A Cross-Cultural Study of Anxiety Among Chinese and Caucasian American University Students

Dong Xie and Frederick T. L. Leong

This study investigated the cross-cultural differences on state, trait, and social anxiety between Chinese and Caucasian American university students. Chinese students reported higher levels of social anxiety than did Caucasian American students. Correlations between trait and state anxiety were compared In light of the trait model of cross-cultural psychology. Implications for multicultural counseling are discussed. Este estudio investlg6 las diferenclas interculturales en cuanto a estado, rasgo y ansiedad social entre alumnos universltarios Chinos y Americanos Caucdsicos. Los alumnos Chinos comunlcaron niveles m^s altos de ansiedad social que los alumnos Americanos Caucaslcos. Se compararon las correlaclones entre rasgo y estado de ansiedad a la luz del modelo de rasgo de la pslcologfa Intercultural. Se discuten las Implicaciones para la consejerfa multicultural.

nxiety is one of the most prevalent psychological issues among university students. However, the understanding of anxiety has lagged behind its prevalence. Whereas anxiety may be a universal emotion, cultural beliefs and practices still have important influences on experiences and manifestations of anxiety (Kirmayer, Young, & Hayton, 1995) and, subsequently, on development, diagnosis, and treatment of anxiety disorders (Scott, Eng, & Heimberg, 2002). However, there has been a lack of knowledge and understanding about how anxiety develops and is experienced differently across various cultures and how treatments can be more culturally responsive for clients with different cultural and ethnic backgrounds. A review of the existing limited literature involving Chinese participants in research studies revealed that Chinese tended to be more anxious than Americans (Chataway & Berry, 1989; Lin, Endler, & Kocovski, 2001; Sun, 1968). Some epidemiological surveys on prevalence of mental disorders also indicated that Chinese reported higher anxiety levels than did Americans (e.g., Chen, 1996). Similarly, cross-cultural studies involving Asian Americans indicated that Asian Americans tended to report higher degrees of anxiety than their Caucasian American counterparts (Okazaki, 1997, 2000; D. W. Sue, Ino, & Sue, 1983; D. W. Sue, Sue, & Ino, 1990). However, one inherent limitation of these studies was their lack of attention to the ethnic heterogeneity of Asian Americans. Moreover, the Asian American samples in these studies were often less culturally
Dong Xie, Department of Psychology and Counseling, University of Central Arkansas; Frederick T. L. Leong, Department ofPsychology, Michigan State University. Correspondence concerning this article should be addressed to Dong Xie, Department of Psychology and Counseling, University of Central Arkansas, 201 Donaghey Avenue, 210 MAS, Conway, AR 72035 (e-mail: dxie@uca.edu).
2008 American Counseiing Association. Ali rights reserved. 52 JOURNAL OF MULTiCULTURAL COUNSELiNG AND DEVELOPMENT January 2008 Vol. 36

