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Cultural Values and Alexithymia:

Cultural Values and Alexithymia: Alexithymia refers to difficulty with reflecting on and articulating emotional states. Previous research has found that Asian groups may tend toward greater alexithymia and that cultural values may mediate this difference, although the content of Asian values that form these pathways is unclear. This study examined the relationship between Confucian values, ethnicity, and alexithymia. A sample of 216 undergraduate students completed the Chinese Value Survey and the Toronto Alexithymia Scale. Asian Canadians scored more highly on alexithymia than non-Asian Canadians. Individuals who valued trustworthiness, patience, and kindness were found to be less alexithymic. The ability to be a source of kindness and security to others may be tied to the development of reflective awareness. Individuals who valued purity from desire and respect for social order were found to be more alexithymic. Such individuals may tend not to reflect on impure or socially disruptive thoughts and feelings. Values associated with purity and order mediated the difference between Asians and non-Asians on alexithymia. Asian Canadians may therefore score more highly on alexithymia because they prefer not to reflect on emotions associated with impurity or social disorder. Keywords alexithymia, culture, emotion, ethnicity, values have been found to score more highly on alexithymia com- Introduction pared with individuals of European background (Dion, 1996; Alexithymia refers to difficulty with reflecting on and articu- Le et al., 2002). This effect may be explained by group dif- lating emotional states (Bagby, Taylor, & Parker, 1997). ferences in cultural values and beliefs relating to individual- Although alexithymia can be conceptualized as psychopa- ism and the expression of inner experience, rather than thology resulting from such factors as trauma (Franzoni biomedical factors or differences in metacognitive ability. et al., 2013) or right hemisphere dysfunction (Jessimer & Dere et al. (2012) found that differences in alexithymia Markham, 1997), it is also an individual difference variable between Asian and European Canadians were mediated by related to beliefs about the value of emotions in social life, the endorsement of modernism and Euro-American values. shaped by developmental context (Eid & Diener, 2001; Le, However, greater specificity in the content of Asian values Berenbaum, & Raghavan, 2002; Mayer, Salovey, Caruso, & associated with alexithymia remains to be identified. Sitarenios, 2001). From this perspective, alexithymia shares Non-Western value systems have been rarely operational- much in common with the construct of emotional ambiva- ized for assessment, but one such system is Confucianism lence, which refers to uncertainty about the value of emo- (Chinese Culture Connection, 1987). Confucianism is an tional rumination and expression and is affected by cultural ethical system that focuses on the cultivation of virtues con- beliefs (Chen, Cheung, Bond, & Leung, 2005). Key attri- ceptualized as foundational to social responsibility and civic butes of alexithymia include difficulty identifying emotional order (Yao, 2000). These virtues include humaneness and states from other bodily sensations, difficulty describing compassion, honesty and righteousness, loyalty and sincer- emotional experiences to others, and an externally oriented ity, propriety and correctness, and wisdom and knowledge. thinking style focused on concrete details of events as Originating in ancient China, the Confucian value system opposed to their emotional significance (Bagby et al., 1997). has had greatest historical influence in East Asia and parts of The purpose of the present study was to examine how alexi- thymia may relate to cultural values and ethnicity. East Asian cultures may tend to emphasize emotional 1 Psychiatry, University of Toronto, Toronto, Ontario, Canada restraint and externally oriented thinking, rather than emo- University Health Network, Toronto, Ontario, Canada tional exploration and articulation relative to Western Corresponding Author: European cultures (Butler, Lee, & Gross, 2007; Chen et al., Chris Lo, 9EN-234A, 200 Elizabeth St., Toronto, Ontario, Canada, M5G 2005; Dere, Falk, & Ryder, 2012; Dere et al., 2013; Tsai, 2C4. Levenson, & McKoy, 2006). Individuals of Asian heritage Email: chrislo@uhnresearch.ca This article is distributed under the terms of the Creative Commons Attribution 3.0 License Creative Commons CC BY: (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://www.uk.sagepub.com/aboutus/openaccess.htm). 2 SAGE Open Southeast Asia, specifically Vietnam and Singapore (Yao, for my feelings), and an externally oriented thinking style 2000). Confucian values have also diffused into other parts (e.g., I prefer to just let things happen rather than to under- of Southeast Asia owing to the influence of Chinese diaspora stand why they turned out that way). The scale generated a that possess an economic and political power disproportion- summed total that could range from 20 to 100. Internal reli- ate to their minority status (Warden, Chen, & Caskey, 2005). ability for the TAS has been found to be 0.81 (Bagby et al., Although Confucian values retain a sense of cultural distinc- 1994) and was 0.84 in the present study. tiveness when articulated, they overlap with other systems of The 40-item Chinese Value Survey (CVS) is a 9-point human valuation and are understandable to different peoples Likert-type scale with a range of 1 = of no importance at all (Chinese Culture Connection, 1987). to 9 = of supreme importance (Chinese Culture Connection, Using a multicultural sample, this study explored the 1987). Respondents rate the personal importance of 40 val- associations between alexithymia, Confucian values, and ues from a Confucian perspective. All CVS items are listed ethnicity. Asian Canadians were hypothesized to score more in Table 1. The CVS was found to have convergent validity highly on alexithymia than non-Asian Canadians. No predic- with Hofstede’s (1980) value dimensions in a large multisite tions were made concerning which Confucian values would international study (Chinese Culture Connection, 1987). be most associated with alexithymia. There were also no pre- However, the findings were from an ecological factor analy- dictions concerning which Confucian values would be asso- sis and the identified factors are not appropriate for individ- ciated with ethnicity beyond the general expectation that ual-level analyses. A preliminary principal components Asian Canadians would score more highly than non-Asians analysis was described by Matthews (2000) who found four on at least some Confucian values. Values that were associ- dimensions. They were Self-Development (reliability = ated with both ethnicity and alexithymia were tested as medi- 0.82), which included such values as persistence, patience, ators of the effect of ethnicity on alexithymia. and sincerity; Relationships with Others (reliability = 0.91), which included such values as having few desires, a belief in benevolent authority, and being contented with one’s posi- Method tion in life; Social Responsibility (reliability = 0.82), which included solidarity with others, ordering relationships by sta- Participants and Procedure tus, and patriotism; and Worldly Wisdom (reliability = 