Anxiety and Culture 1

Running Head: ANXIETY ACROSS CULTURE

Anxiety Across Different Cultures

Jennevie Olivieri López

University of Puerto Rico, Mayagüez Campus

Anxiety and Culture 2

Prologue

Dear reader:

I would like to begin by welcoming you to my Multi-genre research paper.

Anxiety across culture is the title of my piece. For my paper, I really wanted to do

something that was related to my major (psychology), and also a bit that had to do with

different cultures. I actually came up with the idea because I am very interested in how

culture plays a role in our daily lives. Because as we get closer to graduation, the more I

convinced myself, that we experience it a lot. I think it is important to always expand our

knowledge on certain subjects, no matter how broad they seemed. You may also have a

completely different idea of what anxiety was and how it is defined in other cultures.

Studying anxiety is important because we may learn how to deal with it. Not only

do we learn how to treat it when it happens to us, but we also know not to be mad at a

professor who comes to class and starts arguing because you have a picture of a snake on

your notebook. For all we know, this person could have an intense fear of snakes that

causes him/her anxiety.

In conclusion, I don’t mean to sound like a nerd, but I love to learn. I took this

paper as an opportunity to gain knowledge about anxiety and different cultures around

the world, not just the American one. Keep reading, you might find something

fascinating, like I did.

Hope you enjoy it as much as I did writing it,

Jennevie

Anxiety and Culture 3

Anxiety across Different Cultures

People all over the world have a different definition when it comes to anxiety.

Kring, Davison, Neale, & Johnson (2007) tell us that anxiety is known to be the

apprehension we feel over an anticipated problem. They also mention that when we are

having anxiety we usually have stimulation in our sympathetic nervous system. Anxiety

can be adaptive in helping us prepare for future threats or to avoid dangerous situations.

There are different kinds of anxiety disorders, such as: social phobia (scared of people we

don’t know), specific phobias (fear of objects or situations that does not present any real

danger), panic disorder (when the person is scared of having panic attacks), generalized

anxiety disorder (the person cannot stop worrying), obsessive-compulsive (uncontrollable

thoughts and/or impulses that cannot be controlled) and post-traumatic stress disorder

(after a traumatic event has a occur in a persons life, this person keeps relieving the event

over and over). Because of all different types of anxiety psychologists, in general, have to

be cautious of the way they measure it.

It is difficult to come up with ways to measure anxiety in different cultures. Most

of the scales that do measure it are not culturally fair – that is equally appropriate and fair

for all members belonging to different cultures, or culturally relevant – which measure

skills and knowledge that relate to the cultural experiences of the people taking the test

(Stenberg, 2006). This means that not all anxiety scales will measure anxiety exactly the

same way in all cultures. People in every culture tend to have different problems with

anxiety disorders. This is mainly due to the fact that cultures react differently to mental

illnesses, stress, and relationships. For example, Roy-Byrne (1999) writes that Latinos

like to keep their problems “in the family”. So do African-Americans. Therefore these

cultures will also see psychology differently. For this reason it is important to look at

literature and see what type of studies have been done about it.

Vazsonyi and Belliston (2005) ran a study about the cultural and developmental

significance of parenting processes in adolescent anxiety and depression symptoms

with 8,417 adolescents across Europe and the United States. They were asked to

complete demographic surveys (which asked about their age, sex, family structure, and

socioeconomic indicators); there were also surveys that measured parenting processes,

and measures of adjustment. The findings of this study say that there is

certain association between cultures when it comes to individual

parenting processes and measuring the internalizing behaviors, such

as anxiety, so it seems that depending on the culture parents raise

their children, this may also affects the children’s level of anxiety.

Other studies (Eley, Gregory, Lau, McGuffin, Napolitano, Rijsdijk,

et al., 2008) done with twins, related anxiety with ambiguous

information, such as intimidation. Eley, et al. (2008) used 300 pair of

twins that were about 8 years old. Some of the measures used were

the Anxiety Related Behaviors Questionnaire, and then the kids had to

interpret some situations which were threatening (with words or

scenarios). The Screen for Childhood Anxiety Related Emotional

Disorders, or SCARED, was also used, along with the Children’s

Depression Inventory. All of this scales measure anxiety and

depression. What the researchers found was that threat interpretation

actually makes us more depress and does not give us that much

anxiety.

The last article I would like to discuss is one made by Harmon,

Langley, and Ginsburg (2006), which took a closer look at the role

gender and culture play when treating children with anxiety disorders.

