Perceived Impact of Socially Anxious Behaviors on Individuals' Lives in Western and East Asian Countries

Perceived Impact of Socially Anxious Behaviors on Individuals' Lives in Western and East Asian Countries

Available online at www.sciencedirect.com Behavior Therapy 42 (2011) 485 – 492 www.elsevier.com/locate/bt Perceived Impact of Socially Anxious Beha...

177KB Sizes 5 Downloads 66 Views

Available online at www.sciencedirect.com

Behavior Therapy 42 (2011) 485 – 492

www.elsevier.com/locate/bt

Perceived Impact of Socially Anxious Behaviors on Individuals' Lives in Western and East Asian Countries Ronald M. Rapee Jinkwan Kim Macquarie University

Jianping Wang Beijing Normal University

Xinghua Liu Capital Normal University

Stefan G. Hofmann Boston University

Junwen Chen Flinders University of South Australia

Kyung Ya Oh Yonsei University

Susan M. Bögels University of Amsterdam

Soroor Arman Isfahan University of Medical Sciences

Nina Heinrichs University of Bielefeld

Lynn E. Alden University of British Columbia

The research in one campus in China was supported by a National Science Foundation of China Project No.30900411 to Xinghua Liu. Address correspondence to Ronald M. Rapee, Ph.D., Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia, 2109; e-mail: [email protected]. 0005-7894/11/485–492/$1.00/0 © 2011 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.

486

rapee et al.

The current study compared the predicted social and career impact of socially withdrawn and reticent behaviors among participants from Western and East Asian countries. Three hundred sixty-one college students from 5 Western countries and 455 students from 3 East Asian countries read hypothetical vignettes describing socially withdrawn and shy behaviors versus socially outgoing and confident behaviors. Participants then answered questions following each vignette indicating the extent to which they would expect the subject of the vignette to be socially liked and to succeed in their career. Participants also completed measures of their own social anxiety and quality of life. The results indicated significant vignette-by-country interactions in that the difference in perceived social and career impact between shy and outgoing vignettes was smaller among participants from East Asian countries than from Western countries. In addition, significant negative correlations were shown between personal level of shyness and experienced quality of life for participants from both groups of countries, but the size of this relationship was greater for participants from Western than East Asian countries. The results point to the more negative impact of withdrawn and socially reticent behaviors for people from Western countries relative to those from East Asia.

TRAIT SOCIAL ANXIETY OR shyness is a personality type or temperament characterized by withdrawal, wariness, and reticence in social situations (Crozier & Alden, 2001). Individuals differ in their degree of characteristic shyness and across most populations this difference is broadly distributed. Across cultures, population levels of self-reported shyness have been shown to be slightly higher in some East Asian countries, especially in Japan, than in several Western countries (see Norasakkunkit & Kalick, 2009) and this difference has been demonstrated as young as 2 years of age (Rubin et al., 2006). At the more severe end of social reticence, social anxiety disorder is one of the more common mental disorders in Western societies. Prevalence estimates indicate lifetime rates from 2% to 13% in adults and children across several Western countries (Bögels & Stein, 2009; Furmark, 2002; Rapee, Schniering, & Hudson, 2009). This clinical condition also appears to be universal (Stein & Stein, 2008). However, the prevalence of social anxiety disorder is not consistent across countries. In particular, data from several East Asian countries has indicated especially low rates of the disorder (Furmark, 2002; Hofmann, Asnaani, & Hinton, 2010; Wittchen & Fehm, 2001). In one of the few cross-national comparisons, lifetime prevalence of social anxiety disorder was shown to be markedly