0.57), This study was approved by the Research Ethics Board at the which included wealth, a sense of cultural superiority, and a University of Toronto. Participants were undergraduate stu- belief in the repayment of the good and evil of others. dents recruited in exchange for psychology course credit. Uncertainty about the CVS factor structure suggested that After a research assistant obtained written informed consent an exploratory factor analysis be conducted. Principal axis from participants, they were asked to complete a question- factoring is the standard method for factor extraction and naire package and provide demographics as part of a study was used here. Promax rotation was applied because value on cultural values and personality. After completion, indi- dimensions may not be orthogonal. The number of factors viduals were given a debriefing sheet explaining the study extracted was guided by examination of the scree plot and and were given an opportunity to ask questions. Individuals the magnitude of the eigenvalues. Naming of factors was were categorized into one of three broad ethnic groupings: based on the highest loading items on that dimension, ignor- (a) East or Southeast Asian, (b) European, and (c) Remaining ing cross-loading items. Ethnicities, which included all other individuals not falling Five factors were extracted from the CVS, all with eigen- into the first two groups. Sampling continued until these values greater than 1. See Table 1 for factor loadings and groups were approximately balanced. In total, 216 partici- other item statistics. Factor 1 was labeled Trustworthiness. pants consented to this study, with a mean age (SD) of 20.19 Values loading on this dimension included a combination of (2.86) years. Sixty-one percent of the sample (132/216) was personal and relational virtues including patience, persis- female. Thirty-three percent of the sample (71/216) were of tence, trustworthiness, kindness, and personal steadiness and East or Southeast Asian background, 34% (74/216) were of stability. Factor 2 was labeled Purity and Order. Values load- European background, and 33% (71/216) were of Remaining ing on this dimension included remaining disinterested and Ethnicities. pure, having few desires, the importance of chastity in women, and a preference for righteousness and social order. Factor 3 was labeled Confucian Tradition. Values loading on Measures this factor included filial piety, respect for tradition, observa- The 20-item Toronto Alexithymia Scale (TAS) is a 5-point tion of rites, industriousness, and loyalty. Factor 4 was Likert-type scale with a range of 1 = strongly disagree to 5 = labeled Status. Values on this factor included valuing wealth strongly agree (Bagby, Parker, & Taylor, 1994). Items assess and knowledge, reputation, and the power to do unto others difficulty with identifying feelings (e.g., I am often confused as they have done unto you. Factor 5 was labeled Social by what emotion I am experiencing), difficulty with describ- Harmony. Values on this dimension were harmony with oth- ing feelings (e.g., It is difficult for me to find the right words ers, tolerance, and non-competitiveness. Lo 3 Table 1. Chinese Value Survey Factor Loadings and Item Statistics. Item M SD F1 F2 F3 F4 F5 h2 24. Persistence (perseverance) 7.40 1.26 66 −9 10 −3 −9 0.44 25. Patience 7.67 1.40 64 −12 16 −9 9 0.52 30. Trustworthiness 8.21 0.98 57 −5 −2 −5 5 0.33 18. Personal steadiness and stability 7.39 1.41 54 20 −12 26 3 0.43 9. Kindness (forgiveness, compassion) 8.09 1.07 54 6 −9 −22 33 0.55 28. Adaptability 7.30 1.41 50 14 −10 23 −8 0.31 21. Sincerity 7.73 1.44 49 21 21 −31 −21 0.41 32. Courtesy 7.54 1.27 42 2 1 20 19 0.32 36. A close intimate friend 8.14 1.18 39 −21 9 1 2 0.19 13. Self-cultivation 6.91 1.42 31 14 −17 18 13 0.18 19. Resistance to corruption 7.31 1.72 29 30 −6 −27 −5 0.19 22. Keeping oneself disinterested and pure 4.53 2.15 −5 62 14 −29 11 0.48 15. Sense of righteousness 6.01 1.95 30 60 −10 13 −13 0.48 37. Chastity in women 4.52 2.57 −10 59 29 −8 −9 0.49 38. Having few desires 3.88 2.20 −21 48 21 −2 11 0.37 27. A sense of cultural superiority 3.39 2.31 −19 46 3 43 −14 0.55 29. Prudence (carefulness) 6.67 1.56 32 46 −3 21 2 0.45 23. Thrift 4.92 1.75 −12 45 −12 0 24 0.24 14. Ordering relationships by status and observing this 4.05 2.05 −15 43 17 28 1 0.44 order 16. Benevolent authority 5.59 1.91 15 41 2 9 8 0.28 34. Being conservative 4.59 2.11 −2 36 32 18 6 0.44 31. Having a sense of shame 6.06 1.95 19 35 0 26 8 0.32 7. Observation of rites and rituals 5.29 1.91 −4 −2 69 6 −2 0.47 1. Filial piety 6.89 1.75 0 3 67 7 5 0.52 39. Respect for tradition 5.48 1.96 17 18 60 0 −7 0.55 6. Loyalty to superiors 5.83 1.75 −2 14 54 3 24 0.51 2. Industry (working hard) 7.31 1.29 26 3 49 18 −4 0.46 40. Wealth 5.73 2.17 6 −3 13 66 −15 0.50 35. Protecting your “face” 5.11 1.99 −6 23 14 52 2 0.47 26. Repayment of both the good and the evil that 4.97 2.12 −12 10 −3 51 10 0.30 another person has caused you 10. Knowledge (education) 8.24 1.00 18 −28 12 42 13 0.25 8. Reciprocation of greetings, favors, and gifts 6.61 1.60 31 −3 −3 34 14 0.24 4. Harmony with others 7.26 1.44 16 2 10 −1 62 0.54 17. Non-competitiveness 4.70 1.89 −14 18 −15 −10 62 0.39 3. Tolerance of others 7.10 1.64 29 −11 12 −3 43 0.38 12. Moderation (following the middle way) 5.19 2.02 −12 14 15 20 39 0.30 11. Solidarity with others 6.58 1.42 13 2 18 14 38 0.31 33. Contentedness with one’s position in life 7.14 1.79 6 −5 1 9 30 0.11 20. Patriotism 5.32 2.15 15 25 −1 11 29 0.26 5. Humbleness 6.80 1.51 20 28 14 −20 27 0.35 Note. Factor loadings were multiplied by 100. Loadings greater than 35 are bolded. Factor 1 (F1) was labeled Trustworthiness. Factor 2 (F2) was labeled Purity and Order. Factor 3 (F3) was labeled Confucian Tradition. Factor 4 (F4) was labeled Status. Factor 5 (F5) was labeled Social Harmony. Factor 1 or Trustworthiness corresponded to Matthew’s Factors 1 to 5 uniquely explained, respectively, 20%, (2000) dimension of Self-Development. The second factor of 16%, 12%, 14%, and 11% of the common variance. The reli- Purity and Order corresponded to Matthew’s Relationships abilities of Factors 1 to 5 were calculated based on non- with Others. Factor 4 or Status resembled the dimension she cross-loading items loading at least 0.35 on a dimension. labeled as Worldly Wisdom. Her Social Responsibility factor These were found to be, respectively, 0.79, 0.80, 0.79, 0.62, referred to values spread out across the dimensions found and 0.65. See Table 2 for interfactor correlations, which here. ranged from 0 to −.33. This pattern of negative relationship 4 SAGE Open Table 2. Interfactor Correlation Matrix. F1 F2 F3 F4 F5 F1: Trustworthiness 1 F2: Purity and order −.02 1 F3: Confucian tradition −.21 −.33 1 F4: Status .02 −.24 −.14 1 F5: Social harmony −.26 −.10 −.16 −.11 1 indicates varying degrees of antagonism between dimen- sions. Individuals tended to score highly on a dimension to the exclusion of others. Figure 1. Mediation model for Purity and Order controlling for other Confucian value dimensions. Statistical Analysis Note. Path coefficients are shown with standard errors in parentheses. Control variables are not shown. The relationship between alexithymia and ethnicity was examined using two planned orthogonal contrasts. The first contrast was an Asian versus non-Asian comparison testing Ethnicity versus Remaining Ethnicities. Mediation is evalu- whether