Ethnic Variation in Emotion Regulation

Abstract

Emotion regulation (ER) via cognitive reappraisal has been shown to be superior to the use of expressive suppression regarding several aspects of mental well-being. However, a cultural perspective suggests that the consequences of emotional suppression may be moderated by cultural values. In order to examine whether this also applies to clinical samples, we investigated healthy and depressed German women and healthy and depressed Turkish immigrants living in Germany. Groups were compared in terms of frequency of ER strategies (cognitive reappraisal and expressive suppression) and with which different aspects of mental well-being the same are associated. Healthy Turkish immigrants exhibited a greater ER balance (frequent use of suppression plus frequent use of reappraisal), which was associated with more positive outcomes of expressive suppression in Turkish than in German women. None of these differences were found in patient samples, both of which showed a greater use of emotional suppression than cognitive reappraisal. Results suggest that the cultural moderation of the link between emotional suppression and well-being is associated with a greater ER balance in healthy Turkish individuals. Depressed Turkish patients may not profit from suppression due to their more rigid use of it.

Keywords

emotion regulation immigration/migration depression mental well-being

Contemporary research has demonstrated that patterns of emotion regulation (ER) (i.e., the conscious or unconscious attempts people make to modify their emotional responses) (Barnow, in press; Gross & Thompson, 2007) serve crucial functions for individuals’ well-being and health (Gross & Thompson, 2007). It has been shown that response-focused ER strategies (i.e., inhibiting ongoing emotions after they have been generated) are less effective than antecedent-focused ER strategies (i.e., alteration of the emotional response before it arises) (Gross, 2002; Gross & John, 2003; John & Gross, 2004). Thus, expressive suppression, a response-focused strategy, has been repeatedly linked to poor physical (Kune, Kune, Watson, & Bahnson, 1991), social (Butler et al., 2003), affective (Gross & Levenson, 1997; Stepper & Strack, 1993), and cognitive (Richards & Gross, 2000) conditions, whereas the reverse has been true for the antecedent-focused strategy cognitive reappraisal (i.e., the reframing or re(-)contextualization of a negative stimulus in less emotional terms).

However, these studies have been based on data from samples of predominately highly educated Europeans/European Americans (e.g., samples of European/American students)—a fact that questions the ethnic generalizability of these findings (Butler, Lee, & Gross, 2007; Consedine, Magai, & Bonanno, 2002; Consedine, Magai, & Horton, 2005). Indeed, there is recent evidence that frequency and psychological consequences of ER strategies differ in ethnic groups, depending on different cultural values (Barnow, Arens, & Balkir, 2011; Butler et al., 2007; Butler, Lee, & Gross, 2009; Chentsova-Dutton, Chu, Tsai, & Rottenberg, 2007; Gross & John, 2003; Miyamoto & Ma, in press). For instance, a study of Soto et al. has shown that the habitual use of expressive suppression was associated with adverse psychological functioning for European Americans but not for Chinese participants (Soto, Perez, Kim, Lee, & Minnick, 2011).

It has been argued that in Eastern/collectivistic cultures (e.g., Asian countries, Orient, Turkey), which emphasize interdependence and social cohesion (Hofstede, 2001; Markus & Kitayama, 1991), expressive suppression may be more encouraged than in Western/individualistic cultures, in order to fulfill prosocial goals (e.g., suppression of anger to preserve group harmony) (Hui, Triandis, & Yee, 1991). In contrast, in Western/individualistic cultures (e.g., Great Britain, the United States, Germany) expressive suppression may clash with values such as independence and open emotion expression (Hofstede, 2001; Markus & Kitayama, 1991). In such contexts other ER strategies might be preferred (e.g., cognitive reappraisal) (Gross & John, 2003; Matsumoto, Yoo, & Nakagawa, 2008). In line with these assumptions, the use of suppression was shown to be applied more frequently in Eastern collectivistic cultures (Gross & John, 2003), more automatized (Butler et al., 2007; Soto, Levenson, & Eberling, 2005), and related to lower levels of negative emotion (Butler et al., 2007), less negative social consequences (Butler et al., 2007), and better health (Butler et al., 2009; Consedine et al., 2005) than in Western individualistic cultures.

There is recent evidence that the positive consequences of expressive suppression in individuals with a collectivistic background may rest on their not using suppression exclusively and rigidly, but rather shifting to other ER strategies (e.g., cognitive reappraisal), whenever suppression would have a negative impact (Arens, in press; Butler et al., 2007). Indeed, the ability to flexibly regulate emotions has been associated with reduced levels of distress (Bonanno, 2005; Bonanno, Papa, Lalande, Westphal, & Coifman, 2004). Furthermore, it has been demonstrated that the correlation between expressive suppression and cognitive reappraisal is higher in Eastern than in Western countries (Matsumoto et al., 2008).

This indicates that individuals with collectivistic cultural values may have a more balanced use of both strategies and thus may benefit more from the use of expressive suppression (Butler et al., 2007). This might be especially true for immigrants who “live at the juncture between two cultures” (LaFromboise, Coleman, & Gerton, 1993, p. 395) and thus may need to adopt various forms of emotional expression in order to flexibly shift between contrasting culture-specific communication styles (i.e., those of their heritage culture and those of the host culture) (Eng, Kuiken, Temme, & Sharma, 2005). Accordingly, immigrants with a heightened flexibility and an extended repertoire of emotional expressivity/ER were shown to be less depressive and better integrated (Matsumoto, Hirayama, & LeRoux, 2006).

It has been argued that regulating/controlling one’s emotions might be important for positive adjustment, since it allows one to not be overly influenced by stress and negative emotions, which are inevitable in the acculturation process. Instead, emotion regulation and control allows one to think clearly and rationally, paving the way for using other psychological skills important for intercultural adjustment (e.g., openness, critical thinking etc.). Thus, functional ER, flexibly applied suppression in particular, might mediate the link between mental health and integration.

It has been demonstrated that many immigrants are poorly integrated and develop mental disorders such as depression or somatoform disorders (Bengi-Arslan, Verhulst, & Crijnen, 2002; Bhugra, 2003). It has been assumed that mental distress and/or psychopathology is associated with the inflexible use of certain ER strategies. In this case, mental health problems might undermine the flexibility of ER, which in turn might prevent the use of other psychological skills important for intercultural adjustment. Thus, immigrants who develop mental disorders might exhibit dysfunctional ER strategies (i.e., the rigid use of expressive suppression and no/less use of cognitive reappraisal) (Matsumoto et al., 2006, 2008). This raises the question of whether the positive consequences of flexibly applied suppression found in healthy integrated immigrants can be generalized to immigrants with mental disorders, who are poorly integrated and may have a more restricted repertoire of ER strategies (i.e., using suppression less flexibly). To the best of our knowledge no study has been published so far that investigates whether the cultural moderation of expressive suppression is also evident in clinical samples of patients with mental disorders.