They make a very clear and valid point that how

symptoms are expressed varies from culture to culture. Some families

may not seek help at the same time, and that does not make them bad

people. It just means that for them that’s the normal procedure to

follow, culturally speaking. We have to keep in mind that for some

cultures religion has a huge impact. This means that some religions

prohibit

some forms of treatment. The main point is that culture plays a huge

role, not only when the symptoms are been shown, but also in treating

them.

Anxiety in Europe

It would be expected for people in Europe to be as anxious as people in the United

States. Andlin-Sobocki and Wittchen (2005) made a literature review in which they

discuss that due to sky rocketing prices for the treatment of anxiety in Europe it can be

quite difficult to gather data about it. Some studies have been done and they have found

that the epidemiological data is deficient and weak because of diagnostic evaluation.

However, anxiety has turned out to be very costly to the public in general across Europe.

This may be why there is barely any published or reliable data about such disorder.

However, there seems to be some information regarding the generalized anxiety disorder,

or GAD. But that is only one type of anxiety, leaving researchers to guess about the other

types and how they may be affecting Europeans.

Another curious study is one by Alonso, Angermeyer, Bernert, Bruffaerts,

Brugha, Bryson, et al. (2004), which took a closer look at the prevalence of mental

disorders in Europe, and amongst the mental disorders they study were anxiety disorders.

About 21,425 people across Europe participated, where they had to answer a series of

questionnaires about some mental disorder symptoms. One out of four people all across

Europe have some type of mental disorder. However, the interesting thing is that less than

3% of the people who answered the questionnaires did not suffer from any kind of

anxiety. They did find that people women had more probabilities to have anxiety than

men did.

Putting these two studies together, we may conclude that even though there seem

to be people who suffer from anxiety across Europe, there just doesn’t seem to be any

treatment for them. This may be because of how high the prices are for the treatment of

such disorders. Other conclusion we may reach is that because lower than 3% of the

population across Europe suffers from anxiety, psychologists just don’t see a point in

studying it.

Anxiety in Latin Americans

Hispanics are a fast growing population in the United States, which is why it is

important to take a closer look at them. So we can be able to offer them some effective

treatment. Hamilton (2008) had a case study with a Hispanic 14 year old girl who was

hospitalized because of anxiety behaviors. She was unobservant, required too much

attention, and by the time she was barely in pre-school she had been diagnosed with

psychosis and generalized anxiety disorder. Hamilton makes an importance notice that

when evaluating someone from a different culture, their symptoms have to be considered

as culture bound. Let’s take for example the 14 year old Hispanic girl from the case

study. Her anxiety could be interpreted using a cultural lens. Meaning that what we

consider to be anxiety, for the Hispanic culture may be something else.

In 2008 Blunk, Morgan Rusell, and Williams made a study with mothers of

Mexican-American descent. It turns out they have the same types of anxieties as Euro-

American mothers. It can be deduced that anxiety for mothers may not be that culturally

bound, but may approach more broadly.

When studying a Latino/Hispanic population, it is quite common to look at the

term known as “Ataque de Nervios”, or nervous attack. Ataque de Nervios is a type of

fear that involves having physical pain and been scared of going crazy after a traumatic

event. It was originally identified in Puerto Rico. When looking at the concept it can be

related to anxiety, as well as post-traumatic stress disorder. Cintrón, Carter and Sbrocco

(2006) made a study about “ataque de nervios” in relation to anxiety sensitivity among

island Puerto Ricans. They had 177 participants, all residing in the Metropolitan Area of

Puerto Rico. Besides answering the demographic questions, they also had to answer a

couple of questionnaires that measure anxiety. Ataque de nervios was found to be not

very different from depression and anxiety. What they establish was that “ataque de

nervios” is culturally bound. When people are undergoing a nervous attack in Puerto

Rico, they vary in the way they tend to ask for help.

But when looking at “ataque de nervios” in a bigger Latino population, not just

Puerto Ricans, Grames (2006) considered depression, anxiety, and ataque de nervios as

the primary mental health care problem. The principal investigators made three separate

case studies. In each one they took a closer look at depression, anxiety, and ataque de

nervios separately, while also paying attention to the referral, assessment and treatment,

and also the follow-up treatment. What was learned was in order for treatment to be

effective it has to be culturally appropriate. In order to do this the therapist must take into

consideration his clients culture and believe what the client is telling him/her as culturally

relevant.

Anxiety in Asians

Asians are known to be a culture significantly different from others. Some of their

syndromes include the fear of embarrassing others, and there are also fears that are very

similar to anxiety. Lee, Lei, and Sue (2001), made a study about the current state of

mental health on Asian Americans. It turns out that Chinese Americans have low rates of

anxiety. Due to some limitations in this study (such as there been a low number of

participants, the participants not been directly from Asia, and the fact that there are

numerous studies that show that there are high levels of anxiety amongst Asians) this

results may be discrepant.