the mean of the Asian group differed from that of the ated by estimates of the indirect effect of ethnicity on alexi- combined non-Asian groups, that is, (European M + thymia (as operating through values). The indirect effect is Remaining Ethnicities M) ÷ 2. The second contrast was a estimated by multiplying the ethnicity to values path coeffi- European versus Remaining Ethnicities comparison, which cient against the values to alexithymia coefficient. If the CI tested whether the means of the two non-Asian groups dif- of the indirect effect does not encompass zero, then media- fered from each other. The contrasts were conducted within tion is said to be demonstrated. the setting of ANOVA. By combining the two non-Asian groups, this procedure gives a more powerful statistical test of the central hypothesis that Asians would differ from non- Results Asians, relative to conducting all pairwise comparisons or The mean alexithymia (SD) score was 46.19 (11.18). Planned relying on the omnibus F test. The testwise alpha was .025 contrasts revealed that the Asian group was more alexithy- after a Bonferroni correction. mic than non-Asians, M = 48.70 versus 44.95, MS contrast = The relationship between alexithymia and Confucian val- 670.29, MS error = 122.81, F(1, 213) = 5.46, p = .02, Cohen’s ues was examined using regression. Alexithymia was d = 0.34, and that the European group did not differ from the regressed on the five CVS value dimensions as quantified by Remaining Ethnicities group, M = 45.38 versus 44.51, MS their factor scores. Factor scores are linear composites calcu- contrast = 27.04, MS error = 122.81, F(1, 213) = 0.22, p = lated by multiplying item responses by their factor loadings .64, Cohen’s d = 0.08. and summing together (Hatcher, 1994). They are scaled to When regressed on CVS factors, alexithymia was found have a mean of 0 and standard deviation of 1. Only signifi- to be negatively associated with Factor 1 (Trustworthiness), cant predictors were retained in the final regression model. raw beta = −3.15, standard error = 0.80, p = .0001, and posi- CVS factors associated with alexithymia were tested for tively associated with Factor 2 (Purity and Order), raw ethnic group differences using the same contrast procedure beta = 2.76, standard error = 0.80, p = .0007. outlined earlier (i.e., Asian vs. non-Asian; European vs. There were no ethnicity differences on Factor 1 Remaining Ethnicities). (Trustworthiness). Concerning Factor 2 (Purity and Order), CVS factors found to be related to both ethnicity and alex- the Asian group scored higher than non-Asians, M = 0.36 ithymia were tested as mediators of the relationship between versus −0.18, MS contrast = 12.93, MS error = 0.79, ethnicity and alexithymia. If mediation by values is demon- F(1, 213) = 16.35, p < .0001, and the European group scored strated, this would mean that ethnic differences in alexi- lower than the Remaining Ethnicities group, M = −0.35 ver- thymia can be explained by the different values held by sus 0, MS contrast = 4.06, MS error = 0.79, F(1, 213) = 5.14, ethnic groups (i.e., ethnic groups differ in the extent to which p = .02, Cohen’s d = 0.35. they hold certain values, which in turn affect levels of alexi- See Figure 1 for a model specifying Factor 2 (Purity and thymia). Mediation was tested using a path model with boot- Order) as a mediating effect of ethnicity on alexithymia, con- strapped, bias-corrected confidence intervals (CI; Hayes & trolling for other CVS factors. The indirect effect of the Preacher, 2014). The number of resamples was 1,000. Asian versus non-Asian variable on alexithymia was signifi- Ethnicity was again operationalized as contrast variables cant with an estimate of 0.59, CI = [0.02, 1.82]. The identifying Asian versus non-Asian groups, and European 0.95 Lo 5 indirect effect of the European versus Remaining Ethnicities they may be less willing to reflect on undesirable emotional variable was non-significant with an estimate of −0.40, states associated with impurity and disorder. Group differ- CI = [−1.64, 0.009]. ences in alexithymia may therefore be explainable in light of 0.95 the psychological impact of cultural values and practice, as opposed to deficits in cognitive capacity or processing (Dere Discussion et al., 2012). Future work may seek to clarify the sources of In the present study, the association between cultural values disturbing states and the effectiveness of strategies to dimin- and alexithymia was examined in a multicultural sample of ish them within cultural context. 216 undergraduate students. Consistent with the literature, Study limitations that affect the interpretation and gener- individuals of Asian heritage scored more highly on alexi- alizability of findings include its multicultural sample, the thymia than non-Asians. The effect size was small, caution- reliance on self-report measures, and the correlational nature ing against the exaggeration and stereotyping of ethnic of the data, which prevents causal claims. The categorization groups (Terracciano et al., 2005). Nonetheless, small effect of ethnicity was rough and limits the ability to understand sizes can be meaningful (Cohen, 1988) and such cultural dif- psychological relationships within more naturalistic, self- ferences in emotion have been previously documented and identified ethnocultural groupings. It may be problematic discussed as being important (Bond, 1993; Butler et al., that non-Chinese Asians were considered acculturated in the 2007; Markus & Kitayama, 1991). Confucian tradition and that Southeast Asians were com- The present study found that the more individuals valued bined with East Asians in this study. The CVS may benefit Trustworthiness, the lower they tended to score on alexi- from further validation and testing of its psychometric prop- thymia. The Trustworthiness factor reflected values such as erties and other value systems may be worth investigating for trustworthiness, patience, kindness, and personal stability. their relationship to emotional expression. Given that the pri- This finding is consistent with previous research, which has mary dimension on the CVS was not a source of ethnic group found that the ability to be a source of kindness and security differences in this study, it may be advisable to develop the for others develops in tandem with reflective awareness assessment of values and behaviors associated with purity (Fonagy, Gergely, Jurist, & Target, 2004). Much emotional and order, as cultural differences may be most compelling in life occurs in social context, with its attendant frustrations this domain. The use of acculturation measures is also rec- and misunderstandings (Mitchell, 1997). Navigating social ommended in the study of multicultural samples. relationships with patience and compassion requires skill in In conclusion, cultural values were associated with indi- comprehending one’s inner states, perspective-taking, and vidual differences in the processing of emotions, which may the ability to manage affect in oneself and others (Mikulincer help to explain ethnic group differences in alexithymia. More & Shaver, 2007). sophisticated methods may be required to understand alexi- The Purity and Order dimension of the CVS included val- thymia as it relates to the interplay of psychosocial and bio- ues reflecting the importance of righteousness and of purity medical factors within cultural context. Improvements to from desire, and a belief in benevolent authority and social study design would include the study of variation between order. Individuals who valued purity and order tended to be and within self-identified ethnocultural groups. more alexithymic, suggesting that they may prefer not to reflect or dwell on emotions associated with impurity Declaration of Conflicting Interests (Douglas, 2005) and social disruptiveness (Chen et al., 2005; The author(s) declared no potential conflicts of interest with respect Wong, Bond, & Rodriguez Mosquera, 2008). This non- to the research, authorship, and/or publication of this article. reflectiveness may be associated with psychological sup- pression (Douglas, 2005), but it may also, contrastingly, be Funding associated with mindfulness and the belief that emotions can The author(s) received no financial support for the research and/or be let go of (Tsai, Miao, & Seppala, 2007; Wallace & Shapiro, authorship of this article. 