress urges to microaggress. mekawi and todd (2018) examined this issue in their study of the acceptability of microaggressions (microinsults and microinvalidations, specifically), using the 3-item subscales of the short version of the buss perry aggression questionnaire (bpaq; buss & perry, 1992). they did not find strong or consistent correlations between various types of microaggressions and verbal aggression or hostility. there were, however, some methodological weaknesses, such as mixing white students and students of color in the analyses. further, it has been noted that tendencies to be aggressive in one context (against out-group members) do not correlate to aggression in other contexts (against in-group members), and in some  
  microaggressions cases, love for the in-group actually leads to hate for the out-group (brewer, 1999). so measures such as the bpaq may be inadequate for elucidating this link unless they differentiate the targets of the aggressive acts. clearly, this is an interesting question that requires more focused study.  microaggressions are interpreted negatively by people of color when is an offense offensive? in terms of whether microaggressions are interpreted negatively by most people of color, lilienfeld noted that it is “implausible that this is the case for all microaggressions, as this assertion flies in the face of large bodies of research in social cognition and cognitivebehavioral therapy” (p. 159). this is a straw-man argument: no serious microaggressions researcher would argue that all microaggressions are offensive to all people of color at all times. recall that microaggressions are context dependent, so even if a behavior looks topographically the same in two different situations, other features of the interaction may be needed to give it meaning and determine whether it is in fact a microaggression. further, to the extent that some people of color may accept pathological stereotypes and vary in ethnic-identity development, not all will be able to identify all microaggressions when they occur. finally, because of the stress of confronting offenders directly about microaggressions, targets may make a conscious but effortful choice not to be offended or engage in denial as a coping strategy (nadal, 2018). and there are certainly some individuals who simply may not be not offended by anything. more critically, behavior does not have to be offensive to everyone or even most people to be problematic. consider that if someone threw a party for 10 people, and 1 partygoer was insulted by what the host said and went home angry, it might be plausible that the person was overly sensitive and there was really no wrongdoing. but if 2 people went home offended by the host’s comment, we might start to wonder, and if 3 people went home offended, most would consider that party a bust. if half the people became so offended that they started texting their friends to complain about it, then there is a major problem and we are still talking about only half the guests. so, it is not necessary for everyone to leave the party offended to conclude that something offensive was said by the host. likewise, if 30% of people of color are offended by a behavior, but 70% are not, then it is reasonable to assume the behavior is problematic. the fact that the majority are unbothered by the behavior does not mean that everything is  11 fine. rather, the offense of the 30% is sufficient to conclude that the behavior should be avoided for the sake of maintaining a harmonious, functional environment. (this, of course, assumes that there is no important need to commit the offensive behavior.) for example, imagine that the president at a southern university arranged a dinner event to welcome african american students, and cotton stalks were centerpiece decorations on the tables. and then suppose that many—but not all—of the guests were offended, as evidenced by several students posting pictures of the centerpieces on social media and expressing their shock and displeasure to each other. once this came to the attention of the president, it would be appropriate to solicit student concerns and consider whether a microaggression had in fact occurred. one might argue that nothing is inherently wrong with cotton, because we are all wearing it, but if several guests find the unusual decorations offensive because they are painful reminders of the african american history of slave-powered cotton plantations, then the decision to decorate the tables in such a manner is in fact problematic (bever, 2017). correspondingly, we do not need agreement by all or even most targets to classify a microaggression as a problem; we simply need to demonstrate that a sizeable percentage find it racially objectionable.  the cultural cognitions and actions survey (ccas) in our own study of microaggressions, my research team developed several racially charged scenarios along with a series of microaggressive behaviors that people might commit in these situations (kanter et al., 2017). the scenarios were created on the basis of reports by black students who participated in focus groups about their experiences on campus at three different predominantly white institutions. participants were given the definition of microaggressions from sue et al. (2007) and asked to discuss incidents in their lives consistent with that definition, but they were not recruited on the basis of prior knowledge of the microaggression construct. their experiences comprised a range of statements, actions, omissions, and environmental assaults, and these were not unlike experiences reported by students of color who participated in similar focus groups at other institutions (e.g., d. a. clark et al., 2014; harwood et al., 2012). this led to the development of six scenarios involving potential black– white individual or group interactions. for example, scenario 1 was: “a friend of yours has wanted you to meet a friend, saying they think you will like the person. you meet this person one-on-one. he turns out to  
  williams  12 be a tall, fit-looking black man who says he is a law student. he seems very smart and he has a very sophisticated vocabulary. you like his personality.” after each scenario, white participants were provided a series of potential actions or statements one might make in that situation, including those that would be considered microaggressive (e.g., “did you get into school through a minority scholarship?”) and not microaggressive (e.g., invite the black student to a future social engagement, like a lecture, group lunch, or party). respondents were asked to rate how likely they would be to do or say each response (or something similar) using a 5-point scale. to explore the degree to which the items would be experienced as microaggressive, we gave black student observers the same scenarios and items and asked them to rate how racist they would consider each item on a similar scale (for more details on this study and the methodology, see kanter et al., 2017). i revisited the data to determine how many items met the 30% cut-off alluded to above in my example of the offensive party. (nonetheless, i should be clear that this cutoff is arbitrary and illustrative, so i am not conceding that an item that 25% find problematic is not a microaggression.) of the 51 items remaining after i removed the 15 items that were not intended to be microaggressive, only 2 items were deemed “not at all racist” by more than 70% of african american respondents (and there were no items for which all white students agreed they would not do/say the microaggression). this means that 96.1% of items that we thought black people would deem to be microaggressions were in fact considered potentially or definitely racially objectionable by 30% or more. this provides evidence that (a) it is not particularly difficult to identify microaggressions by consensus and (b) many or most people of color (and white people) do interpret them negatively. the issue of consensus surrounding what constitutes a microaggression is discussed further in the “microaggressions can be validly assessed using subjective reports” section.  