lower in Korea (0.5%) than in the U.S. (2.6%) or Canada (1.7%) (Weissman et al., 1996). When it did occur, social anxiety disorder in Korea was shown to have an onset around 10 years later than in the U.S. or Canada. The relationship between shyness and the clinical condition of social anxiety disorder has been the source of some discussion and there is a lack of certainty whether the constructs differ qualitatively or quantitatively (Rapee & Coplan, 2010). One suggestion is that the conditions differ in terms of the distress or life interference associated with the behaviors (Rapee & Spence, 2004). That is, while both shyness and social anxiety disorder share similar cognitive, emotional, and behavioral features, it is when these characteristics begin to have an impact on and reduce quality of life that they are referred to as a clinical syndrome (Rapee & Coplan, 2010). One possible explanation for differences between the rates of shyness and social anxiety disorder across cultures is the different meanings and impact of withdrawn behaviors in these societies (Hofmann, Asnaani, & Hinton, 2010). A given set of behaviors may produce more or less personal distress, depending on the ways in which those behaviors affect their interpersonal relationships, career prospects, and social standing. To some degree, these factors may be partly influenced by cultural norms and expectations. Several East Asian philosophies value a quiet, self-effacing behavioral style including modesty, social harmony, and deference to parents (King & Bond, 1985). Thus, shy and withdrawn behaviors are likely to be viewed as socially syntonic and may not result in great distress, at least until the more extreme manifestations. In contrast, much of the West places value, to varying degrees, on a self-promoting, individualistic behavioral style (Marjoribanks, 1994). Therefore, even more moderate socially avoidant behaviors would be seen as socially dystonic, resulting in negative perceptions and personal distress. A small amount of research has supported the contention that East Asian societies value behaviors and beliefs that are characteristic of shy individuals more than do Western societies. In contrast to the common demonstration that shyness among Western children is associated with poor psychosocial outcomes (Caspi, Elder, & Bem, 1988; Coplan & Armer, 2005), several studies have shown that shy Chinese children and adolescents often show positive longer-term adjustment (Chen, Chen, Li, & Wang, 2009; Chen, Rubin, & Li, 1995). For example, greater withdrawal among Chinese preschool children has been shown to predict more positive outcomes in peer liking, social integration, and school competence 5 years later (Chen et al.,

impact of social anxiety across cultures 2009). Chinese mothers have also been found to report more positive attitudes and increased warmth in response to withdrawn behaviors in their toddlers while Canadian mothers showed less acceptance and encouragement of these behaviors (Chen et al., 1998). Interestingly, these results have not always been consistent (Schwartz, Chang, & Farver, 2001) and it is possible that this cultural difference is reducing as China is exposed to a stronger Western influence. Consistent with the suggestion that positive effects of shyness are associated with more traditional Chinese values, Chen et al. (2009) found that shyness was associated with difficulties among Chinese children from urban areas but associated with positive effects among rural Chinese. Direct comparisons have shown that shy and withdrawn behaviors are associated with positive reactions from others in Chinese society but with negative peer reactions in Western countries (Chen, DeSouza, Chen, & Wang, 2006; Chen & Tse, 2008). A previous study from our own group showed undergraduate students from collectivistic countries (primarily East Asian) reported more positive attitudes toward vignettes describing withdrawn and socially unassertive behaviors than did students from Western countries (Heinrichs et al., 2006). In a recent replication, we showed that this effect was not actually reflective of all collectivistic countries but was specific to East Asian societies (Schreier et al., 2010). Thus, there is some (mostly circumstantial) evidence that people in East Asian countries perceive less negativity and life impact from socially anxious behaviors than do people from Western countries. However, the evidence to date is still scant and mostly comes from studies in children. Examination of this issue speaks to the very nature of disorder. Therefore, our cross-cultural research group felt that this was an important question to address. Based on the above suggestions, we predicted that students from Western countries would rate shy, withdrawn behaviors as markedly more negative and as having a greater impact on life satisfaction and career achievement than more outgoing behaviors and that this difference would be less extreme in East Asian countries. Following this prediction to a personal level, we expected that the correlation between students' own levels of social anxiety and their current life satisfaction would be stronger in Western than East Asian countries.