In order to address this question, we compared frequency of expressive suppression and cognitive reappraisal and their implications for subjective well-being not only between healthy Turkish immigrants living in Germany and healthy German women but also between Turkish migrants with depressive disorders and depressed German patients. Measurement of well-being included positive and negative affectivity, loneliness, and dysfunctional attitudes, all of which have been cited as common problems experienced by immigrants (Vedder & Virta, 2005) and hence might be crucial areas impacted by ER.

Turkish immigrants were chosen because Turkish culture has often been described as high in collectivism (Hofstede, 1980; Schwartz, 1994) and they are the largest (Report of German Federal Statistical Office, 2010) yet the least integrated immigrant group in Germany (Woellert, Kröhnert, Sippel, & Klingholz, 2009). This puts them at a high risk of reduced quality of life, including physical and psychological disorders (Bongard, Pogge, Arslaner, Rohrmann, & Hodapp, 2002), unemployment (Kogan, 2004), and lower education (Söhn & Özcan, 2006). Thus, our study avoids sample bias caused by the selection of primarily highly educated Europeans/European Americans, which might have reduced the validity of previous research findings. Furthermore, we investigated only women because female Turkish immigrants present a high-risk group, with higher rates of negative health outcomes in comparison to male Turkish immigrants (David & Borde, 2000), especially regarding suicidal ideation and depression (Bengi-Arslan et al., 2002).

In this article, we test the hypotheses that (1) healthy Turkish immigrants show a more balanced use of ER strategies than healthy German women (i.e., in addition to frequent use of expressive suppression, they will also report frequent use of cognitive reappraisal). Furthermore, (2) when this greater balance of ER in healthy immigrants is observed, we expect that expressive suppression is associated with better mental well-being (i.e., lower negative affectivity, higher positive affectivity, fewer feelings of loneliness, and fewer dysfunctional attitudes when compared to healthy German women). It is further hypothesized that these cultural differences will be absent in the clinical samples; that is, (3) both Turkish and German depressed patients are expected to use expressive suppression more rigidly (i.e., frequent use of expressive suppression, no or less use of cognitive reappraisal), and thus, (4) suppression is expected to be associated with worse mental well-being in both groups (i.e., higher negative affectivity, lower positive affectivity, more feelings of loneliness, and more dysfunctional attitudes).

Method

Participants

The participants were 108 women: Turkish healthy immigrants with no current diagnosis or history of mental disorder (n = 28; mean age 43.6, SD = 9.6) as assessed with the SCID-I Interview (see below; First, Spitzer, Gibbon, Williams, & Benjamin, 1997), German healthy women with no current diagnosis or history of mental disorder (n = 26; mean age 43.8, SD = 11.2), Turkish patients with a current Major Depressive Disorder (MDD) (n = 29; mean age 44.4, SD = 8.1), and German patients with a current MDD (n = 25; mean age 43.4, SD = 10.7). Additionally, condition of participation for both Turkish healthy and depressed participants included Turkey as birthplace and immigration to Germany after the age of 11. This procedure established that both Turkish groups consisted of first-generation immigrants and did not differ in their length of residence in Germany, t(55) = 1.81, ns.

All participants gave written informed consent after the study and its objectives had been explained to them. All participants were paid 50 Euro for their participation. Investigations of both healthy and depressed Turkish participants were conducted by a native-speaking Turkish psychologist to allow flexibility regarding the investigation’s language (i.e., availability of German and Turkish versions of questionnaires/interviews). Healthy Turkish and German women were solicited through advertisements in local newspapers and numerous locations in the local community (e.g., supermarkets, cinemas). Participants’ responses to a telephone interview provided initial selection information. This phone screening established participants were female, did not have a university degree, and never visited a psychotherapist. Potentially suitable participants were then invited to come to the laboratory for a more extensive interview.

During the interview session, trained interviewers administered the Structured Clinical Interviews for the Diagnostic and Statistical Manual for Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) for Axis-I and Axis-II disorders (SCID-I and SCID-II; First, Spitzer, Gibbon, & Williams, 1997; First, Spitzer, Gibbon, Williams, & Benjamin, 1997). SCID-I and SCID-II interviews assess DSM-IV current and lifetime diagnoses for anxiety, mood, and psychotic disorders; alcohol and substance abuse; somatoform and eating disorders; as well as personality disorders. Interrater reliability has been shown to be fairly good to excellent for SCID-I, with kappa values ranging from .61 to .83, and excellent for SCID-II, with kappa values ranging from .77 to .94 (Lobbestael, Leurgans, & Arntz, 2011). Participants were included when they did not meet diagnostic criteria for current or history of Axis I or Axis II disorders. Several questionnaires (see below) were then handed out to these participants. They were asked to fill them out at home and send them back via mail.

Data collection of Turkish and German depressed patients was conducted in two psychosomatic clinics and one psychiatric clinic in Southwest Germany. In each clinic, one member of our research team visited group therapy sessions of patients with depressive disorders to introduce the study. Patients who were willing to participate were given several questionnaires (see below) and asked to complete them by the next study session. During the next study session, trained interviewers administered SCID-I and SCID-II interviews. Patients were excluded for a current diagnosis or history of bipolar disorder, alcohol or substance abuse, and the presence of personality disorders. Participants were included in the patient samples if they currently met the DSM-IV criteria for MDD. The Turkish patient sample included individuals with MDD single episode, mild (n = 2); single episode, severe (n = 1); recurrent, moderate (n = 4); recurrent, severe (n = 11); and recurrent, severe with psychotic features (n = 11). The German patient group consisted of participants with MDD single episode, mild (n = 1); single episode, moderate (n = 1); single episode, severe (n = 3); recurrent, mild (n = 1); recurrent, moderate (n = 8); recurrent severe (n = 10); and recurrent, severe with psychotic features (n = 1).