different from Caucasian Americans than they were from Asians living outside of the United States. Thus the previous Asian ethnic minority comparisons may not have been powerful enough to identify how culture may influence the experience and report of anxiety in more subtle ways. Most previous cross-cultural studies only focused on one type of anxiety (e.g., Klopf & Cambra, 1980) or did not specify what type of Einxiety was mecisured (e.g.. Sun, 1968). It is unclear whether a difference observed for one type of anxiety can be observed for other types of anxiety, or whether the magnitude of a difference may vary across different types of anxiety. Anxiety can be classified based on the stimuli or on the situations that are causes of anxiety. Among these types of anxiety, social anxiety was defined as "anxiety resulting from the prospect or presence of interpersonal evaluation in real or imagined social settings" (Schlenker & Leary, 1982, p. 642). Social anxiety is characterized by fear associated with social situations in which one might be viewed or scrutinized by others. Relatively few studies have specifically addressed the cross-cultural differences between Chinese participants and those from other cultures in experiencing social anxiety. Furthermore, findings from these limited studies tended to be mixed. For example, Klopf and Cambra found no significant difference between Chinese and Western participants in apprehension about speaking . However, using the same measure of apprehension about speaking as Klopf and Cambra, Y. Zhang, Butler, and Pryor (1996) found that Chinese university students reported significantly higher apprehension about communication compared with the data on American norms established in 1982. Chan's (1996) study found that Chinese students' scores on a social anxiety measure were similar to scores of their American counterparts but higher than those of French, Dutch, and Swedish students. D. W. Sue et al. (1990) combined the self-report and behavior measures in their study on assertiveness and social anxiety in Chinese American female university students. They found that Chinese American women were as assertive as the Caucasian American female students, but they reported more apprehension about social situations than Caucasian American students did. These studies indicated that Chinese Americans tend to report more anxiety in social situations but may behave as assertively as their Caucasian American counterparts. Although it is difficult to explain the discrepancy between self-report and behavioral measures of social anxiety, such a discrepancy may support the hypothesis that a cultural norm of nonassertiveness (e.g., for the Chinese) may result in negative self-evaluations of Asian Americans rather than actual deficits in their assertive behavior (Alden & Cappe, 1981). Because social anxiety involves social interactional situations, social anxiety may reflect more cultural variations than other types of anxiety that involve nonsocial situations. In other words, how people experience and express social anxiety may be more likely to be influenced by cultural factors. Therefore, we hypothesize that cross-cultural difference for social anxiety will be greater than it is for other types of anxiety such as trait anxiety and state anxiety.
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One significant advancement in anxiety research is the differentiation of state anxiety and trait anxiety, which are related yet logically different anxiety constructs. State anxiety is an unpleasant emotional state that varies in intensity and fluctuates over time, whereas trait anxiety describes the relatively stable individual differences in anxiety proneness as a personality trait (Spielberger, 1985). This conceptualization assumes that the intensity of state anxiety can be measured at a given time, and the experience of state anxiety may fluctuate over time as a function of the extent to which an individual perceives his or her environment as dangerous or threatening. Trait anxiety is defined as relatively stable individual differences in anxiety-proneness. It is the tendency to perceive stressful situations as dangerous or threatening, especially situations that involve being evaluated by other people or threats to one's self-esteem (Spielberger, Sydeman, Owen, & Marsh, 1999). The conceptual distinction between state and trait anxiety makes it possible to examine whether the correlation between state anxiety and trait anxiety differs across cultures. However, until now, there has been no study addressing the cross-cultural differences of this relationship. There is a moderate-to-high correlation between state anxiety and trait anxiety, and under relatively nonstressful conditions, the scores of nonclinical participants on state anxiety and trait anxiety are generally identical (Spielberger, 1983,1985). However, most of these studies were conducted in Western cultures. Will the same high correlation be observed among individuals with a different cultural background, such as Chinese participants? According to Hsu (1971), in a collectivistic culture like Chinese society, the behavior of individuals is more likely to be determined by situational or contextual factors rather than by personality traits. Similarly, Church (2000) proposed that even though traits exist in every culture, they may be less likely to account for behavior in collectivistic than in individualistic cultures. Thus, the strong correlation between state anxiety and trait anxiety may not appear to be as strong for Chinese participants, who are more contextually oriented, as it is for Caucasian Americans, who are more individual oriented. In sum, cross<ultural studies on anxiety have been very limited compared with cross-cultural studies on other constructs such as depression. We believe knowledge and understanding of how culture may influence anxiety can be better accumulated by cross-cultural studies focusing on specific types of anxiety and comparisons between "purer," or more culturally distant, samples. The purpose of the present study was to investigate the cross-cultural differences of state anxiety, trait anxiety, and social anxiety between mainland Chinese university students and their Caucasian American counterparts. We hypothesized that, overall, Chinese university students would score higher on anxiety measures than would Caucasian American university students and that the largest difference would be observed on social anxiety. We also hypothesized that the correlation between state anxiety and trait anxiety would be weaker for mainland Chinese

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university students than for Caucasian American university students because of the greater emphasis on contextual factors in Chinese culture.

method
PARTICIPANTS

This study consisted of two samples: a mainland Chinese sample (n = 324) and a Caucasian American sample (n = 333). Participants in the Chinese sample were students enrolled in a large, comprehensive university in Beijing, China. Among these Chinese students, 42.3% (n= 137) were men, and 57.7% (n = 187) were women. Their ages ranged from 18 to 27 years (M = 20.1). The Caucasian American sample consisted of students enrolled in a ' large, comprehensive university in the Midwest region of the United States. Among these students, 37.2% (n= 124) were men, and 62.8% (n = 209) were women. Their ages ranged from 18 to 33 years (M= 18.7).
INSTRUMENTS State-Trait Anxiety Inventory (STAJ, Form Y; Spielberger, 1983). State anxiety and