Method participants Data from a total of 916 (239 males and 577 females) university students in Australia (n = 78, 30

487

males and 48 females), Canada (n = 40, 12 males and 28 females), China (n = 259, 70 males and 189 females), Germany (n = 42, 4 males and 38 females), Japan (n = 105, 37 males and 68 females), Korea (n = 91, 25 males and 66 females), The Netherlands (n = 58, 19 males and 39 females), and the United States (n = 143, 42 males and 101 females) were employed in the study. Participants in all countries were included if they met the following inclusion criteria: (a) they were aged 18 to 22 years, (b) they had been born in their respective country, (c) both of their parents had been born in their respective country, (d) they identified their ethnicity to be the major one in their respective country, and (e) they spoke the native language in the country as their primary language. The countries were allocated to either a Western group (Australia, Canada, Germany, The Netherlands, and the United States) or an East Asian group (China, Japan, and Korea). There were 107 males (29.64 %) and 254 (70.36 %) females in the Western group (n = 361) and 132 males (29.01 %) and 323 females (70.99 %) in the East Asian group (n = 455). The mean age for the Western group was 19.27 (SD = 1.29) (Australia, 18.95, SD = 1.04; Canada, 19.73, SD = 1.32; Germany, 20.52, SD = 1.15; Netherlands, 19.97, SD = 1.43; America 18.67, SD = 0.91) and for the East Asian group 19.90 (SD = 1.44) (China, 20.03, SD = 1.09; Japan, 19.27, SD = 2.08; Korea, 20.23, SD = 1.21). One hundred percent of those in the East Asian group reported their ethnicity to be “Asian” and 99.7% of those in the Western group reported their ethnicity as “Caucasian” or “European.” 99.6% of the East Asian and 100% of the Western participants reported having lived in the relevant country for most of their life. The groups differed significantly on parent education. For example, 67.9% of Western mothers and 37.3% of East Asian mothers attended university, χ2 (2, N = 764) = 79.32, p b .001, and 76.9% of Western fathers and 52.4% of East Asian fathers attended university, χ2 (2, N = 766) = 49.09, p b .001.

measures Vignettes on Shy and Outgoing Behaviors Four vignettes were developed for the current study. Vignettes were initially drafted by the second author (who is from Korea) following which all authors provided input. Each vignette consisted of a single paragraph describing a particular individual and his/her typical behaviors and interests in social situations. Two vignettes described shy and reserved behaviors. The vignettes were identical except for gender (one male, one female). Two other vignettes (one male, one female) portrayed

488

rapee et al.

outgoing and socially confident behaviors. Both vignette types were matched in terms of the material described. The vignettes describing males are included in the Appendix. Immediately following each vignette, participants were asked to rate how popular or liked the person would be by each of four different others: a potential romantic partner, an acquaintance, friends, and the respondent. Liking was rated on a 6-point scale from 0 (very much disliked) to 5 (very much liked). Scores were averaged for each vignette across the four items of the scale. Internal consistencies among the four items for the two populations ranged from alpha = .67–.74 (Western) and alpha = .73–.80 (East Asian). Following these questions, four further items asked participants the extent to which they believed the behaviors described in the vignette would help or hinder the character's future career. Two items reflected overall career options and prospects (extending future career options and success in future career) while two items reflected their relationships at work (future relationships with colleagues, future relationships with bosses). Items were rated on a 6-point scale from 0 (hinder very much) to 5 (help very much) and again scores within each subscale were averaged. Life Satisfaction In order to assess participants' own satisfaction with life, a Life Satisfaction Questionnaire was developed for the current study. This face valid 20item self-report questionnaire was designed to measure how satisfied participants felt with different areas of their life, including career (e.g., “My academic competence”), social relationships (e.g., “My friendships”), leisure activities (e.g., “My active leisure”), physical status (e.g., “My physical fitness”), and self-image (e.g., “The meaning in my life”). Each item was rated on a 6-point scale from 0 (very dissatisfied) to 5 (very satisfied) and total scores comprised the sum of all 20 items.1 Based on separate principal components analyses with varimax rotation in both Western and Eastern samples, the measure demonstrated five factors with Eigenvalues greater than 1 (which roughly corresponded with the areas above), and the dominant factor accounted for a similar proportion of variance in both (Western = 37.2%, East Asian = 32.5%). Internal consistency of the scale in both samples was also similar (alpha [Western] = .90, alpha [East Asian] = .88) as were the item-total correlations (Western range, .26–.69; East Asian range, .30–.64). 1

A copy of the scale is available from the first author.