Questionnaires

We used the German (Hautzinger, Bailer, Worall, & Keller, 1994) and Turkish (Hisli, 1989) version of the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) as an additional tool to evaluate depressive symptoms in healthy and depressed participants. The BDI is a 21-item self-rating questionnaire that asks participants to rate their response to items related to depressive symptoms such as hopelessness, feelings of guilt, or fatigue on a scale of 0 to 3. Scores range from 21 to 63, with higher scores indicating a greater level of depression. Internal consistency reliability for the current samples was found to be excellent for both the Turkish (Cronbach’s α = .93) and German versions (Cronbach’s α = .95). The Turkish (Dag, 1991) and German (Franke, 2002) versions of The Symptom Checklist-90-R (SCL-90-R; Derogatis, 1994) were used to assess general psychopathological complaints. The SCL-90-R consists of 90 self-rated items regarding recent physical and psychological complaints that are scored on a 5-point scale. On the basis of eight subscales (e.g., anxiety, somatization, depression), a global severity index (GSI) is calculated. Internal consistencies of the SCL-90 R scales were excellent for both the Turkish (GSI Cronbach’s α = .98) and German samples (GSI Cronbach’s α = .97).

The presence and intensity of dysfunctional beliefs were assessed with the German (Hautzinger, Luka, & Trautmann, 1985) and Turkish (Sahin & Sahin, 1992) versions of the Dysfunctional Attitude Scale Form A (DAS-A; Weissman & Beck, 1978). The DAS-A consists of 40 items rated on a Likert-type scale ranging from totally disagree (1) to totally agree (7). In the present study, the total score used was generated by summing all 40 item scores. Higher scores indicate more dysfunctional attitudes. In the current study, internal consistency reliability was shown to be good in the German (Cronbach’s α = .82) and Turkish samples (Cronbach’s α = .82).

Subjective feelings of loneliness were assessed with the German (Lamm & Stephan, 1986) and Turkish version (Demir, 1989) of the Revised University of California Los Angeles (UCLA) Loneliness Scale developed by Russell, Peplau, and Cutrona (1980). This self-rating questionnaire consists of 20 statements related to the experience of loneliness based on satisfaction of interpersonal relationships. Participants rated how often they experience each feeling on a 4-point scale (never, rarely, sometimes, often). Internal consistency of the UCLA was found to be high for the Turkish version (Cronbach’s α = .88) and satisfactory for the German version (Cronbach’s α = .78) in the current samples.

In order to measure positive and negative affectivity we administered the German (Krohne, Egloff, Kohlmann, & Tausch, 1996) and Turkish (Gençöz, 2000) version of the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988). The PANAS is a self-rating instrument consisting of 20 adjectives, 10 of which encompass positive affect (e.g., feelings of activation, enthusiasm) and 10 that encompass negative affect (e.g., distress, hostility). Participants were asked how often they have experienced these feelings within the past 4 weeks. Items were rated on a 5-point scale ranging from 1 (not at all) to 5 (very often). Cronbach’s alphas of the PANAS scales were excellent in the German sample (positive affect: α = .92; negative affect: α = .92) and acceptable to excellent in the Turkish (positive affect: Cronbach’s α = .65; negative affect: Cronbach’s α = .91) version.

To assess emotion regulation strategies we used the German (Abler & Kessler, 2009) and Turkish (Yurtsever, 2004) version of the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003). The ERQ is a 10-Item self-report measuring the habitual use of expressive suppression and cognitive reappraisal as strategies to regulate emotions. Each item is rated on a 7-point Likert-type scale (1 = strongly disagree, 7 = strongly agree). The subscale of Reappraisal (e.g., I control my emotions by changing the way I think about the situation I’m in) contains six items, and the subscale of Expressive Suppression (e.g., I keep my emotions to myself) consists of four items, with subscales scored as the mean of the items. Internal consistencies (Cronbach’s alpha) were good in the German (suppression, Cronbach’s α = .82; reappraisal, Cronbach’s α = .88) and acceptable to good in the Turkish version (suppression, Cronbach’s α = .65; reappraisal, Cronbach’s α = .80).

Results

Table 1 and Table 2 display sociodemographic and psychopathological complaints of healthy and depressed Turkish and German women as well as comorbid Axis-I disorders of the patient samples. Groups did not differ in age. Healthy Turkish women exhibited a significantly lower level of education than healthy German participants. They further reported a significantly higher level of psychopathological complaints in the SCL-90 and BDI. Poorer education was also found in Turkish patients. Due to education differences between Turkish and German participants in both healthy and depression groups, we controlled for education in all statistical analyses. There was also a higher level of general psychopathology in Turkish than in German depressives. Severity of depression was comparable between both groups, as the mean BDI score and the score on SCL-90 Depression subscale did not differ significantly between Turkish and German patients. Comorbidity was also similar, with the exception of a significantly higher level of comorbid obsessive-compulsive disorder in Turkish depressed women.

Table 1.

Demographic Characteristics of Healthy Turkish (HC Turk, n = 28) and Healthy German Women (HC Ger, n = 26) and Depressed Turkish (DEP Turk, n = 29) and German Patients (DEP Ger, n = 25)

					t Test /Chi-Square Test t/p, Χ²/p (Effect Size)
	HC Turk	HC Ger	DEP Turk	DEP Ger	HC Turk vs. HC Ger	DEP Turk vs. DEP Ger
Mean age, yr (SD)	43.6 (9.6)	43.8 (11.2)	44.4 (8.1)	43.4 (10.7)	t = −0.1/ns^a	t = 0.4/ns
Place of birth, %
Turkey	100	0	100	0	χ² = 48.0/***^b	χ² = 53.0/***
Germany	0	100	0	100	(λ = .92)^c	(λ = .95)
Years in Germany, mean (SD)	20.4 (11.1)	—	25.1 (8.1)	—	—
Marital status, %
Single	0	15.4	3.4	36.0
Married/cohabiting	75	69.2	65.5	28.0	χ² = 8.3/*	χ² = 11.1/**
Divorced/separated	10.7	15.4	31.0	36.0	(λ = .12)	(λ = .18)
Widowed	14.3	0	0	0
Number of children, mean (SD)	2.3 (1.1)	1.5 (0.9)	2.5 (1.1)	1.2 (1.2)	t = 2.7/** (d = .7)^d	t = 3.8/*** (d = 1.1)
Education, %
No graduation	7.1	0	6.9	0
High school (8 grades)	57.1	7.7	69.0	16.0
High school (10 grades)	17.9	61.5	24.1	56.0	χ² = 19.6/***	χ² = 21.8/***
Advanced high school (13 grades)	10.7	23.1	0	20.0	(λ = .42)	(λ = .43)
Technical college	7.1	7.7	0	8.0

Note: (—) not calculated.