trait anxiety of the participants were measured by the STAI (Form Y), which has been widely used to measure anxiety. It consists of two subscales measuring state anxiety and trait anxiety, respectively. For the State Anxiety subscale, respondents are instructed to focus on their feelings of "right now, at this moment" and rate 20 statements describing anxiety on a 4-point Likert scale ranging from 1 {not at all) to 4 {very much so). For the Trait Anxiety subscale, respondents are instructed to focus on how they feel generally and rate another 20 statements describing more stable traits on a 4-point Likert scale
ranging from 1 (almost never) to 4 (almost always). Social Avoidance andDistress (SAD; Watson & Friend, 1969) scale. The SAD scale

is a widely used measure of social anxiety. It contains 28 items, with 14 items assessing social avoidance, and 14 items assessing social distress. Participants were asked to rate their behavior and feelings in various social situations on
a 5-point Likert scale (1 = not at all characteristic of me, 5 = extremely characteris-

tic of me). Social avoidance and distress refer to the tendency to avoid social situations and to feel anxious in such situations. Thus, the SAD scale focuses on the behavioral and affective components of social anxiety.
PROCEDURE

The instruments measuring state anxiety, trait anxiety, and social anxiety were translated to Mandarin and back translated to English to ensure the linguistic and conceptual equivalence. The first author translated the original English scales into Mandarin. Then, the translated Mandarin versions were back-translated into English by a second bilingual person. The two English
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versions were then compared, and the discrepancies were discussed by the two translators. To resolve identified discrepancies, they consulted with native speakers of English and Mandarin who were familiar with both languages and cultures. On the basis of these consultations, the translators selected terms and determined wordings that would be most representative of linguistic and conceptual equivalence between the two cultures.

rp suits
COMPARISONS OF DEMOGRAPHIC CHARACTERISTICS

Chi-square analyses indicated no significant differences for distribution of gender, x^(l, N= 657) = 1.75, ns; marital status, x^{2, N= 654) = 4.86, ns; and previous counseling experience, X^(l. ^= 656) =0.13, ns. In both samples, there were more women than men, almost all ofthe students were unmarried, and about 75% of the students had no previous counseling experience. However, chi-square analyses indicated that the two samples differed on distributions of age, x2(io, N= 651) = 244.00, p < .001, and academic rank, xH^, N= 657) = 138.21, /)< .001. Overall, 20- to 22-year-old participants represented a larger proportion of the Chinese sample (64.7%) than of the Caucasian American sample (14.1%), whereas 18- to 19-year-old participants made up a larger proportion of the Caucasian American sample (83.2%) than of the Chinese sample (31.5%). The age difference between the two samples was consistent with the difference on academic year rank. Second-year and 3rd-year students made up a larger proportion ofthe Chinese sample (59.8%) than of the Caucasian American sample (18.3%), whereas lst-year students made up a larger proportion of the Caucasian American sample (79.6%) than of the Chinese sample (34.3%).
INTERNAL CONSISTENCY

Means, standard deviations, and internal consistency statistics of the measures are summarized in Table 1. Cronbach's alphas for the scales measuring state anxiety, trait anxiety, social avoidance, and social distress ranged from .82 to .90 for the Chinese sample and from .88 to .94 for the Caucasian American sample. These internal consistency coefficients indicated high reliability and were comparable with those in existing literature (see Leary, 1991; Spielberger etaL, 1999).
INTERCORRELATIONS AMONG ANXIETY VARIABLES

Table 2 presents the intercorrelations among measures of state anxiety, trait cinxiety, social avoidance, and social distress. For the Chinese sample, trait anxiety was positively correlated with state anxiety (r = .68), social avoidance (r= .36), and social distress (r= .44). Similarly, for the Caucasian sample, trait anxiety was
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TABLE 1 Between-Group Comparisons on Anxiety Measures for Chinese (n = 324) and Caucasian American (n = 333) Students
Chinese Variable Caucasian American a

tvi

SD

tvi

SD

F 23,02*** 9,62** 0.66 85,96*** 47,40***

r\' ,12 ,02 ,00 .12 ,07

Omnibus State and Trait Anxiety Trait Anxiety 42,89 38.91 State Anxiety Social Anxiety Social Avoidance 35,88 Social Distress 36,83

8,33 9,05 8.88 9,60

,89 ,90 ,82 .88

40,53 38,20 29,43 31,82

10,69 12,19 8.95 9,06

,92 ,94 ,88 ,89

**p< ,01.***p< ,001.

also positively correlated with state anxiety (r= .74), social avoidance (r= .44), and social distress (r= .45). The correlations between trait anxiety and other types of anxiety were smaller for Chinese than for Caucasian American university students. However, when subjected to the Fisher's Z score transformation procedure, none of these differences reached a statistically significant level.
CROSS-CULTURAL DIFFERENCES ON ANXIETY

