Individual and ethnic differences in habitual usage of reappraisal and suppression in relationship with their associated psychological and physiological consequences 3

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CHAPTER I
INTRODUCTION
Successful regulation of emotion and appropriate expression of emotion are vital for
everyday social life (Gross & John, 2003). Publications discussing this important ability such as
the mechanisms underlying emotion regulation, as well as the effects of different emotion
regulation strategies have increased exponentially over the past years (Joormann & D’Avanzato,
2010). With the large number of studies on the effect of emotion regulation on health outcome,
however, very few studies with Southeast Asian populations have been reported. In line with this,
the present project attempted to investigate the mechanism and effect of two emotion regulation
strategies – reappraisal and suppression, on subjective well-being (SWB) and cardiovascular
reactivity (CVR) among Singaporeans, focusing on two ethnic groups: Chinese and Indians.
Process Model of Emotion Regulation
It has been widely acknowledged that people do not just passively experience their
emotions but rather are actively involved in all stages of emotion generation and have the ability
to modify them (Eid & Diener, 2001). Emotions are believed to have evolved to serve survival
functions, which can be seen in many species (Levenson, 1999). As conscious social creatures,
human beings constantly engage in the process of modulating emotions to fit societal rules
(Manstead & Fischer, 2000). As important and interesting the topic is emotion regulation is a
very difficult topic to study empirically because emotion generation and emotion regulation
processes are intertwined with each other and difficult if not impossible to tease apart in real
experiences (Joormann & D’Avanzato, 2010). Researchers can still define the two processes
theoretically. Emotion can be seen as a response to an external or internal situation, or in other
words, a person—situation transaction (Lazarus, 1991). On the other hand, emotion regulation is
often defined as the “processes by which individuals influence which emotions they have, when
they have them, and how they experience and express these emotions” (Gross, 1998, p. 275).
EMOTION REGULATION, CULTURE, AND HEALTH
2
Emotional experience is dynamic, and constantly changes in response to the changing
situations and the coping attempts of the person (Lazarus, 1991). Appraisal theories emphasize

that it is the interpretation of the situation, but not the situation itself, that determines the nature of
the emotional responses. In many studies researchers have documented that people exposed to the
same event displayed a variety of emotional responses depending on their different appraisals of
the situation. For example, Siemer, Mauss, and Gross (2007) reported that participants responded
to a standardized laboratory task with a variety of different emotions, and different aspects of
appraisal could predict the intensity of individual emotions across participants. These theories and
evidence all support the position that emotion generation (response to a situation) and emotion
regulation (modulating the emotional responses) processes are recursive in nature, and in theory
people can intervene to modify their emotions at any point along the chain of emotional response
(Joormann & D’Avanzato, 2010). Gross (1998) has proposed the process model, which depicts
emotion regulation as interventions which may take place at numerous points in the emotion
generation sequence. The advantage of this model is that it takes into account the aspects of both
emotion generation and regulation, thereby providing a platform to empirical studies on emotion
experience.
The process model of emotion regulation (Figure 1) differentiates two broad categories
of emotion regulation strategies: antecedent-focused and response-focused strategies (Gross,
Richards, & John, 2006). Antecedent-focused strategies focus on the modulation of future
emotional responses, which refer to things people do before the emotion tendencies become fully
activated. For example, situation selection and situation modification are antecedent-focused
emotion regulation strategies that affect the emotion-eliciting situation directly, and thereby alter
the entire emotion trajectory. By comparison, the purpose of response-focused strategies is to
manage the existing emotions, which refer to things people do after the emotion is fully activated
and the response tendencies have been generated. Expression suppression is one example of the
EMOTION REGULATION, CULTURE, AND HEALTH
3
response-focused strategies. For example, one might bite one’s lip to appear unfazed by an unfair
comment from a manager despite underlying feelings of anger.

Figure 1. Process Model of Emotion Regulation (from Gross & John, 2003)
Two Specific Strategies: Cognitive Reappraisal and Expression Suppression

As discussed in the above section, there are numerous entry points at which one can
actively intervene in the process of emotional experience. It is not practical to study all of the
possible regulation strategies at once. Rather, two strategies are of particular interest in the
current project: cognitive reappraisal, an antecedent-focused emotion regulation strategy, and
expressive suppression, a response-focused strategy. Despite the fact that each strategy belongs to
one broad category, three factors were considered when selecting which strategies to study: (1)
the two strategies are commonly used in everyday life and there are a number of available studies
documenting the effects of the two strategies; (2) the two strategies are potentially influenced by
culture; and (3) there are no studies reporting the comparison between Chinese and Indians in
their usage of these two strategies.
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4
Cognitive reappraisal refers to a type of early regulatory effort to modulate one’s
potential emotional responses, including changing the subject one sees in the situation, or
changing the way one interprets the situation (Gross & John, 2003). It was first studied by
Lazarus and colleagues, who reported that instructing participants to view an upsetting surgical
procedure in a more analytical and detached way could decrease their subjective and
physiological responses (Lazarus & Alfert, 1964).
Expressive suppression, on the other hand, refers to efforts that come in late in the
emotional generation and regulation process. In particular, it is a form of response modification
that inhibits ongoing emotion expressive behaviors (Gross & John, 2003). This strategy has been
studied in different theoretical frameworks, such as from the perspective of self-control in
Lazarus’ coping inventory (Lazarus, 1993). In addition, it has been repeatedly observed that
suppression of emotion expressions is often associated with heightened physiological responses
(e.g. Gross & Levenson, 1993).
Gross and John (2003) conceptualized the individual differences in emotion regulation
based on the process model, and developed the Emotion Regulation Questionnaire (ERQ), a ten-
item scale, to measure one’s general usage of reappraisal and expression suppression in everyday
life. The ERQ has been tested in different populations and in different languages (e.g. Balzarotte,
John, & Gross, 2010; Zhu, Auerbach, Yao, Abela, Xiao, & Tong, 2008), and its reliability and

