Journal of Contextual Behavioral Science 20 (2021) 89–93

Contents lists available at ScienceDirect

Journal of Contextual Behavioral Science

journal homepage: www.elsevier.com/locate/jcbs

Interrupting internalized racial oppression: A community based

ACT intervention
Kira Hudson Banks a, *, Spondita Goswami a, Dazialee Goodwin a, Jadah Petty b, Velma Bell 1,
Imman Musa a
a
Saint Louis University, Missouri Department of Psychology, 3700 Lindell Blvd, St. Louis, MO, 63108, USA
b
VA, Greater Los Angeles Trauma Recovery Services Clinic 351 E Temple Street, Los Angeles, CA, 90012, USA

A R T I C L E I N F O A B S T R A C T

Keywords: There is a dearth of psychological intervention research to guide clinicians in supporting individuals who are
Internalized racial oppression impacted by systemic racism. Internalized racial oppression, adopting the negative beliefs about one’s group, is
Internalized shame one pathway through which racism affects mental health. Techniques from Acceptance Commitment Therapy
Acceptance commitment therapy
have been found to decrease internalized self-stigma and to mitigate negative mental health symptoms. The
Racial trauma
current pilot study examined the feasibility of a group-based intervention for Black women targeting internalized
racial oppression. We found pre-post decreases in internalized racial oppression and shame, and psychological
distress.

The recent protests across the country in response to murders of
Black Americans, such as George Floyd, Ahmaud Arbery, and Breonna
Taylor, have refocused attention on the continued relevance of psy­
chological interventions that address the effects of racism. The current
study focuses on an intervention, which centers individuals impacted by
racism. While the most effective intervention would be to end systemic
racism, in the interim, psychologists can develop techniques tailored to
support targets of racism in navigating the psychological impacts.
Racism is a system of oppression based on racial group designations
(Essed, 1991; Harrell, 2000). Research on racism has focused largely on
the deleterious effects of discriminatory acts. The Surgeon General’s
report at the turn of the century highlighted a byproduct of racism, the
internalization of negative content about one’s group, as an important
pathway through which racism is harmful (U.S. Department of Health
and Human Services, 2001). Individuals believing negative content
might be influenced by misinformation and distortion embedded within
messages of inferiority and society’s overall devaluing of some groups.
While this internalized content represents a pattern of maladaptive
thinking, in the context of racism, the thoughts are merely a reflection of
the broader systemic devaluing of people of color. They do not represent
internal failings or weaknesses on the part of the individual. Recent
researchers have conceptualized harm done as a result of racism as racial
trauma (Comas-Daiz, Hall & Neville, 2019). Internalized racial
oppression is a specific harm that is essential to address in the path to
healing from racial trauma (Bryant & Ocampo, 2006; Comas-Díaz,
2016). Given that Black Americans are exposed to racial discrimination
are greater rates than other racial and ehtnic groups, this study focuses
on Black women (Chou, Asnaani, & Hofmann, 2012).
1. Internalized racial oppression
Internalized racial oppression is a form of self-stigma where in­
dividuals adopt negative messages and beliefs of inferiority about their
group (Syzmanski & Gupta, 2009; Williams & Williams-Morris, 2000). It
is associated with shame, evaluative thoughts, and fear of the enacted
stigma that results from individuals’ identification with a stigmatized
group (Luoma et al., 2007). Internalized racial oppression is associated
with increased psychological distress, depressive symptoms, anxiety
symptoms, self-degradation, and decreased self-esteem (Campón &
Carter, 2015; Watts-Jones, 2002; Williams & Williams-Morris, 2000).
Recent research found an indirect effect of internalized racial oppression
on past year major depressive disorder via self-esteem, such that at high
levels of self-esteem, as internalized racial oppression increased, the risk
for MDD also increased (James, 2017). Graham, West, Martinez, and
Roemer (2016) found that internalized racial oppression mediated the
relationship between racist events and anxiety and stress symptoms,

* Corresponding author.
E-mail address: kira.banks@health.slu.edu (K.H. Banks).
1
Private practitioner.