Degrees of freedom for all t tests, t(52).

Degrees of freedom for all chi-square tests, df = 1.

Goodman and Kruskal’s lambda as chi-square effect size measure.

Cohen’s d as effect size measure for mean comparisons.

p ≤ .05. **p ≤ .01. ***p ≤ .001. ns, not significant.

Table 2.

Clinical Characteristics of Healthy Turkish (HC Turk, n = 28) and Healthy German Women (HC Ger, n = 26) and Depressed Turkish (DEP Turk, n = 29) and Depressed German Women (DEP Ger, n = 25)

					t Test/MANOVA/ Chi-Square Test t/p, F/p, Χ²/p (Effect Size)
	HC Turk	HC Ger	DEP Turk	DEP Ger	HC Turk vs. HC Ger	DEP Turk vs. DEP Ger
Psychopathological complaints
(SCL 90-R), mean (SD)
Somatization	1.2 (0.7)	0.2 (0.3)	2.3 (0.8)	1.5 (0.7)	F = 34.1/***^d (d = 1.1)^e	F = 14.7/*** (d = 1.0)
Obsessive-compulsive attitude	1.2 (0.6)	0.2 (0.3)	2.3 (0.8)	1.8 (0.9)	F = 40.0/*** (d = 2.2)	F = 5.0/* (d = .5)
Interpersonal sensitivity	0.9 (0.6)	0.2 (0.3)	1.8 (0.7)	1.2 (0.6)	F = 26.4/*** (d = 1.5)	F = 9.1/** (d = .9)
Depression	1.1 (0.6)	0.2 (0.3)	2.3 (0.8)	1.9 (0.7)	F = 30.1/*** (d = 2.0)	F = 3.1 ns
Anxiety	0.8 (0.6)	0.1 (0.3)	2.0 (0.7)	1.3 (0.8)	F = 19.5/*** (d = 1.5)	F = 11.5/*** (d = .9)
Hostility	0.8 (0.5)	0.2 (0.4)	1.7 (0.8)	0.7 (0.5)	F = 11.6/*** (d = 1.3)	F = 23.3/*** (d = 1.5)
Phobic anxiety	0.5 (0.5)	0.1 (0.3)	1.5 (0.9)	0.9 (0.8)	F = 11.6/*** (d = 1)	F = 5.7/* (d = .7)
Paranoid ideation	0.9 (0.6)	0.2 (0.2)	1.8 (0.8)	0.8 (0.5)	F = 25.5/*** (d = 1.7)	F = 26.2/*** (d = 1.5)
Psychoticism	0.6 (0.4)	0.1 (0.1)	1.4 (0.7)	0.6 (0.3)	F = 32.3/*** (d = 1.6)	F = 25.4/*** (d = 1.6)
Global severity index (GSI)	0.9 (0.5	0.2 (0.3)	2.0 (0.6)	1.3 (0.4)	F = 34.4/*** (d = 1.7)	F = 17.9/*** (d = 1.4)
Beck Depression Inventory
Total scores, mean (SD)	7.0 (4.7)	3.7 (4.5)	32.4 (12.8)	26.7 (11.2)	t = 4.3/***^f (d = .7)	t = 1.7 ns
Comorbid Axis I disorders, %
Anxiety disorders^a	—	—	10.3	16.7	—	χ² = 0.4^g ns
OCD^b	—	—	31.0	4.2	—	χ² = 6.1/** (λ = .1)^h
PTSD	—	—	3.4	8.3	—	χ² = 0.5 ns
Eating disorders^c	—	—	0	8.3	—	χ² = 2.5 ns

Note: (—) not calculated.

Including panic disorder with/without agoraphobia, agoraphobia without panic disorder, social phobia, and simple phobia.

OCD = obsessive compulsive disorder.

Including anorexia nervosa, bulimia nervosa, and not otherwise specified eating disorders.

Degrees of freedom for all F tests, F(10, 42).

Cohen’s d as effect size measure for mean comparisons.

Degrees of freedom for all t tests, t(52).

Degrees of freedom for all chi-square tests, df = 1.

Goodman and Kruskal’s lambda as chi-square effect size measure.

p ≤ .05. **p ≤ .01. ***p ≤ .001. ns = not significant.

ER Balance

Healthy Turkish immigrants (M = 3.95, SD = 1.29) reported higher levels of suppression than healthy German women (M = 2.77, SD = 0.83), t(52) = 3.98, p ≤ .001, d = 1.12), whereas there were no significant differences in cognitive reappraisal between healthy Turkish (M = 4.07, SD = 1.18) and German women (M = 4.66, SD = 1.41), t(52) = −1.65, ns. Analyses of depressed patient samples revealed no significant differences, neither in the use of suppression (Turkish patients: M = 4.60, SD = 1.43; German patients: M = 4.41, SD = 1.26), t(52) = .52, ns, nor in the use of cognitive reappraisal (Turkish patients: M = 3.28, SD = 1.47; German patients: M = 3.41, SD = 1.01), t(52) = −.36, ns. Comparing both healthy and depressed immigrant groups, healthy Turkish women (M = 4.13, SD = 1.12) reported significantly higher levels of cognitive reappraisal than depressed Turkish women (M = 3.23, SD = 1.42), t(55) = −2.22, p ≤ .05, d = .65, whereas there were no significant differences in the use of suppression between both groups, t(55) = 1.78, ns.

In order to test our hypothesis about whether there are differences in ER balance between healthy Turkish and German women and whether these differences are absent in the clinical samples, we created difference scores. First, directional difference scores were created, in order to look at the relative preference for one strategy over the other in all groups. This score was calculated by subtracting the mean value of cognitive reappraisal from the mean value of expressive suppression for each subject; thus, while higher positive scores represent a favor of suppression over reappraisal (and vice versa), values close to zero imply a balanced use of both strategies (see Figure 1). Some t tests were conducted to test for significant difference scores in ER strategies and group differences. Since we were interested in the absolute difference between the use of suppression and reappraisal (and not in the relative preference for one over the other), directional difference scores were turned into absolute difference scores (balance scores). There was a significant difference in balance scores between healthy German and Turkish women, t(52) = −2.65, p ≤ .01, d = .83. German women reported a primary use of cognitive reappraisal, as their difference score significantly differed from zero, t(25) = 7.64, p ≤ .001. Turkish women reported to use both ER strategies to a similar extent, as their difference score did not significantly differ from zero, t(27) = 1.63, ns. Comparing the clinical samples, analyses revealed no significant differences between both groups regarding ER balance, t(52) = 1.07, ns. Balance scores of Turkish, t(28) = 6.80, p ≤ .001, and German, t(24) = 6.69, p ≤ .001, depressed patients differed significantly from zero, indicating a primary use of expressive suppression in both groups (see Figure 1).

