Culture, emotion suppression and disclosure, and health

The impact of culture on emotion suppression: Insights from an electrophysiological study of emotion regulation in Japan

Prior theory and evidence suggest that native East Asians tend to down-regulate their emotional arousal to negatively valenced experiences through expressive suppression, an emotion regulation technique focused on suppressing one's emotional experience. One proposed explanation for this choice of regulation strategy and its efficacy is rooted in their commitment to the cultural value of interdependence with others. However, prior work has not yet thoroughly supported this hypothesis using in vivo neural correlates of emotion regulation. Here, we utilized an established electroencephalogram (EEG) correlate of emotional arousal, the late positive potential (LPP), to examine whether down-regulation of the LPP in native East Asians might be particularly pronounced for those relatively high in interdependent self-construal. In this study, native Japanese participants attempted to suppress their emotional reaction to unpleasant images during EEG recording. In support of the hypothesis that emotion suppression among native East Asians is influenced by the cultural value of interdependence, there was a significant effect of interdependent self-construal on the LPP. Specifically, those relatively high in interdependent (versus independent) self-construal exhibited a smaller LPP in response to unpleasant pictures when instructed to suppress their emotions versus a passive viewing condition. However, this effect was negligible for those relatively low in interdependent self-construal, suggesting that cultural values impact the in vivo efficacy of different emotion regulation techniques. These results demonstrate the importance of identifying correspondence between self-report measures and in vivo correlates of emotion regulation in cross-cultural research.

A meta-analytic review of the relations between anxiety and empathy

Although theory suggests that empathy may signal a risk for anxiety (Tone & Tully, 2014), the relation between these constructs remains unclear due to the lack of a quantitative synthesis of empirical findings. We addressed this question by conducting three meta-analyses assessing anxiety and general, cognitive, and affective empathy (k's = 70-102 samples; N's = 19,410-25,102 participants). Results suggest that anxiety has a small and significant association with general empathy (r = .08). The relation of clinical anxiety with cognitive empathy was significant but very weak (r = -.03), and small for affective empathy (r = .16). Geographic region and the type of cognitive (e.g., perspective taking, fantasy) and affective empathy (e.g., affective resonance, empathic concern) emerged as moderators. Results suggest that anxiety has a weaker association with general empathy but a stronger association with affective empathy in participants from predominantly collectivistic geographic regions. Further, greater anxiety was weakly associated with less perspective-taking and greater fantasy, and anxiety had a more modest association with empathic concern than other types of affective empathy. Targeting affective empathy (e.g., promoting coping strategies when faced with others' distress) in interventions for anxiety may be beneficial.

The Impact of Virtual Humans on Psychosomatic Medicine

OBJECTIVE

Virtual humans are likely to enhance the delivery of health care over the next decade. Virtual humans are artificially intelligent computer agents with hyperrealistic, autonomously animated embodiments based on affective computing techniques. Virtual humans could be programmed to screen for health conditions, triage patients, and deliver health interventions, with appropriate facial expressions and body gestures, functioning as a supplement to human care. This article provides a perspective on the implications of virtual humans for behavioral and psychosomatic medicine, and health psychology.

METHODS

A narrative review was conducted to integrate observations and findings from research on virtual humans from 91 articles in this multidisciplinary area.

RESULTS

Virtual humans can be used for multimodal behavior analysis of patients, individualized tailoring of interventions, and detection of changes of psychological and behavioral measures over time. Virtual humans can also pair the scalability of a website with the interactivity and relational skills of a human tele-therapist. Research is beginning to show the acceptability, feasibility, and preliminary effectiveness of virtual humans in a range of populations. Virtual humans can be easily tailored in terms of their appearance, voice, and language, and may be adapted to fit the characteristics of a patient population or hard-to-reach groups. If co-designed with these communities, virtual humans may help to promote health care engagement and improve outcomes.

CONCLUSIONS

Virtual humans can engage and motivate patients, and deliver personalized psychological and behavioral health care. This article provides an overview of the potential impact of virtual humans on psychosomatic medicine and discusses ethical implications.

The generation that lived during/participated in the war and the generation that inherited it: association between veterans PTSD and adult offspring's emotional regulation strategies and alexithymia levels

BACKGROUND

The long-term repercussions that war can have on both war generations and post-war generations lack in the literature. It is imperative to understand the psychological consequences of the Lebanese Civil War that took place from 1975 to 1990, on the offspring of those who took part in it. Accordingly, the objective of this study was to assess the association between paternal/veterans PTSD and adult offspring's emotional regulation strategies and alexithymia levels, 30 years after the end of war.