Social Interaction Anxiety Individual level of anxiety when interacting with others was assessed using the Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998). This measure has previously shown good reliability and validity, including Cronbach's alphas ranging from .88 to .93 (Mattick & Clarke, 1998). In the current samples internal consistencies were alpha = .92 (Western), alpha= .90 (East Asian). As expected, the East Asian group scored significantly higher on the SIAS (M = 27.01, SD = 13.42) than the Western group (M = 21.99, SD = 13.70), t(814) = 5.27, p b .001. However, both groups had a similar range, skew and kurtosis on the scale (Western = 66.0, 0.79, 0.21; East Asian = 69.0, 0.71, 0.01, respectively).

procedure One of the key difficulties in cross-cultural comparisons is ensuring that the populations differ only on cultural factors. Although it is extremely difficult to match populations on all possible confounds, we selected all samples from ostensibly equivalent pools to try to restrict noncultural variation. Thus, all populations were university students who were selected from their respective undergraduate research participant pools. Universities in all countries were primarily urban-based and were considered a mix of mid- to upper-ranking that was equally spread across the two country groups. Students completed the measure of all four vignettes and were tested in a mix of individual sessions or class groups spread across the country groups and returned the questionnaires anonymously. In Canada and Germany, students were asked to fill out questionnaires at home and return them anonymously to the university. Questionnaires were delivered in all countries using paper-andpencil completion. In all but two countries (Netherlands and China), students received course credit for their voluntary participation. Unfortunately, due to an oversight, the order of vignettes was not counterbalanced. Measures were originally developed in English and were then translated into the various languages by native speakers who were also fluent in English. Back translation was only done in China. statistical analysis To compare participants' reactions to the vignettes, each dependent variable (likeability and career prospects) was subjected to a two-way, repeated measures ANCOVA comparing the two country groups (Western vs. East Asian) by vignette type (shy vs. outgoing). Because individual levels of social anxiety might influence results and because differences in social anxiety were found between

impact of social anxiety across cultures Table 1 Mean Scores, Standard Deviations, and Estimated Marginal Means on Vignette Type × Country Group Across the Two Dependent Variables Measure and vignette type

East Asian M

Social Likeability Outgoing 4.06 Shy 3.38 Career impact Outgoing 4.16 Shy 2.41

Western

SD

EMM

M

SD

EMM

0.60 0.62

4.07 3.38

4.44 3.45

0.41 0.61

4.43 3.45

0.70 0.72

4.17 2.41

4.33 2.07

0.53 0.73

4.32 2.08

Note. Scale ranges: Likeability (0 = dislike very much, 2 = dislike slightly, 3 = like slightly, 5 = like very much); Career (0 = hinder very much, 2 = hinder slightly, 3 = help slightly, 5 = help very much).

country groups, scores on the SIAS were entered as a covariate for all analyses. In order to test for the possible confounding effects of gender, two additional sets of analyses were conducted. First, in order to examine possible differences in reactions to the male and female vignettes, gender of vignette was included as an additional variable. For both analyses the pattern of results was the same across male and female vignettes and there were no significant three-way interactions. Second, to examine possible differences between responses of male and female respondents, the analyses were run again including respondent gender as an additional variable. For both analyses, the patterns of differences between country groups were similar for both males and females and there were no significant three-way interactions. Therefore, to simplify the results and retain a clear focus of the paper on cultural differences, analyses are reported based on two-way interactions averaging across male and female vignettes and collapsing across male and female respondents.

