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... Albert, 2007) In Eastern culture encouragement of harmonious interpersonal relations and discouragement of conflicts is one of the principles of problem solving Culture and anger regulation Individuals’... that reappraisal is more beneficial than suppression in both experiential and physiological domains Suppression and reappraisal in the context of anger Next consider the consequences of suppression. .. consequences of suppression and reappraisal in the context of anger As indicated, effects of anger suppression (anger- in) on cardiovascular responses have been intensively examined in previous research
CHAPTER 1 INTRODUCTION Overview Anger is a negative emotion which people encounter in daily life from time to time. It is usually generated in social interactions due to frustration and perceptions of unfairness triggered by anger provoking events. The regulation of anger is considered important due to its consequences with respect to social relationships. However, regulation of anger is also related to cardiovascular health. There have been a number of studies focusing on relationships between anger expression styles and cardiovascular disease (CVD). To date, the literature suggests that both anger exhibition and inhibition are related with higher risk of development of CVD. Literature on anger expression style and its relation with CVD will be reviewed in this section. The hypothesized underlying mechanism linking anger regulation and CVD is through exaggerated cardiovascular reactivity (CVR) triggered by acute anger episodes. CVR is defined as change of cardiovascular parameters (e.g., blood pressure, heart rate, cardiac output and total peripheral resistance) from baseline. Repeated experience of exaggerated CVR is considered as the key linking acute effects of anger regulation and long term influence on cardiovascular disease. CVR has been found to be an independent risk factor of CVD. Given adverse outcomes of both anger exhibition and inhibition, healthy regulatory strategies are of interest. Cognitive reappraisal is proposed as a healthy anger regulatory strategy. By comparing with suppression, reappraisal was related with beneficial outcomes in various domains including more adaptive cardiovascular 1 responding. However, such effects of reappraisal have been rarely examined in the context of anger. The present study compares reappraisal with expression and suppression. Considering that anger regulation is heavily influenced by social norms, cultural differences may lead to differences in the consequences of particular anger regulatory strategies. Western culture and Asian culture are well-known to differ on individualism and collectivism. Patterns of social relationship are very different in the two cultures. Existing literature suggests there are differences in anger regulation and corresponding consequences in these two societies. The possible moderation effect of culture in the relationship between anger regulation and CVR will be examined. Literature Review Anger Regulation and Consequences Anger regulation and its relation with cardiovascular health. It’s believed that anger is related with many domains of functioning including subjective well-being, social relationships, and physical health. Especially given its possible relation with the development of cardiovascular diseases, research on anger regulation has attracted interest of researchers for decades. There have been two main streams of research on anger regulation and cardiovascular health. One is a huge body of epidemiological investigations with cross-sectional, case-control or cohort designs. The other is a series of laboratory experiments in which acute effects of situational anger expression methods are examined. A correlation of anger exhibition and negative consequences on cardiovascular responses has been obtained in cross sectional studies. There seems to be a tendency that people who express anger more openly have greater cardiovascular 2 reactivity. For example, an investigation with a Mexican American sample suggested that people scoring high in Anger-out scale of STAXI-II had greater systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity than people low in Anger-out (Gleiberman, Greenwood, Luke, Delgado, & Weder, 2008). Another study found that people high in Anger-out displayed high blood pressure during work compared with people low in Anger-out (Bongard & al'Absi, 2005). A large body of epidemiological research with more controlled design has been done to clarify the role of anger expression in the development of CVD. In a case-control study, a higher likelihood of myocardial infarction was found associated with Anger-out in a sample of low SES middle-aged men ( Mendes, 1992). Results of another case-control study suggested that quicker experience of anger with greater verbal expression was the best predictor of CHD compared with other types of anger experience and expression (Atchison & Condon, 1993). Stronger evidence has been obtained in prospective research. Everson and colleagues (1998) studied 537 healthy volunteers for 4 years for the development of hypertension. They found that 1 point increase out of 4 points in Anger-out scale increased by 12% the risk of incident hypertension after controlling all other risk factors of hypertension. Anger expression was also found to influence patients’ prognosis after a coronary event. A sample of female patients with CHD was followed up for an average of 6.4 years for total mortality and the combination of cardiovascular death and non-fatal acute myocardial infarction (AMI). The results indicated that a 1 point increase in the four-point Anger-out subscale of STAXI was associated with a 42% increase in the risk of cardiac death or a new AMI (László, Janszky, & Ahnve, 2008). 