https://doi.org/10.1016/j.jcbs.2021.02.006
Received 4 September 2020; Received in revised form 24 February 2021; Accepted 27 February 2021
Available online 6 March 2021
2212-1447/© 2021 Association for Contextual Behavioral Science. Published by Elsevier Inc. All rights reserved.
K.H. Banks et al.
such that when internalized racial oppression was added to the model, it
significantly predicted anxious arousal and stress symptoms while racist
events no longer significantly predicted anxiety or stress. This research
highlights the critical role of internalized racial oppression in the
experience of distress pointing to the need to develop interventions
targeting internalized racial oppression among discriminated group
members.
2. Black Women and internalized oppression
Black women are particularly affected by internalized racial
oppression because along with racism they also bore the burden of
sexism. Intersectionality theory suggests that Black women’s various
identities (e.g., race, gender, sexual orientation, etc.) influence the types
of racial trauma and race-related stress they experience and how they
cope and heal (Adhikary, 2020; Moody & Lewis, 2019). The concept of a
Strong Black Woman (SBW) is the internalization of the stereotypes of
what it means to be a Black woman in the United States (Liao, Wei, &
Yin, 2020). Current literature characterizes the Strong Black Woman
schema as being composed of self-reliance, affect regulation, and care­
taking (Abrams, Hill, & Maxwell, 2019; Liao et al., 2020). SBW attitudes
are associated with psychological maladjustment and also negatively
correlated with self-esteem (Abrams et al., 2019). This cycle of taking
care of others and pushing away personal needs can be categorized as a
coping strategy in the context of racism and sexism (Thompson, 2003).
Research suggests that when used in moderation, this coping strategy
can be beneficial in buffering against the negative effects of racism and
sexism (Hamin, 2008; Thompson, 2003). Nevertheless, addressing SBW
in the context of discriminaiton is essential to help mitigate its delete­
rious effect on the psychological health of Black women.
3. Shame and internalized oppression
Shame is found to be an emotional reaction to discrimination and
oppression (Matheson & Anisman, 2009). Discriminated individuals
often internalize the socially devalued messages associated with their
stigmatized identities such that it involves fusion with the beliefs of
being flawed or unlovable (Matheson & Anisman, 2009). Shame has
been found to increase psychological distress and to mediate the rela­
tionship between discriminaiton and psychological distress (Covert,
Tangney, Maddux, & Heleno, 2003). Hence, it is important to explore
shame in the context of internalized racial oppression.
Acceptance Commitment Therapy in the Context of Internalized
Racial Oppression.
As mentioned earlier internalized racial oppression is socially rein­
forced, making the elimination of such thoughts and feelings difficult
(Devine, 1989). Acceptance Commitment Therapy (ACT) seeks to
change the relationship with negative thoughts and feelings through
techniques that decrease experiential avoidance (Hayes, Strosahl, &
Wilson, 2012). This reasoning suggests interventions that address the
functional link between thoughts, feelings and overt behavior related to
internalized racial oppression might be more beneficial compared to
those that attempt to directly change the content and of those thoughts
and feelings. For example, if a Black woman has internalized, “I am
incompetent,” based on the messages racism has told her, Cognitive
Behavioral Therapy would seek to challenge the thought; whereas, ACT
would seek to guide the woman to notice the thought as just a thought,
increase the distance between herself and the thought and to take
value-based action regardless of the plethora of messages that racism
creates about who she is or what she is capable of doing.
The current intervention seeks to build on previous research that has
found ACT to be effective in helping individuals navigate stigma. ACT
has been found to be effective in decreasing effects of self-stigma,