microaggressions are caused (at least in part) by racial biases the role of racism lilienfeld (2017b) argued that there is no evidence that the commission of microaggressions is related to racial prejudice. admittedly, those of us who study microaggressions have not felt a need to prove this because the connection between racism and microaggressions appears evident through our research and  lived experiences. but it does make sense that this connection might not be obvious to those who have not been the target of racism. in our initial efforts to develop our measure of microaggression likelihood, we collected data from white students about racial prejudice using several validated measures, which included color-blind, symbolic, and modern racist attitudes (kanter et al., 2017). we also collected data on affinity toward out-group members (allophilia), which we expected to be negatively correlated to racism. finally, we appreciated that some measures of racism may be confounded with political views, so we administered a “racial-feelings thermometer,” a more pure measure of racial bias, in which white participants were asked to indicate their attitudes toward black people on a scale from 0 (extremely unfavorable) to 100 (extremely favorable). after controlling for social desirability, the likelihood of students engaging in microaggressions across several common contexts was robustly correlated with all five of our measures of racial prejudice (rs .36–.45, all ps .001; kanter et al., 2017). specifically, white students who reported that they were more likely to commit microaggressions were more likely to endorse color-blind, symbolic, and modern racist attitudes, and they held significantly less favorable feelings and attitudes toward black people. this was especially true for white students who thought that minorities are too sensitive about matters related to racial prejudice, which was the item most strongly correlated to the racial feeling thermometer, our most explicit measure of racial bias (r –.41, p .001). these data were from a sample of students in kentucky, but we have since collected data from students in seattle and new england (for similar findings, see also mekawi & todd, 2018). this study provides important empirical support for something that diversity researchers knew all along— microaggressive acts are rooted in racist beliefs and underlying feelings of hostility that cannot be dismissed as simply subjective perceptions of the target (kanter et al., 2017). however, even if there were no correlation between racism and microaggressions, the subjective perceptions of targets would nonetheless be crucial; if targets agree on what constitutes a microaggression, the construct remains valid and important.  the role of interracial anxiety: avoidant behavior and racism avoidance, exclusion, and ostracization are all recognized in psychology as forms of aggression (ren, wesselmann, & williams, 2018), and many microaggressions fall into this category. interracial anxieties on the part of offenders  
  microaggressions may play a role in situations in which would-be offenders do not want to appear prejudiced and are motivated by a desire to avoid wrongdoing (i.e., aversive racism; gaertner & dovidio, 2005). as a result, when in the company of people of color, they may stumble over their words, say something they did not intend, say nothing, or leave the situation entirely. although wanting to avoid wrongdoing could be considered well-intentioned behavior, one must also consider what motivates the offender’s discomfort and the consequences to the person of color in that interaction. one mechanism for this is that offenders have had little contact with people of color because they (a) avoid them as a result of pathological stereotypes (e.g., assumed dangerousness), (b) have had few opportunities at cross-racial interactions (e.g., because of segregated social experiences), and/or (c) think a racial mistake will result in harsh response (e.g., from stereotypes about people from certain groups being hostile). consequently, a person communicates this discomfort with body language (e.g., physical distancing, looking away, blinking, nervous laughter). the offender’s comfort takes precedence over exhibiting courteous behavior, and instead of making the person of color feel welcome, the offender causes the target to feel out of place and unwanted or even feared. the offender does not attempt a genuine social connection but instead endures the presence of the person of color while looking for opportunities to escape (plant & butz, 2006). as previously noted, many people of color are keen observers of subtle signs of racism and will realize immediately that their presence is unwanted (dovidio et al., 2002). this qualifies as microaggressive behavior because it reinforces traditional rules that maintain separation between people of different races, and it reminds the person of color that social interactions outside of one’s group are off limits; further, it may also be driven by negative assumptions about the person of color based on pathological stereotypes. we found that this sort of avoidance was significantly correlated with five separate measures of racism (parigoris, kuczynski, carey, corey, & williams, 2018).  microaggressions can be validly assessed using subjective reports self-report measures by targets sue et al.’s (2007) nine original categories of microaggressions were based on the subjective reports of people of color, but in the intervening decade, classifications arising from statistical analyses have emerged as well as sound measures for quantifying experiences. for example, torres-harding, andrade, and romero diaz  13 (2012) developed the racial microaggressions scale (rmas) to quantify microaggression frequency, which was found to have good psychometric properties. exploratory and confirmatory factor analyses were used to assess dimensionality, and six factors (categories of microaggressions) were identified and included in the total scale. these partially map onto sue et al.’s (2007) taxonomy and include items about (a) feeling invisible because of race, (b) being subject to assumptions of criminality by others, (c) being sexually objectified, (d) being low-achieving or part of an undesirable culture, (e) being a foreigner or not belonging, and (f) experiencing environmental omissions. another important measure of microaggression frequency is the racial and ethnic