3 In the population research above, anger expression was examined as a relatively stable disposition and there has been evidence that it is related to the development of CVD in healthy people and the prognosis of patients with CVD. In laboratory research, the manipulation of anger expression also impacts CVD and cardiovascular reactivity (CVR). Siegman and colleagues (1990) found that both physiological and experiential arousal were affected by how anger was vocally expressed. Anger expression in a fast-loud manner was associated with greater blood pressure and heart rate reactivity than expression in a normal manner (Siegman, Anderson, & Berger, 1990). Moreover, participants were found to have high levels of CVR in an anger-out condition in which they were asked to express anger fast and loudly whereas the heighten CVR was not observed when they were asked to keep anger-arousing events inward (Siegman & Snow, 1997). Although evidence of negative consequences of anger expression has been obtained in many studies, there are also conflicting findings. The deleterious outcomes of anger expression were not found in some epidemiological research. Anger expression was even found as a protective factor of CHD in some studies. For example, habitual usage of anger-out was associated with lower heart rate and norepinephrine reactivity in a laboratory induced stressor which was a 5 min mental arithmetic task (Mills, Schneider, & Dimsdale, 1989). And a cohort study, in which 23,522 male professionals were followed up for 2 years, suggested that moderate anger expression was a protective factor for CHD among high socioeconomic status professionals (Eng, Fitzmaurice, Kubzansky, Rimm, & Kawachi, 2003). The inconsistency of results may come from the limited external validity of previous studies. The differences on demographic characteristics of samples, 4 selection of anger expression measures and the selection of research method can influence conclusions. For example, anger expression can be a protective factor for the male professionals with high socioeconomic status (Eng, et al., 2003), but a risk factor for the sample of low SES men (Mendes, 1992). It may imply that career or SES moderates the relation between anger expression and its health consequences. Selection of research method plays a role in the inconsistency of results too. For epidemiological research, prospective methods provide stronger evidence for causal relationship than case-control studies and cross-sectional investigations. Further, Anger-out was used as a personality disposition in epidemiological studies whereas it was manipulated by vocal behaviour in some laboratory studies, e.g., Seigman’s work. The extent to which the manipulation for anger expression is successful impacts the internal validity of experimental studies. Evidence of a relationship between anger suppression and cardiovascular diseases has been obtained as well. High Anger-in was found related with increased arterial stiffness in adults which is part of the pathogenesis of CHD (Anderson, Metter, Hougaku, & Najjar, 2006). MacDougall and colleagues (1985) reported that Anger-in was significantly associated with the severity of CVD in patients undergoing angiography. In the Framingham Heart Study between 1965 and 1967, 1674 coronary disease free individuals were followed up for the development of CHD over an eight-year period. The results indicated that not discussing anger was an independent predictor of CHD incidence when controlling for all other coronary risk factors and other psychosocial scales (Haynes, Feinleib, & Kannel, 1980). Although some studies did not find relationships between suppressed anger and CHD (Dembroski, MacDougall, Costa, & Grandits, 1989), most findings from 5 epidemiological studies indicated that anger suppression was an independent risk factor for development of CHD (Haynes, et al., 1980; Kneip et al., 1993; MacDougall, Dembroski, Dimsdale, & Hackett, 1985). Laboratory research reaches a similar conclusion. Anderson & Lawler’s (1995) study revealed that women who suppressed anger experienced grater BP change in anger recall task. Another experiment found high inhibition coupled with family history of CVD was related with the highest SBP in a sample of 60 boys aged 12-16 (Vögele & Steptoe, 1993). Taken together, the previous results seem to suggest that extremes of expression in both directions are related to adverse cardiovascular outcomes. This is also found in some studies interested in cardiovascular consequences of both anger exhibition and inhibition (Everson, Goldberg, Kaplan, Julkunen, & Salonen, 1998; László, et al., 2008). The adverse consequences of anger expression towards both sides also indicate that healthy anger regulation is far more than simply expressing or suppressing. Mechanism of the link between anger regulation and cardiovascular diseases. To link the acute effects of regulation in single anger episodes and the long term influence of anger regulation on the development of CVD, the reactivity hypothesis was proposed and has been widely accepted. According to the reactivity hypothesis, frequent experience of heighten cardiovascular responses may have deleterious impact on cardiovascular functioning and facilitate the development of CVD. In laboratory experiments, researchers are interested in comparing cardiovascular reactivity (CVR) which serves as an indicator related to cardiovascular health. Individuals who exhibit exaggerated cardiovascular responses to mental 6 challenges have a higher risk for subsequent cardiovascular diseases in contrast to their low-reactive counterparts (Kaplan, Manuck, Williams, & Strawn, 1993; Manuck, Kamarck, Kasprowicz, & Waldstein, 1993). Cardiovascular reactivity in a specific situation is also influenced by environmental variables. For example, anger regulatory strategy can be a variable that affects cardiovascular reactivity in anger situations. If a certain anger regulatory strategy is related with higher levels of CVR, people using it frequently may have higher risk of cardiovascular disease compared with other regulatory strategies. Results of some laboratory studies suggested that both anger expression and anger suppression were related with exaggerated CVR (Engebretson, Matthews, & Scheier, 1989; Houston, 1994). In line with this