2006). Asians scored higher on Purity and Order than non- References Asians, and those with European heritage scored lower on Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty- this dimension than the Remaining Ethnicities group. Purity item Toronto Alexithymia Scale—I. Item selection and cross- and Order was tested as a mediator of the effect of ethnicity validation of the factor structure. Journal of Psychosomatic on alexithymia. Only the difference between Asians and non- Research, 38, 23-32. Asians on alexithymia was found to be significantly medi- Bagby, R. M., Taylor, G. J., & Parker, J. D. A. (1997). The nomo- ated by Purity and Order. This finding would support the logical domain of the alexithymia construct. In A. Vingerhoets, hypothesis that Asians are more alexithymic than non-Asians F. van Bussel, & J. Boelhauwer (Eds.), The (non)-expression because they more highly value Purity and Order. To the of emotion in health and disease (pp. 95-102). Tilburg, The extent that Asians exhibit a preference for Purity and Order, Netherlands: Tilburg University. 6 SAGE Open Bond, M. H. (1993). Emotions and their expression in Chinese cul- Le, H. N., Berenbaum, H., & Raghavan, C. (2002). Culture and ture. Journal of Nonverbal Behavior, 17, 245-262. alexithymia: Mean levels, correlates, and the role of parental Butler, E. A., Lee, T. L., & Gross, J. J. (2007). Emotion regulation socialization of emotions. Emotion, 2, 341-360. and culture: Are the social consequences of emotion suppres- Markus, H. R., & Kitayama, S. (1991). Culture and self: Implications for cognition, emotion, and motivation. Psychological Review, sion culture-specific? Emotion, 7, 30-48. 98, 224-253. Chen, S. X., Cheung, M. C., Bond, M. H., & Leung, J. P. (2005). Matthews, B. M. (2000). The Chinese Value Survey: An interpre- Decomposing the construct of ambivalence over emotional tation of value scales and consideration of some preliminary expression in a Chinese cultural context. European Journal of results. International Education Journal, 1, 117-126. Personality, 19, 185-204. Mayer, J. D., Salovey, P., Caruso, D. R., & Sitarenios, G. (2001). Chinese Culture Connection. (1987). Chinese values and the search Emotional intelligence as a standard intelligence. Emotion, 1, for culture-free dimensions of culture. Journal of Cross- 232-242. Cultural Psychology, 18, 143-164. Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Cohen, J. (1988). Statistical power analyses for the behavioral sci- Structure, dynamics, and change. New York, NY: Guilford ences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum. Press. Dere, J., Falk, C. F., & Ryder, A. G. (2012). Unpacking cultural Mitchell, S. A. (1997). Influence and autonomy in psychoanalysis. differences in alexithymia: The role of cultural values among Hillsdale, NJ: Analytic Press. Euro-Canadian and Chinese–Canadian students. Journal of Terracciano, A., Abdel-Khalek, A. M., Ádám, N., Adamovová, L., Cross-Cultural Psychology, 43, 1297-1312. Ahn, C. K., Ahn, H. N., . . .McCrae, R. R. (2005). National Dere, J., Tang, Q., Zhu, X., Cai, L., Yao, S., & Ryder, A. G. (2013). character does not reflect mean personality trait levels in 49 The cultural shaping of alexithymia: Values and externally ori- cultures. Science, 310, 96-100. ented thinking in a Chinese clinical sample. Comprehensive Tsai, J. L., Levenson, R. W., & McKoy, K. (2006). Cultural and Psychiatry, 54, 362-368. temperamental variation in emotional response. Emotion, 6, Dion, K. L. (1996). Ethnolinguistic correlates of alexithymia: 484-497. Toward a cultural perspective. Journal of Psychosomatic Tsai, J. L., Miao, F. F., & Seppala, E. (2007). Good feelings in Research, 41, 531-539. Christianity and Buddhism: Religious differences in idea Douglas, M. (2005). Purity and danger: An analysis of concepts of affect. Personality and Social Psychology Bulletin, 3, 409-421. pollution and taboo. New York, NY: Routledge. Wallace, B. A., & Shapiro, S. L. (2006). Mental balance and well- Eid, M., & Diener, E. (2001). Norms for experiencing emotions in being: Building bridges between Buddhism and Western psy- different cultures: Inter- and intranational differences. Journal chology. American Psychologist, 61, 690-701. of Personality and Social Psychology, 81, 869-885. Warden, C. A., Chen, J. F., & Caskey, D. (2005). Cultural val- Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2004). Affect ues and communication online: Chinese and Southeast Asian regulation, mentalization and the development of the self. students in a Taiwan international MBA class. Business and London, England: Karnac Books. Professional Communication Quarterly, 68, 222-232. Franzoni, E., Gualandi, S., Caretti, V., Schimmenti, A., Di Pietro, Wong, S., Bond, M. H., & Rodriguez Mosquera, P. M. (2008). The E., Pellegrini, G., . . .Pellicciari, A. (2013). The relationship influence of cultural value orientations on self-reported emo- between alexithymia, shame, trauma, and body image disorders: tional expression across cultures. Journal of Cross-Cultural Investigation over a large clinical sample. Neuropsychiatric Psychology, 39, 224-229. Disease and Treatment, 9, 185-193. Yao, X. (2000). An introduction to Confucianism. Cambridge, UK: Hatcher, L. (1994). A step-by-step approach to using the SAS sys- Cambridge University Press. tem for factor analysis and Structural Equation Modeling. Cary, NC: SAS Institute. Author Biography Hayes, A. F., & Preacher, K. J. (2014). Statistical mediation analysis with a multicategorical independent variable. British Journal Dr. Lo is a research psychologist and assistant professor who stud- of Mathematical and Statistical Psychology, 67, 451-470. ies issues of adult development and adaptation within social and Hofstede, G. (1980). Culture’s consequences: International differ- cultural context. He has investigated how self-concept and person- ences in work-related values. Newbury Park, CA: SAGE. ality is shaped by cultural values and beliefs; the manner in which Jessimer, M., & Markham, R. (1997). Alexithymia: A right hemi- social relatedness protects against distress and promotes wellbeing; sphere dysfunction specific to recognition of certain facial and the assessment and treatment of death anxiety in patients with expressions? Brain and Cognition, 34, 246-258. advanced cancer near the end of life. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png SAGE Open SAGE

Cultural Values and Alexithymia:

SAGE Open , Volume 4 (4): 1 – Oct 15, 2014