microaggressions scale (rems; nadal, 2011), which was validated with a large sample of african americans, hispanic americans, asian americans, and multiracial participants. it has a sixfactor structure that includes (a) assumptions of inferiority, (b) treatment as second-class citizens and assumptions of criminality, (c) microinvalidations, (d) exoticization or assumptions of similarity, (e) environmental microaggressions, and (f) workplace and school microaggressions. this structure was confirmed using exploratory and confirmatory factor analyses, and the measure was found to have good psychometric properties. other scholars have done similar work, including the development of measures that are specific to particular ethnic groups. these measures have been reviewed elsewhere (see wong et al., 2014). collectively, the examples provided illustrate sound psychometric research applied to the microaggressions concept, allowing its study just like any other psychological construct. contrary to lilienfeld’s concerns about how microaggressions can be validly assessed using selfreport measures, they can be assessed and are assessed in this manner all the time.  addressing high reliability/cronbach’s αs lilienfeld (2017b) noted that “microaggressions are posited to comprise an extremely diverse class of slights, insults, and snubs of various sorts emanating from a diverse array of individuals. thus, it is not at all clear why microaggression measures should be internally consistent” (p. 156). in other words, measures of microaggression frequency (such as those listed above) should not have high internal consistency because these varied behaviors should be inflicted on targets randomly, and therefore items should not be strongly correlated. lilienfeld conjectured that these random slights subsequently become the subject of hyperfocus by targets, who then mislabel them as microaggressions. lilienfeld hypothesized that measures of microaggression  
  williams  14 frequency tend to have high cronbach’s αs because they are simply a manifestation of negative personality attributes of high scorers. lilienfeld’s notions about negative personality traits will be deconstructed in the next section. but the important thing to note here is that, again, these acts are not random, and their causes (e.g., pathological stereotypes) provide one important explanation for why certain individuals, but not others, would consistently have the misfortune of being recipients of a variety of microaggressions from multiple individuals across multiple settings. here are just a few reasons why some people of color might experience more microaggressions than others: race—some racialized groups experience more racism than others (chou, asnaani, & hofmann, 2012); regional differences—some parts of the country are more racist than others (chae et al., 2015); personal characteristics—people with darker skin experience more discrimination (keith et al., 2017); language fluency—people with limited english proficiency experience more discrimination, and some accents are more devalued than others (rivera, westolatunji, conwill, garrett, & phan, 2008); community differences—living, working, and/or attending school in primarily white communities as opposed to same-ethnic-group communities will result in more daily experiences of racism (e.g., winkle-wagner & mccoy, 2016); interpersonal aptitude—people with more cognitive complexity are better at discerning subtle racism (reid & foels, 2010); training—people with better racial socialization may be better at identifying microaggressions (brown & tylka, 2010); and avoidance—those who have very bad experiences of racism may avoid interracial interactions and thereby experience fewer microaggressions (e.g., davis, 1989; dovidio et al., 2002; plant & butz, 2006). so it is clear from these examples that microaggressions are not randomly distributed, and some people will experience more than others for reasons unrelated to pathological personality characteristics. further, these characteristics are not uncorrelated, and the intersectionality of identities may make some persons more stigmatized than others (e.g., a low-income black man vs. an affluent asian woman; ching et al., 2018). thus, individual differences are an important area of future study to determine what factors predispose some more  than others to microaggressions. finally, in reviewing varied measures of aggression, carlson, marcusnewhall, and miller (1989) demonstrated high levels of convergence across a wide range of laboratory aggression measures. microaggressions are correlated because they share common features, such as communicating hostility and being unwanted.  self-report measures by potential offenders lilienfeld noted that all microaggressions research has been based on the subjective experiences of the targets rather than the offenders. i would point out that we understand many psychological concepts exclusively in terms of subjective states, and so that alone does not invalidate the concept (elasy & gaddy, 1998). several popular and well-validated measures of psychological constructs have been developed on the basis of self-report alone. that being said, even if we did study the microaggressions construct from the point of view of both the offender and the target, there is no reason that they must agree to validate the concept. nonetheless, in response to this gap in the literature, we decided to study both potential offenders and targets to determine how we could reliably measure a would-be offender’s propensity to microaggress. using methodology described in the previous section, we administered an expanded version of the ccas (including 8 scenarios and 88 microaggressions) to 64 students at the university of connecticut (michaels et al., 2018). the scenarios presented were as follows: 1. having a conversation with a black law student at a social get-together 2. meeting a young black female with african-style dress and braided hair 3. a discussion about white privilege at a diversity training 4. a study session talking about various current events and political issues 5. a lost black man asking for directions in your neighborhood 6. doing karaoke with friends and a song with the “n-word” comes up 7. watching the news about police brutality with mixed-race friends at a sports bar 8. talking to a racially ambiguous lab mate about a science project (michaels et al., 2018, p. 316) items were included if diversity experts agreed they were at least slightly racist. there was a very strong  