METHOD

A cross-sectional study was carried out between September 2020 and September 2021 on a sample of 75 fathers of Lebanese former veterans and paramilitary veterans and their adult offspring. For the veterans and paramilitary veterans' population, the PTSD Checklist was used to assess post-traumatic stress disorder, and the Combat Exposure Scale (CES) was used to measure the level of combat exposure. For the offspring population, the Emotional Regulation Questionnaire (ERQ) was used to assess emotional regulation strategies and the Toronto Alexithymia Scale (TAS) was used to measure the levels of alexithymia.

RESULTS

Paternal PTSD (Beta = 10.19) was associated with higher levels of alexithymia in the offspring population. Regarding emotional regulation strategies, results showed that paternal PTSD (Beta = -3.24) was significantly associated with a decrease in the cognitive reappraisal score in the offspring. Also, paternal PTSD (Beta = 4.57) was significantly associated with an increase in expressive suppression score. Additionally, an older father's age (Beta = 1.11) was significantly associated with an increased alexithymia score in the offspring. Moreover, results showed that paternal combat injuries (Beta = -4.24) were significantly associated with a decrease in the alexithymia score in the offspring population and an increase in the expressive suppression score (Beta = 3.28).

CONCLUSION

This study shows that fathers' traumatic experience of war influences emotion regulation and alexithymia levels in their offspring. Longitudinal studies taking into account the age of the offspring at the time of onset of fathers' symptoms may provide us with additional information to understand the influence of paternal PTSD on the emotional functioning of offspring during different phases of emotional development.

Cultural differences in the relations between expressive flexibility and life satisfaction over time

Background

Expressive flexibility refers to the ability to assess situational demands and adjust one's emotion expressions via enhancement or suppression. It has been associated with lower levels of depressive and anxiety symptoms and greater social acceptance. These relationships, however, have not yet been examined across cultures-where prior research has found cultural differences in norms on emotion displays and their associations with mental health. This study examined expressive flexibility across three cultural groups and their associations with life satisfaction and depressive symptoms over time.

Methods

276 first-year college students (146 Asian American, 71 European Americans, and 62 Latinx Americans) completed two online surveys during the first (T1) and thirteenth week (T2) of the Fall 2020 academic semester.

Results

Results revealed no significant cultural group differences in the ability to enhance or suppress emotions. However, we found a significant ethnicity x enhancement ability interaction in predicting T2 life satisfaction, controlling for T1 life satisfaction, age, gender, and emotion regulation frequency. Specifically, greater ability to enhance one's emotions was significantly associated with higher life satisfaction over time among Asian Americans, but not for European Americans and Latinx Americans.

Discussion

Our findings illustrate the importance of not looking just at cultural group differences in the levels of expressive flexibility, but also at the associations between expressive flexibility and mental health.

Beyond emotional intelligence: The new construct of meta-emotional intelligence

Meta-emotional intelligence is a recently developed multidimensional construct that, starting from the original ability model of emotional intelligence, focuses on the cognitive aspects of emotional abilities and on the metacognitive and meta-emotional processes that influence our emotional life. Thus, meta-emotional intelligence is the combination of emotional abilities and meta-emotional dimensions, such as the beliefs about emotions, the self-concept about one's emotional abilities, and the self-evaluation of performance. This article aims to illustrate the theoretical and methodological background of this construct and to describe the IE-ACCME test, an original multi-method tool that has been developed to measure the different variables that compose meta-emotional intelligence. Applications of this construct will be discussed, as well as future directions.

The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial

BACKGROUND

Expressive writing interventions confer mental health benefits for non-Hispanic Whites. However, research is lacking in adapting this paradigm for minoritized groups. This study evaluated the impacts of two culturally adapted expressive writing interventions on depressive and anxiety symptoms and potential mediators (perceived stress and intrusive thoughts) among Chinese American breast cancer survivors (CABCS).

METHODS AND RESULTS

CABCS (N = 136) were randomly assigned to one of three conditions to write three weekly essays: enhanced self-regulation condition (ESR) to write about stress and coping (Week 1), deepest feelings (Week 2), and finding benefits (Week 3); self-regulation condition (SR) to write about deepest feelings (Week 1), stress and coping (Week 2), and finding benefits (Week 3); and control condition to write about facts relevant to their cancer experience (Weeks 1-3). Compared with the control condition, the ESR but not SR, reduced depressive and anxiety symptoms at all follow-up time points (1, 3, and 6-months) through reductions in perceived stress.

CONCLUSION

A cultural adaptation altering the order of expressive writing prompts resulted in the greatest benefit for CABCS' depressive and anxiety symptoms. Research testing both the content and ordering of components may be vital to advance cultural adaptation science and optimize intervention efficacy.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02946619.