A simple muitivariate analysis of variance was performed to test the betweengroup differences on state anxiety, trait anxiety, social avoidance, and social distress. Tests of equivalence did not suggest any violation of variance equivalence. Results indicated that Chinese and Caucasian American university students differed significantly on the combined set of anxiety measures, F(4, 651) = 23.02, p< .001, r|^= .12. Specifically, Chinese students scored significantly higher than Caucasian students on the Trait Anxiety (M= 42.89 for Chinese, M= 40.53 for Caucasian Americans), F{1, 654) = 9.62, /*< .01, rf= .02; Social Avoidance (M= 35.88 for Chinese, M= 29,43 for Caucasian Americans), F{1, 654) = 85.96, p < .001, rf-^ .12; and Social Distress (M= 36.83 for Chinese,
TABLE 2 Intercorreiations Among Anxiety iVIeasures for Chinese Students and Caucasian American Students
Anxiety Measure 1. 2. 3, 4, State Anxiety Trait Anxiety Social Avoidance Social Distress 1 .68 ,29 ^8 2 ,74 ,36 .44 3 ,33 ,44 /78 4 ,32 ,45 ,83

Note. All coefficients are statistically significant, p < .001, two-tailed. Coefficients above the diagonal are for Caucasian American students; coefficients below tiie diagonal are for Chinese students.

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57

Af= 31.82 for Caucasian Americans), F{1, 654) = 47.40, p < .001, ^^= .07, subscales. There was no significant difference in scores on the State Anxiety subscale between the two groups, F{1, 654), ns, yf= .00. Therefore, these results supported the hypothesis that Chinese university students would report higher levels of anxiety than would Caucasian American university students, and such a difference was more significant for social anxiety.

dism.ssinn
Existing cross-cultural studies on anxiety have often failed to differentiate among different types of anxiety. Moreover, the within-group samples involved in these studies were often ethnically heterogeneous, and the between-group samples were not culturally distinct from each other. With these limitations being considered, the present study investigated the cross-cultural differences of state anxiety, trait anxiety, and social anxiety between mainland Chinese university students and Caucasian American university students. The results indicated that Chinese university students reported higher levels of Trait Anxiety and Social Anxiety (operationalized by two subscales as Social Avoidance and Social Distress) than did Caucasian American university students, but the two groups did not differ on levels of State Anxiety. Among these differences, as hypothesized, the difference on Social Anxiety had a greater effect size (rj^ = .12 for Social Avoidance, .07 for Social Distress) than for Trait Anxiety (ti^ = .02). This finding suggests that Chinese and Caucasian American university students were more different on social anxiety than on trait anxiety. This finding is generally consistent with the conceptualizations of social anxiety and trait anxiety and suggest that culturally related factors have more influence on social anxiety than on trait anxiety. The present study not only supported previous findings that Chinese as well as Asian Americans report higher levels of anxiety but also provided a better understanding of these cross-cultural differences on specific types of anxiety. The Chinese culture prescribes high expectations concerning interpersonal relationships, which may appear to be more taxing in social interactions and thus may make people more susceptible to social anxiety. For example, the Chinese culture typically prescribes face and relationship orientations. These orientations represent the value prescribed by traditioneil Chinese culture of enhancing one's social standing, avoiding losing face, and exchanging social favors based on reciprocity. Individualistic cultures, such as that found in the United States, mainly prescribe high expectations concerning personal achievement. These expectations may be relatively independent of interpersonal situations, which make Caucasian Americans less susceptible to social anxiety. Moreover, Chinese culture is characterized by a strong harmony orientation. For Chinese students, a strong harmony orientation implies orientation to preserving harmony in interpersonal relationships. To maintain a harmoni58 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT January 2008 Vol. 36