  microaggressions correlation between the black student scores on what they considered racist and whether the white student would say or do the microaggression (r .93, p .001); white students denied that they would commit most microaggressions. that tells us there is some degree of agreement between black and white students as to what microaggressions are and that they generally recognize one when they see it. the items had good reliability (cronbach’s αs were .97 for black students, .95 for white students, and .95 for diversity experts), indicating that the items were highly related even though they span a wide range of different types of microaggressions. this is what one would expect when the same underlying construct is present across items (tavakol & dennick, 2011). finally, we asked white students how likely they would be to think the microaggression, regardless of whether they would actually say or do it. there was a somewhat weaker but still robust correlation between the white students’ thoughts and the black students’ ratings of how racist the microaggressions were (r .64, p .001, α .93), and white students were significantly less likely to commit the microaggression than think it, indicating that white students may be purposefully suppressing microaggressive tendencies (michaels et al., 2018). listed in table 2 are examples of the various types of microaggressions that we studied. these are classified on the basis of groupings from the literature and the research from my lab. also included are the percentage of black students who found the statement objectionable in the context of the scenarios listed above (rated as “very racist” or “slightly racist”), and the percentage of white students who reported that they were “unlikely” or “very unlikely” to say or do each item. (environmental microaggressions are not included because we did not include these in our questions to participants.) it is clear that, despite some variability, there is agreement on most items that these microaggressions are generally unacceptable.  microaggressions exert an adverse impact on mental health microaggressions are harmful although questioned by lilienfeld, microaggressions and the largely overlapping construct termed everyday racial discrimination are in fact associated with many negative mental-health consequences, including stress (torres, driscoll, & burrow, 2010), anxiety (banks et al., 2006; blume et al., 2012), depression (huynh, 2012; nadal, griffin, wong, hamit, & rasmus, 2014), symptoms of posttraumatic stress disorder (williams, printz, & delapp, 2018), low self-esteem (nadal, wong, griffin,  15 davidoff, & sriken, 2014; thai et al., 2017), obsessivecompulsive disorder (williams et al., 2017), substance use (t. t. clark, salas-wright, vaughn, & whitfield, 2015; gerrard et al., 2012), alcohol abuse (blume, lovato, thyken, & denny, 2012), severe psychological distress (banks et al., 2006; hurd, varner, caldwell, & zimmerman, 2014), reduced self-efficacy (forrest-bank & jenson, 2015), and suicide (hollingsworth et al., 2017; o’keefe, wingate, cole, hollingsworth, & tucker, 2015). i should note that i cite only a small sample of the vast literature linking racism and psychopathology to emphasize those studies focused on microaggressions. we would be derelict in our duties as helping professionals to ignore the mounting evidence that microaggressions are harmful and even deadly to our clients of color. how do microaggressions cause harm? experiencing a microaggression signals a dangerous environment, resulting in corresponding psychological and physiological stress responses (e.g., r. clark et al., 1999). reactions following experiences of microaggressions may include confusion, anger, anxiety, helplessness, hopelessness, frustration, paranoia, and fear. in addition to stress, this may lead to dysfunctional coping strategies, such as denial, withdrawal, and substance abuse. because microaggressions are so common, they can be conceptualized as a form of chronic stress that may also result in physical problems, such as hypertension and impaired immune response (e.g., berger & sarnyai, 2015; r. clark et al., 1999). further, microaggressions that interrogate targets about where they are from constitutes a means of “othering”—reminders that people of color are not considered real americans or a meaningful part of our social tapestry. it communicates lack of belonging and exclusion, which can lead to feeling alienated, which is psychologically damaging, especially for children. microaggressions cause harm in other ways, too, in that they contribute to barriers to treatment (e.g., walls et al., 2015). the commission of microaggressions by clinicians undermines trust among patients of color, who may in turn avoid care (freeman & stewart, 2019). as a result, people of color may not visit a doctor or therapist until problems are severe, and if they do initiate treatment, they may drop out early because of microaggressions. a study by owen, tao, imel, wampold, and rodolfa (2014) found that among people of color, satisfaction with counseling was directly correlated to their experiences of microaggressions from their therapists. as a result, a person of color with a treatable condition may opt out of mental-health care, be needlessly disabled for years, end up in an emergency room, or be imprisoned or shot when mental dysregulation is misinterpreted as criminality. to this point, national statistics indicate that people from the  
  williams  16  table 2. examples of black and white student assessments of microaggressions from the cultural cognitions and actions survey (ccas) category of microaggression 1. a  ssumption that someone is not a true citizen (sue et al., 2007)  ccas scenario  black students rating as racist  white students unlikely to say/do  8 2 8 8 2  “how long has your family been in the united states?” “you speak english really well.” “what is your nationality?” “are you black or white?” “what are you?” “are you from africa?”  72% 94% 33%  86% 96% 70%  76% 83% 50%  95% 94% 84%  1 8  “you are a credit to your race.” “how did you get so good at science?”  95% 53%  94% 54%  4 4  “all lives matter, not just black lives.” “i don’t see race . . . i see people for who they really are.” “statistics show that minorities commit most crimes.” checking that one’s wallet/purse is secure [on seeing a lost black man in one’s neighborhood]. “i have other black friends.” “just because i don’t believe in political correctness doesn’t mean i’m a racist.” “everyone can succeed in this society, if they work hard enough.” “white privilege doesn’t really exist.” “discrimination against white people has gotten as bad as discrimination against blacks.” “people of color are given extra unfair benefits because of their race.” “black kids shouldn’t dress that way.” “the problem is that too many black parents don’t take responsibility for their kids.” continue singing along, including the n-word. “the police have a tough job. it is not their fault if they occasionally make a mistake.” “why do black women wear their hair in these sorts of styles?” “why do black people listen to rap music where they always say the n-word?”  88% 52%  62% 50%  73%  84%  90%  55%  80% 69%  95% 74%  65%  51%  93% 85%  88% 87%  88%  85%  98% 98%  93% 91%  75%  87%  78%  70%  63%  93%  66%  84%  76%  92%  83%  89%  2  2. forcing a racial category and sameness (huynh, 2012; nadal, vigilia escobar, prado, david, & haynes, 2012) 3. a  ssumptions about intelligence, competence, or status (sue et al., 2007) 4. c  olorblindness or invalidating racial or ethnic identity (sue et al., 2007) 5. c  riminality or dangerousness (sue et al., 2007)  5  6. d  enial of individual racism (sue et al., 2007)  1 3  7. m  yth of meritocracy, or race is irrelevant for success (sue et al., 2007) 8. r  everse racism hostility (clark et al., 2014; lewis, chesler, & forman, 2000)  4  4  3 3  4 9. p  athologizing minority culture or appearance (sue et al., 2007)  7 7  10. s econd-class citizen treatment, or being ignored and invisible (sue et al., 2007)  6  11. t  okenism or representing a whole group (poolokasingham, spanierman, kleiman, & houshmand, 2014) 12. a  ttempting to connect using stereotypes (minikellacocque, 2013; nadal et al., 2012)  4  2 6 4 6  description of microaggression  telling a racial joke to diffuse the tension. continue singing but explain that there is a difference between “nigga” and the “n-word.”  (continued)  