Figure 1.

Difference Scores^a between Expressive Suppression (ES) and Cognitive Reappraisal (CR) in Turkish (n = 28) and German Healthy Controls (n = 26) and Turkish (n = 29) and German Depressed Patients (n = 25)

Associations Between ER Strategies and Mental Well-Being

In order to test our hypothesis about whether associations between expressive suppression and subjective well-being would differ between healthy Turkish and healthy German women, we conducted a Multivariate Analysis of Variance (MANOVA) and tested for interactive effects. Different measures of mental well-being were entered as dependent variables and group (healthy Turkish vs. healthy German women) and expressive suppression (low [≤ 25th percentile] vs. high [≥ 75th percentile]) as fixed factors. There was no main effect for suppression, F(4, 19) = .57, ns, but there was a significant group effect, F(4, 19) = 5.58, p ≤ .01, partial eta² = .54, indicating significant differences between groups in terms of their mental well-being (see Table 3). Healthy Turkish women reported significantly lower positive affectivity, more dysfunctional attitudes, and greater loneliness. On entering education as a covariate, results did not change significantly.

Table 3.

Statistical Comparisons (Multivariate Statistics) between Healthy Turkish (HC Turk, n = 28) and German (HC Ger, n = 26) Women and Depressed Turkish (DEP Turk, n = 29) and German (DEP Ger, n = 25) Patients in Different Measures of Mental Well-Being

					MANOVA, F/p (Cohen’s d)^d
	HC Turk	HC Ger	DEP Turk	DEP Ger	HC Turk vs. HC Ger	DEP Turk vs. DEP Ger
PANAS Positive Affectivity,^a mean (SD)	2.9 (0.6)	3.6 (0.5)	2.7 (0.5)	2.4 (0.5)	F = 19.1/*^e (1.2)	F = 0.1 ns
PANAS Negative Affectivity, mean (SD)	2.3 (0.8)	2.1 (0.6)	3.4 (0.9)	3.5 (0.7)	F = 0.1 ns	F = 0.6 ns
UCLA, Loneliness^b, mean (SD)	2.0 (0.5)	1.5 (0.3)	2.4 (0.6)	2.2 (0.4)	F = 12.5/*** (1.2)	F = 0.6 ns
DAS Dsyfunctional Attitudes, mean (SD)^c	3.4 (0.6)	2.7 (0.6)	3.9 (0.6)	3.7 (0.8)	F = 15.6/*** (1.1)	F = 1.6 ns

Positive and Negative Affect Schedule (Watson et al., 1988).

UCLA-Loneliness Scale (Russell et al., 1980).

Dysfunctional Attitude Scale (Weissman & Beck, 1978).

Cohen’s d is standardized difference, obtained by dividing the difference between group means by the pooled within group standard deviation.

Degrees of freedom for all F tests, F(4, 48).

p ≤ .05. ***p ≤ .001. ns = not significant.

Furthermore, we found a significant interaction between group and expressive suppression, F(4, 19) = 3.99, p ≤ .05, partial eta² = .45. While for German women greater suppression was accompanied by higher negative affectivity, F(1, 22) = 5.30, p ≤ .05, partial eta² = .19 (see Figure 2), greater loneliness, F(1, 22) = 4.97, p ≤ .05, partial eta² = .18 (see Figure 3), and more dysfunctional attitudes, F(1, 22) = 15.60, p ≤ .001, partial eta² = .41 (see Figure 4), the reverse was true for Turkish migrant women. There was no effect for positive affectivity, F(1, 22) = 2.45, ns. Results remained unchanged when controlling for education. The same analyses were conducted for the clinical samples. There was no group effect, F(4, 16) = .62, ns, implying that both patient samples did not differ in terms of their mental well-being (see Table 3). There was also no significant interaction effect, F(4, 16) = .28, ns, indicating that expressive suppression has the same negative impact on all mental well-being measures in both groups (see Figures 2, 3, and 4). Given that our hypotheses suggest that differences in ER balance and suppression-outcomes are associated, we investigated whether our findings were connected in the form of a mediated moderation model. We tested for this by following the three-step procedure for mediated moderation models outlined by Baron and Kenny (1986). This involved the moderation effect of culture, which shows that expressive suppression is associated with differential mental health conditions depending on patient’s culture (Step 1). This has already been demonstrated above. Second, the model was used to show that ER balance is different depending on patient’s culture (Step 2), which has also been demonstrated above. In Step 3, we tested a model containing suppression scores, the interaction term (Culture × Suppression), and balance scores. This analysis was conducted for each dependent variable that stood out in Step 1. Mediated moderation would be suggested if Steps 1 and 2 were met, and additionally if in Step 3 ER balance predicted measures of mental well-being, while the differential outcomes of suppression, depending on culture, were reduced. Indirect effects were tested for significance using the Sobel test (Baron & Kenny, 1986; Preacher & Leonardelli, 2001).

Figure 2.

Negative Affect^a depending on Expressive Suppression and Culture in Healthy Turkish and German Women and Depressed Turkish and German Patients

Figure 3.

Loneliness^a depending on Expressive Suppression and Culture in Healthy Turkish and German Women and Depressed Turkish and German Patients

Figure 4.

Dysfunctional Attitudes^a depending on Expressive Suppression and Culture in Healthy Turkish and German Women and Depressed Turkish and German Patients

We found evidence for mediated moderation for all variables that stood out in Step 1. On entering all predictors, we found an effect of ER balance scores on negative affect (B = .27, ß = .42, p ≤ .01), loneliness (B = .12, ß = .27, p ≤ .05), and dysfunctional attitudes (B = .24, ß = .36, p ≤ .01), whereas the interaction of culture and expressive suppression was no longer a significant predictor of any mental well-being measures. The tests of indirect effects were also significant (negative affect: Sobel test statistic = 2.73, p ≤ .001; loneliness: Sobel test statistic = 3.05, p ≤ .001; dysfunctional attitudes: Sobel test statistic = 2.87, p ≤ .001), suggesting that the associations between suppression and more positive mental well-being in healthy Turkish women can be attributed to their more balanced use of ER strategies.

