Anger regulation and culture role of culture in consequences of anger expression, suppression and reappraisal

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
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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
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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).

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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,
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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
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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
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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
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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
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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,
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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.

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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
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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).
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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).

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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-

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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
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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.
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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.

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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.
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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.
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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
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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.

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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
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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.

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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

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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.
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