Results social likeability Mean scores on likeability were compared between groups and vignette types using a 2 × 2 repeated measures ANCOVA (including SIAS as a covariate; see Table 1). There was a significant main effect of country group with Westerners returning higher scores on likeability than East Asians, F(1, 813) = 44.20, p b .001, partial η2 = .05, a significant main effect of vignette type, with outgoing characters being rated as more likeable overall than shy characters, F(1, 813) = 328.03, p b .001, partial η2 = .29, qualified by a significant Country Group × Vignette Type interaction, F(1, 813) = 36.18, p b .001, partial η2 = .04. To assist interpretation, likeability ratings were compared between the two

489

country groups separately for each vignette using one-way ANCOVA to allow examination of effect sizes. The shy vignettes were not rated significantly differently on likeability between the two country groups, F(1, 813) = 2.02, p = .16, partial η2 b .01, but Westerners reported significantly greater liking of outgoing characters than East Asians, F(1, 813) = 94.34, p b .001, partial η2 = .10.

career influence A 2 (country group) × 2 (vignette type) repeated measures ANCOVA was also conducted to examine the predicted impact on the vignette characters' careers (Table 1). There was a significant main effect of country group, F(1, 813) = 7.71, p b .01, partial η2 = .01, together with a significant main effect of vignette type, with shy characters being rated as having far weaker career prospects than outgoing characters, F(1, 813) = 997.53, p b .001, partial η2 = .55, that was modified by a significant Country Group × Vignette Type interaction, F(1, 813) = 50.83, p b . 001, partial η2 = .06. To assist interpretation, career impact ratings were compared between the two country groups separately for each vignette type using one-way ANOVA to allow examination of effect sizes. For shy characters, Westerners rated their career options as significantly poorer than did East Asians, F(1, 813) = 42.41, p b .001, η2 = .05. In contrast, for outgoing characters, Westerners rated their career options as significantly better than did East Asians, F(1, 813) = 12.70, p b .001, η2 = .02. personal impact of shyness Although both country groups reported a moderately negative and significant relationship between social anxiety (SIAS) and life interference (LSQ), the size of this relationship was significantly greater for the Western group (r = - .58) than the East Asian group (r = - .41), z = 3.2, p = .001.

Discussion Consistent with a number of previous studies (Dinnel, Kleinknecht, & Tanaka-Matsumi, 2002; Heinrichs et al., 2006; Kleinknecht, Dinnel, & Kleinknecht, 1997; Okazaki, 1997), participants from East Asian countries reported higher levels of shyness than did participants from Western countries. However, as predicted, the perceived negative impact of shyness was less in the East Asian countries participating in this study. There was also a stronger positive perception of confident, outgoing characteristics among participants from Western countries than those from East Asia. These results are consistent with studies in children

490

rapee et al.

showing more negative reactions and interactions from peers of shy children from Western than East Asian countries (Chen et al., 2006; Chen & Tse, 2008). Interestingly, some research from children has indicated a positive influence of shyness on peer relations among East Asian children (Chen et al., 2006, 2009). However, in the current study, young adults universally reported negative correlates of shyness, even when they were from East Asian countries. Of course, one of the key difficulties of conducting research using vignettes is their hypothetical nature. The lack of social and physical context for the described behaviors may have had a major influence on results. Replication of these results using alternate methods (e.g., role-play, video) would be very valuable. Because research with hypothetical vignettes lacks ecological validity, one of the more meaningful findings in this study was the significant relationship between personal levels of social anxiety and overall life satisfaction. Although participants from both groups reported a significant negative relationship between self-reported shyness and life satisfaction, the size of this relationship was greater among participants from Western countries than those from East Asia. This result is consistent with demonstration that Japanese participants report high levels of emotional well-being despite reporting significantly higher social anxiety than do European Americans (Norasakkunkit & Kalick, 2009). Thus, cultural factors appear able to buffer the effects of social anxiety, suggesting that the function and meaning of reticent behaviors might differ between cultures. The findings are congruent with data indicating that socially withdrawn and reticent behaviors are more consistent with social norms and expectations in East Asian than Western societies (Heinrichs et al., 2006). In contrast, Western societies value outgoing and self-promoting behaviors. As a result, social anxiety will be associated with somewhat greater impairment and distress for individuals in these societies as their behavior is more socially dystonic. Reasons for the greater synchrony between East Asian society and social reticence are not clear. Some authors point out that most East Asian societies tend toward greater collectivism while many of the Western societies sampled here value more individualistic characteristics (Singelis, 1994). Similarly, East Asian cultures tend to be more “norm-driven.” Within both constructs, a greater tendency to be socially reticent and not to stand out is likely to produce considerably less distress than in countries where minor rebellion and individualism are considered positive characteristics.

These effects were replicated in the results from the hypothetical vignettes. While participants from all countries reported similar liking of shy characters, participants from Western countries were more positively disposed to the outgoing characters. Even stronger effects were demonstrated in ratings of the impact of behaviors on career prospects where participants from Western countries predicted a greater positive impact of outgoing behaviors and a stronger negative impact of shy behaviors. The size of these interactions was very small and it is unlikely that culture is a dominant influence on perceptions of withdrawn vs outgoing behaviors. Given the difficulty in assessing cultural differences, reductions in cultural differences over recent years, and the many likely sources of variability in the data, a very small impact of culture on the perceived effects of social anxiety is all that would be theoretically expected. Nevertheless, the fact that such differences are able to be demonstrated does hold implications for understanding the nature and influence of psychopathology. A key implication is that the experience of psychopathology reflects more than simply the experience of symptoms. Symptoms are expressed in a context and the context (not only cultural) is likely to influence the nature of the psychopathology and associated distress (Hofmann et al., 2010; Moscovitch, Hofmann, & Litz, 2005). Although the primary interest from the current study lies in the cross-cultural differences, differences in the overall reactions to the two types of vignettes were associated with considerably larger effects and deserve mention. Participants from both country groups predicted far more negative impact from shy, withdrawn behaviors than outgoing, confident behaviors. Compared with the outgoing characters, shy characters were perceived as much less likeable and as likely to be far less successful in career prospects. These data support numerous previous findings of the universally negative impact that subclinical social anxiety and clinical social anxiety disorder have on individuals' lives (Caspi et al., 1988; Norton et al., 1996; Stein & Kean, 2000). While most previous research has been conducted within Western populations, the current results suggest that similar impact data would be shown within Asian societies, albeit perhaps with slightly smaller effect sizes. Several limitations to the study deserve mention since they need to temper conclusions. First, regardless of simple translation issues, it is always unclear whether given terms convey the same meaning across cultures. Therefore, it cannot be certain that a given questionnaire taps exactly the same construct in two different cultures. The fact

impact of social anxiety across cultures that the measure was not back-translated in some of the non-English-speaking countries adds to this limitation in the current study. Second, it is very difficult to ensure that groups across countries differ only with respect to their dominant culture. In the current study we restricted recruitment to similar age and gender distributions and settings. However, it is possible that the university populations in the various countries differed in some subtle ways that might have influenced results. The lack of gender effects in our data were somewhat surprising. It should be pointed out that our unreported data analyses clearly showed evidence for male/female differences in their overall reactions to outgoing and withdrawn behaviors. However, these differences did not interact significantly with country group and were therefore not reported further. The uneven gender distributions in the two groups may possibly have limited opportunities to detect gender influences. Due to an error in delivery of the measures, the order of completion of the four vignettes was not counterbalanced. Thus, we cannot rule out the possibility that the results reflect an order effect. In the current case, the two shy vignettes were always presented first. Therefore, it is possible that the more positive reactions to the outgoing vignettes reflected some sort of contrast or related effect. However, the fact that the main analyses of interest involved an interaction between country and vignette type means that this explanation would require the country type to interact with the presentation order, a not very likely explanation. Nevertheless, the study would benefit from replication in which the order of presentation of vignettes is varied. Finally the lack of non-Asian, non-Western cultures and the lack of vignettes describing other sorts of behaviors (e.g., antisocial) means that specificity in the conclusions is limited. In brief, the results pointed to the negative impact of socially withdrawn behaviors across countries, but suggested that the extent of this impact might be buffered by culturally imposed meaning. This relationship has implications for the nature of psychopathology. Clearly, at least some forms of psychopathology are not universal truths but may be influenced by social reactions and personal meaning. Theories of the development of psychopathology such as social anxiety disorder need to take this into account.