logic, suppression and exaggerated expression may share the same pathway as related to adverse cardiovascular outcomes. However, findings of experimental research on relations between anger manipulation and consequent CVR are not consistent. For example, an association between exaggerated CVR and anger suppression after provocation was observed in some studies (Engebretson, et al., 1989; Houston, 1994), but not in others (Powch & Houston, 1996; Smith & Houston, 1987). Anger expression was not consistently found related with greater CVR as well (Smith & Houston, 1987). The inconsistency may be due to differences in the effectiveness of angry provocation tasks, different timing of reactivity measurement and ignoring the influence of habitual anger expression style (Engebretson, et al., 1989). Can induced CVR in laboratory studies predict CHD? This question is crucial to bridge the acute effect obtained in laboratory studies and long term health outcomes. There are several considerations in addressing this question. First, repeated 7 exaggerated CVR may contribute to an increase of peripheral resistance which ultimately contributes to the development of CVD. There has been evidence that frequent and chronic exaggerated CVR may promote hypertrophy of the smooth muscle in arterioles which can lead to vasoconstriction (Mauss & Gross, 2004). The cardiac output which is excessive relative to demand can also trigger peripheral vasoconstriction. Both factors may lead to chronically increased peripheral resistance. Second, the trigged release of catecholamines during repeated CVR episodes is related to the development of atherosclerotic plague. Catecholamines, particularly epinephrine, may cause injury of the intimal endothelium of the coronary arteries in hemodynamic and/or biochemical ways. Once the coronary endothelium is damaged, catecholamine-induced release of free fatty acids in excess of levels needed for metabolic requirements can cause platelet aggregation, smooth muscle proliferation, and the deposition of core lipids within the lesion area. CVR has been found as an independent risk factor for development of ischemic heart disease (Kamarck et al., 1997; Treiber et al., 2003) and hypertension (Carroll, Smith, Sheffield, Shipley, & Marmot, 1995; Carroll et al., 2001; Markovitz, Raczynski, Wallace, Chettur, & Chesney, 1998; Menkes et al., 1989). Aside from the reactivity hypothesis, Brosschot & Thayer (1998) proposed an alternative mechanism linking anger suppression and cardiovascular disease which emphasized low parasympathetic activity and slow cardiovascular recovery rather than high sympathetic tone and elevated reactivity. According to their theory, parasympathetic activity (vagal tone) is suppressed during stressful circumstances which require organized behavioral and autonomic responses (Porges, 1991). As such, low vagal tone may be involved in the process of anger suppression. From a 8 physiological perspective, low vagal tone is associated with decreased control of heart rate and thus slower recovery of both heart rate (HR) and blood pressure (BP). This reasoning has been supported by experimental studies in which slower cardiovascular recovery when suppressing anger rather than expressing anger has been observed (Engebretson, et al., 1989). Slow recovery is considered as a critical factor for the development of CVD (Brosschot & Thayer, 1998). The relationship between slow cardiovascular recovery and CVD has been found in empirical studies. Such findings can serve as evidence of this model. Cardiovascular responses to anger episodes may vary in magnitude, frequency, and duration. Reactivity captures response magnitude whereas low vagal tone captures duration (Schwartz et al., 2003). Combining two mechanisms may give better explanation of the link of anger regulation and CVD. Regarding the specific cardiovascular parameters, indices utilized in the present study includes cardiac output (CO), pre-ejection period (PEP) total peripheral resistance (TPR), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP). HR is one of the most common indicators of autonomic activation, which reflects both sympathetic and parasympathetic influences on the sino-atrial node and the atrioventricular node. CO is the volume of blood pumped by the heart per minute. It serves as a general indicator of myocardial contractility. PEP is another cardiac indicator which refers to the time interval between onset of contraction to the ejection of blood. PEP has been widely used in the cardiovascular psychophysiology research as an indicator of cardiac performance. PEP was considered related to contractility of the ventricles of the heart (Brownley, Hurwitz, & Schneiderman, 2000; Wilson, 9 Lovallo, & Pincomb, 1989). TPR is an index of total peripheral resistance and was used to indicate vascular responses. SBP and DBP were also measured. Both SBP and DBP were determined by myocardial contractility and vascular resistance. However, SBP is more determined by the force with which the heart contracts whereas DBP is more related to systemic vascular resistance (Wright & Kirby, 2001). It has been argued that the cardiovascular system responds with a limited number of organized patterns of response (Allen, 2000). There is growing literature looking at the cardiovascular responding in patterns rather than looking at each index independently (e.g., Blascovich & Katkin, 1993; Blascovich, Mendes, Hunter, & Salomon, 1999; Tomaka, Blascovich, Kibler, & Ernst, 1997). CO and PEP are usually used as cardiac indicators and TPR is used as a vascular indicator. Comparison of cardiac and vascular activities differentiated two typical patterns of cardiovascular reactivity which are labeled as the challenge pattern and the threat pattern (Tomaka, Blascovich, Kelsey, & Leitten, 1993). Challenge vs. threat patterns were originally determined by cognitive appraisal of demand of task and available resource for coping. The challenge pattern occurs when personal abilities are appraised as congruent with situational demands. Challenge pattern was found related to an increase in cardiac activities and little or no change in systemic vascular resistance. In contrast, the threat pattern occurs when psychological resources are perceived as less than task demands. The physiological responses of threat pattern is moderate increase in cardiac activities along with an increase in vascular resistance (Mendes, Reis, Seery, & Blascovich, 2003; Tomaka, et al., 1993). CVR responses in the current study will be viewed in the context of these patterns. 