validity have been established. The current study focused on reappraisal and suppression and used
the ERQ as one of the main measurements, and also extended the investigation on the mechanism
and consequences of the two strategies.
Two Specific Health Indicators: Subjective Well-being and Cardiovascular Reactivity
Much past work in health psychology has emphasized that negative emotions, such as
anger, depression, and anxiety, are associated with higher morbidity and mortality from a range
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5
of chronic illnesses, including cardiovascular disease (Barefoot, Brummett, Helms, Mark, Siegler,
& Williams, 2000) and diabetes (Lustman, Frank, & McGill, 1991). More recent evidence has
suggested that negative emotions may also play an important role in the development of such
diseases (e.g. Carnethon, Kinder, Fair, Stafford, & Fortmann, 2003). Positive emotions, on the
other hand, may play a protective role with respect to the development of hypertension, diabetes,
and respiratory tract infections (Richman, Kubzansky, Maselko, Kawachi, Choo, & Bauer, 2005).
Therefore, the success of emotion regulation, that is, successful enhancement of positive
emotions and decrease of negative ones, is closely related to one’s health condition in a positive
manner.
The mechanisms that have been proposed to link emotional experiences and health
outcomes include direct pathways involving physiological activation, and indirect pathways that
involve behavioral and cognitive elements, as well as coping resources. For physiological
pathways, many studies have focused on the acute alterations of sympathetic nervous system
(SNS) and/or parasympathetic nervous system (PNS) in response to an emotional episode. In
particular, the regulation of negative mood in relationship with cardiovascular health has attracted
the interest of researchers for decades. For example, it is believed that the inhibition of anger
expression, as well as exaggerated anger expression, can both lead to an increased risk on the
development and progression of cardiovascular diseases (Everson, Goldberg, Kaplan, Julkunen,
& Salonen, 1998). The link between the acute effect of regulation in isolated anger episodes and
the long-term influence of emotion regulation on the development of cardiovascular disease
(CVD) is specified in the reactivity hypothesis, which proposes that frequent experience of
exaggerated cardiovascular reactivity (CVR) is related to enhanced atherosclerosis progression,

and therefore facilitates CVD development (e.g. Jennings, Kamarck, Everson-Rose, Kaplan,
Manuck, & Salonen, 2004). For indirect pathways, much work has emphasized the cognitive
elements such as attitudes and beliefs, as well as health behaviors. In particular, the stress and
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6
coping model attempts to account for both deleterious and protective health correlates of emotion
regulation. According to the stress and coping model (Lazarus & Folkman, 1984), cognitive
appraisal, which refers to “the process of categorizing an encounter, and its various facets, with
respect to its significance for well-being” (p. 31), influences individual reaction to the
environment. The cognitive appraisal process mediates one’s health beliefs, behaviors, as well as
physiology, therefore has an important impact on one’s health outcome.
In this research, subjective well-being (SWB) and CVR are selected as two indicators of
the consequences of emotion regulation for the following reasons. Firstly, SWB and CVR are
widely used as health indicators in studying the relationship between psychosocial factors and
health. And they are closely related to the hypothesized mechanisms linking emotional
experiences and health, as discussed in the above paragraphs: CVR reflects the short-term
physiological changes in one emotional episode, and SWB indicates long-term affective
consequence. Secondly, there is a rich literature on SWB and CVR studies, so the current
research can build on a solid theoretical framework. Thirdly, SWB and CVR patterns are both
potentially influenced by cultural background.
SWB is an overall assessment on one’s self-reported well-being level and has been
widely used in cross-cultural studies. In short, SWB is the operationalized concept of happiness
by self-report. The greatest challenge has been how to define happiness in a way that enables it to
be studied. A very comprehensive review of the subjective well-being literature found that high
levels of life satisfaction and positive affect, and low levels of negative affect are very commonly
used to indicate one’s happiness level (Tov & Diener, 2007). Therefore these indicators are used
in the current research as surrogates of SWB. Moreover, the CES-D (Center for Epidemiological
Studies Depression Scale) was also used as an additional indicator for one’s SWB with
depression indicating lower SWB. The CES-D is commonly used to measure depressive
symptomatology and the items focus on behavioral responses. Firstly, depression itself is a