Exploring Malaysian parents' and teachers' cultural conceptualization of adolescent social and emotional competencies: A qualitative formative study

Introduction

Global implementation of social and emotional learning (SEL) has been suggested to incorporate a systematic cultural adaptation process which relies on ground-up empirical data of a target cultural group in tailoring a culturally sensitive SEL intervention. Preliminary formative studies among local parents and educators were done to explore the conceptualization of social and emotional competencies (SECs) in various cultural settings, such as the continent of Africa and among the indigenous and refugee groups. Unfortunately, little scholarship has been devoted to studying the SEL adaptation process in Southeast Asian regions. This formative study aimed to explore Malaysian parents' and teachers' cultural conceptualization of adolescent SECs.

Methods

This qualitative study interviewed 12 Malaysian parents and 10 Malaysian teachers comprising of Malay (82%), Chinese (9%) and Indian (9%) races in an online focus group discussion. Sampling is purposive to parents of adolescents and teachers at secondary school only. Data were analyzed thematically to determine the culturally sensitive SEL constructs for Malaysian adolescents.

Results

All themes and sub-themes of SEC regarded as crucial for Malaysian adolescents are aligned with CASEL's five domains of competencies. Our findings extended the conceptualization of subskills under CASEL's relationship skills and responsible decision-making domains, which reflect Asian cultural values. The main themes of social competency: (a) preserving interpersonal relationships, (b) utilizing intrapersonal skills, and (c) communicating effectively, are shared with the established CASEL constructs. However, the underlying subthemes denote the unique cultural manifestation of social competency in Malaysia. Two of the emotional competency themes represent the established CASEL constructs: (a) practicing self-regulation, (b) demonstrating help-seeking behavior, and the other two themes signify Asian values: (c) upholding altruism, and (d) maintaining cultural display rules.

Discussions

This formative study revealed the habitual use of experiential and expressive suppressions as adaptive emotion regulation strategies in Malaysian collectivist culture and offered a potential alternative emotion regulation pathway suitable for Malaysian adolescents. It also informed the feasibility of implementing SEL modules developed based on the CASEL framework in Malaysia and suggested two key lessons to enhance the cultural sensitivity of SEL in Malaysia: effective, respectful communication and expressive writing.

Spontaneous suppression in dating couples: Social and physiological correlates of suppressing negative and positive emotions during negative and positive conversations

Suppression (i.e., inhibiting one's emotional expression) has typically been associated with social and physiological costs. However, recent theorizing calls into question the inevitability of these costs. The present study takes a more nuanced approach and examines the social and physiological correlates of spontaneous (i.e., uninstructed) suppression when considering two potentially critical factors: the valence of the suppressed emotions (i.e., negative vs. positive) and the valence of the emotional context in which emotions are suppressed (i.e., negative conversation vs. positive conversation). Specifically, dating couples (N = 196 couples) completed both a negatively-valenced and a positively-valenced conversation in the laboratory while their autonomic-physiological responses were recorded. After each conversation, participants rated 1) the extent to which they had suppressed their negative and positive emotions, 2) the quality of the conversation, and 3) how connected they felt with their partner. We used Actor-Partner Interdependence Models to estimate actor effects (e.g., association of one's own suppression and one's own connectedness) and partner effects (e.g., association of one's partner's suppression and one's own connectedness). Suppression was associated with lower conversation quality and connectedness for the actors but largely not for the partners, regardless of the valence of the suppressed emotions and of the context, even when adjusting for felt emotion. Additionally, suppression was consistently not associated with physiological responses of actors or partners. Together, these findings suggest that, during emotional conversations with one's romantic partner, spontaneous (unlike instructed) suppression is associated with social but not physiological costs for the self but not one's partner.

Promoting healthy trajectories for urban middle school youth through county-funded, parks-based after-school programming

Ongoing pressure for public schools to prioritize academics has increased attention on after-school settings as a critical space for social-emotional learning (SEL). After-school programs are uniquely positioned to build protective and promotive factors that contribute to positive future orientation, especially within communities where systemic inequities create barriers to high school graduation, higher education, employment, and earnings. This study examines Fit2Lead Youth Enrichment and Sports (YES), a county-funded, parks-based after-school collaboration for middle schoolers that merges mental health and recreation to promote healthy trajectories. Eight Miami neighborhood parks were selected based on county data indicating high rates of violence. An open trial design (N = 9 parks, 198 youth; ages 9-15; 40.5% female; 66.5% Black/African American, 24.9% Hispanic/Latinx, and 76.3% low-income) tested hypotheses that participation for adolescents exposed to community violence would disrupt a commonly reported decline in self-regulation and self-efficacy, and mitigate risk for anxiety and depression. Youth completed questionnaires at the beginning and end of one school year. Paired t-tests revealed no changes from pre to post, and no differences by baseline levels of youth and parent mental health. Findings highlight the promise of prevention programs to disrupt downward trajectories for youth during the risky time of early adolescence.