10 Anger regulation and CVR. Based on the existing research, anger is related to cardiovascular health and the regulation of anger is more than simply expression or suppression. It is, therefore, important to explore effective methods to regulate anger. To address the topic of anger regulation, the bigger picture of general emotion regulation will be briefly reviewed. Gross (1998) proposed a process model to specify each step of emotion regulation and classify two broad forms of emotion regulatory strategies: strategies to manipulate the input for emotion (antecedent-focused strategies) and strategies to manipulate the output of emotion (response-focused strategies). Antecedent-focused regulation means to regulate the potential emotion before it is triggered. Take regulating negative emotion as an example. One can choose to avoid some people and situations to avoid the likely negative emotion response; turn attention away from the emotional cue or reevaluate the situation in order to alter the emotion. Responsefocused emotion regulation deals with emotional responses when the emotion is already generated. There are several types of response-focused regulation, such as to intensify, diminish, prolong or curtail ongoing experience, expression of the emotion or physiological responding (Gross, 1998). As representatives of antecedent-focused regulatory strategies and responsefocused regulatory strategies respectively, reappraisal and suppression were compared on many domains of functioning including cognition, social relationship and physical health. These two strategies were also chosen to be examined in this present study for two reasons. First, the concept of suppression corresponds to anger inhibition in the context of anger regulation. Reappraisal appears to be a beneficial 11 strategy judging from the process model theory and the available empirical studies. The effect of reappraisal in anger situation is worth being examined. Second, there has been a large body of literature comparing the effects of these two strategies, which provides rich background information to facilitate the present research. Comparison of suppression and reappraisal. Suppression is defined as inhibition of emotional expressive behavior when emotionally aroused. It is a type of response-focused regulatory strategy. Reappraisal is a form of cognitive change by which a potential emotion-eliciting situation would be reconstrued and the emotional impact would be changed (Gross & John, 2003). It is a form of antecedent-focused regulatory strategy. The acute effects of suppression and reappraisal on experiential, cognitive and physiological domains have been examined in laboratory studies. In some studies, researchers manipulated the usage of suppression and reappraisal experiments and compared their effects. In other studies, habitual usage of suppression and expression were used as a trait to predict the experiential and physiological responses in the situation created in laboratory. Results of the experimental studies revealed that instructed usage of suppression did not reduce, and might even increase, negative emotional experiences such as disgust, anger, sadness and embarrassment (Gross, 1998; Gross & Levenson, 1993, 1997; Harris, 2001). As a result of increasing cognitive load, suppression impaired memory for socially relevant information (Richards & Gross, 2000). Suppression was found accompanied by increased sympathetic and cardiovascular responding in most studies (Gross, 1998; Gross & Levenson, 1993, 1997). In contrast, instructed usage of reappraisal was related to less negative experience and more adaptive cardiovascular responding (Gross, 1998). 12 With respect to the acute effects of habitual usage of suppression and reappraisal, similar results were found. Egloff and colleagues (2006) observed the spontaneous usage of suppression and reappraisal in the standard setting and measured the corresponding emotional experience, expressive behavior and physiological response. Their results suggested that suppression had no impact on negative affect but was related to less expressive behavior and higher physiological activation. In contrast, reappraisal was related to less expressive behavior but had no impact on negative affect and physiological responses. In a study that examined anger specifically, it was found that people high in reappraisal felt less angry, showed greater cardiac output and ventricular contractility, and less total peripheral resistance than people low in reappraisal (Mauss, Cook, Cheng, & Gross, 2007). As noted above, emotion regulation style can be considered as a relatively stable trait. Gross and colleagues (2003) developed the Emotion Regulation Questionnaire (ERQ) to measure individual differences in habitual usage of emotion suppression and reappraisal. A series of studies has been done to compare the consequences of habitual usage of these two regulatory strategies. Instead of focusing on the immediate effects in the experimental studies, the questionnaire studies looked at the long term and cumulative effects of using suppression and reappraisal on a regular basis. Findings revealed that suppression was related to more negative experience, poorer well-being and less interpersonal closeness. On the other hand, reappraisal was related to less negative experience, higher level of life satisfaction and greater social closeness (Gross & John, 2003; Richards & Gross, 2000). 