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7
manifestation of impaired emotion regulation (Joormann & Gotlib, 2010). Secondly, items in the
Life Satisfaction Scale are primarily focused on cognitive evaluation, whereas the Positive and
Negative Affect Schedule (PANAS) focuses on affects that reflect personal feelings, it is believed
that the CES-D provides necessary behavioral-oriented information on one’s self-reported well-
being state. In addition, many studies have included self-reported depression scales as one of the
indicators of well-being (e.g. Gross & John, 2003). Combining all these dimensions, an overall
SWB index can be obtained, with higher scores indicating higher self-reported well-being level.
In laboratory experiments, researchers commonly use CVR patterns as indicators of
SNS or PNS activation, which are closely linked to cardiovascular health. It is believed that
individuals who exhibit exaggerated cardiovascular responses to simulated challenges have an
increased risk for subsequent CVD, compared to their low-reactive counterparts (Lavallo, 2005).
CVD is the world’s No. 1 killer, claiming 17.1 million lives a year (WHO, 2011); therefore CVR
pattern provides useful information as an indicator of health risk.
Affective and Physiological Consequences of Reappraisal and Suppression
As social animals with societal rules, human beings constantly regulate experienced
emotions through a number of effortful strategies, which is a type of adaptive behavior that is not
seen in other species (Kalisch, 2009). However, emotion regulation is not cost-free, as energy and
cognitive resources must be summoned in order to modulate our emotions (Muraven, Tice, &
Baumeister, 1998). As proposed by the process model of emotion regulation, different regulatory
strategies are associated with differentiated affective and physiological consequences.
By definition, reappraisal occurs early in the emotion generative and regulative process.
Therefore, it is hypothesized that reappraisal, when used to down regulate negative emotions, will
effectively lead to reduced negative experience and expressions, with relatively little
physiological cost (Mauss, Cook, Cheng, & Gross, 2007). By contrast, suppression starts late in
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8
the chain of emotion generation and regulation process, and targets primarily the behavioral
aspect of the emotional responses. As such, suppression is hypothesized to require more effortful

management, without effectively reducing negative emotional experience, and is associated with
stronger physiological responses (Gross, Richards, & John, 2006). A series of survey and
experimental studies have tested these hypotheses in regard to the affective and physiological
consequences of reappraisal and suppression. The differentiated effects between reappraisal and
suppression were generally supported in the literature.
For example, it has been shown that people with high reappraisal scores in comparison
to those with low reappraisal scores, report greater positive and less negative emotional
experience, are more effective in interpersonal functions (Gross & John, 2003), and show a more
adaptive profile of cardiovascular responding to a laboratory provocation procedure (Mauss et al,
2007). On the contrary, suppression has been linked to lower positive but higher negative
emotional experience, impaired interpersonal functions (Gross & John, 2003), as well as
magnified blood pressure responses (Roberts, Levenson, & Gross, 2008).
Moderation Effect of Culture between Emotion Regulation and Consequences
One obvious limitation of the previous research on emotion regulation is the failure to
take into account the influence of culture on the consequences of emotion regulation. Most
studies were conducted in Western countries with predominantly North American participants.
Cultural psychologists have documented notable differences between Eastern and Western
cultures. As a result, the relationship between emotion regulation and health in the Southeast
Asian context might be different from the existing reports that were obtained from participants in
the Western countries. In addition, Chinese and Indians may differ in important ways concerning
emotion regulation. In this section, the relationships between culture and emotion regulation and
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9
its consequences will be discussed, and the specific design and implications relative to this
research will be emphasized.
Individual and Group Differences in Usage of Reappraisal and Suppression
Individuals differ in their use of various cognitive processes during any given event in
order to regulate their feelings (John & Gross, 2004). For example, one individual may shift
attention away from disturbing elements of a situation in order to down-regulate negative
emotions, while another individual may focus on those very elements and reinterpret their

meaning to feel better. This illustrates that individuals may differ in their usage of cognitive
reappraisal. The existence of individual differences is actually the theoretical basis to further
investigate the relationship between the usage of reappraisal and its consequences in different
domains. The mechanism underlying differences in the usage of reappraisal, however, has not
been investigated systematically. Research on reappraisal differences has mainly focused at the
individual level (e.g. see Mauss et al, 2007).
Nevertheless, differences in perception and cognition have been documented between
traditional Eastern and Western ways of thinking. There is evidence that differences exist
between different cultural groups in how people perceive and analyze specific situations. For
example, there are traditions of holistic versus analytic reasoning in East Asian and Western
cultures respectively (Nisbett, 2003). Holistic thought involves a tendency to perceive the field as
a whole by explaining the events on the basis of the relationship between objects and the field. By
contrast, analytic thought involves the inclination to detach the objects from their context and
focus on attributes and category of the objects, and then use rules about the categories to explain
the behaviors of the objects (Norenzayan, Choi, & Peng, 2007). Although both systems are
available to all people in all cultures, cultural context may encourage the usage of one system
over the other, giving rise to systematic cultural differences.
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10
If Westerners and Easterners focus and analyze the event differently, it is very likely
that they interpret and perhaps reinterpret the entire situation differently. Therefore, it can be
expected that the exact mode and frequency of reappraisal usage might be different in different
groups, based on their habit of activating different cognitive systems of thinking. Until now,
however, there has been no report of cultural differences in reappraisal usage using the ERQ
reappraisal scale (ERQ.R): Asian Americans reported statistically similar levels of reappraisal
usage as European Americans, African Americans, and Latino Americans (Gross & John, 2003).
One possible reason to explain the discrepancy between the expected difference and the non-
significant results may be that the ERQ.R is a general assessment on individual’s usage of the
particular strategy to do one type of particular regulation — down regulation of negative feelings
— and may not be sensitive enough to detect cultural differences. Possible group differences may