There is however, one study by Iwata and Higuchi (2000), which gives the

responses to the State Trait Anxiety Inventory (better known as the STAI, a scale that

measures anxiety), given to Japanese students and American students. One hundred and

one Japanese students enrolled in a university in Japan participated and about 50

Japanese students enrolled in American universities participated. As expected, American

students show more positive feelings when compared to Japanese students. Japanese

students also turned out to be more anxious when responding to the negative items on the

STAI. What this means is that not only are Asians more anxious but they also their

negative and positive feelings. Maybe that’s why they get more anxious when compared

to other cultures.

When comparing the two studies, it has to be taken into account that the study

made by Lee, et. Al. (2001) was made on Chinese Americans, therefore they were not

directly from Asia, but descendants from Asia. Maybe that played a role in the reason

that they didn’t suffer from that much anxiety. An interesting fact that may be added is

that Asians get anxious because they don’t want to make others look bad. They do not

like to make eye contact, because this too causes a great deal of anxiety for them. In my

opinion, this is a very interesting population.

Future research

It would be great to keep studying this fascinating subject. It’s important to study

the children of these different cultures; they are the ones that can tell us how to make

preventions at an early age. It is also important to change the way we see things,

culturally speaking. We have to create awareness about what it means to be from a

different culture. Yes, we know there are people who are not like us and believe different

things. But do we know that that means? Do we know what makes that other culture

different from ours?

Annotated Bibliography

The Reality of Anixety and Coping Strategies to Manage It. (2009). Retrieved April 20, 2009, Website: http://anxiousnomore.blogspot.com

This website is an anonymous blog about anxiety. People write about the different causes of anxiety, such as stress. Then they tell you how to deal with it. People also share situations that caused them anxiety and how they dealth with it.

Barlow, D.H. (2004). Anxiety and it’s disorders. New York: Guilford Publications.

This book talks about how the experience of anxiety can affect us. Does anxiety happen to smart people or when we are near a death experience? It also relates anxiety ans fear, while telling us the biological aspects of anxiety.

Cintrón, J.A., Carter, M.M., & Sbrocco, T. (2005). Ataques de nervios in Relation to Anxiety Sensitivity Among Island Puerto Ricans. Culture, Medicine, and Psychiatry, 29, 415-431.

The researchers found that ataque de nervios is not related to anxiety or depression. They did find that it had culture specific psychological and physiological factors. It also gives advice about what to do with conditions that are culturally relevant. Some of the advices are: for the culture to accept it.

Eley, T.C., Gregory, A.M., Lau, J.Y.F., et. al. (2007). In the Face of Uncertainty: A Twin Study of Ambiguous Information, Anxiety and Depression in Children. Journal of Abnormal Child Psychology, 36, 55-65.

Our genes help develop different cognitive styles, but so does the environment. Meaning that if we have a bad relationship with family members it may have the same effect on how much anxiety we go through, as if it were on your genes. Not only will our genes play a role n how much anxiety we suffer, but so will the environment in which the child develops.

Harmon, H., Langley, A., & Ginsburg, G.S. (2006). The Role of Gender and Culture in

Treating Youth with Anxiety Disorders. Journal of Cognitive Psychoterapy, 20(3), 301-311.

This article talks about how anxiety can affect children of different cultures and what are some ways to deal with it. It also mentions how people should not be forced to change in order for them to fit their environments. Because this may cause a lot of anxiety.

ObituaryAnxiety – (Age unknown). Real pain in the butt and major headache giver passed April 23. It wasn’t a loving husband, father, brother and grandfather. Till this day remains a legend in his time and a pillar of strength for those that enjoy suffering and courage for those that think that there is no way out. It will not be missed by anyone. It is survived by his devoted wife, Stress, his loving sons Phobia, and Fear, and a granddaughter Obssesive-Compulsive. Over all of eternity, Anxiety, has been a constant companion to everyone that has ever lived. Anxiety had a passion for making people feel aroused and worry before a problem. Oh Anxiety, we may now rest relax in our lives without anyone activating our nervous system. You will NOT be missed!

Advice Column: Ask ME

Dear ME:

My in-laws are often worried about not embarrassing us in public, so they barely talk to the people we introduce them to. They don’t make any eye contact at all, they shower like a 1,000 times a day because they are terrified of smelling bad, and if somebody that is handicap comes anywhere near us they look at the other direction as if that person didn’t exist. I asked them why they do this, and they just told me that there wasn’t anything wrong with that. I don’t know if the fact that they are from Japan has anything to do with this but PLEASE HELP ME!!