13 Taken together, evidence from experimental studies and questionnaire surveys demonstrates that reappraisal is more beneficial than suppression in both experiential and physiological domains. Suppression and reappraisal in the context of anger. Next consider the consequences of suppression and reappraisal in the context of anger. As indicated, effects of anger suppression (anger-in) on cardiovascular responses have been intensively examined in previous research. Available evidence suggested anger suppression was related with greater CVR and higher risk of CHD. Although reappraisal has been found to be beneficial when regulating some specific emotions (e.g., disgust and sadness), it has not been much studied in the context of anger. For example, only two studies on the relationship between reappraisal of anger and CVR responding was found. In one study, researchers manipulated the regulatory strategies used. Results revealed that reappraisal led to less negative experience, less intensity of CVR and faster CVR recovery compared with rumination (Ray, Wilhelm, & Gross, 2008). In the other study, effects of habitual usage of reappraisal were examined. People used reappraisal habitually in daily life showed less cardiovascular reactivity than people seldom use reappraisal to regulate anger (Mauss, et al., 2007). Reappraisal has been widely used in clinical practice of anger management. Most anger management programs are designed following the Cognitive-Behavioral Approach, in which cognitive reconstructing plays a vital role. Clients are usually asked to think before they react according to the automatic wind-up thoughts triggered by the anger event. They are trained to use self-monitoring and self- 14 instruction to alter automatic thoughts, interpretations and assumptions about the trigger (O'Neill, 2006). Based on the available evidence of positive outcomes of reappraisal in the context of various emotions and the effectiveness of cognitive reconstructing in clinical practice, it is reasonable to hypothesize that using reappraisal in the context of anger situations can engender beneficial experiential and physiological outcomes. Thus, together with anger expression and suppression, effects of reappraisal will be examined in the present study. Moderation of Culture in the Relationship between Anger Regulatory Strategies and Consequences One important limitation of the previous research on emotion regulation is that it ignores the influence of culture on the consequences of emotion regulation. Most studies were conducted in Western countries with predominantly European American participants. Given notable differences between Asian and European American cultures, results in the Asian cultural context might be different. In the following section, relation of culture and emotion regulation will be explained and cultural influence of anger regulation will be emphasized. Western culture vs. Asian culture. Kroeber & Kluckhohn (as cited in Tsai, Levenson, & McCoy, 2006) defined culture as socially shared transmitted patterns of ideas (values, norms, and beliefs) that are instantiated in everyday practices, institutions, and artifacts. Individualismcollectivism is a well-known dimension in the culture studies related to Western culture and Asian culture. According to this theory, a fundamental difference between 15 members of individualistic cultures and members of collectivistic culture lies in their view of the relation of self, group and environment. Individuals in an individualistic cultural context place self over the group concerns. They are more concerned with their own views, needs, and goals rather than others. In contrast, members of collectivistic cultures place group over individual concerns. They are more concerned with the views, needs and goals of the group rather than themselves (Leung & Bond, 1984). Due to the fundamental differences in value system, members of Western culture and Asian culture are different in many aspects of social life. Differences in patterns of social relationship and emotion regulation will be elaborated because they are directly related with how people deal with anger. In the research on cultural differences in social relationships, the Western style was described as individual orientation which refers to a form of relationship that “has autonomy as its predominant feature. It motivates the person to dominant, control and change the biological, physical and social environment to fulfil personal desires, motives and ambitions” (Yang, 1995, p. 21). In Western culture, relationships are evaluated by the extent to which they meet one’s personal needs. Because of the frequent expression and negotiation of personal needs, interpersonal conflicts are considered as inevitable (Mesquita & Albert, 2007). In contrast, the Eastern style of social relationships has been described as a collectivistic orientation which “has harmony as predominant feature. And it found its expression in people’s attempts to establish and maintain harmonious relationship with the environment by submitting to, cooperating with, or merging into the physical, biological, and social surroundings” (Yang, 1995, p. 21). Individuals in Eastern culture are considered in relation to others and belonging to social groups. 16 Relationships are based on the fulfilment of role-based obligations ( Mesquita & Albert, 2007). In Eastern culture encouragement of harmonious interpersonal relations and discouragement of conflicts is one of the principles of problem solving. Culture and anger regulation. Individuals’ beliefs, values, attitudes, affect and behaviours are heavily influenced by culture. Emotion regulation is also always embedded in the meanings and practices that constitute the socio-cultural world. Cultural models focus attention, guide perception, lend meaning and imbue emotional value. How culture shapes emotions. Kitayama et al (2006) proposed a dual process model to explain how culture shapes individuals’ emotional responses. Social affordance and social reinforcement are two important mechanisms. In terms of social affordance, a specific culture provides dominant themes for some emotions rather than others; for example, Western culture nurtures disengaging emotions which come from success or failure in personal achievements whereas Eastern culture nurtures engaging emotions which derive from success or failure in relationship goals. For example, in one study Japanese showed a pervasive tendency to report experiencing engaging emotions more strongly than they experienced disengaging emotions, but American showed a reversed tendency (Kitayama, Mesquita, & Karasawa, 2006). Additionally, culture modifies emotion responses by valuing and devaluing the corresponding experience, expression style or regulatory strategy. This is the process called social reinforcement. 