The July BABCP Article of the Month is from Behavioural and Cogntive Psychotherapy (BCP) and is entitled “A pilot study of experiencing racial microaggressions, obsessive-compulsive symptoms, and the role of psychological flexibility” by Morgan Browning, Elizabeth Lloyd Richardson, Sidney Satterfield and Akshay Trisal.

There is a growing understanding that experiences of racism and discrimination have broad health and mental health impacts. Suggested reasons for this link include stretched cognitive resources for coping, and rigid responding to one’s own physiological responses and use of coping skills.

As MacIntyre and colleagues (2023) discuss, it is important to further examine associations between experiencing racism and other anxiety and OCD related diagnoses. Also, OCD impairs daily life, and there are effective treatments. And yet, while researchers are making strides, such as Williams and colleagues (2017), much of the work in the field so far has been with racial, ethnic, and gender homogenous samples.

Psychological flexibility is a potential concept to frame examinations of the associations between racism and mental health outcomes. It can account for complicated cognitive and emotional responses to situations, while also understanding an individual’s values and context they live in (Kashdan & Rottenberg, 2010; Hayes et al., 2006; Martinez et al., 2022).

We disseminated a survey to all undergraduate and graduate students at our university. This manuscript represents data from the first 77 participants as of Fall 2022. Participants had at least one non-white racial identity and were over age 18. We found associations between OCD symptoms, experiences of microaggressions and psychological flexibility. Experiences of racial microaggressions explained responsibility for harm and contamination OCD symptoms, while accounting for depression and anxiety.

This is a moderately sized sample of racially and ethnically diverse young adults. While it is not a treatment-seeking sample, participants neared clinical levels of symptoms. We also utilized a recent measure of psychological flexibility.

Of course, there may be less specificity with the self-report surveys between OCD symptoms and other mood or trauma symptoms. Additionally, there are a vast number of ways to measure and conceptualize experiencing racism.

This project can support future research into relationships between experiencing racism, social, cognitive and emotional responses, and influences on OCD symptoms. It also supports a focus on individual agency in coping. We summarized many recent treatment protocols and guidelines for supporting people of color experiencing racism, such as that of De Lapp and colleagues (2022). We encourage others to use them in both clinical work and research.

Finally, multiple participants expressed concern that this study only focused on individual diagnoses and treatment, instead of acknowledging potential biases in misdiagnosis, and structural influences on racism. We acknowledged to them, as I now write here, the importance of simultaneous work to support and empower individuals, while also addressing structural change.

DeLapp, R. C., & Gallo, L. (2022). A Flexible Treatment Planning Model for Racism-Related Stress in Adolescents and Young Adults. Journal of Health Service Psychology, 1-13.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25.

Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical psychology review, 30(7), 865-878. https://doi.org/10.1016/j.cpr.2010.03.001

MacIntyre, M. M., Zare, M., & Williams, M. T. (2023). Anxiety-related disorders in the context of racism. Current Psychiatry Reports, 1-13.

Martinez, J. H., Suyemoto, K. L., Abdullah, T., Burnett-Zeigler, I., & Roemer, L. (2022). Mindfulness and valued living in the face of racism-related stress. Mindfulness, 1-14.

Williams, M. T., Taylor, R. J., Mouzon, D. M., Oshin, L. A., Himle, J. A., & Chatters, L. M. (2017). Discrimination and symptoms of obsessive-compulsive disorder among African Americans. The American journal of orthopsychiatry, 87(6), 636–645. https://doi.org/10.1037/ort0000285

Acknowledgements: Thank you to the other authors for their work on the project and to the students for their participation in the study!

Author Bio:

Morgan completed her masters degree in research psychology at the University of Massachusetts Dartmouth, and then has stayed affiliated as a volunteer research assistant. Much of her career has been spent in clinical work and research with people with OCD, and her research interests are in acceptance and mindfulness based treatments, and improving reach and effectiveness of OCD treatment.

From Paul Salkovskis, Editor of BCP: Why I chose this article

Few doubt that racism and discrimination in various forms has a corrosive effect on mental health. This paper stands out as being a rare example of research which establishes and evidences such links. As might be expected with good quality research, the answers obtained are outstripped by the further questions posed. Further research is needed on the mechanisms involved. Recent work on the link between Betrayal and OCD are one of several candidates. How do people react to the mass betrayal characteristic of system wide racism? The authors discuss the important issue of specificity, and offers some hope in terms of ways in which minoritized groups may best be supported.