Social constraints and fear of recurrence among Chinese American breast cancer survivors: An exploration of psychosocial mediators

OBJECTIVE

Fear of cancer recurrence (FCR) is commonly experienced among Caucasian and Chinese American breast cancer survivors (BCS). Emerging studies have suggested that Caucasian BCS' communication with family members contributes to their FCR. However, whether such findings apply to Chinese American BCS has yet to be explored. This study examined the association between social constraints (i.e., perceived barriers from significant others inhibiting cancer-related disclosure) and FCR among 136 Chinese American BCS, plus proposed that self-stigma (i.e., internalized feelings of shame about having cancer), bodily pain, and ambivalence over emotional expression (AEE; conflict between the desire to express emotions and the fear of its consequences) would mediate the association.

METHODS

Participants recruited through cancer associations in the USA were invited to complete a cross-sectional survey measuring their socio-demographic/cancer-related variables and the above-mentioned psychological variables.

RESULTS

Higher levels of social constraints, AEE, self-stigma, and bodily pain were associated with higher FCR (rs ranged from 0.27 to 0.40, ps < 0.01). After controlling for covariates, path analysis results supported the proposed mediation model with satisfactory fit indices (χ² (7) = 2.08, Comparative Fit index = 1.00, Tucker Lewis Index = 1.08, Root Mean Square Error of Approximation = 0.00). Specifically, social constraints were associated with higher FCR through increased self-stigma (β = 0.10, 95% confidence interval [CI] = 0.02, 0.17), AEE (β = 0.14, 95% CI = 0.01, 0.27), and bodily pain (β = 0.09, 95% CI = 0.02, 0.17), indicating significant mediation effects. After considering the mediators, the direct effect from social constraints to FCR was no longer significant.

CONCLUSIONS

The association between social constraints and higher FCR could be mediated by increased self-stigma, AEE, and bodily pain among Chinese American BCS. Interventions targeting to address those variables may reduce FCR among those BCS.

Emotion regulation during personal goal pursuit: Integration versus suppression of emotions

OBJECTIVE

Goal pursuit may involve setbacks likely to elicit negative emotions. To continue pursuing the goal, an individual may need to regulate those emotions. In this study, we compared the unique contributions of two emotion regulation styles, integrative emotion regulation (IER) and suppressive emotion regulation (SER), to goal pursuit processes. We tested the hypotheses that IER and SER would be differentially related to goal progress and goal-related effort and goal-related depressed mood would mediate those relations.

METHOD

255 Israeli participants completed five web questionnaires at two-week intervals. We examined the mediation hypothesis using multilevel structural equation modeling.

RESULTS

At the within-person level, increases in IER predicted increases in goal progress at a given time point through increases in goal-related effort, while increases in SER predicted decreases in goal progress through increases in goal-related depressed mood. At the between-persons level, participants with higher IER reported more goal progress; this effect was mediated by goal-related effort. Participants with higher SER reported lower goal progress; this effect was mediated by higher goal-related depressed mood. The findings held after controlling for such factors as participants' perceived goal competence, goal stress, sex, and age.

CONCLUSIONS

IER promotes goal pursuit, but SER impedes it.

Longitudinal Relations between Emotion Restraint Values, Life Stress, and Internalizing Symptoms among Vietnamese American and European American Adolescents

Objective: Recent research has documented cultural differences in the extent and manner in which various forms of emotion regulation are linked with psychological well-being. Most of these studies, however, have been cross-sectional, nor have they directly examined the values underlying the use of emotion regulation. The present study examined emotion restraint values and their interactions with life stress in predicting internalizing symptoms across time among Vietnamese American and European American adolescents. The study focused on adolescence as a critical developmental period during which life stress and internalizing symptoms increase significantly. Method: Vietnamese American (n = 372) and European American (n = 304) adolescents' levels of emotion restraint values, internalizing symptoms, and stress were assessed at two timepoints six months apart. Results: Results indicated differential associations between emotion restraint values, stress, and symptoms over time for the two groups. For Vietnamese American adolescents, emotion restraint values did not predict depressive, anxiety, or somatic symptoms. For European American adolescents, emotion restraint values predicted higher somatic symptoms but buffered against the effects of interpersonal stress on anxiety and depressive symptoms. Conclusions: These results provide increased understanding of the role of values related to emotion restraint in shaping adolescent internalizing symptoms and responses to stress across cultural groups. Implications of the findings for guiding intervention efforts are discussed.