Sincerely;needsomeserioushelp

Dear needsomeserioushelp:

First of all stop been so anxious and stressed about the whole situation. First of all remember they are from a different culture. Let me remind you that in Asia, it is considered quite common and respectful to not act embarrassing in public. For them, it is an issue if you have body odors and they try to distance themselves not only from handy cap people, but from everyone in general. Because if not this would all cause great ordeal and anxiety for them. So, if I were you I would be more culturally sensitive.

Hope that helps; ME

Encyclopedia Entry

Anxiety – Heart palpitations, fatigue, nausea, pale skin, are some of the symptoms that accompany anxiety. Not to be confused with a panic disorder. According to some psychology theorist, when we feel anxiety, we feel small and insignificant, and very vulnerable. When we are children, we try to evade anxiety by securing love from others and gaining power. When children do this, is a self-defense mechanism. For example, when we ask others, do you love me?, when they answer yes, we immediately think, “if you love me, you won’t hurt me”. We also try not to bother others or make them mad with our words and attitudes, avoiding anxiety that way.

A common symptom in anxiety is fear. Fear is a reaction we have to immediate danger. Fear usually occurs at the very moment when the threat is happening. But anxiety is about what may happen in the future.

Having anxiety is not necessarily a bad thing. It helps us plan for the future, feel secure about it.

There seven different types of anxiety disorder: Specific phobia, social phobia, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and acute stress disorder.

Specific phobia is when a person has a big fear of objects or situations that has no justification. Let’s visualize a person who does not like flying. Then out of a sudden this person is given a trip to Europe as a gift. His/her intense fear of flying can get in the way of his/her trip. So much that he/she may cancel it.

Social phobia is when a person has a lasting fear of being around people that are not familiar. A good example

social phobia is somebody who does not interact socially with anybody, but family members. These types of people are usually afraid that others may think he/she is stupid or doesn’t know what they are talking about.

A panic disorder is better known as panic attack. When having one a person will have constant and intense worry about a specific situation. Let’s take for example a girl who has to give an oral presentation she is not prepared for at all. She will experience intense feelings of doom and terror because of it.

Generalized anxiety is also characterized by worry. But here person tends to worry too much about the little things. For example, a person that is on an interview. During the interview this person tends to constantly ask for water, looks sweaty, and playing with his hands and hair.

Obsessive-compulsive disorder is known to happen to people that have uncontrollable urges (sometimes known as obsessions) that have to be repeated several times during the day. A person, that when goes to the bathroom, must wash his/her hands five or twelve times before leaving has obsessive-compulsive disorder.

Posttraumatic stress disorder entails having an extreme response to something that causes great stress. People that go to the war usually suffer

from this disorder. They tend to have constant nightmares about the war, specifically about horrific events.

Last, but not least is acute stress disorders. It’s symptoms are very similar to Posttraumatic stress disorders, except that they occur between two days and four weeks after the traumatic experience.

Gender and culture also play a role in how this anxiety disorders decide to manifest themselves.

Recipe: Removing anxiety with an orange flavor

INGREDIENTS

1 cup of looking inside (ask yourself what the real issue is) 1 cup packed of making decisions 1 teaspoon of deep breaths extract 2 cups of all-purpose planning 1 teaspoon of meditation 1 teaspoon of building up your self-esteem 1/2 teaspoon of exercise 2 cups of doing something for yourself 2 cups of orange-flavored talking with someone and letting go

DIRECTIONS

1. In large mixing bowl, cream together looking inside (ask yourself what the real issue is), and making decisions till fluffy. Add deep breaths extract; beat well. Stir together the all purpose planning, meditation, building your self-esteem, and exercise. Stir into creamed mixture.

2. Stir in doing something for yourself, and the orange candy. NOTE: Dip a pair of kitchen shears into a glass of hot water or spray with a non-stick spray to make snipping the anxiety orange slices easier. If not anxiety shall stay. Using about one tablespoon of mixture for each cookie, roll into one inch balls. Place on greased cookie sheets.

3. Bake in a 350 degree F (175 degrees C) oven for 10 to 12 minutes or until lightly browned. Remove and cool on a wire rack.