emerge when other aspects of seeing the situation are tested, such as whether one keeps positive
feelings down. Another reason may be that the different groups in the Gross & John (2003) study
were assessed within the same cultural context, American culture, which may have reduced
differences. A recent study conducted at NUS has documented that Chinese Singaporeans
reported significantly different reappraisal usage than Caucasians to anger-provoking situations
(Zhou, 2010). This research aims to take a closer look into the potential difference of reappraisal
usage among Chinese and Indians.
On the other hand, group level differences in emotion suppression have been reported
repeatedly with respect to cultural display rules for emotion. As early as the 1970’s, Friesen
(1972) reported a study that became very famous in the field of cultural difference of emotional
display rules, even though it was an unpublished dissertation. In that study, American and
Japanese participants viewed a highly stressful film under two conditions. Similar levels of facial
signs of negative expression, such as disgust, fear, or distress, were observed for Americans and
Japanese when they viewed the film alone. However, in the presence of an experimenter,
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11
Japanese used smiles to mask their negative feelings while Americans showed the same level of
negative expressions as the alone condition. Those findings can be accounted by a neurocultural
theory of emotion, proposed by Ekman. This theory proposed that there exists an innate facial
affect program, which stores the prototypical emotional expressions explaining the universality of
certain emotions, and cultural display rules, which explain cultural specificity in their expression
(Ekman & Friesen, 1971). Since then, the proposition that culture influences the way people
express their emotions has been largely accepted. Gross and John (2003) has reported that
European Americans score lower on ERQ suppression scale (ERQ.S) than Asian Americans.
However, there has been no report on the comparison of emotion expression patterns between
Chinese and Indians. This research aims to fill this gap in the literature.
Culture Shapes the Relationship between Emotion Regulation Strategies and Consequences
There is a lack of consensus on a definition of culture. In the field of cultural
psychology, culture is generally referred to as a socially shared transmitted pattern of ideas
(values, norms, and beliefs, etc.) that are instantiated in everyday practices (Tsai, Levenson, &

McCoy, 2006). Many psychological processes which were considered as universal prove to be
shaped by culture. One such example is that individual emotional responses are influenced by
cultural background. A specific culture provides dominant themes for some emotions rather than
others; for example, Western culture encourages disengaging emotions, whereas Eastern culture
promotes engaging emotions (Kitayama, Mesquita, & Karasawa, 2006). In addition, culture
modifies emotional responses by valuing or devaluing particular expression styles and regulatory
strategies. These are the social affordance and social reinforcement mechanisms, proposed in the
“dual process model” (Kitayama et al., 2006). Emotion regulation, especially reappraisal and
suppression, is embedded in the meanings and practices that constitute the sociocultural
environment. Therefore, culture directly influences an individual’s usage of emotion regulation,
as well as the consequences of those emotion regulation strategies.
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12
For example, as discussed in the study by Butler, Lee, and Gross (2009), cultural
differences between West and East could influence the outcome of emotion suppression.
European American traditions value and encourage self-expression. Children are taught to speak
up, and emotional expression is not only condoned with in-group members, but also with out-
group members. By contrast, Asian traditions do not assume the expression of one’s personal
feelings to be equally appropriate as do European Americans. In line with this, Asian Americans
indeed reported significantly higher scores than European Americans on the ERQ.S (Gross &
John, 2003). Moreover, Asian Americans who suppressed their emotions could remain
interpersonally responsive, probably due to repeated engagement in this behavior. European
Americans, on the other hand, showed a more negative consequence when engaging in
suppression than Asian Americans (Butler et al., 2009). Considering that Asians use suppression
more frequently and under more conditions, the usage of suppression can be expected to require
fewer cognitive resources to execute with the process being more automated. This is the
“automaticity hypothesis” that can explain the moderation effect of culture between emotion
regulation strategy and its consequences.
Chinese and Indians
Traditional Chinese and Indian societies are hierarchically organized and patriarchal in

nature, and both cultures are predominantly interdependent and collectivistic. Direct comparison
of emotion-related concepts between these two cultures is rare, but a general appreciation of
Confucian and Hindu worldviews will be helpful to understanding the similarities and differences
in socialization goals and practices in Chinese and Indian cultures.
Firstly, there is a different emphasis of “nature versus nurture” in these two traditions. If
people in a society believe that “nature” or predetermined tendencies limit and shape the
development of an individual, this society is more likely to accept individual differences. Indian
EMOTION REGULATION, CULTURE, AND HEALTH
13
culture is one example: nature is given more importance than nurture in Hindu conceptualization
(Rao, McHale, & Pearson, 2003). On the other hand, in Confucian thought, the environment is
considered the most important influence on the developmental course of an incident or even an
individual (Wu, 1996). From this perspective, Chinese are expected to view a given incident as
more associated with the context compared to Indians. In other words, Chinese would be more
likely to see the situation, whereas Indians see the person as the center of an event. As a result,
Chinese are encouraged to think of the situation repeatedly before taking an action from (san si er
hou xing). Since this is in line with the meaning of reappraisal, it is expected that Chinese will
score higher on reappraisal scale than Indians.
Secondly, traditional Chinese thought emphasizes control of emotions and behavioral
conformity (Ho, 1996). Therefore Chinese are expected to report a high level of expressive
suppression of their emotions. In the literature there are very few studies on emotion suppression
among Asian Indians. In one study, Mandal and colleagues have shown that compared to
Caucasian Canadians, Indians rated negative emotions significantly more unpleasant (Mandal,
Bryden, & Bulman-Fleming, 1996). The authors argue this result indicated that expressions of
negative emotions are perceived with greater degree of unpleasantness, thereby the expressive
behavior is less preferred among Indians. Therefore, the currently available literatures suggest
that both cultures may have the elements to encourage expressive suppression. The direct
comparison between Chinese and Indians on their usage of different emotion expression styles
has not been conducted, though. Based on daily observation we would expect Indians to report
higher emotion expression (or lower emotion suppression) than Chinese under certain