Appendix sample vignettes Shy Male John is a 22-year-old university student. When he is in a group, he tends to not say very much, but he

491

does answer when people talk to him. When he does talk, he usually speaks in a fairly quiet voice and sometimes starts a little hesitantly. However, he always makes sense when he talks. John usually seems friendly, although he is often reserved and he would rarely start a conversation with anyone. When he speaks up, he sometimes blushes a little bit and may look a little uncomfortable. His grades at university are good and he works hard. John usually goes to parties and social gatherings when he is directly asked, but he sometimes makes excuses not to go and will never organize a social gathering. He spends most of his time with a small number of friends. Outgoing Male Adam is a 22-year-old university student. When he is in a group, he tends to be active and talk voluntarily. When he talks, he usually looks confident and animated, and speaks in a loud and cheerful voice. Also, he always makes sense when he talks. Adam usually seems friendly and outgoing, and would like to start a conversation with anyone. His grades at university are good and he works hard. Adam usually welcomes the opportunities to go to parties and social gatherings. He also enjoys starting a social gathering. References Bögels, S. M., & Stein, M. B. (2009). Social phobia: Towards DSM-V. In G. Andrews, D. S. Charney, P. Sirovatka, & D. A. Regier (Eds.), Stress-induced and fear circuitry disorders: Advancing the research agenda for DSM-V Washington, DC: American Psychiatric Association. Caspi, A., ElderJr., G. H., & Bem, D. J. (1988). Moving away from the world: Life-course patterns of shy children. Developmental psychology, 24, 824–831. Chen, X., Chen, H., Li, D., & Wang, L. (2009). Early childhood behavioral inhibition and social and school adjustment in Chinese children: A 5-year longitudinal study. Child Development, 80, 1692–1704. Chen, X., DeSouza, A. T., Chen, H., & Wang, L. (2006). Reticent behavior and experiences in peer interactions in Chinese and Canadian children. Developmental Psychology, 42, 656–665. Chen, X., Hastings, P. D., Rubin, K. H., Chen, H., Cen, G., & Stewart, S. L. (1998). Child-rearing attitudes and behavioral inhibition in Chinese and Canadian toddlers: A crosscultural study. Developmental Psychology, 34, 677–686. Chen, X., Rubin, K. H., & Li, Z. (1995). Social functioning and adjustment in Chinese children: A longitudinal study. Developmental Psychology, 31, 531–539. Chen, X., & Tse, H. C. H. (2008). Social functioning and adjustment in Canadian-born children with Chinese and European backgrounds. Developmental Psychology, 44, 1184–1189. Coplan, R. J., & Armer, M. (2005). Talking yourself out of being shy: Shyness, expressive vocabulary, and socioemotional adjustment in preschool. Merrill-Palmer Quarterly, 51(1), 20–41.

492

rapee et al.