internalized oppression, and other psychologically deleterious effects
of discrimination (Brewster, Moradi, DeBlaere, & Velez, 2013; Lucksted
& Drapalski, 2015; Luoma, Kohlenberg, Hayes, & Fletcher, 2011; Vogel,
90
Journal of Contextual Behavioral Science 20 (2021) 89–93
Wade, & Hackler, 2007; Vogel, Bitman, Hammer, & Wade, 2013).
Similarly, Luoma et al. (2007) found that ACT was efficacious in
reducing self-stigma among individuals with a history of substance
abuse. This intervention was found to decrease internalized stigma,
self-esteem, experiential avoidance, and internalized shame. In line with
this, in a small study of five individuals, a 6–10 session ACT intervention
on internalized homophobia was effective in reducing self-reported
depressive symptoms and stress, and increasing social support and
quality of life (Yadavaia & Hayes, 2012).
This intervention tests the extent to which the six core processes
within the ACT-informed unified model for behavior change can help
individuals extricate themselves from the dynamics of internalized
oppression. For example, there are exercises within the intervention that
promote acceptance of the negative content of internalized racial
oppression and then utilize cognitive defusion to change the stimulus
value of the negative content. Self-compassion, which involves self-
kindness and mindfulness, was also incorporated as it has been going
to buffer against the deleterious effects of racial discrimination (Neff,
2003; Yadavaia, Hayes, & Vilardaga, 2014). ACT overlaps with this
conceptualization, because it helps individuals to acknowledge one’s
painful experiences and offer self-kindness when hurting instead of
evaluating experiences as bad or wrong (Yadavaia et al., 2014). This
stance can help individuals acknowledge the harm caused by internal­
ized racial oppression rather than evaluating the thoughts or feelings as
bad or wrong. Understanding internalized racial oppression in the
context of racism allows individuals to see the negative thoughts and
feelings as a result of context rather than a description of the self that
needs to be disproved. The current pilot intervention attempts to apply
these concepts to an ACT-based group for Black women.
4. Method
The current study investigated the feasibility of a protocol to support
Black women in healing from racial oppression. The university’s Insti­
tutional Review Board approved the study, and consent was obtained
from participants before initiating procedures.
4.1. Participants
Black women in a Midwestern city in the US were recruited through
email, newsletters, snowball sampling, and word of mouth. The final
sample included twenty participants (7 college students and 13 com­
munity members) whose age ranged from 18 to 60 (M = 36.26, SD =
14.92). Almost half of the participants obtained a college degree
(41.6%). Almost half of the participants’ income ranged between
$20,000-$39,999 (46.1%). Participants were eligible if they identified as
a Black woman and were over the age of 18.
4.2. Procedure
Participants who responded to the recruitment methods outlined
above were directed to a website displaying the recruitment statement.
The recruitment statement contained details about the study and
informed potential participants of their participation’s scope and
voluntary nature. Upon providing consent by clicking to continue, par­
ticipants were directed to the survey, which took approximately 30 min
to complete. Participants were compensated for their participation with
a $10 gift card. After completing the survey, a research assistant con­
tacted participants with an invitation to participate in the 6-session
intervention. Nine women participated in groups on campus, and four­
teen women participated in community groups.
Student participants were compensated with $10 gift cards for each
session attended and another $10 gift card for completing the post-study
survey. Upon request from the community partner, community partici­
pants were not compensated for each session but received a $10 gift card
upon completion of the post-study survey. The partner was concerned
K.H. Banks et al. Journal of Contextual Behavioral Science 20 (2021) 89–93