  microaggressions  17  table 2. (continued) category of microaggression 13. e  xoticization and eroticization (torresharding et al., 2012; nadal, 2011) 14. a  voidance and distancing (parigoris et al., 2018;  poolokasingham et al., 2014)  ccas scenario  description of microaggression  black students rating as racist  white students unlikely to say/do  2 8  “black women are so exotic.” “do you date white guys or other minorities?”  71% 83%  87% 96%  3  “we shouldn’t talk about race. it makes people uncomfortable.” crossing the street to avoid [a black man asking for directions in one’s neighborhood].  73%  88%  81%  70%  5  notes: ccas scenarios are as follows: (1) having a conversation with a black law student at a social get-together, (2) meeting a young black female with african-style dress and braided hair, (3) a discussion about white privilege at a diversity training, (4) a study session talking about various current events and political issues, (5) a lost black man asking for directions in your neighborhood, (6) doing karaoke with friends and a song with the “n-word” comes up, (7) watching the news about police brutality with mixed-race friends at a sports bar, (8) talking to a racially ambiguous lab mate about a science project. (michaels et al., 2018, p. 316)  most stigmatized ethnic groups are overrepresented among those disabled from mental-health conditions, admitted as inpatients, and serving as inmates (alexander, 2012; jackson et al., 2004; snowden, hastings, & alvidrez, 2009).  negative emotionality: the missing link? lilienfeld dismissed these findings, instead asserting that microaggression researchers have ignored the role of negative emotionality/affectivity, a marker of neuroticism. people with higher negative emotionality experience greater psychological distress and are more likely to feel victimized from interpersonal slights; he advanced negative emotionality as a potential explanation for the relationship between microaggressions and psychopathology. it should be no surprise that negative emotionality is correlated to reports of both racial mistreatment and psychopathology because negative emotionality is correlated to just about all mental-health symptoms, so that in and of itself tells us very little (watson & pennbaker, 1989). further, even if negative affectivity played a role, it could be that the directionality is in the opposite direction: years of experiencing unchecked microaggressions could result in trait-like negative emotionality and neuroticism. lilienfeld instead employed a cultural-deficit approach to explain the relationship without sufficient evidence to support this approach, coupled with an incomplete examination of alternative explanations. for example, there was no discussion of the possibility that a unique set of talents, abilities, aptitudes, and training in some people may make them better detectors of microaggressions. for example, a study conducted by  reid and foels (2010) with a multiethnic sample demonstrated that the ability to identify subtle racism is a sign of greater attributional complexity, which means use of a more sophisticated reasoning process about cause, effect, people, and situations. attributional complexity is associated with intelligence, so it could be that higher intelligence predicts greater recognition of microaggressions. in examining the literature, one finds very little research on ethnic differences in personality traits, but what little exists does not support lilienfeld’s notions about negative emotionality. for example, using the differential emotions scale (des) with older adults, consedine, magai, cohen, and gillespie (2002) found that whites had significantly greater negative emotionality than blacks. further, our own research found the same relationship between negative affectivity using the positive and negative affectivity scale (panas; watson, clark, & tellegen, 1988): white students showed significantly greater trait negative affectivity than did black students (williams, kanter, & ching, 2018). we then examined the relationships between frequency of experiencing microaggressions using the rmas and measures of anxiety (beck anxiety inventory; beck, epstein, brown, & steer, 1988), stress (general ethnic discrimination scale; landrine, klonoff, corral, fernandez, & roesch, 2006), and trauma (trauma symptoms of discrimination scale; williams, printz, & delapp, 2018). three hierarchical linear regressions were modeled to predict these symptoms, controlling for the panas negative affectivity subscale (panasneg) “in general” (as a trait). for each regression, predictors were entered hierarchically: the panas-neg was entered in block 1, gender was added in block 2,  
  williams  18 and the rmas was added in block 3. we found that trait negative affectivity in african americans was related to some perceptions of the experience of discrimination but not all. for example, for the beck anxiety inventory, the panas-neg was a significant predictor at stage 1, f(1, 59) 36.12, p .001, accounting for 36.4% of the variance; gender was not a significant predictor at stage 2, and the rmas was a significant predictor at stage 3, accounting for an additional 4.2% of the variance. for the trauma symptoms of discrimination scale, the panas-neg was a significant predictor at stage 1, accounting for 23.8% of the variance; gender was not a significant predictor at stage 2, and the rmas was a significant predictor at stage 3, accounting for an additional 24.4% of the variance. finally, for the general ethnic discrimination scale-stress, neither the panasneg nor gender was a significant predictor at stages 1 or 2, collectively accounting for 3% of the variance, but the rmas was a significant predictor at stage 3, accounting for an additional 57.2% of the variance. in summary, a strong and significant relationship between racial mistreatment and symptoms of psychopathology was found that cannot be explained simply by negative emotionality. further, the relationship to negative affectivity was weakest when examining symptoms specifically connected to experiences of discrimination (for further details, see williams, kanter, & ching, 2018). prospective studies have provided convergent findings. for example, a research study by ong et al. (2013) followed asian american participants over a 2-week period and found that the experience of microaggressions predicted somatic symptoms and state negative affect, even after controlling for trait neuroticism. asians americans are typically considered “model minorities,” yet they encountered microaggressions frequently; 78% experienced at least one during the 2-week study period.  