Crozier, W., & Alden, L. E. (Eds.). (2001). International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness New York: John Wiley & Sons. Dinnel, D. L., Kleinknecht, R. A., & Tanaka-Matsumi, J. (2002). A cross-cultural comparison of social phobia symptoms. Journal of Psychopathology and Behavioral Assessment, 24, 75–84. Furmark, T. (2002). Social phobia: Overview of community surveys. Acta Psychiatrica Scandinavica, 105, 84–93. Heinrichs, N., Rapee, R. M., Alden, L. A., Bögels, S. M., Hofmann, S. G., Oh, K. J., & Sakano, Y. (2006). Cultural differences in perceived social norms and social anxiety. Behavior Research & Therapy, 44, 1187–1197. Hofmann, S. G., Asnaani, A., & Hinton, D. E. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depression and Anxiety, 27, 1117–1127. King, A. Y. C., & Bond, M. H. (1985). The Confucian paradigm of man: A sociological view. In W. S. Teng, & D. Y. H. Wu (Eds.), Chinese culture and mental health New York: Academic Press. Kleinknecht, R. A., Dinnel, D. L., & Kleinknecht, E. E. (1997). Cultural factors in social anxiety: A comparison of social phobia symptoms and Taijin Kyofusho. Journal of Anxiety Disorders, 11, 157–177. Marjoribanks, K. (1994). Cross-cultural comparisons of family environments of Anglo-, Greek-, and Italian-Australians. Psychological Reports, 74, 49–50. Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behavior Research and Therapy, 36, 455–470. Moscovitch, D. A., Hofmann, S. G., & Litz, B. T. (2005). The impact of self-construals on social anxiety: A gender-specific interaction. Personality and Individual Differences, 38, 659–672. Norasakkunkit, V., & Kalick, S. (2009). Experimentally detecting how cultural differences on social anxiety measures misrepresent cultural differences in emotional wellbeing. Journal of Happiness Studies, 10, 313–327. Norton, G. R., McLeod, L., Guertin, J., Hewitt, P. L., Walker, J. R., & Stein, M. B. (1996). Panic disorder or social phobia: Which is worse? Behavior Research and Therapy, 34, 273–276. Okazaki, S. (1997). Sources of ethnic differences between Asian American and White American college students on measures

of depression and social anxiety. Journal of Abnormal Psychology, 106, 52–60. Rapee, R. M., & Coplan, R. J. (2010). Conceptual relations between anxiety disorder and fearful temperament. In H. Gazelle, & K. H. Rubin (Eds.), Social anxiety in childhood: Bridging developmental and clinical perspectives. New Directions for Child and Adolescent Development, Vol. 127. (pp. 17–31)Jossey-Bass: San Francisco. Rapee, R. M., Schniering, C. A., & Hudson, J. L. (2009). Anxiety disorders during childhood and adolescence: Origins and treatment. Annual Review of Clinical Psychology, 5, 311–341. Rapee, R. M., & Spence, S. H. (2004). The etiology of social phobia: Empirical evidence and an initial model. Clinical Psychology Review, 24, 737–767. Rubin, K. H., Hemphill, S. A., Chen, X., Hastings, P., Sanson, A., Coco, A. L., & Cui, L. (2006). A cross-cultural study of behavioral inhibition in toddlers: East-West-North-South. International Journal of Behavioral Development, 30, 219–226. Schreier, S. S., Heinrichs, N., Alden, L., Rapee, R. M., Hofmann, S. G., Chen, J., & Bögels, S. (2010). Social anxiety and social norms in individualistic and collectivistic countries. Depression and Anxiety, 27, 1128–1134. Schwartz, D., Chang, L., & Farver, J. M. (2001). Correlates of victimization in Chinese children's peer groups. Developmental Psychology, 37, 520–532. Singelis, T. M. (1994). The measurement of independent andn interdependent self-construals. Personality and Social Psychology Bulletin, 20, 580–591. Stein, M. B., & Kean, Y. M. (2000). Disability and quality of life in social phobia: Epidemiologic findings. American Journal of Psychiatry, 157, 1606–1613. Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. The Lancet, 371(9618), 1115–1125. Weissman, M., Bland, R., Canino, G., Greenwald, S., Lee, C., Newman, S., et al. (1996). The cross-national epidemiology of social phobia: A preliminary report. International Clinical Psychopharmacology, 11(Suppl 3), 9–14. Wittchen, H. U., & Fehm, L. (2001). Epidemiology, patterns of comorbidity, and associated disabilites of social phobia. The Psychiatric Clinics of North America, 24(4), 617–641. R E C E I V E D : May 25, 2010 A C C E P T E D : November 24, 2010 Available online 16 March 2011