Discussion

Our findings are in line with several other studies, suggesting cultural differences in ER practices and health outcomes (Consedine et al., 2002, 2005; Gross & John, 2003). More recently, Butler et al. (2007) found that among Asian and European Americans, those individuals holding Eastern values showed less negative consequences of emotional suppression. However, their study focused primarily on interpersonal outcomes, such as social withdrawal and responsiveness, and placed less emphasis on the effects of suppression on intrapersonal functioning. The present study addresses this gap by showing that individuals holding Eastern collectivistic cultural values may benefit from emotional suppression not only at the social level but also at the individual level in terms of lower negative affectivity, loneliness, and dysfunctional attitudes.

Furthermore, it could be shown that these benefits of emotional suppression in healthy Turkish women can be attributed to their additional use of cognitive reappraisal and hence greater ER balance in comparison to their German counterparts. There is also evidence from other studies pointing to cultural differences in the flexibility/balance of ER strategies. Intercultural studies carried out by Bonanno et al. (Bonanno, 2005; Bonanno, Papa, Lalande, Nanping, & Noll, 2005) have shown that in contrast to participants with Western individualistic cultural values (e.g., USA), individuals from collectivistic cultures (e.g., China) are characterized by a more balanced repertoire of coping strategies, which enables them to flexibly move between expressing and suppressing emotions. Similarly, Miyamoto and Ma (in press) have shown in several studies, first, that Easterners combine both up- and down-regulation strategies in order to experience a balance between positive and negative emotions and, second, that this dialectical regulation is related to a better health profile in Eastern than in Western cultures.

In contrast, we did not find cultural differences in balance and mental health outcomes of ER in the depressed samples. These results are in accordance with previous research relating psychopathology to a rigid and contextually insensitive application of ER strategies (Mennin, Holaway, Fresco, Moore, & Heimberg, 2007), in particular to the inflexible use of emotional suppression (Aldao & Nolen-Hoeksema, 2010). In their review on ER strategies in depressed individuals, Joormann and D’Avanzato (2010) conclude that depression may not be so much associated with the use of ER strategies, which differ dramatically from strategies used by other people, but rather with an inflexible use of specific strategies: the poor fit of the strategy to the situation, and differences in the ability to implement important effective strategies.

Furthermore, the present results substantiate earlier studies demonstrating that cultural differences in emotional processes shrink or disappear when it comes to psychopathology (Schrier et al., 2010). Therefore, it can be assumed that Turkish immigrant patients may benefit from an ER skills training that is commonly applied in Western therapeutic approaches (e.g., Beck, Rush, Shaw, & Emery, 1979). However, there is some evidence that cultural variability decreases as psychological disturbance becomes more severe (Draguns & Tanaka-Matsumi, 2003). Given that patients of our samples can be considered as relatively serious cases, exhibiting moderate-to-severe depressive symptoms, the examination of less disabling forms of psychopathology might have revealed different results.

There is mounting evidence that a flexible use of emotion regulation strategies is an indication of resilience. The ability to balance ER strategies and the use of flexible forms of emotional expression was shown to be related to higher effectiveness in problem solving (Blanchard-Fields, 2007) and lower current (Mino & Kanemitsu, 2005) and prospective levels of distress (Bonanno et al., 2004). Additionally, emotional flexibility has been related to higher bicultural competence and better integration of immigrants (Eng et al., 2005; Matsumoto et al., 2006). Accordingly, a balanced use of ER strategies may have prevented healthy Turkish women from the development of mental disorders in contrast to their depressed compatriots. Importantly, both healthy and depressed immigrant groups did not differ in frequency of suppression but rather in the additional use of cognitive reappraisal. This may enable healthy Turkish women to flexibly adapt to alternating culture-specific communication requirements and hence achieve a better integration that may buffer deleterious effects of acculturation stress (Crockett et al., 2007).

Several caveats for this study are noteworthy. The major limitation of the present study concerns the relatively small sample sizes of the groups investigated. As a consequence, the risk of Type II error was elevated, and some of the associations among variables may have been significant with larger sample sizes. However, it must be noted that in the current study special emphasis was given to avoiding sampling bias, which has permeated many previous studies on this topic, investigating young, highly educated, and privileged college students (Consedine et al., 2002, 2005). Recruitment criteria such as middle adulthood, low to moderate education, and in the case of Turkish immigrants, Turkey as birthplace and immigration after the age of 11 were set at the expense of larger sample sizes. Additionally, it is important to mention that all participants in the present study were female. The generalizability of the present findings to the male population remains to be explored, as there is evidence for gender differences in the associations between ER strategies and mental well-being (Thayer, Rossy, Ruiz-Padial, & Johnsen, 2003).

Another limitation stems from how ER balance was operationalized in the present study. Instead of calculating balance scores representing (a)symmetry of ER repertoire, we could have directly measured ER flexibility by using specific questionnaires (e.g., Coping Flexibility Questionnaire, CFQ; Cheng, 2001) or situational measurements (e.g., Ecological Momentary Assessment; EMA). Future studies might use more sophisticated measurements that also include ER strategies other than cognitive reappraisal and expressive suppression. In sum, the present research serves to mitigate the rigid distinction between the culturalist and universalist views on emotional phenomena. On the one hand, current findings demonstrate the importance of going beyond the conception of ER as an individual process and considering ER as a sociocultural phenomenon. On the other hand, the present study points out that the impact of cultural factors on emotional processes is not unlimited, as it shows the absence of cultural differences in frequency and outcomes of ER strategies in clinical samples. Future research is required in order to shed more light on universal and culturally specific features of ER.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Excellence Initiative of the German Research Foundation (DFG)

References

Abler

Kessler

(2009). Emotion Regulation Questionnaire [Eine deutschsprachige fassung des ERQ von Gross und John]. Diagnostica, 55, 144-152.

Aldao

Nolen-Hoeksema

(2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour Research and Therapy, 48, 974-983.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Arens

E.A.

(in press). Unpacking cultural differences in emotion regulation: The role of flexibility. In Barnow

Balkir

(Eds.), Cultural variation in psychopathology: From Research to Practice (pp. 115-134). Göttingen: Hogrefe Publishing GmbH.

Barnow

(in press). Emotion regulation and psychopathology: A summarizing review. Psychologische Rundschau.

Barnow

Arens

E. A.

Balkir

(2011). Emotion regulation and psychopathology taking cultural influences into account. Psychotherapie in Psychiatrie, Psychotherapeutischer Medizin und Klinischer Psychologie, 16, 7-17.