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Abstract

Alexithymia refers to difficulty with reflecting on and articulating emotional states. Previous research has found that Asian groups may tend toward greater alexithymia and that cultural values may mediate this difference, although the content of Asian values that form these pathways is unclear. This study examined the relationship between Confucian values, ethnicity, and alexithymia. A sample of 216 undergraduate students completed the Chinese Value Survey and the Toronto Alexithymia Scale. Asian Canadians scored more highly on alexithymia than non-Asian Canadians. Individuals who valued trustworthiness, patience, and kindness were found to be less alexithymic. The ability to be a source of kindness and security to others may be tied to the development of reflective awareness. Individuals who valued purity from desire and respect for social order were found to be more alexithymic. Such individuals may tend not to reflect on impure or socially disruptive thoughts and feelings. Values associated with purity and order mediated the difference between Asians and non-Asians on alexithymia. Asian Canadians may therefore score more highly on alexithymia because they prefer not to reflect on emotions associated with impurity or social disorder. Keywords alexithymia, culture, emotion, ethnicity, values have been found to score more highly on alexithymia com- Introduction pared with individuals of European background (Dion, 1996; Alexithymia refers to difficulty with reflecting on and articu- Le et al., 2002). This effect may be explained by group dif- lating emotional states (Bagby, Taylor, & Parker, 1997). ferences in cultural values and beliefs relating to individual- Although alexithymia can be conceptualized as psychopa- ism and the expression of inner experience, rather than thology resulting from such factors as trauma (Franzoni biomedical factors or differences in metacognitive ability. et al., 2013) or right hemisphere dysfunction (Jessimer & Dere et al. (2012) found that differences in alexithymia Markham, 1997), it is also an individual difference variable between Asian and European Canadians were mediated by related to beliefs about the value of emotions in social life, the endorsement of modernism and Euro-American values. shaped by developmental context (Eid & Diener, 2001; Le, However, greater specificity in the content of Asian values Berenbaum, & Raghavan, 2002; Mayer, Salovey, Caruso, & associated with alexithymia remains to be identified. Sitarenios, 2001). From this perspective, alexithymia shares Non-Western value systems have been rarely operational- much in common with the construct of emotional ambiva- ized for assessment, but one such system is Confucianism lence, which refers to uncertainty about the value of emo- (Chinese Culture Connection, 1987). Confucianism is an tional rumination and expression and is affected by cultural ethical system that focuses on the cultivation of virtues con- beliefs (Chen, Cheung, Bond, & Leung, 2005). Key attri- ceptualized as foundational to social responsibility and civic butes of alexithymia include difficulty identifying emotional order (Yao, 2000). These virtues include humaneness and states from other bodily sensations, difficulty describing compassion, honesty and righteousness, loyalty and sincer- emotional experiences to others, and an externally oriented ity, propriety and correctness, and wisdom and knowledge. thinking style focused on concrete details of events as Originating in ancient China, the Confucian value system opposed to their emotional significance (Bagby et al., 1997). has had greatest historical influence in East Asia and parts of The purpose of the present study was to examine how alexi- thymia may relate to cultural values and ethnicity. East Asian cultures may tend to emphasize emotional 1 Psychiatry, University of Toronto, Toronto, Ontario, Canada restraint and externally oriented thinking, rather than emo- University Health Network, Toronto, Ontario, Canada tional exploration and articulation relative to Western Corresponding Author: European cultures (Butler, Lee, & Gross, 2007; Chen et al., Chris Lo, 9EN-234A, 200 Elizabeth St., Toronto, Ontario, Canada, M5G 2005; Dere, Falk, & Ryder, 2012; Dere et al., 2013; Tsai, 2C4. Levenson, & McKoy, 2006). Individuals of Asian heritage Email: chrislo@uhnresearch.ca This article is distributed under the terms of the Creative Commons Attribution 3.0 License Creative Commons CC BY: (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://www.uk.sagepub.com/aboutus/openaccess.htm). 2 SAGE Open Southeast Asia, specifically Vietnam and Singapore (Yao, for my feelings), and an externally oriented thinking style 2000). Confucian values have also diffused into other parts (e.g., I prefer to just let things happen rather than to under- of Southeast Asia owing to the influence of Chinese diaspora stand why they turned out that way). The scale generated a that possess an economic and political power disproportion- summed total that could range from 20 to 100. Internal reli- ate to their minority status (Warden, Chen, & Caskey, 2005). ability for the TAS has been found to be 0.81 (Bagby et al., Although Confucian values retain a sense of cultural distinc- 1994) and was 0.84 in the present study. tiveness when articulated, they overlap with other systems of The 40-item Chinese Value Survey (CVS) is a 9-point human valuation and are understandable to different peoples Likert-type scale with a range of 1 = of no importance at all (Chinese Culture Connection, 1987). to 9 = of supreme importance (Chinese Culture Connection, Using a multicultural sample, this study explored the 1987). Respondents rate the personal importance of 40 val- associations between alexithymia, Confucian values, and ues from a Confucian perspective. All CVS items are listed ethnicity. Asian Canadians were hypothesized to score more in Table 1. The CVS was found to have convergent validity highly on alexithymia than non-Asian Canadians. No predic- with Hofstede’s (1980) value dimensions in a large multisite tions were made concerning which Confucian values would international study (Chinese Culture Connection, 1987). be most associated with alexithymia. There were also no pre- However, the findings were from an ecological factor analy- dictions concerning which Confucian values would be asso- sis and the identified factors are not appropriate for individ- ciated with ethnicity beyond the general expectation that ual-level analyses. A preliminary principal components Asian Canadians would score more highly than non-Asians analysis was described by Matthews (2000) who found four on at least some Confucian values. Values that were associ- dimensions. They were Self-Development (reliability = ated with both ethnicity and alexithymia were tested as medi- 0.82), which included such values as persistence, patience, ators of the effect of ethnicity on alexithymia. and sincerity; Relationships with Others (reliability = 0.91), which included such values as having few desires, a belief in benevolent authority, and being contented with one’s posi- Method tion in life; Social Responsibility (reliability = 0.82), which included solidarity with others, ordering relationships by sta- Participants and Procedure tus, and patriotism; and Worldly Wisdom (reliability = 0.57), This study was approved by the Research Ethics Board at