Table 1 For example, they practiced saying the phrases in multiple voices (e.g.,
Session topics. robot, newscaster, whiny child). They also practiced personifying their
1. Define race, racism, and colorblind ideology inner bully (e.g., giving them a name, attire, and other details that make
Begin conversation about noticing, willingness, and self as context rather than self them someone separate and depersonalizes the voice). Cultivation of
as content self-compassion and engaging in value-directed behavior were discussed
2. Define and reflect on internalized racism, Strong Black Women Schema, and racial
in later sessions. Music, quotes, and poems written by Black women from
identity
Begin conversation about content of messages related to internalized racial various backgrounds were woven throughout the sessions.
oppression
3. Awareness, Noticing, and Willingness 4.3. Measures
Exercises: “Brief mindfulness” and “Noticing the impact of internalized oppression”
Metaphor: “The unwanted party guest”
4. Cognitive Defusion
Internalized Racial Oppression Scale (IROS; Bailey, Chung, Williams,
Exercises: “Experiential practice with defusion” Metaphors: “Thoughts as Singh, & Terrell, 2011). The IROS is a 28-item measure on a 5-point
passengers” Likert type scale ranging from strongly disagree to strongly agree (cur­
5. Mindfulness and Compassion rent sample alpha = .73) that measures the extent of agreement with
Exercise: “Compassion is different from self-esteem,” “Recognize myths/thoughts
statements such as “I wish I looked more White,” and “Black women are
we have about developing compassion,” “Getting to know my inner bully,” and “My
compassionate reframe” confrontational.” This scale was validated using an African American
6. Values, Goals, and Intentions sample (Bailey et al., 2011).
Exercises: “Life wheel directions” and “Stand up and declare” Acceptance and Action Questionnaire-II (AAQ-II; Bond et al., 2011).
The AAQ-II is a measure of experiential avoidance (current sample
alpha = .88) and psychological inflexibility across seven items, such as
that compensation for every session would set a precedent for programs
"I’m afraid of my feelings," and "Emotions cause problems in my life."
at the center it could not maintain and potentially decrease interest in
Participants respond on a 7-point Likert type scale ranging from Never
their standard programming that was offered for free with no incentives
True to Always True. Research has also indicated adequate reliability
for participation. Therefore, compensation was given only for the sur­
and validity of this questionnaire with samples including college stu­
veys and not session attendance. After the intervention, participants
dents, community samples, and African American samples (Bond et al.,
were asked to respond to the same questions as were included in the
2011; Morgan, Masuda, & Anderson, 2014).
baseline for another $10 gift card.
Depression Anxiety Stress Scale (DASS-21; Lovibond and Lovibond,
Intervention. Participants attended six, 90-min weekly sessions of a
1995). The DASS is a 21-item measure designed to assess depressive,
manualized intervention to decrease the negative impact of internalized
anxiety, and stress symptoms (current sample alpha = .91). Participants
racial oppression on Black women’s psychological well-being (Table 1).
are asked to rate the frequency for each symptom over the past week
The manual was shaped by the lead researchers’ knowledge of the
using a 4-point Likert type scale. Item responses ranged from 0 (did not
psychological effects of racism, racial identity, internalized racial
apply to me at all-NEVER) to 3 (applied to me very much, or most of the
oppression, mindfulness, and ACT gathered over an almost 20-year
time – almost always). A representative item includes, "I couldn’t seem
career as a clinical psychologist and researcher. The manual included
to experience any positive feeling at all." Past research has indicated
music and poems rooted in the Black experience. The ACT-specific ex­
adequate validity and reliability of the DASS-21 in African American
ercises and metaphors were based on Hayes et al. (2012) and Neff
samples (Morgan et al., 2014).
(2011). The leader research, a Black woman, studied ACT for seven
Internalized Shame Scale (ISS; Cook et al., 1994). The ISS measures
years and attended various ACT trainings in addition to specialized
shame and guilt experiences (current sample alpha = .97). It utilizes a
training in research methods with diverse racial and ethnic groups. A
5-point Likert type scale (Seldom to Almost Always) to capture the fre­
clinical psychology doctoral student facilitated campus sessions, and a
quency with which statements describe feelings and experiences that
clinical social worker-led the community group. Both group leaders
participants have had over the past week. A representative item is, "I felt
identified at Black women and had training in ACT, experience with ACT
like I am never quite good enough." This scale has been used in African
treatment manuals prior to this intervention, and were supervised by the
American Sample (Johnson, 2020).
lead researcher. Adherence to the protocol was fostered by the lead
Strong Black Woman Attitudes Scale (SBW; Hamin, 2008). Three sig­
researcher teaching the protocol to the group leaders over a
nificant characteristics define the SBW: self-reliance, affect regulation,
multi-session training in addition to reviewing the session content and
and caretaking. These characteristics are captured by 22 items on a
materials prior to each week. Adherence was also checked through su­
5-point Likert scale ranging from Never to Almost Always (current
pervision as well as the lead researcher attending several sessions.
sample alpha = .76). Representative items include "I believe that it is
The program began with two sessions that were focused on psy­
best not to rely on others," and "I am strong."
choeducation regarding race, racism, colorblind racial ideology, the
Qualitative Questions- The post-study survey included additional
strong Black women schema, racial identity, systems of oppression, and
questions that are qualitative in nature. These questions ask participants
internalized racial oppression and their impact on Black women. The
to indicate what was most and least helpful about the intervention.
remaining four sessions focused on implementing new strategies and
Participants were also asked from their perception if their thoughts,
ways of interacting with thoughts and feelings that are a result of
attitudes, or behaviors changed concerning internalized oppression and
internalized racial oppression. While no formal homework was assigned
the Strong Black Woman ideal.
and collected, participants were encouraged to use and reflect on the
Demographics Questionnaire- The study included a demographics
material in between sessions.
questionnaire assessing age, income, education, gender, religious affil­
Cognitive defusion was the mechanism of focus with exercises
iation, and racial/ethnic background.
touching on the other core processes of ACT as well. Examples of
internalized oppression including, "I am a fraud and incompetent," "I
4.4. Statistical analysis
must work harder and be perfect to be seen as worthy," and "I’m sup­
posed to be independent and not need anyone or need help." Acceptance
The statistical analyses were performed using SPSS, version 25. Tests
and Commitment Therapy was introduced, and the women participated
were two-sided and statistical significance was set at p < .05. To test the
in exercises on awareness, noticing, and willingness in the context of
effectiveness of the intervention, the mean scores on pre-and-post
thoughts and feelings. They were invited to practice cognitive defusion
measures on study variables were compared using the paired-samples
with their comments that were rooted in internalized racial oppression.
t-tests bootstrapped with 10,000 samples. Effect sizes were calculated