17 Culture differences in anger regulation. Anger is a negative emotion which mostly occurs in interpersonal situations. Anger is usually generated when an event is unexpected, unpleasant, obstructs goals, is seen as unfair and as caused by other people (Mesquita & Ellsworth, 2001). Based on the research of Kitayama and colleagues, anger is considered as a socially disengaging emotion, which is grounded in independence and autonomy of self (Kitayama, et al., 2006). As a public emotion, regulation of anger is heavily influenced by cultural context. The regulation of anger is determined by anger experience and social norms in different situations. As noted above, in the Chinese cultural context, social harmony is highly valued. People are educated to maintain interpersonal harmony by avoiding conflicts. Open expression of anger is considered as impropriate in most social situations. Chinese tend to moderate their actions and performance to fit social norms and others’ opinions and tend to ignore their own feelings (Yang, 1995). And that’s why situation seems a better predictor of behaviour than personality for Chinese people (Wang & Cui, 2006). It seems that the socialization process of Chinese is the process of learning to tolerate and live with unavoidable inconsistencies between the public self and private self. In contrast, although open expression of anger may bring negative consequences for relationship in Western societies, norms against open expression of negative emotion are weaker with less social pressure for Westerners against expressing negative emotions such as anger. Additionally, individuals in a Western cultural context are perceived to be autonomous and self-sufficient and may be less concerned about the social restraint of anger expression. Finally, expressing anger directly sometimes can be interpreted as assertiveness which may be encouraged. 18 Hence, the open expression of anger can be reinforced by cultural values. For these reasons, Caucasians were expected to use expression more than suppression in daily life. Therefore, it’s reasonable to hypothesize Chinese are more likely to use suppression to regulate anger in daily life rather than expressing it and the reverse is true for Caucasians. Further, since Chinese receive positive reinforcement when they suppress anger and they are used to doing that, the consequences of suppression would not be as harmful as literature has suggested for Westerners. These two hypotheses will be examined in this present study. Regarding the usage of reappraisal, from Confucian teachings, Chinese people are educated to think repeatedly before taking action (san si er hou xing). This is in line with the meaning of reappraisal. Chinese may be more likely to use reappraisal to avoid conflicts and help them to fit others’ expectation. This question will be also addressed in the current study. Empirical evidence of cultural differences in emotion regulation. Several empirical studies have been conducted to examine cultural differences in emotion regulation. Gross & John (2003) assessed emotion suppression among different ethnicities in the United States and found that minorities, including Asians, reported higher levels of habitual suppression than did Caucasians (Gross & John, 2003). Suchday & Larkin (2004) reported Asian Indian men had higher habitual anger suppression levels than Caucasian men. Butler et al (2007) categorized their sample by cultural values and found women with predominantly European values reported lower levels of habitual suppression than did women with bicultural European-Asian values. 19 Does habitual use affect the outcomes of anger regulation strategies? Engebretson, Matthews, & Scheier (1989) proposed a “matching hypothesis” to answer this question. The matching hypothesis states that when an individual uses a particular method of dealing with anger (e.g., anger suppression) that is different from his or her typical method of dealing with anger (e.g., anger expression), he or she will show exaggerated cardiovascular responses to those situations. Their experiment provided evidence for the hypothesis by indicating that individuals allowed to act in their preferred mode of anger expression showed a quicker decrease in SBP reactivity than those not allowed to act in their preferred mode of anger expression. Considering that Asians use suppression more frequently, under more conditions, the usage of suppression may be more automatic and require fewer cognitive resources to execute. The consequences of anger suppression should be different between Asians and Caucasians. This reasoning gets some support from previous research. Suh & colleagues (1998) found that emotional ambivalence, which refers to a conflicting desire to express versus inhibit emotions, was negatively related to life satisfaction for Caucasians, but not for Chinese. Butler, Lee & Gross (2007) compared Caucasian Americans and Asian Americans on anger suppression and its social consequences. They found deleterious effects reduced when people with more Asian values used suppression. In terms of cardiovascular response, the existing findings are inconsistent. Suchday & Larkin (2004) did a comparison of cardiovascular reactivity between Indian and Caucasian men in an anger provocation interaction. They found that for Indians, the recovery of DBP was delayed when anger expression preceded anger 20 inhibition compared to the reverse order. For Caucasians, DBP recovery did not differ between the two orders. In a more recent research, Caucasian American females and Asian American females were compared in terms of emotion expressivity and blood pressure in a face-to-face interaction about a distressing film. Increase in emotion expressivity was found to be associated with a decrease in blood pressure in Caucasians dyads, but the reverse was true in Asian American dyads (Butler, Lee, & Gross, 2009). In general, the consequences of anger regulation in an Asian cultural context have so far received insufficient research attention. One purpose of the present study is to clarify the effects of habitual usage of anger regulatory strategies on the consequences of regulation for Asian and Caucasian participants. In the existing cross-cultural research on anger regulation, culture differences are often represented by ethnicity differences. Although ethnicity grouping is a reasonable way to represent different cultural models, it is still unclear the degree to which the differences are due to cultural factors. In the present study, cultural values will be measured to get a clearer look at the relationship between culture and emotion regulation. Overview of the Present Study The purpose of present study was to examine the experiential and cardiovascular outcomes of three specific anger regulation strategies (i.e., expression, suppression and reappraisal) in a laboratory environment. Two cultural groups were involved in the experiment and the moderation effect of culture in the strategyoutcome relationship was examined. 21 Three sets of hypotheses were proposed. Hypothesis 1 Because of an emphasis on harmony in relationships and restraint of emotion expression, Chinese participants are predicted to be more likely to suppress anger compared with their Caucasian counterparts. What’s more, affected by other orientation which is a main feature of social relationships in Chinese culture, Chinese participants are expected to be more likely to engage in reappraisal (thinking from the partner’s point of view) in anger situations. Hypothesis 2 Culture will moderate the relationship between anger expression and suppression and the corresponding emotional experience. Experiential outcomes of reappraisal are hypothesized as most beneficial in both cultural groups. Caucasians will feel the greatest intensity of anger when they are asked to suppress anger, be less angry when expressing anger outwardly and least angry when doing reappraisal. Chinese are expected to experience greatest intensity of anger when asked to express freely, be less angry when suppressing anger and least angry when doing reappraisal. The same pattern of means is expected for negative emotion while the reverse pattern of means is expected for positive emotion. Hypothesis 3 Culture is expected to have a moderation effect in the relationship between anger regulatory strategies and cardiovascular reactivity (CVR). Based on the existing literature on emotion-specific physiological responses, CVR responses to 22 anger are in line with the challenge pattern (i.e., significant increase in CO, decrease in PEP and decrease or no change in TPR) (Herrald & Tomaka, 2002), therefore, CVR responses of participants across all conditions are expected to show a challenge pattern. Furthermore, Caucasians assigned to the anger suppression condition will have greatest CVR challenge reactivity, followed by Caucasians in the expression condition and the reappraisal condition. In contrast, Chinese assigned to the anger expression condition will have the greatest CVR challenge pattern, followed by Chinese in the suppression condition and the reappraisal condition. 23 CHAPTER 2 METHOD Participants Forty-five Chinese and 45 Caucasian females were recruited in the experiment. Chinese participants were undergraduate students from the Research Participation Program of Psychology Department of National University of Singapore (NUS) and earned course credits for participation. Caucasians were exchange students at NUS from North American and European countries who volunteered to participate in the research activity and got S$10 in return. Chinese participants were 20.82 years old on average with the standard deviation of 0.31 and the average age of Caucasian participants was 21.00 years with the standard deviation of 0.26. There was no significant difference in age between two groups, t (87) = -.44, p ns. To rule out the possible confounding effect of gender, only female participants were involved in the experiment. Potential participants were screened by a demographic questionnaire to ensure they had not been diagnosed with heart disease and hypertension and were not under any medication which might affect cardiovascular indices. They were also screened for cultural background. For Chinese participants, the requirements were that, (a) parents and grandparents were Chinese; (b) parents and grandparents were born and raised in Asian countries; (c) participants themselves were born and raised in Asian countries and (d) participants were able to speak Chinese (e.g., Mandarin). For Caucasian participants the requirements were that (a) parents and grandparents were European or European American; (b) parents and grandparents were born and 24 raised in North America or Europe; and (c) participants themselves were born and raised in North America or Europe1. As shown in Table 1, 88 respondents reported their parents and grandparents from the same ethnicity as them with one exception that one Caucasian participant had one Turkish grandmother. Of all participants studied, 86 reported their parents and grandparents were born and raised in their original culture (i.e. Chinese in Asian culture and Caucasian in Western culture). 