circumstances.
As discussed in the above section, culture is a poorly defined concept with multiple
facets. In the existing cross-cultural research on emotion regulation, cultural differences are often
represented by ethnicity differences. To the best of the author’s knowledge, there are no good
EMOTION REGULATION, CULTURE, AND HEALTH
14
scales in comparing Chinese and Indian cultures in their beliefs, values, or attitudes. Therefore,
this research uses ethnic background as an indicator of cultural influence, which has been widely
used in intergroup comparison in Singapore context (e.g. Eong, Tay, & Lim, 1993, Chua, 1998;
Ounpuu & Yusuf, 2003).
Overview of the Present Research
The current research is based on the process model of emotion regulation, taking a
socio-cultural functioning perspective. Three studies are conducted with the main objectives of
the thesis as follows:
Firstly, the main objective of the study is to compare the habitual usage of emotion
regulation strategies between Chinese and Indians. In the cultural psychology literature, the main
focus has been put on the systematic comparison between Western and Eastern cultures on self-
construct, perception and cognition, as well as emotion and motivation (e.g. see Kitayama &
Cohen, 2007). The comparison at a finer level, that is, comparison among groups within Western
or Eastern systems, has not been widely conducted. It is likely that groups within the Western or
Eastern system will show variation in the psychological domains mentioned above. For example,
Chinese and Indians together take up more than one third of the total population in the world, and
both groups have very long history. It is unlikely that they think and behave similarly. The direct
comparison between the two groups, however, has been rare in empirical studies. Casual
observations suggest that the two groups have different emotion expression patterns. For example,
it is sometimes noted that Chinese are very reluctant to say “you bother me” in public, whereas
Indians will speak up with less restriction.
Existing scales on emotion expression/suppression style have not shown differences
between Chinese and Indians. In the terminology of cultural psychology, Chinese and Indians are
both considered interdependent groups, and they both express emotions to a moderate degree and

EMOTION REGULATION, CULTURE, AND HEALTH
15
both groups reported relatively high suppression scores in general. However, there is reason to
believe that Indians are more emotionally expressive than Chinese under some particular
situations. For instance, Rao and colleagues (2003) have documented that Indian mothers assign
greater importance to emotional expression than Chinese mothers in child raring, which may
reflect different socialization goals. The exploration of the possibly differences in emotion
expression patterns among Chinese and Indians is one major objective of this thesis.
In regard to the habitual usage of reappraisal, there have been no reports of group
differences. However, Asians did have a higher score of ERQ.R (though not statistically
significant) than other groups (Gross & John, 2003). When Asian groups are broken down by
ethnicity, we believe the difference should be more obvious. In Particular, we believe that
Chinese should report a higher ERQ.R than Indians, as discussed in the previous section.
The second main objective is to explore the relationship between emotion regulation
strategies and self reported well-being, and whether these relationships are moderated by cultural
background. Research to date (Gross & Thompson, 2007) indicates that reappraisal is associated
with a higher level of happiness, while suppression is associated with a lower level of happiness.
As discussed in the above sections, Chinese are expected to use both reappraisal and suppression
very frequently. At the same time, it has been repeatedly documented that Chinese report low
SWB level compared to Western groups (Diener, Shu, Smith, & Shao, 1995). How can we
explain the seemingly complicated relationship between reappraisal, suppression, and SWB for
Chinese? On the other hand, Indians also report relatively low SWB (Tov & Diener, 2007). The
few available studies on Asian Indians’ emotional experience suggested that Indians also inhibit
their expression on negative feelings, at least compared with North Americans (Mandal et al.,
1996). In this situation, how can we understand the relationship between the emotion regulation
and SWB in Indians? The potential moderation effect of cultural background between emotion
regulation strategies and consequences will be addressed in this research.
EMOTION REGULATION, CULTURE, AND HEALTH
16
Lastly, this study also aims to investigate the relationship between the habitual usage of