Baron

R. M.

Kenny

D. A.

(1986). The moderator/mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.

Beck

A. T.

Rush

A. J.

Shaw

B. F.

Emery

(1979). Cognitive therapy of depression. New York: The Guilford Press.

Beck

A. T.

Ward

C. H.

Mendelson

Mock

Erbaugh

(1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.

10.

Bengi-Arslan

Verhulst

F. C.

Crijnen

A. A. M.

(2002). Prevalence and determinants of minor psychiatric disorder in Turkish immigrants living in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 37, 118-124.

11.

Bhugra

(2003). Migration and depression. Acta Psychiatrica Scandinavica, 108, 67-72.

12.

Blanchard-Fields

(2007). Everyday problem solving and emotion: An adult developmental perspective. Current Directions in Psychological Science, 16, 26-31.

13.

Bonanno

G. A.

(2005). Resilience in the face of potential trauma. Current Directions in Psychological Science, 14, 135-138.

14.

Bonanno

G. A.

Papa

Lalande

Nanping

Noll

J. G.

(2005). Grief processing and deliberate grief avoidance: A prospective comparison of bereaved spouses and parents in the United States and China. Journal of Consulting and Clinical Psychology, 73, 86-98.

15.

Bonanno

G. A.

Papa

Lalande

Westphal

Coifman

(2004). The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15, 482-487.

16.

Bongard

Pogge

S. F.

Arslaner

Rohrmann

Hodapp

(2002). Acculturation and cardiovascular reactivity of second-generation Turkish migrants in Germany. Journal of Psychosomatic Research, 53, 795-803.

17.

Butler

E. A.

Egloff

Wilhelm

F. H.

Smith

N. C.

Erickson

E. A.

Gross

J. J.

(2003). The social consequences of expressive suppression. Emotion, 3, 48-67.

18.

Butler

E. A.

Lee

T. L.

Gross

J. J.

(2007). Emotion regulation and culture: Are the social consequences of emotional suppression culture-specific? Emotion, 7, 30-48.

19.

Butler

E. A.

Lee

T. L.

Gross

J. J.

(2009). Does expressing your emotions raise or lower your blood pressure? The answer depends on cultural context. Journal of Cross-Cultural psychology, 40, 510-517.

20.

Cheng

(2001). Assessing coping flexibility in real-life and laboratory settings: A multimethod approach. Journal of Personality and Social Psychology, 80, 814-833.

21.

Chentsova-Dutton

Y. E.

Chu

J. P.

Tsai

J. L.

Rottenberg

(2007). Depression and emotional reactivity: Variation among Asian Americans of East Asian descent and European Americans. Journal of Abnormal Psychology, 116, 776-785.

22.

Consedine

N. S.

Magai

Bonanno

G. A.

(2002). Moderators of the emotion inhibition-health relationship: A review and research agenda. Review of General Psychology, 6, 204-228.

23.

Consedine

N. S.

Magai

Horton

(2005). Ethnic variation in the impact of emotion and emotion regulation on health: A replication and extension. Journal of Gerontology: Psychological Sciences, 60, 165-173.

24.

Crockett

L. J.

Iturbide

M. I.

Stone

R. A. T.

McGinley

Raffaelli

Carlo

(2007). Acculturative stress, social support, and coping: Relations to psychological adjustment among Mexican American college students. Cultural Diversity and Ethnic Minority Psychology, 13, 347-355.

25.

Dag

(1991). Beliri tarama listesi (SCL-90-R)’nin universite ogrencileri icin guvenirligi ve gecerligi [The reliability and validity of SCL-90-R for university students]. Turk Psikiyatri Dergisi, 2, 5-12.

26.

David

Borde

T. H. K.

(2000). Knowledge among German and Turkish women of specifically female bodily functions, contraception, preventative medical examination and menopause. Ethnicity Health, 5, 101-112.

27.

Demir

(1989). Reliability and validity studies of UCLA loneliness scale among college students. Turkish Journal of Psychology, 7, 4-18.

28.

Derogatis

L. R.

(1994). SCL-90-R: Administration, scoring, and procedures manual (3rd ed.). Minneapolis, MN: National Computer Systems.

29.

Draguns

J. G.

Tanaka-Matsumi

(2003). Assessment of psychopathology across and within cultures: Issues and findings. Behaviour Research and Therapy, 41, 755-776.

30.

Eng

T. C.

Kuiken

Temme

Sharma

(2005). Navigating the emotional complexities of two cultures: Bicultural competence, feeling expression, and feeling change in dreams. Journal of Cultural and Evolutionary Psychology, 3, 261-279.

31.

Federal Statistical Office of Germany (2011). Immigrant population. Results from Mikrozensus 2010, Wiesbaden, 2011

32.

First

M. B.

Spitzer

R. L.

Gibbon

Williams

J. B. W.

(1997). User’s guide for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID II). Washington, DC: American Psychiatric Press.

33.

First

M. B.

Spitzer

R. L.

Gibbon

Williams

J. B. W.

Benjamin

(1997). User’s guide for the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I). Washington, DC: American Psychiatric Press.

34.

Franke

G.H.

(2002). Symptom Checkliste von L.R. Derogatis-Deutsche Version. 2., vollständig überarbeitete und neu normierte Auflage [Symptom Checklist of L.R. Derogatis - German Version. 2. completely revised and newly standardized version]. Göttingen, Germany: Beltz Test GmbH.

35.

Gençöz

(2000). Positive and negative affect schedule: A study of validity and reliability. Turk Psikoloji Dergisi, 15, 19-28.

36.

Gross

J. J.

(2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281-291.

37.

Gross

J. J.

John

O. P.

(2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348-362.

38.

Gross

J. J.

Levenson

R. W.

(1997). Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, 106, 95-103.

39.

Gross

J. J.

Thompson

R. A.

(2007). Emotion regulation: Conceptual foundations. In Gross

J. J.

(Ed.), Handbook of emotion regulation (pp. 3-24). New York: Guilford Press.

40.

Hautzinger

Bailer

Worall

Keller

(1994). Beck-Depressions-Inventar (BDI). Bearbeitung der deutschen Ausgabe. Testhandbuch [Beck-Depression-Inventory (BDI). Adaptation of the German version.Test manual]. Bern, Germany: Huber.

41.