the which included wealth, a sense of cultural superiority, and a University of Toronto. Participants were undergraduate stu- belief in the repayment of the good and evil of others. dents recruited in exchange for psychology course credit. Uncertainty about the CVS factor structure suggested that After a research assistant obtained written informed consent an exploratory factor analysis be conducted. Principal axis from participants, they were asked to complete a question- factoring is the standard method for factor extraction and naire package and provide demographics as part of a study was used here. Promax rotation was applied because value on cultural values and personality. After completion, indi- dimensions may not be orthogonal. The number of factors viduals were given a debriefing sheet explaining the study extracted was guided by examination of the scree plot and and were given an opportunity to ask questions. Individuals the magnitude of the eigenvalues. Naming of factors was were categorized into one of three broad ethnic groupings: based on the highest loading items on that dimension, ignor- (a) East or Southeast Asian, (b) European, and (c) Remaining ing cross-loading items. Ethnicities, which included all other individuals not falling Five factors were extracted from the CVS, all with eigen- into the first two groups. Sampling continued until these values greater than 1. See Table 1 for factor loadings and groups were approximately balanced. In total, 216 partici- other item statistics. Factor 1 was labeled Trustworthiness. pants consented to this study, with a mean age (SD) of 20.19 Values loading on this dimension included a combination of (2.86) years. Sixty-one percent of the sample (132/216) was personal and relational virtues including patience, persis- female. Thirty-three percent of the sample (71/216) were of tence, trustworthiness, kindness, and personal steadiness and East or Southeast Asian background, 34% (74/216) were of stability. Factor 2 was labeled Purity and Order. Values load- European background, and 33% (71/216) were of Remaining ing on this dimension included remaining disinterested and Ethnicities. pure, having few desires, the importance of chastity in women, and a preference for righteousness and social order. Factor 3 was labeled Confucian Tradition. Values loading on Measures this factor included filial piety, respect for tradition, observa- The 20-item Toronto Alexithymia Scale (TAS) is a 5-point tion of rites, industriousness, and loyalty. Factor 4 was Likert-type scale with a range of 1 = strongly disagree to 5 = labeled Status. Values on this factor included valuing wealth strongly agree (Bagby, Parker, & Taylor, 1994). Items assess and knowledge, reputation, and the power to do unto others difficulty with identifying feelings (e.g., I am often confused as they have done unto you. Factor 5 was labeled Social by what emotion I am experiencing), difficulty with describ- Harmony. Values on this dimension were harmony with oth- ing feelings (e.g., It is difficult for me to find the right words ers, tolerance, and non-competitiveness. Lo 3 Table 1. Chinese Value Survey Factor Loadings and Item Statistics. Item M SD F1 F2 F3 F4 F5 h2 24. Persistence (perseverance) 7.40 1.26 66 −9 10 −3 −9 0.44 25. Patience 7.67 1.40 64 −12 16 −9 9 0.52 30. Trustworthiness 8.21 0.98 57 −5 −2 −5 5 0.33 18. Personal steadiness and stability 7.39 1.41 54 20 −12 26 3 0.43 9. Kindness (forgiveness, compassion) 8.09 1.07 54 6 −9 −22 33 0.55 28. Adaptability 7.30 1.41 50 14 −10 23 −8 0.31 21. Sincerity 7.73 1.44 49 21 21 −31 −21 0.41 32. Courtesy 7.54 1.27 42 2 1 20 19 0.32 36. A close intimate friend 8.14 1.18 39 −21 9 1 2 0.19 13. Self-cultivation 6.91 1.42 31 14 −17 18 13 0.18 19. Resistance to corruption 7.31 1.72 29 30 −6 −27 −5 0.19 22. Keeping oneself disinterested and pure 4.53 2.15 −5 62 14 −29 11 0.48 15. Sense of righteousness 6.01 1.95 30 60 −10 13 −13 0.48 37. Chastity in women 4.52 2.57 −10 59 29 −8 −9 0.49 38. Having few desires 3.88 2.20 −21 48 21 −2 11 0.37 27. A sense of cultural superiority 3.39 2.31 −19 46 3 43 −14 0.55 29. Prudence (carefulness) 6.67 1.56 32 46 −3 21 2 0.45 23. Thrift 4.92 1.75 −12 45 −12 0 24 0.24 14. Ordering relationships by status and observing this 4.05 2.05 −15 43 17 28 1 0.44 order 16. Benevolent authority 5.59 1.91 15 41 2 9 8 0.28 34. Being conservative 4.59 2.11 −2 36 32 18 6 0.44 31. Having a sense of shame 6.06 1.95 19 35 0 26 8 0.32 7. Observation of rites and rituals 5.29 1.91 −4 −2 69 6 −2 0.47 1. Filial piety 6.89 1.75 0 3 67 7 5 0.52 39. Respect for tradition 5.48 1.96 17 18 60 0 −7 0.55 6. Loyalty to superiors 5.83 1.75 −2 14 54 3 24 0.51 2. Industry (working hard) 7.31 1.29 26 3 49 18 −4 0.46 40. Wealth 5.73 2.17 6 −3 13 66 −15 0.50 35. Protecting your “face” 5.11 1.99 −6 23 14 52 2 0.47 26. Repayment of both the good and the evil that 4.97 2.12 −12 10 −3 51 10 0.30 another person has caused you 10. Knowledge (education) 8.24 1.00 18 −28 12 42 13 0.25 8. Reciprocation of greetings, favors, and gifts 6.61 1.60 31 −3 −3 34 14 0.24 4. Harmony with others 7.26 1.44 16 2 10 −1 62 0.54 17. Non-competitiveness 4.70 1.89 −14 18 −15 −10 62 0.39 3. Tolerance of others 7.10 1.64 29 −11 12 −3 43 0.38 12. Moderation (following the middle way) 5.19 2.02 −12 14 15 20 39 0.30 11. Solidarity with others 6.58 1.42 13 2 18 14 38 0.31 33. Contentedness with one’s position in life 7.14 1.79 6 −5 1 9 30 0.11 20. Patriotism 5.32 2.15 15 25 −1 11 29 0.26 5. Humbleness 6.80 1.51 20 28 14 −20 27 0.35 Note. Factor loadings were multiplied by 100. Loadings greater than 35 are bolded. Factor 1 (F1) was labeled Trustworthiness. Factor 2 (F2) was labeled Purity and Order. Factor 3 (F3) was labeled Confucian Tradition. Factor 4 (F4) was labeled Status. Factor 5 (F5) was labeled Social Harmony. Factor 1 or Trustworthiness corresponded to Matthew’s Factors 1 to 5 uniquely explained, respectively, 20%, (2000) dimension of Self-Development. The second factor of 16%, 12%, 14%, and 11% of the common variance. The reli- Purity and Order corresponded to Matthew’s Relationships abilities of Factors 1 to 5 were calculated based on non- with Others. Factor 4 or Status resembled the dimension she cross-loading items loading at least 0.35 on a dimension. labeled as Worldly Wisdom. Her Social Responsibility factor These were found to be, respectively, 0.79, 0.80, 0.79, 0.62, referred to values spread out across the dimensions found and 0.65. See Table 2 for interfactor correlations, which here. ranged from 0 to −.33. This pattern of negative relationship 4 SAGE Open Table 2. Interfactor Correlation Matrix. F1 F2 F3 F4 F5 F1: Trustworthiness 1 F2: Purity and order −.02 1 F3: Confucian tradition −.21 −.33 1 F4: Status .02 −.24 −.14 1 F5: Social harmony −.26 −.10 −.16 −.11 1 indicates varying degrees of antagonism between dimen- sions. Individuals tended to score highly on a dimension to the exclusion of others. Figure 1. Mediation model for Purity and Order controlling for other Confucian value dimensions. Statistical Analysis Note. Path coefficients are shown with standard errors in parentheses. Control variables are not shown. The relationship between alexithymia and ethnicity was examined using two planned orthogonal contrasts. The first contrast was an Asian versus non-Asian comparison testing Ethnicity versus Remaining Ethnicities. Mediation is evalu- whether the mean of the Asian group differed from that of the ated