Quiz

1.Anxiety can be adaptive in helping us prepare for future threats or to avoid dangerous situations.

a)Trueb)False

2.What are some disorders that are consider an anxiety disorder?a)social phobia b)specific phobias c)panic disorder d) Only a and be)All of the above f)None of the above

3.Which culture is has proven to be more anxious?a)Europeanb)Latin Americane)Asianf)American

4.There is a lot of money been devoted to anxiety research across Europe.

a)Trueb)False

5.For future research it is important to keep in mind that:

a)Not all culture are the sameb)It doesn’t matter what culture you are from, anxiety is the same everywherec)Each culture is different and uniqued) a and c

Epilogue

Writing about anxiety, and looking at it from the point of view of different

cultures has really open my eyes to new ideas. Just because we all do certain things

equally, doesn’t mean it’s the same thing in a different culture. The same thing happens

with anxiety. Overall I learned that Latin Americans worry a lot, Europeans are really

chill people, and Asians turned out to be more anxious than Europeans and Latin

Americans put together. But that doesn’t surprise me, EVERYTHING gives them

anxiety, and when I say everything, I do mean everything. They get anxious from

embarrassing others, to looking at people on the eyes. But it was interesting to find out.

At first I didn’t know how to feel about writing a multi-genre research paper. It

was something I had never done before, and honestly I didn’t know what to expect. But

all it took was for me to write my obituary (which was the first genre I wrote) and it was

so much fun. It took less than a day for me to have all my genres written because it was

really enjoyable to do.

I hope my audience gets a better understanding of what anxiety is and how it can

affect a lot of people differently. I do feel like I accomplished this in my paper. After re-

reading it a couple of times it feels like you, the reader, will be able to grasp upon the

concept of anxiety. Mainly, I just want this paper to be a starter point for people. Like a

first place to look for information when looking for information, just look at my genres.

The genres I chose (recipe, advice column, encyclopedia entry, obituary, and a

quiz) give examples and help people understand anxiety (encyclopedia entry), see how it

can affect people (obituary and advice column), learn how to deal with it (recipe), and

test their knowledge on what they had read (quiz).

References

Alonso, J., Angermeyer, M.C., Bernert, S., Bruffaerts, R., Brugha, T.S., Bryson, H., et.

al. (2004). Prevalence of mental disorders in Europe: results from the European

study of the epidemiology of mental disorders (ESEMeD) project. Acata

Psychiatr Scand, 109, 21-27.

Andlin-Sobocki, P., & Wittchen, H.U. (2005). Cost of anxiety disorders in Europe.

European Journal of Neurology, 12(1), 39-44.

Blunk, E.M., Rusell, E.M., & Williams, S.W. (2008). Pilot study of Hispanic mothers and

maternal separation anxiety. Social behavior and personality, 36(6), 727-736.

Cintrón, J.A., Carter, M.M., & Sbrocco, T. (2006). Ataque de nervios in relation to

anxiety sensitivity among island Puerto Ricans. Culture, Medicine, and

Psychiatry, 29, 415-431.

Eley, T.C., Gregory, A.M., Lau, J.Y.F., McGuffin, P., Napolitano, M., & Rijsdijk, F.V.,

et. al. (2008). Journal of Abnormal Child Psychology, 36, 55-65.

Grames, H.A. (2006). Depression, anxiety, and ataque de nervios: the primary mental

health care model in a Latino population. Journal of Systematic Therapies, 25(3),

58-72.

Hamilton, J.M. (2008). Culture bound: anxiety disorder in adolescence: a case study.

Journal of Child & Adolescence Psychiatry Nursing, 21(3), 186-190.

Harmon, H., Langley, A., & Ginsburg, G.S. (2006). The role of gender and culture in

treating youth with anxiety disorders. Journal of Cognitive Psychotherapy, 20(3),

301-311.

Itawa, N., & Hiaguchi, H.R. (2000). Responses of Japanese and American university

students to the STAI items that assess the presence or absence of anxiety. Journal

Personality Assessment, 74(1), 48-62.

Kring, A.M., Davidson, G.C., Neale, J.M., & Johnson, S.L. (2007). Abnormal

Psychology. New Jerse: John Wiley & Sons, Inc.

Lee, J., Lei, A., & Sue, S. (2001). The current state of mental health research on Asian

Americans. Journal of Human Behavior in the Social Environment, 3, 159—178.

Roy-Byrne, P.P. (1999). Cultural issues in the treatment for anxiety. The American

Journal of Psychiatry, 156(10), 1658.

Stenberg, R.J. (2006). Cognitive Psychology. Thompson Wardsworth.

Vazsonyo, A.T., & Belliston, L.M. (2006). The cultural and developmental significance

of parenting processes in adolescent anxiety and depression symptoms. The

Journal of Youth and Adolescence, 35(4), 491-505.