Hautzinger

Luka

Trautmann

R. D.

(1985). Skala dysfunktionaler Einstellungen—Eine deutsche Version der Dysfunctional Attitude Scale [Scale of dysfunctional attitudes - A German version of The Dysfunctional Attitude Scale]. Diagnostica, 31, 312-323.

42.

Hisli

(1989). Reliability and validity of Beck Depression Inventory for university students (in Turkish). Turkish Journal of Psychology, 7(23), 3-13.

43.

Hofstede

(1980). Culture’s consequences: International differences in work-related values. Thousand Oaks, CA: Sage.

44.

Hofstede

(2001). Culture’s consequences, comparing values, behaviors, institutions, and organizations across nations. Thousand Oaks, CA: Sage Publications.

45.

Hui

C. H.

Triandis

H. C.

Yee

(1991). Cultural differences in reward allocation: Is collectivism the explanation? British Journal of Social Psychology, 30, 145-157.

46.

John

O. P.

Gross

J. J.

(2004). Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. Journal of Personality, 72, 1301-1333.

47.

Joormann

D’Avanzato

(2010). Emotion regulation in depression: Examining the role of cognitive processes. Cognition and Emotion, 24, 913-939.

48.

Kogan

(2004). Last hired, first fired? The unemployment dynamics of male immigrants in Germany. European Sociological Review, 20, 445-461.

49.

Krohne

H. W.

Egloff

Kohlmann

Tausch

(1996). Untersuchungen mit einer deutschen Version der “Positive and Negative Affect Schedule” (PANAS) [Investigations with a German version of the “Positive and Negative Affect Schedule” (PANAS)]. Diagnostica, 42, 139-156.

50.

Kune

Watson

Bahnson

(1991). Personality as risk factor in large bowel cancer: Data from the Melbourne Colorectal Cancer Study. Psychological Medicine, 21, 29-41.

51.

LaFromboise

Coleman

L. K. H.

Gerton

(1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395-412.

52.

Lamm

Stephan

(1986). Zur messung von einsamkeit: Entwicklung einer deutschen fassung des fragebogens von russell und peplau [On the measurement of loneliness:Development of the German version of the questionnaire of Russell and Peplau]. Zeitschrift für Arbeits- und Organisationspsychologie, 30, 132-134.

53.

Lobbestael

Leurgans

Arntz

(2011). Inter-Rater Reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clinical Psychology and Psychotherapy, 18, 75-79.

54.

Markus

H. R.

Kitayama

(1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98, 224-253.

55.

Matsumoto

Hirayama

LeRoux

(2006). Psychological skills related to intercultural adjustment. In Wong

P. T. P.

Wong

L. C. J.

(Eds.), Handbook of multicultural perspectives on stress and coping (pp. 387-405). New York: Kluwer Academic/Plenum Publishing.

56.

Matsumoto

Yoo

S. H.

Nakagawa

(2008). Culture, emotion regulation, and adjustment. Journal of Personality and Social Psychology, 94, 925-937.

57.

Mennin

D. S.

Holaway

Fresco

D. M.

Moore

M. T.

Heimberg

R. G.

(2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38, 284-302.

58.

Mino

Kanemitsu

(2005). Cognitive reappraisal and situation-appropriate coping flexibility as related to clerical workers’ job satisfaction in stressful situations. Japanese Journal of Health Psychology, 18, 34-44.

59.

Miyamoto

(in press). Dampening or savoring positive emotions: A dialectical cultural script guides emotion regulation. Emotion.

60.

Preacher

K. J.

Leonardelli

G. J.

(2001). Calculation for the Sobel test: An interactive calculation tool for mediations tests [computer software]. Available at http://www.unc.edu/~preacher/sobel/sobel.htm

61.

Richards

J. M.

Gross

J. J.

(2000). Emotion regulation and memory: The cognitive costs of keeping one’s cool. Journal of Personality and Social Psychology, 79, 410-424.

62.

Russell

Peplau

L. A.

Cutrona

C. E.

(1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472-480.

63.

Sahin

N. H.

Sahin

(1992). How dysfunctional are the dysfunctional attitudes in another culture. British Journal of Medical Psychology, 65, 17-26.

64.

Schrier

A. C.

de Wit

M. A. S.

Rijmen

Tuinebreijer

W. C.

Verhoeff

A. P.

Kupka

R. W. K.

Dekker

Beekman

A. T. F.

(2010). Similarity in depressive symptom profile in a population-based study of migrants in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 45, 941-951.

65.

Schwartz

S.H.

(1994). Cultural dimensions of values: Towards an understanding of national differences. In Kim

Triandis

H. C.

Kagitcibasi

Choi

S. C.

Yoon

(Eds.), Individualism and collectivism: Theoretical and methodological issues (pp. 85-119). Thousand Oaks, CA: Sage.

66.

Söhn

Özcan

(2006). The educational attainment of Turkish migrants in Germany. Turkish Studies, 7, 101-124.

67.

Soto

J. A.

Levenson

R. W.

Eberling

(2005). Cultures of moderation and expression: Emotional experience, behavior, and physiology in Chinese Americans and Mexican Americans. Emotion, 5, 154-165.

68.

Soto

J. A.

Perez

C. R.

Kim

Y.- H.

Lee

E. A.

Minnick

M. R.

(2011). Is expressive suppression always associated with poorer psychological functioning? A cross-cultural comparison between European Americans and Hong Kong Chinese. Emotion, 11, 1450-1455.

69.

Stepper

Strack

(1993). Proprioceptive determinants of emotional and nonemotional feelings. Journal of Personality and Social Psychology, 64, 211-220.

70.

Thayer

J. F.

Rossy

L. A.

Ruiz-Padial

Johnsen

B. H.

(2003). Gender differences in the relationship between emotional regulation and depressive symptoms. Cognitive Therapy and Research, 27, 349-364.

71.

Vedder

Virta

(2005). Language, ethnic identity, and the adaption of Turkish immigrant youth in the Netherlands and Sweden. International Journal of Intercultural Relations, 29, 317-337.

72.

Watson

Clark

L. A.

Tellegen

(1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070.

73.

Weissman

Beck

(1978, November). Development and validation of the Dysfunctional Attitude Scale. Paper presented at the meeting of the Association for Advancement of Behavior Therapy, Chicago.

74.

Woellert

Kröhnert

Sippel

Klingholz

(2009): Untapped Potential. On the situation of integration in Germany. Berlin-Institute for Population and Development, Berlin.

75.

Yurtsever

(2004). Emotional regulation strategies and negotiation. Psychological Reports, 95, 780-786.