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K.H. Banks et al.
Table 2
Means and standard deviations of pre- and post-treatment measures.
Community (n = 13)
Variables Pre-test Mean (SD) Post-test Mean (SD)
Depression Anxiety and Stress Scale 1.64 (.52) .60 (.37)
Acceptance & Action Questionnaire 2.72 (1.20) 2.60 (1.40)
Internalized Racial Oppression 1.67 (.31) 1.59 (.30)
Internalized Shame 1.91 (.78) .84 (.79)
Strong Black Women Attitudes 2.95 (1.04) 3.20 (.42)
for each t-test.
5. Results
5.1. Feasibility
Attendance and attrition. Twenty of the 23 people who completed the
intervention (86%) participated in the pre and post evaluation. The
number of sessions attended ranged from four to six, with 90% attending
five or six sessions.
Satisfaction. Most participants (75%) reported that the intervention
"changed their thoughts, attitudes, or behavior related to internalized
oppression." Others expressed: “Definitely, this interaction should be
continued," and "It was awesome, and I am better for having taken the
series. I would sign up for it again, and/or like to see a monthly check-in
for Black women." The suggestions were also given to focus more on
sexism and consider creating a workbook rather than handing out ex­
ercises at each session.
5.2. Descriptive statistics
Experiential avoidance was positively correlated with DASS scores (r
= .51, p < .05), and internalized shame scores (r = 0.77, p < .01) but
was weakly correlated with internalized racial oppression in this study
(r = .-0.04, p > .05). Internalized shame was also positively correlated
with DASS scores (r = 0.70, p < .01) and Strong Black woman (SBW)
attitudes (r = 0.50, p < .05), but again weakly correlated with inter­
nalized racial oppression.(r = − 0.12, p > .05) for the participants in this
study. Finally, internalized racial oppression was also weakly correlated
with depression, anxiety and stress scores (r = 0.15, p > .05).
Means and standard deviations of study variables are listed in
Table 2. The participants were psychologically flexible (M = 2.69, SD =
1.07). In addition, participants reported mild levels of IRO (M = 1.78,
SD = 0.34) and internalized shame (M = 1.97, SD = 0.98) scores. Par­
ticipants’ were also somewhat aware of their Black racial identity (M =
2.90, SD = 0.90) and majority of participants were classified in the
normal range of depression, anxiety, and stress scores.
5.3. T-tests
T-tests were run as one group due to the small sample size. Signifi­
cant decreases were found in pre and post scores for depression anxiety
and stress symptoms [t = 5.97(18) p = .00 d= 1.37 ] internalized
oppression [t = 2.93(19) p = .02 d=.53], internalized shame [t = 1.69
(19) p = .01 d= .91], and strong Black woman attitudes [t = -2.14(16) p
= .05 d= -0.52]. However there was no significant pre to post change for
experiential avoidance scores [t = -1.52(19) p = .14 d= -0.34].
6. Discussion
The present study’s primary aim was to explore the feasibility and
effectiveness of an ACT-based protocol in addressing internalized
oppression among Black Women. Previous ACT-based interventions
have proven useful for stigmatized groups and the reduction of shame
(Brewster et al., 2013; Lucksted & Drapalski, 2015; Luoma et al., 2007;
Journal of Contextual Behavioral Science 20 (2021) 89–93
College (n = 7) Total Sample (n = 20)
Pre-test Mean (SD) Post-test Mean (SD) Pre-test Mean (SD) Post-test Mean (SD)
1.99 (0.72) 1.33 (0.58) 1.72 (0.64) .86 (0.57)
2.81 (.87) 3.77 (1.33) 2.69 (1.07) 3.02 (1.42)
1.95 (0.34) 1.92 (0.34) 1.77 (0.34) 1.70 (0.34)
2.20 (1.32) 1.8 (1.07) 1.97 (0.98) 1.19 (0.97)
2.70 (0.49) 3.60 (0.26) 2.91 (0.91) 3.33 (0.41)
Luoma et al., 2011; Vogel et al., 2007; Vogel et al., 2013). This inter­
vention is the first of its kind to use ACT to address the harms of racism,
specifically internalized racial oppression. Results suggest the protocol
was adhered to successfully, and attendance and response rates suggest
it was well-received by participants. Statistical analysis of pre and post
responses highlight decreased internalized racial oppression, internal­
ized shame, psychological distress, and strong Black woman attitudes.
These results are particularly promising given the nascent literature
on addressing internalized racial oppression. However, an increase in