by estimates of the indirect effect of ethnicity on alexi- combined non-Asian groups, that is, (European M + thymia (as operating through values). The indirect effect is Remaining Ethnicities M) ÷ 2. The second contrast was a estimated by multiplying the ethnicity to values path coeffi- European versus Remaining Ethnicities comparison, which cient against the values to alexithymia coefficient. If the CI tested whether the means of the two non-Asian groups dif- of the indirect effect does not encompass zero, then media- fered from each other. The contrasts were conducted within tion is said to be demonstrated. the setting of ANOVA. By combining the two non-Asian groups, this procedure gives a more powerful statistical test of the central hypothesis that Asians would differ from non- Results Asians, relative to conducting all pairwise comparisons or The mean alexithymia (SD) score was 46.19 (11.18). Planned relying on the omnibus F test. The testwise alpha was .025 contrasts revealed that the Asian group was more alexithy- after a Bonferroni correction. mic than non-Asians, M = 48.70 versus 44.95, MS contrast = The relationship between alexithymia and Confucian val- 670.29, MS error = 122.81, F(1, 213) = 5.46, p = .02, Cohen’s ues was examined using regression. Alexithymia was d = 0.34, and that the European group did not differ from the regressed on the five CVS value dimensions as quantified by Remaining Ethnicities group, M = 45.38 versus 44.51, MS their factor scores. Factor scores are linear composites calcu- contrast = 27.04, MS error = 122.81, F(1, 213) = 0.22, p = lated by multiplying item responses by their factor loadings .64, Cohen’s d = 0.08. and summing together (Hatcher, 1994). They are scaled to When regressed on CVS factors, alexithymia was found have a mean of 0 and standard deviation of 1. Only signifi- to be negatively associated with Factor 1 (Trustworthiness), cant predictors were retained in the final regression model. raw beta = −3.15, standard error = 0.80, p = .0001, and posi- CVS factors associated with alexithymia were tested for tively associated with Factor 2 (Purity and Order), raw ethnic group differences using the same contrast procedure beta = 2.76, standard error = 0.80, p = .0007. outlined earlier (i.e., Asian vs. non-Asian; European vs. There were no ethnicity differences on Factor 1 Remaining Ethnicities). (Trustworthiness). Concerning Factor 2 (Purity and Order), CVS factors found to be related to both ethnicity and alex- the Asian group scored higher than non-Asians, M = 0.36 ithymia were tested as mediators of the relationship between versus −0.18, MS contrast = 12.93, MS error = 0.79, ethnicity and alexithymia. If mediation by values is demon- F(1, 213) = 16.35, p < .0001, and the European group scored strated, this would mean that ethnic differences in alexi- lower than the Remaining Ethnicities group, M = −0.35 ver- thymia can be explained by the different values held by sus 0, MS contrast = 4.06, MS error = 0.79, F(1, 213) = 5.14, ethnic groups (i.e., ethnic groups differ in the extent to which p = .02, Cohen’s d = 0.35. they hold certain values, which in turn affect levels of alexi- See Figure 1 for a model specifying Factor 2 (Purity and thymia). Mediation was tested using a path model with boot- Order) as a mediating effect of ethnicity on alexithymia, con- strapped, bias-corrected confidence intervals (CI; Hayes & trolling for other CVS factors. The indirect effect of the Preacher, 2014). The number of resamples was 1,000. Asian versus non-Asian variable on alexithymia was signifi- Ethnicity was again operationalized as contrast variables cant with an estimate of 0.59, CI = [0.02, 1.82]. The identifying Asian versus non-Asian groups, and European 0.95 Lo 5 indirect effect of the European versus Remaining Ethnicities they may be less willing to reflect on undesirable emotional variable was non-significant with an estimate of −0.40, states associated with impurity and disorder. Group differ- CI = [−1.64, 0.009]. ences in alexithymia may therefore be explainable in light of 0.95 the psychological impact of cultural values and practice, as opposed to deficits in cognitive capacity or processing (Dere Discussion et al., 2012). Future work may seek to clarify the sources of In the present study, the association between cultural values disturbing states and the effectiveness of strategies to dimin- and alexithymia was examined in a multicultural sample of ish them within cultural context. 216 undergraduate students. Consistent with the literature, Study limitations that affect the interpretation and gener- individuals of Asian heritage scored more highly on alexi- alizability of findings include its multicultural sample, the thymia than non-Asians. The effect size was small, caution- reliance on self-report measures, and the correlational nature ing against the exaggeration and stereotyping of ethnic of the data, which prevents causal claims. The categorization groups (Terracciano et al., 2005). Nonetheless, small effect of ethnicity was rough and limits the ability to understand sizes can be meaningful (Cohen, 1988) and such cultural dif- psychological relationships within more naturalistic, self- ferences in emotion have been previously documented and identified ethnocultural groupings. It may be problematic discussed as being important (Bond, 1993; Butler et al., that non-Chinese Asians were considered acculturated in the 2007; Markus & Kitayama, 1991). Confucian tradition and that Southeast Asians were com- The present study found that the more individuals valued bined with East Asians in this study. The CVS may benefit Trustworthiness, the lower they tended to score on alexi- from further validation and testing of its psychometric prop- thymia. The Trustworthiness factor reflected values such as erties and other value systems may be worth investigating for trustworthiness, patience, kindness, and personal stability. their relationship to emotional expression. Given that the pri- This finding is consistent with previous research, which has mary dimension on the CVS was not a source of ethnic group found that the ability to be a source of kindness and security differences in this study, it may be advisable to develop the for others develops in tandem with reflective awareness assessment of values and behaviors associated with purity (Fonagy, Gergely, Jurist, & Target, 2004). Much emotional and order, as cultural differences may be most compelling in life occurs in social context, with its attendant frustrations this domain. The use of acculturation measures is also rec- and misunderstandings (Mitchell, 1997). Navigating social ommended in the study of multicultural samples. relationships with patience and compassion requires skill in In conclusion, cultural values were associated with indi- comprehending one’s inner states, perspective-taking, and vidual differences in the processing of emotions, which may the ability to manage affect in oneself and others (Mikulincer help to explain ethnic group differences in alexithymia. More & Shaver, 2007). sophisticated methods may be required to understand alexi- The Purity and Order dimension of the CVS included val- thymia as it relates to the interplay of psychosocial and bio- ues reflecting the importance of righteousness and of purity medical factors within cultural context. Improvements to from desire, and a belief in benevolent authority and social study design would include the study of variation between order. Individuals who valued purity and order tended to be and within self-identified ethnocultural groups. more alexithymic, suggesting that they may prefer not to reflect or dwell on emotions associated with impurity Declaration of Conflicting Interests (Douglas, 2005) and social disruptiveness (Chen et al., 2005; The author(s) declared no potential conflicts of interest with respect Wong, Bond, & Rodriguez Mosquera, 2008). This non- to the research, authorship, and/or publication of this article. reflectiveness may be associated with psychological sup- pression (Douglas, 2005), but it may also, contrastingly, be Funding associated with mindfulness and the belief that emotions can The author(s) received no financial support for the research and/or be let go of (Tsai, Miao, & Seppala, 2007; Wallace & Shapiro, authorship of this article. 