incremental validity although lilienfeld conceded that major discrimination may be harmful, he rejected the idea that microaggressions may be comparably harmful. he invoked the concept of incremental validity in an attempt to explain research findings connecting microaggressions to harm. lilienfeld hypothesized that most of the harm attached to microaggressions is actually caused by concomitant major discrimination experienced by the victim. he grounded his argument in practical considerations— why waste resources combatting microaggressions if the real problem is blatant racism? several diversity researchers have theorized that microaggressions actually may be more harmful than overt discrimination (e.g., solorzano, ceja, & yosso,  2000), and everyday discrimination has been shown to be more detrimental than experiences of major discrimination (e.g., ayalon & gum, 2011). i recently examined this issue with a sample of monoracial and biracial african americans (n 123), focusing on symptoms of trauma (williams, printz, & delapp, 2018). participants completed several questionnaires, including a measure of anxious trauma-related symptoms of discrimination, several assessments of racial discrimination, and a broad range of psychopathology measures. linear regression was used to predict the trauma symptoms of discrimination from frequency of different types of discrimination. i found that all forms of discrimination individually significantly predicted anxiety-related trauma symptoms in two separate subsamples in the data set. in the first analysis, both measures of everyday discrimination and major experiences of discrimination were highly significant, even when including gender, biracial status, and ethnic identity as covariates. this means that everyday discrimination significantly contributes to trauma symptoms, even when controlling for experiences of major discrimination over one’s entire life. this is particularly compelling when considering the overlap (r .519, p .001) between these two variables. to address the possibility that racial-trauma symptoms were confounded by prior traumatic experiences, i added history of conventional trauma into the regression, but that variable was not significant and the overall model was mostly unchanged. the second analysis revealed something similar. in predicting trauma symptoms of discrimination from both the frequency of microaggressions and lifetime general ethnic discrimination, both were significant predictors, even when including gender and ethnic identity. this means that the regular experience of racial microaggressions significantly contributed to trauma symptoms, even when controlling for general ethnic discrimination over one’s entire life. again, this is particularly compelling when considering the overlap (r .469, p .001) between these two variables. further, the regressions were conducted in stages to illustrate that adding the more subtle forms of racism made a meaningful contribution to the model even after accounting for more overt lifetime experiences. thus it seems clear that microaggressions are traumatizing in their own right.  discussion negative emotionality this article has addressed the main tenets of lilienfeld’s (2017b) critique of the microaggressions research program, as shown in table 1, but there were several other  
  microaggressions troublesome facets of his article that should be addressed as well. it would be irresponsible of me as a diversity educator to ignore racist frameworks and approaches embedded in an article about racism. i am not specifically accusing lilienfeld personally of being racist or having racist motives. by “racist frameworks,” i mean approaches that favor the dominant racial group at the expense of subordinate groups. for example, a systematic tendency to see microaggression harm as deriving from “oversensitivity” of the targets rather than problems with the offenders would reflect a racist lens. a research framework could itself constitute a microaggression. as an extreme analogy, placing a psychopathology label on people of color who do not want to be mistreated reminds us of the mental-health problem once known as drapetomania, a term invented by dr. samuel cartwright in 1851 to explain the seemingly irrational desire of slaves to be free (suite, la bril, primm, & harrison-ross, 2007). just as it would be incorrect to assume that slaves who resist being enslaved are displaying psychopathology, it would be likewise incorrect to assume that people of color who complain of microaggressions are simply exhibiting personality pathology. the more parsimonious explanation is that they just do not want to be mistreated. so, on the basis of our original definition, we can classify the negative emotionality/ neuroticism argument as a microaggression because oppressed people of color are being pathologized simply for resisting oppression (suite et al., 2007).  is ignorance bliss? as an educator, i find the most troubling aspect of lilienfeld’s article in the end section on pragmatic and policy implications, where he opposed efforts to educate people about microaggressions, calling for a “moratorium” on training. jonathan haidt (2017) echoes this sentiment in a related commentary, stating, an essential first step that every college should take is to renounce the microaggression program and discourage faculty and administrators from even using the term. instead, colleges that care about fostering diversity and inclusion should ask themselves: how can we teach students to give each other the benefit of the doubt? how can we cultivate generosity of spirit? (p. 177) this exhortation may sound fair and even compelling at first blush, but there are several problematic messages that must be critically examined. we can consider the recommendations objectively (without passing judgment on the recommenders) and determine whether these result in outcomes that maintain racial  19 in-group (white) dominance while disproportionally harming the out-group (people of color), which would therefore make them racist recommendations. if lilienfeld’s review were complete and compelling, his policy implications would be less objectionable, but good policy demands good science, and with the broader view provided here, we can see that his policy implications are unjustified. consider that these two scholars are saying we should stop educating people about the findings of microaggressions research and silence the recommendations made by leaders in the field (see note). 