Strong Black Women attitudes was an unexpected result. Recent
research suggests further investigation is needed to understand variables
that affect the relationship between Strong Black Women attitudes and
psychological outcomes (Liao et al., 2020). In the current study, it ap­
pears that these values were strengthened without being correlated with
negative implications for mental health.
Contrary to the expectation, the mean score of experiential avoid­
ance did not significantly improve from pre to post-intervention. The
lack of significance could suggest that improvement in outcomes
occurred via processes other than psychological flexibility. However, the
AAQ-II scores did increase pre to post so that a larger sample size would
be important for future research. It is also possible that progress
occurred via an aspect of psychological flexibility not captured by the
AAQ-II. Indeed, the seven-item AAQ-II may not be of sufficient scope to
comprehensively capture all facets of psychological flexibility (Francis,
Dawson, & Golijani-Moghaddam, 2016).
As the field continues to explore the mechanisms through which
individuals navigate racism generally, and internalized oppression
specifically, this pilot suggests that it is important for clinicians to give
attention to these topics. The preliminary results suggest that ACT-
techniques might be beneficial in changing Black women’s relation­
ship with internalized content. The finding is in line with previous
research where ACT has been found to be effective in decreasing effects
of self-stigma, internalized oppression, and other psychologically dele­
terious effects of discrimination (Brewster et al., 2013; Lucksted &
Drapalski, 2015; Luoma et al., 2011; Vogel et al., 2013; Vogel et al.,
2007). To engage this content effectively, clinicians need to build their
capacity to address racism and internalized racial oppression in therapy
(Dadlani, Overtree, & Perry-Jenkins, 2012). Having cultural humility is
important as practitioners create space for clients to address the harms
of racial trauma (Mosher et al., 2017).
This study has limitations that affect the generalizability of the
findings. The lack of a control group is significant as a control group is
necessary to rule out important non-intervention related influences on
the outcome variables and to improve our confidence in the conclusion
that the improvements are due to the intervention and not other factors,
such as the passage of time, regression to the mean, or expectancy ef­
fects. In addition, the community and university groups being differ­
entially compensated is also a limitation. Across both groups, the small
sample consisted of highly identified Black women who did not endorse
high levels of internalized racial oppression. In addition, many of the
women were recruited via the snowball method; therefore, participants
might not be representative.
Future research should include a larger sample size to offer a more
definitive, well-powered test of the current promising findings.
Furthermore, follow-up assessments should be included to understand if
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the findings last. The protocol could be implemented within the context
of individual therapy to understand the intervention’s effects in psy­
chotherapy. Additionally, future research should replicate the protocol
with participants from different ethnic groups to examine if the protocol
is generalizable to other groups experiencing internalized racial
oppression.
This study suggests that addressing internalized racial oppression
through psychoeducation and ACT exercises may enhance Black
women’s psychological well-being and decrease feelings of internalized
oppression and shame. The protocol developed for the current study
provides clinicians with a framework for using existing theories to
interrupt deleterious effects of racism. While some might worry that
naming and acknowledging the harm of racism might exacerbate its
effects, this pilot study demonstrates that an approach to healing racial
trauma that names internalized racial oppression can be effective at
reducing negative outcomes.
Declaration of competing interest
None.
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