2006). Asians scored higher on Purity and Order than non- References Asians, and those with European heritage scored lower on Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty- this dimension than the Remaining Ethnicities group. Purity item Toronto Alexithymia Scale—I. Item selection and cross- and Order was tested as a mediator of the effect of ethnicity validation of the factor structure. Journal of Psychosomatic on alexithymia. Only the difference between Asians and non- Research, 38, 23-32. Asians on alexithymia was found to be significantly medi- Bagby, R. M., Taylor, G. J., & Parker, J. D. A. (1997). The nomo- ated by Purity and Order. This finding would support the logical domain of the alexithymia construct. In A. Vingerhoets, hypothesis that Asians are more alexithymic than non-Asians F. van Bussel, & J. Boelhauwer (Eds.), The (non)-expression because they more highly value Purity and Order. To the of emotion in health and disease (pp. 95-102). Tilburg, The extent that Asians exhibit a preference for Purity and Order, Netherlands: Tilburg University. 6 SAGE Open Bond, M. H. (1993). Emotions and their expression in Chinese cul- Le, H. N., Berenbaum, H., & Raghavan, C. (2002). Culture and ture. Journal of Nonverbal Behavior, 17, 245-262. alexithymia: Mean levels, correlates, and the role of parental Butler, E. A., Lee, T. L., & Gross, J. J. (2007). Emotion regulation socialization of emotions. Emotion, 2, 341-360. and culture: Are the social consequences of emotion suppres- Markus, H. R., & Kitayama, S. (1991). Culture and self: Implications for cognition, emotion, and motivation. Psychological Review, sion culture-specific? Emotion, 7, 30-48. 98, 224-253. Chen, S. X., Cheung, M. C., Bond, M. H., & Leung, J. P. (2005). Matthews, B. M. (2000). The Chinese Value Survey: An interpre- Decomposing the construct of ambivalence over emotional tation of value scales and consideration of some preliminary expression in a Chinese cultural context. European Journal of results. International Education Journal, 1, 117-126. Personality, 19, 185-204. Mayer, J. D., Salovey, P., Caruso, D. R., & Sitarenios, G. (2001). Chinese Culture Connection. (1987). Chinese values and the search Emotional intelligence as a standard intelligence. Emotion, 1, for culture-free dimensions of culture. Journal of Cross- 232-242. Cultural Psychology, 18, 143-164. Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Cohen, J. (1988). Statistical power analyses for the behavioral sci- Structure, dynamics, and change. New York, NY: Guilford ences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum. Press. Dere, J., Falk, C. F., & Ryder, A. G. (2012). Unpacking cultural Mitchell, S. A. (1997). Influence and autonomy in psychoanalysis. differences in alexithymia: The role of cultural values among Hillsdale, NJ: Analytic Press. Euro-Canadian and Chinese–Canadian students. Journal of Terracciano, A., Abdel-Khalek, A. M., Ádám, N., Adamovová, L., Cross-Cultural Psychology, 43, 1297-1312. Ahn, C. K., Ahn, H. N., . . .McCrae, R. R. (2005). National Dere, J., Tang, Q., Zhu, X., Cai, L., Yao, S., & Ryder, A. G. (2013). character does not reflect mean personality trait levels in 49 The cultural shaping of alexithymia: Values and externally ori- cultures. Science, 310, 96-100. ented thinking in a Chinese clinical sample. Comprehensive Tsai, J. L., Levenson, R. W., & McKoy, K. (2006). Cultural and Psychiatry, 54, 362-368. temperamental variation in emotional response. Emotion, 6, Dion, K. L. (1996). Ethnolinguistic correlates of alexithymia: 484-497. Toward a cultural perspective. Journal of Psychosomatic Tsai, J. L., Miao, F. F., & Seppala, E. (2007). Good feelings in Research, 41, 531-539. Christianity and Buddhism: Religious differences in idea Douglas, M. (2005). Purity and danger: An analysis of concepts of affect. Personality and Social Psychology Bulletin, 3, 409-421. pollution and taboo. New York, NY: Routledge. Wallace, B. A., & Shapiro, S. L. (2006). Mental balance and well- Eid, M., & Diener, E. (2001). Norms for experiencing emotions in being: Building bridges between Buddhism and Western psy- different cultures: Inter- and intranational differences. Journal chology. American Psychologist, 61, 690-701. of Personality and Social Psychology, 81, 869-885. Warden, C. A., Chen, J. F., & Caskey, D. (2005). Cultural val- Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2004). Affect ues and communication online: Chinese and Southeast Asian regulation, mentalization and the development of the self. students in a Taiwan international MBA class. Business and London, England: Karnac Books. Professional Communication Quarterly, 68, 222-232. Franzoni, E., Gualandi, S., Caretti, V., Schimmenti, A., Di Pietro, Wong, S., Bond, M. H., & Rodriguez Mosquera, P. M. (2008). The E., Pellegrini, G., . . .Pellicciari, A. (2013). The relationship influence of cultural value orientations on self-reported emo- between alexithymia, shame, trauma, and body image disorders: tional expression across cultures. Journal of Cross-Cultural Investigation over a large clinical sample. Neuropsychiatric Psychology, 39, 224-229. Disease and Treatment, 9, 185-193. Yao, X. (2000). An introduction to Confucianism. Cambridge, UK: Hatcher, L. (1994). A step-by-step approach to using the SAS sys- Cambridge University Press. tem for factor analysis and Structural Equation Modeling. Cary, NC: SAS Institute. Author Biography Hayes, A. F., & Preacher, K. J. (2014). Statistical mediation analysis with a multicategorical independent variable. British Journal Dr. Lo is a research psychologist and assistant professor who stud- of Mathematical and Statistical Psychology, 67, 451-470. ies issues of adult development and adaptation within social and Hofstede, G. (1980). Culture’s consequences: International differ- cultural context. He has investigated how self-concept and person- ences in work-related values. Newbury Park, CA: SAGE. ality is shaped by cultural values and beliefs; the manner in which Jessimer, M., & Markham, R. (1997). Alexithymia: A right hemi- social relatedness protects against distress and promotes wellbeing; sphere dysfunction specific to recognition of certain facial and the assessment and treatment of death anxiety in patients with expressions? Brain and Cognition, 34, 246-258. advanced cancer near the end of life.

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SAGE OpenSAGE

Published: Oct 15, 2014

Keywords: alexithymia; culture; emotion; ethnicity; values

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