different emotion regulation strategies and the cardiovascular parameters. The tradition of the
investigation on this relationship is long standing. However, the results have remained
inconsistent and the mechanism unclear. It has been reported that Chinese and Indians showed
different CVR patterns in response to anger provocation (Bishop & Robinson, 2000). Is it
possible that the different CVR patterns among Chinese and Indians are due to differences in
emotion regulation effectiveness? Reappraisal has been associated with more adaptive CVR
profile in response to an anger provocation (Mauss et al., 2007), and suppression associated with
heightened CVR (Roberts et al., 2008). Recent study has also shown that Chinese participants,
compared to Caucasian participants, exhibited significantly lower reactivity of heart rate and
cardiac output in response to an anger provocation when instructed to do emotion suppression
(Zhou, 2010). How will the habitual usage of reappraisal and suppression be associated with CVR
among Chinese and Indians? These questions will be addressed in the laboratory-based
experiment.
All three studies are designed with a coherent theme on how people engage in
reappraisal and suppression, and their in relationship with health outcomes under different
cultural influences. Study 1 and Study 3 are survey studies and Study 2 is a laboratory-based
study.
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17
CHAPTER II
STUDY 1. Emotion Reappraisal and Suppression, and Their Relationship with Subjective Well-
being among Chinese and Indians
Overview
According to the process model of emotion regulation (Gross & John, 2003), there are
two broad categories of regulatory strategies: antecedent- and response-focused strategies.
Antecedent-focused strategies, such as reappraisal, start early in the emotion experience chain and
are associated with positive consequences, such as lowered negative emotional experience and
higher level of wellbeing. By contrast, response-focused strategies, such as expressive
suppression, start relatively late and have been associated with less desirable consequences, such
as impaired interpersonal functioning and lower level of wellbeing. Gross and John (2003)

developed a short inventory, the Emotion Regulation Questionnaire (ERQ), assessing one’s
habitual usage of reappraisal and suppression, which has been validated in different populations
with different languages (e.g. Zhu et al, 2008). The short inventory has also been used in some
clinical populations. Its reliability and validity have been established (Joormann & Gotlib, 2010).
However, there has not been any published report on ERQ among Southeast Asian
populations. This study is among the first to administer the ERQ scale using a Singaporean
sample. Singapore is a country that is resident to people of different ethnic backgrounds, with 74%
Chinese, 13% Malay, and 9% Indian as the three main ethnic groups for its resident population
(Singapore Statistics Department, 2010). Matsumoto (1993) has emphasized the importance of
studying the possible cultural differences in emotion within a country. In such studies, not only
can researchers test the psychometric properties in different groups, inter-group comparisons can
also be made. In the current study, special focus will be put on the comparison between Chinese
and Indians because there is evidence that these two groups may show different patterns of
EMOTION REGULATION, CULTURE, AND HEALTH
18
emotion regulation, as well as different response to negative emotions (Bishop & Robinson, 2000;
Why et al., 2003). Surprisingly few studies have compared Chinese and Indians in their emotion
regulation directly, so the hypotheses are mainly based on information that was gathered through
different sources, such as anthropological documents. As discussed in the general introduction in
Chapter 1, under the influence of Confucian traditions, it is expected that Chinese will score
higher on reappraisal than Indians.
Emotion regulation style can be considered as a relatively stable trait. As mentioned
above, the ERQ is able to measure an individual’s habitual usage of reappraisal and suppression.
However, it is worth noting that the expression and suppression of subjective emotional feelings
are highly related to the context that elicits the emotional reaction. People from interdependent
cultures are believed to have distinctively different expression styles in private versus in public.
For example, as documented in Friesen’s study (1972), Japanese masked their expression of
negative feelings with smiles when they watched a disgusting film with an authority figure, but
they showed more facial expressions when they believed that they were watching the film alone.
Basically, display rules govern what type of emotion and how much emotion is appropriate to be

shown to whom and under what circumstances, and everyone will show different emotion
expression according to the different situations. People from interdependent cultural backgrounds,
in particular, may show a larger variation across different situations than do people from
independent cultures (Oishi, Diener, Scollon, & Biswas-Diener, 2004). Along this line, it is
expected that Chinese and Indians will show different expression styles in front of different
audiences, depending on the relationship between the subject and the audience. Oishi and
colleagues (2004) also reported that situations have considerable impact on one’s affective
experiences, such that people report more positive and less negative experiences when with a
romantic partner, friends, or family members than when with a stranger or a classmate/coworker.
Similarly, there are logical reasons to believe that people would show higher emotion expression
EMOTION REGULATION, CULTURE, AND HEALTH
19
in front of close others than not-close others. Therefore, items were developed to test the emotion
expression patterns in front of different audiences among Chinese and Indians.
Moreover, the relationship between the usage of a given emotion regulation strategy
and SWB is tested. SWB is an indicator on one’s self-reported happiness level. The purpose of
emotion regulation is to make one feel more positive and less negative emotions. Therefore, the
successful regulation of one’s emotions should be closely linked to high SWB. Reappraisal helps
people see the silver lining of a dark cloud, thereby it should help people be more satisfied with
their current life situation, increasing one’s positive feelings and decreasing negative feelings, and
thereby report fewer depressive symptoms. On the other hand, suppression may have a negative
influence on one’s evaluation of well-being in general. When a person is unhappy and not
expressing the negative feeling, he or she is unlikely to receive any support that may change the
situation. This lack of natural flow of interpersonal exchange may decrease one’s life satisfaction
and positive affect, and increase negative affect and ratings of depressive symptoms.
There is a growing literature that tests the relationship between emotion regulation
strategies and SWB directly. Results are largely consistent with the prediction from the process
model. That is, reappraisal is positively linked to SWB and suppression shows the opposite trend.
However, results from different studies are not completely consistent. For example, Martini and
Busseri (2010) have grouped emotion regulation as passive and active strategies, according to the