3 Caucasian participants reported one of their grandparents was born in Poland, Turkey and Russia, respectively. For the participants themselves, 87 of them were born and raised in their original culture. One Chinese participant was born in Canada but was taken back to Singapore at 2 years old. One Caucasian participant was born in Poland but grew up in France. All Chinese participants could speak Chinese. Although some participants didn’t fulfill the requirements completely, there were only minor deviations. Hence, they were still involved in the experiment and it could be roughly considered that the ethnicity groups were culture-representative. Table 1. Cultural background Congruence with original culture Ethnicity of Parents and grandparents (N=89) Yes 88 No 1 Parents and grandparents born and raised (N=89) 86 3 Participants’ born and raised(N=89) Language (for Chinese group, n=45) 87 2 45 0 1 All potential participants filled in the demographic questionnaire and 89 valid responses were obtained since one participant’s data was lost due to computer failure. 25 Equivalencies on health condition and habits were examined between the cultural groups. As shown in Table 2, two cultural groups did not differ in family history of CVD, χ2 (1, N=89) = 1.15, p ns. and the habit of smoking, χ2 (1, N=89) = 1.03, p ns. A marginal significant difference of BMI between two groups emerged, t (85) = -1.98, p=.051. Chinese and Caucasians also differed in alcohol consumption, χ2 (1, N=89) = 24.96, p < .01, and frequency of exercise, t (87) = -2.09, p = .039. Due to effect of estrogen on cardiovascular functioning (Mendelsohn & Karas, 1999) and possible enhanced responsiveness to psychosocial stressor in the luteal phase relative to situation in the follicular phase (Kajantie & Phillips, 2006), menstrual cycle was also investigated. No significant difference was found between two cultural groups with respect to menstrual cycle stage, χ2 (1, N=86) = .30, p ns. Table 2. Demographic Equivalence Characteristic Chinese Caucasians χ2 t Family history 1.15 Yes 8 12 No 37 32 Menstrual status 0.30 Follicular phase 19 22 . Luteal phase 23 21 Alcohol consumption 24.96** Yes 12 35 No 33 9 Smoking 1.03 Yes 0 45 No 1 43 BMI 20.41±3.63a 21.75±2.58b -1.98 c d Exercise 2.89±1.05 3.34±.987 -2.09* Note an=44. bn=43. cn=45. dn=44 *p[...]... studies and questionnaire surveys demonstrates that reappraisal is more beneficial than suppression in both experiential and physiological domains Suppression and reappraisal in the context of anger Next consider the consequences of suppression and reappraisal in the context of anger As indicated, effects of anger suppression (anger- in) on cardiovascular responses have been intensively examined in previous... Negative emotion 84 83 Anger- in and Anger- out Subscales of STAXI-II The Anger- in and Anger- out subscales of STAXI-II were used to assess habitual anger expression style Reliability and validity of STAXI has been examined in Singaporean Chinese population and results indicated an acceptable high internal consistency with Cronbach’s α of 0.69 for Anger- out subscale and α of 0.68 for Anger- in subscale The test-retest... grandmother Of all participants studied, 86 reported their parents and grandparents were born and raised in their original culture (i.e Chinese in Asian culture and Caucasian in Western culture) 3 Caucasian participants reported one of their grandparents was born in Poland, Turkey and Russia, respectively For the participants themselves, 87 of them were born and raised in their original culture One Chinese... levels of cultural background (Asian and European/American) and 3 levels of regulatory strategy (anger expression, anger suppression and reappraisal) Participants in each cultural group were randomly assigned to expression, suppression or reappraisal conditions Two sets of dependent variables (changes in emotional experience and indicators of cardiovascular reactivity including CO, PEP, TPR, HR, SBP and. .. and social surroundings” (Yang, 1995, p 21) Individuals in Eastern culture are considered in relation to others and belonging to social groups 16 Relationships are based on the fulfilment of role- based obligations ( Mesquita & Albert, 2007) In Eastern culture encouragement of harmonious interpersonal relations and discouragement of conflicts is one of the principles of problem solving Culture and anger. .. were detached Finally, the participant was asked to complete the Anger- in and Anger- out subscales of STAXI-II and reappraisal subscale of ERQ to measure individual difference in anger expression, suppression and reappraisal and the Portrait Value Questionnaire (PVQ) to assess cultural values During the whole procedure, HR, BP, CO, TPR and PEP were measured continuously in the baseline, during the task... together with anger expression and suppression, effects of reappraisal will be examined in the present study Moderation of Culture in the Relationship between Anger Regulatory Strategies and Consequences One important limitation of the previous research on emotion regulation is that it ignores the influence of culture on the consequences of emotion regulation Most studies were conducted in Western countries... outcomes of three specific anger regulation strategies (i.e., expression, suppression and reappraisal) in a laboratory environment Two cultural groups were involved in the experiment and the moderation effect of culture in the strategyoutcome relationship was examined 21 Three sets of hypotheses were proposed Hypothesis 1 Because of an emphasis on harmony in relationships and restraint of emotion expression,. .. for Anger- out and Anger- in subscales was 0.61 and 0.81 respectively (Bishop & Quah, 1998) Cronbach’s α was calculated for Anger- out and Anger- in in the present study Results indicated both scales had high internal consistency with α=0.80 for Angerout, α=0.76 for Anger- in 28 Reappraisal Subscale of Adapted Emotion Regulation Questionnaire (ERQ) To measure habitual usage of reappraisal, the Emotion Regulation. .. grounded in independence and autonomy of self (Kitayama, et al., 2006) As a public emotion, regulation of anger is heavily influenced by cultural context The regulation of anger is determined by anger experience and social norms in different situations As noted above, in the Chinese cultural context, social harmony is highly valued People are educated to maintain interpersonal harmony by avoiding conflicts