2,3 the assertion that microaggression science should not be taught has tentacles that stretch back centuries. recall that during the era of slavery, slaves were forbidden to learn to read or write in order to prevent them from becoming a threat to white superiority, and stateenforced disparities lasted until the civil rights era, when the equal education of people of color had to be implemented by force of law. even today, many racial and ethnic groups face societal barriers to education (williams, 2019), and so it is unconscionable that any member of the academy would advocate for ignorance, especially around matters of race and oppression. failing to educate people about microaggressions helps to ensure that people will keep committing them and people of color will continue to suffer from them. perhaps the most puzzling of lilienfeld’s assertions is the idea that teaching people of color about microaggressions might “sensitize” them to seeing slights everywhere, leading to psychological harm as they “become more likely to perceive themselves as emotionally fragile” (p. 162). he compared the potential harms of educating people about microaggressions to symptoms of dissociative identity disorder or posttraumatic stress disorder, the victims in mental torment and suffering from personality fragmentation. the only sensible recourse, he seemed to conclude, is to withhold the information, suggesting that people of color might not have the mental constitution to withstand it. consider that one historical rationale for failing to properly educate many people of color was the notion that they were incapable of handling the same amount of information as the white man. there is no empirical evidence that people of color as a group are too emotionally fragile to digest troubling information, so again a deficit model is being invoked, perhaps on the basis of pathological stereotypes about certain ethnic groups having disordered personality characteristics. information about microaggressions must not be suppressed. the greater harm comes when young people of color realize through these subtle mechanisms they are not favored by teachers or peers, and, sensing ubiquitous slights with no forthcoming explanation, they come to  
  20 conclude they are inherently defective (nadal, wong, et al., 2014; thai et al., 2017). it is much more honest, empowering, and psychologically healthy to put the blame where it belongs—on the offender and our social psychopathology—rather than on stigmatized individuals who have endured a lifetime of unacknowledged racism. in line with the idea that microaggressions are no more than “ever-smaller specks,” (p. 176), haidt (2017) emphasizes giving offenders the benefit of the doubt, but neither lilienfeld nor haidt discussed the major dangers of ignoring microaggressions. beyond the physical chronic stress response and mental-health issues linked to these pervasive experiences, microaggressions are indicative of racial prejudice in offenders (kanter et al., 2017; mekawi & todd, 2018); consequently, there could be damaging consequences for ignoring these subtle warning signs. a person of color might decide to trust someone who has microaggressed only to find that person subsequently behaves in a way that is hurtful, untrustworthy, or deceitful. given that empirical data show that microaggressions are correlated with racism, this is not an unreasonable expectation. therefore targets cannot simply assume everyone means well because misinterpreting microaggressions can lead to real-life problems. for example, as a black female academic, i experience so many microaggressions that assault my intelligence, worthiness, work ethic, priorities, intentions, and abilities, that if i had chosen to give all offenders the “benefit of the doubt,” i would have arrived at some very unhelpful conclusions about myself and my work, and quit the academy a long time ago. and sadly many people of color do just that (e.g., chambers, 2012; williams, 2019). this is why potential targets must learn to identify all forms of microaggressions—because they signal danger and, taken at face value, can lead to harmful consequences.  education is helpful, not harmful in a related online article, lilienfeld (2017a) warned that “the microaggression culture prevalent on many campuses and in many businesses makes just about everyone feel threatened, and could amp up already simmering racial tensions” (para. 44). no doubt some microaggression trainings are unhelpful. educating people about racism is hard, and if done by unqualified instructors without proper training, it can do more harm than good. that being said, we do not simply decide to stop educating people about important issues just because some people do it poorly. in haidt’s (2017) commentary, praised by lilienfeld, he worried about the future of democracy should we all be well-informed about microaggressions, arguing  williams that “microaggression training is—by definition— instruction in how to detect ever smaller specks in your neighbor’s eye” (p. 176). haidt profoundly misunderstood the point of microaggressions training. the idea is not simply to help people of color identify that they have been insulted (usually they know). the idea is to raise awareness, understanding, and consciousness in would-be offenders to enable them to understand the implicit errors in their beliefs about those who are different, how these errors are communicated to others through their words and actions, and to cultivate compassion for those they have harmed. it is not about teaching those who have been victimized to become victims, but it is about giving language and voice to those who are routinely dismissed in their suffering and empowering them with meaningful and accurate explanatory models. it is about helping people understand each other better across stereotypes and stigma. we need more of this, not less. to address the need for empirically supported interventions to reduce racism in the form of microaggressions, i and my colleagues brought our years of experience and research to bear in the development the racial harmony workshop (rhw). this workshop was designed to reduce the commission of microaggressions through education, discussion, and experiential intergroup contact exercises, with an emphasis on promoting intimacy through reciprocal vulnerability (kanter, williams, & masuda, 2018; williams, in press). we simultaneously conducted a control intervention to compare a standard education and discussion-based protocol with the rhw protocol. the main difference between these two interventions is that the rhw addresses microaggressions directly and emphasizes actual social connection between participants of different races. we found positive benefits for both black and white participants, including improved mood and positive feelings toward black people for the white students. the black students did not become weaker, as lilienfeld predicted; rather, we saw an increase in positive racial identity, meaning they got emotionally stronger (williams, chapman, wong, & turkheimer, 2012). white students in both groups showed a decrease in microaggressive behaviors, and those in the rhw condition also reported a decrease in biased thoughts (kanter et al., 2018). the workshop was not punishing for participants; the white students demonstrated a significant increase in positive affect at the end, and all the participants reported high satisfaction with the workshop. these results show that it is possible to deliver a nonaversive diversity training that actually puts participants in a more positive mood. modified versions of this training have been used to educate graduate student therapists,  