distinction between problem-solving and emotion-focused approaches. Both reappraisal and
suppression belong to passive regulation category in this study. They have shown that passive
emotion regulation strategies all together predict greater negative affect, lower level of
satisfaction, and less positive affect for both selves and partners in mother and adult daughter
dyads. This way of grouping the regulatory strategies makes the positive link between reappraisal
and health consequences questionable. In another study, Schutte, Manes, and Malouff (2009)
used an Australia sample, and found that antecedent focused regulation strategies (including
EMOTION REGULATION, CULTURE, AND HEALTH
20
reappraisal) were associated with greater well-being as expected, but response modulation
(including suppression of emotion expression) was not necessarily linked with negative well-
being outcomes. These different conclusions in regard to the relationship between emotion
regulation strategies and health outcomes are likely due to the different measuring instruments, as
well as the different participant samples used in the different studies. In line with this, the current
study attempts to explore the relationship between reappraisal, suppression and SWB among
Chinese and Indians, using well-established instruments. It is believed that reappraisal should be
associated with decreased negative emotion and greater positive feelings. However, the
relationship between suppression and SWB might be largely attenuated in our Asian population
compared to Western population, based on the automaticity hypothesis.
Objectives and Hypotheses
Firstly, the habitual usage of reappraisal and suppression will be compared across
groups. As reported in previous studies, American females scored lower on suppression level than
males (Gross & John, 2003) due to the socio-cultural influence on gender role: males are
expected to be cool and express few emotions, while females are allowed to express their feelings
more freely. This gender difference is expected in Asian sample as well. In addition, with the
influence of Confucian tradition, Chinese are believed to think about a situation more, as well as
exert more expression control than Indians do. Moreover, a few items on one’s emotion
expression style in front of different audience are tested. Hypothesis 1.1 is about ERQ scores and
Hypothesis 1.2 is about the expression levels under specific situations.
Hypothesis 1.1a: There will be a main effect for ethnicity such that Chinese will score

higher on ERQ.R than Indians.
Hypothesis 1.1b: There will be a main effect for ethnicity such that Chinese will score
higher on ERQ.S than Indians.
EMOTION REGULATION, CULTURE, AND HEALTH
21
Hypothesis 1.1c: There will be a main effect for gender such that Asian males will
score higher on ERQ.S than Asian females.
Hypothesis1.2: There will be a significant interaction effect for ethnicity by situation,
such that Indians will report greater emotion expression than Chinese with others to
whom they are not close.
Next, this study tests the relationship between different emotion regulation strategies
and SWB, and whether gender and ethnicity moderate this relationship. There is good reason to
believe that reappraisal is an adaptive strategy and therefore positively associated with SWB
among both males and females, and Chinese and Indians. On the other hand, emotion suppression
is negatively associated with SWB (e.g. Gross & John, 2003). However, the negative relationship
between suppression and SWB may be attenuated in people who are good at it and use it
frequently. As proposed by Butler et al. (2009), individuals from cultures that promote emotion
suppression may make this behavior normative and automated by daily practice thereby the
associated negative consequences may become ameliorated. If Chinese and Indians report
different frequencies of suppression usage, the degree of the negative consequences associated
with suppression may also be different between Chinese and Indians. There is evidence as well as
general impression that Indians are more expressive than Chinese. Therefore it is hypothesized
that:
Hypothesis 1.3a: ERQ.R will show a positive association with SWB, and this
relationship will hold for males and females, as well as Chinese and Indians.
Hypothesis 1.3b: On the other hand, there will be a significant moderation effect of
ethnicity on the relationship between ERQ.S and SWB, such that suppression will show
a more pronounced negative association with SWB in Indians than in Chinese.

EMOTION REGULATION, CULTURE, AND HEALTH

22
Method
Participants
Prior to recruiting participants, the procedures were approved by Institutional Review
Board (IRB) of the National University of Singapore (NUS). Participants of this study included
Chinese and Indian male and female university students aged between 18 and 37 years, with an
average age of 21.99 years. Volunteers were approached on the NUS campus. The purpose of the
study was explained, and after obtaining the consent from the volunteer, a booklet of
questionnaires was passed to them. It took about 15 minutes to finish the survey. 130 participants
finished the survey. Of these, data from 24 participants were not included because they belong to
ethnic groups other than Chinese or Indian. Thus the final data analysis included data from 106
participants (Chinese, 32 females and 28 males; Indian, 22 females and 24 males).
Measures
Emotion Regulation Strategies
Reappraisal: The ERQ reappraisal subscale was used. There were six items, and one
example was “I control my emotions by changing the way I think about the situation I am in”.
Responses were on a 7-point scale ranging from “strongly disagree” to “strongly agree”. The
complete scale was listed in the Appendix A. Alpha for the six items was .83 in our sample.
Suppression: The ERQ suppression subscale was used to measure the general usage of
suppression. One example of suppression items is “I keep my emotions to myself” (Appendix A
lists the complete scale). Responses were on a 7-point scale ranging from “strongly disagree” to
“strongly agree”. Alpha for the four-item scale was .72.
Emotion Expression Pattern: Eight statements on one’s positive and negative emotion
expression pattern in front of different audiences were tested. Responses were on a 7-point scale
EMOTION REGULATION, CULTURE, AND HEALTH
23
from “strongly disagree” to “strongly agree”. Items on the expression in front of close others were:
1) “When something good has happened to me, I share my feelings with family and close friends”;
2) “If a family member or close friend makes me happy, I tell him or her how I feel”; 3) “When
something bad has happened to me, I share my feelings with family and close friends”; 4) “If a

