Reducing Internalized Transnegativity: Randomized Controlled Trial of an Online Intervention

Given the degree of hostility toward transgender people and the pervasiveness of societal messages regarding gender roles, transgender people may internalize negative attitudes and beliefs about being transgender in the form of internalized transnegativity (IT). IT has been shown to contribute to negative behavioral health outcomes including suicide among transgender people (Breslow et al., 2015; Staples, Neilson, Bryan, & George, 2018). In this study, we developed an online intervention designed to reduce IT among transgender people and evaluated its efficacy using a randomized controlled trial. The IT intervention consisted of 4 modules aimed at (a) combatting stereotypes, (b) identifying and rejecting negative messages, (c) reinforcing the rejection of negative messages, and (d) enhancing identity affirmation. We analyzed data from 639 participants recruited with Amazon Mechanical Turk (Mturk) and randomly assigned to the intervention (n = 294) or a control (n = 345) addressing stress management. We measured IT using 2 subscales from the Transgender Identity Survey (TIS; Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, 2013): shame and pride. At posttest, those who received the IT intervention reported significantly lower levels of shame and higher levels of pride when compared to control. The intervention conferred small to medium effects for reducing shame (d = .43) and increasing pride (d = .43). As IT represents a transdiagnostic risk factor for many behavioral health problems among transgender people, our brief online intervention offers a highly promising and accessible means of addressing public health issues in this population. Future research directions include dismantling studies and enhancing generalizability to transgender subpopulations.