  microaggressions licensed mental-health professionals, and others. for example, in a randomized controlled trial with medical students, we found measurable improvements in their ability to communicate with standardized patients of color compared with medical students in a control condition who did not receive the training (rosen et al., 2018). altogether, the evidence weighs in favor of training over ignorance (williams, in press).  social connection is the solution as illustrated above, cross-racial social connections are key for multicultural development. such relationships are necessary for the cultivation of cultural humility and to learn and grow as a human beings in our increasingly diverse society (mckinney, 2006; okech & champe, 2008). pathological stereotypes about people of color flourish in the absence of social connections across race. writing about ethnic and racial groups that one was not born into inevitably means working with blind spots. others’ perspectives are needed to challenge and correct the writer, especially if the writer wades into controversial waters. a diversity researcher colleague could have checked lilienfeld, in terms of the many errors, stereotypes, insults, biases, dated terms, and microaggressions, woven into the manuscript before the article was submitted (one concrete example is the use of the dated term “transgendered”). likewise, any reviewers competent in the subject matter could have addressed these issues before the article was published, preventing the many scholars and students of color who read his article from being unnecessarily hurt and offended. i ask myself, “who sits on the editorial board of perspectives on psychological science?” and i see no one like myself. perhaps this is part of the problem as well—a lack of diversity in our networks. in his 18 recommendations for the microaggression research program, lilienfeld advised enlisting collaborators who do not agree with one’s research agenda, but in this context his proposal is problematic and potentially unscientific. this is not a political debate with several legitimate differing opinions that need to be moderated. this is about empirically testing ideas and theories in a way that minimizes confirmation bias and allows for us to reject information that does not support our hypotheses. the scientific reality is that subtle racism is pervasive in american society, and this has been demonstrated through decades of systematic research and is not simply an opinion (e.g., gaertner & dovidio, 2005). further, the 18 recommendations seem to imply that microaggressions are not very important, but the literature and experiences of people  21 of color are compelling in showing very important negative consequences. although a single microaggression may not produce great harm (although some single instances have done just that), their chronic nature is a significant deleterious stressor. i would advise scholars who are challenged by the microaggressions research agenda, or those who would like to better understand the phenomena, to consider the following points for adoption: 1. try not to commit microaggressions because doing so is offensive and hurtful to many. this includes refraining from giving unsolicited advice outside your scope of expertise, given that this could be considered patronizing. ask someone with expertise on microaggressions to proof papers as necessary. 2. enlist collaborators who understand and appreciate the published literature on race and racism, including both subtle and overt forms of racism and individual versus structural racism. 3. cultivate close professional and personal connections across race to help broaden your cultural perspective. learn about their racialized experiences and share information about yours. 4. ask independent observers to point out when microaggressions occur in real time to increase awareness and better understand their ubiquity. 5. educate yourself on the serious problem of subtle prejudice in american society and develop an appreciation for how people may have very different life experiences because of racialization. 6. acknowledge your unearned power and privilege in your perspective, research, and writings. 7. develop an understanding of how racist messages are differentially embedded in both leftand right-wing political beliefs and how political messages often propagate microaggressions. 8. adopt a broader perspective on psychological topics that includes a multicultural framework. 9. when someone says they have experienced a microaggression, practice showing care and concern. do not interrogate them about whether it really happened. 10. study the personality characteristics of people who commit microaggressions and those who deny their existence. 11. examine the racial and ethnic diversity of those in scholarly positions of power, such as editorial boards and organizational governance. advocate for more inclusion and examine any internal and external resistance you encounter.  
  williams  22  conclusion  notes  we have more than enough empirical evidence to conclude that microaggressions are real, harmful, and demand action. it the duty of those in our field to acknowledge the mental-health consequences of racism in all its forms, no matter how covert or subtle. we must continue to advocate for quality diversity education, where we can teach every person how to identify, defend against, and stop microaggressions even before they occur. we are obliged as mental-health professionals to help those who have been injured by microaggressions, because in an ethical and compassionate society, we invest in the development of interventions to reduce suffering. this means believing victims rather than pathologizing their character. it means conducting clinical treatment research and urging sponsors and our professional organizations to fund this work. i close with a quote from chester pierce (1970) who, when reflecting on the plight of the oppressed african american community, wrote  1. “i call for a moratorium on microaggression training programmes and publicly distributed microaggression lists now widespread in the college and business worlds” (lilienfeld, 2017a, para. 1). 2. “i ... call for a moratorium on microaggression training programs and publicly distributed microaggression lists pending research to address the mrp’s scientific limitations” (lilienfeld, 2017b, p. 138, abstract). 3. “an essential first step that every college should take is to renounce the microaggression program and discourage faculty and administrators from even using the term” (haidt 2017, p. 177).  it is my fondest hope that the day is not far remote when every black child will recognize and defend promptly and adequately against every offensive microaggression. in this way, the toll that is registered after accumulation of such insults should be markedly reduced. what this is saying is that the final clinical application of the knowledge of offensive mechanisms should be to help make each black child an expert in propaganda. (p. 280) let us all become experts in recognizing racism, whether it be a blatant hate crime, junk race science, covert discrimination, and/or microaggressions. there is much to do as we work to create a society where our all of our words and actions communicate inclusion and care by design. action editor brad j. bushman served as action editor and june gruber served as interim editor-in-chief for this article.  orcid id monnica t. williams  https://orcid.org/0000-0003-0095-3277  acknowledgments i thank timothy michaels and terence ching for assistance with proofing and literature review and douglas medin for his helpful comments, edits, support, and encouragement.  declaration of conflicting interests the author(s) declared that there were no conflicts of interest with respect to the authorship or the publication of this article.  references alabi, j. 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