family member or close friend annoys me, I tell him or her how I feel”. Items on the expression if
front of not very close others were: 5) “When something good has happened to me, I share my
feelings with colleagues or acquaintances”; 6) “If a colleague or acquaintance makes me happy, I
tell him or her how I feel” 7) “When something good has happened to me, I share my feelings
with colleagues or acquaintances”; 8) “If a colleague or acquaintance makes me happy, I tell him
or her how I feel”.
Subjective Well-being
Life satisfaction: The 5-item Life Satisfaction Scale was used (Diener, Emmons, Larsen,
& Griffin, 1985). Responses were on a 7-point scale ranging from “strongly disagree” to
“strongly agree”. One example was “I am satisfied with my life”. The complete scale is included
in the Appendix A. This scale showed good internal consistency (Cronbach’s α = .80).
Positive and negative affect: Participants indicated their general affective states on a
cluster of ten positive and ten negative emotions. Responses were on a 5-point scale ranging from
“very slightly or not at all”, “a little”, “moderate”, “quite a bit”, to “very much”. The emotion
terms were taken from the Watson, Clark, & Tellegen (1988) PANAS study. The positive cluster
was enthusiastic / interested / determined / excited / inspired / alert / active / strong / proud /
attentive (α = .88), while the negative cluster was afraid / ashamed / distressed / guilty / hostile /
irritable / jittery / nervous / scared / upset (α = .80).
Depression: The twenty-item CES-D scale developed by Radloff (1977) was used.
Participants were asked how often they felt the way stated in the questionnaire during the past
EMOTION REGULATION, CULTURE, AND HEALTH
24
week. Responses were on a 4-point scale which included rarely or none of the time (less than 1
day), some or a little of the time (1-2 days), occasionally or moderate amount of time (3-4 days),
or most of the time (5-7 days). An example of the statement was “I was bothered by things that
usually don’t bother me”. The complete scale is included in the Appendix A. Alpha for the 20-
item scale was .82.
SWB index: SWB is often indicated by high life satisfaction, high frequency of
experiencing positive affect, low frequency of experiencing negative affect and depressive
symptoms. Therefore, an SWB index was calculated by summing the life satisfaction score and

positive affect score, then subtracting the negative affect score and depression score. Standardized
scores were used in all scales to give each scale equal weight in the SWB index. Similar way of
calculating SWB index score had been reported in previous studies, in which the Alpha was .71
(Schutte et al., 2009). Alpha for the SWB index in the current study was .68.
Results
Preliminary Analyses
Structure of the ERQ Scale
Gross and John (2003) reported that the ERQ scale fit a two-factor model with an
American sample. Confirmatory factor analysis (CFA) was conducted to test the structure and
psychometric properties of ERQ among our Singaporean sample. AMOS 18 was used to compare
three models: (a) one general-factor model of emotion regulation; (b) an orthogonal two-factor
model with two factors correlation zero; (c) an oblique two-factor model with the factor inter-
correlation freely estimated. Across all standard fit indexes, the oblique two-factor model
provided the best fit. Both the general one-factor model and orthogonal two-factor model were
significantly worse fit than the oblique two-factor model (∆χ
2
(1) = 3.99, p = .045; ∆χ
2
(1) = 6.78,
p = .01, respectively).
EMOTION REGULATION, CULTURE, AND HEALTH
25
This result was slightly different from the report by Gross and John (2003), who found
that the orthogonal two-factor model was not statistically different from the oblique two-factor
model with North American sample in their study. In our sample, however, the reappraisal and
suppression subscales were not completely independent but had an inter-correlation .316 in the
two-factor CFA model. Nevertheless, the two-factor model was still significantly better than the
one-factor model. In the two-factor model, the coefficient for each item was significant, loading
to the corresponding factor (all p < .01). Therefore, the ERQ scale also fit a two-factor model in
our Singaporean sample.

SWB Scales
A series of 2 (ethnicity) by 2 (gender) ANOVA tests were conducted on each individual
scale. Results revealed main effects of ethnicity (Chinese M = 4.28 [SD = 1.11], Indian M = 4.74
[SD = 1.04]), F (1, 102) = 5.46, p = .021, η
2
p
= .05, and gender (Male M = 4.22 [SD = 0.99],
Female M = 4.73 [SD = 1.04]), F (1, 102) = 7.02, p = .009, η
2
p
= .06, on LS score. Previous
studies have documented similar patterns that females reported higher life satisfaction than males,
and Chinese reported a low level of life satisfaction in general (Tov & Diener, 2007). No
significant gender or ethnic differences were detected on PA, NA, or CES-D scores.
A model with LS, PA, NA, and CES-D scores loading on one latent construct,
subjective well-being, was tested with AMOS 18. All regression weights were significant (p < .01)
and the model fit indices were good: GFI = 0.99, CFI = 0.99, RMSEA < .001, AIC =17.34. These
results suggested that the dimensions of LS, PA, NA and CES-D formed one latent construct very
well, χ
2
(df =2) = 1.34, p = .512. It further supported the calculation of the SWB index by
combining these four composite scores. No significant differences were found by ethnicity,
gender, or their interaction for SWB index. Means and standard deviations of each scale and the
SWB index were summarized in Table 1.