ous interpersonal relationship, Chinese university students might choose to do things not so much because it is what they want to do, but to receive the positive comments others may make. As a result, they may become overly sensitive to interpersonal relationships and others' evaluations. To minimize the risk of being negatively evaluated, Chinese university students may constrain their behavior or even reduce their social interaction with others. An authoritarian orientation in Chinese culture may also explain the high social anxiety among Chinese students. Obedience to authority is one important aspect that characterizes social interactions in Chinese society (Yang, 1996) and is one of the elements of hierarchical collectivism (Triandis & Suh, 2002). One of the behavioral consequences of this authoritarian orientation is constant vigilance regarding one's behavior or opinions in social situations to be certain that they parallel the authority's perspective. Collectivistic people with high authoritarian orientation may be more susceptible to social anxiety for three reasons. First, they tend to eagerly identify an authoritative figure in social interactions. Once such an authoritative figure is identified, collectivistic people become sensitive to their own behaviors and subject these to the judgment of this authoritative figure. Second, if collectivistic people cannot identify an authoritative figure in a social situation, they may either imagine one or subject their behavior to internalized authoritative standards governing the social situation. Third, collectivistic people may experience anxiety when they cannot identify or imagine an authoritative figure, or they may identify two or more authoritative figures representing conflicting standards. Thus Chinese people who observe an authoritarian orientation experience anxiety in response to authority figures associated with social situations. The finding in this study that Chinese university students reported higher levels of social anxiety is, in general, consistent with the communication norm that is typical of Chinese culture. Hall (1977) conceptualized high-context\ersus low-context communication as a cultural variation. High-context communication relies on presumptions shared by people, nonverbal signals, and specific situations in which interaction occurs, whereas low-context communication requires clear, explicit verbal articulation as well as elaborated expressions that are relatively independent of situational interpretation. Overall, high-context communication tends to be more endorsed in the Chinese culture and other Asian cultures than in Western cultures. By comparing these two types of communications, it might be inferred that people who rely on high-context communication may appear more socially submissive or socially avoidant than those who rely on low-context communication. The present study indicated that Chinese university students scored higher on trait anxiety and social anxiety than did Caucasian American university students. However, the conclusion that Chinese students in the present study were more anxious, socially avoidant, and distressed than Caucasian American students cannot be warranted without the equivalence of these anxiety
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measurements being established (see Marsella & Leong, 1995, for a review of equivalence issues of assessment in cross-cultural studies). Further research is needed to investigate normative equivalence and how it may affect the differences in reported anxiety between Chinese university students and Caucasian American university students. From a multicultural counseling perspective, this study may have implications for assessment of, conceptualization of, and interventions for anxiety disorders when working with mainland Chinese clients. Although multicultural counseling has been an important issue in the United States with respect to providing services to an increasingly diverse clientele, it is ironic that diversity issues have not yet drawn adequate attention in China, a country inhabited by one fifth of the world's total population. This is probably because of a misconception that multicultural counseling is a practice involving different ethnicity or race between a counselor and a client. This conceptualization would exclude the practice of counseling in China from taking a multicultural perspective because, in most cases, the counselor and client have the same ethnic background. However, both the theory and the practice of counseling in China have been mainly transplanted from Western countries with few cultural variations (Duan & Wang, 2000). In addition to counselor and client ethnicities, multicultural counseling should also be understood as a practice of attending to cultural and social factors that may have an impact on clients' reporting and experience of symptoms as well as counselors' assessment, case conceptualization, and intervention. Sociocultural inclusiveness has been noted in the recent literature on multicultural counseling competencies (e.g., Roysircar, 2005; Roysircar, Arredondo, Fuertes, Ponterotto, & Toporek, 2003)
and current issues of the Journal of Multicultural Counseling and Development,

such as Volume 35, Number 4, October 2007. This is particularly important for counseling in non-Western countries, where there has been a strong reliance on the counseling theories developed in Western cultures. The present study found that the dijfference between Chinese and Caucasian American university students on social avoidance had the largest effect size. The practical implication of this finding is that a counselor should particularly consider cultural influences in conceptualizing a case involving social anxiety. It is both functional and dysfunctional for Chinese students to be socially avoidant. In the Chinese culture, students who are socially avoidant may feel distressed because they are socially isolated; however, their socially avoidant behavior might also be interpreted as being nonaggressive and conflict-avoidingbehaviors that are valued in Chinese culture. If this is the case, then the counselor may help the client to be more aware of and to differentiate functional and dysfunctional aspects of his or her socially avoidant behavior. With this conceptualization, a more culturally responsive intervention would not only recommend assertiveness training but would also include exploration of other ways to fulfill the client's need to be nonaggressive or harmonious.
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The present study is among the first to empirically test Church's (2000) trait model of cross-cultural psychology. According to Church's model, traits may account less for behavior in a high contextual culture, and in the present study a lower correlation between trait anxiety and other types of anxiety would be expected for the Chinese sample than for the American Caucasian sample. However, the present study showed somewhat mixed findings with respect to supporting the trait model. On the one hand, the correlations between trait anxiety and other types of anxieties were all smaller for the Chinese (r= .36 to .68) than for the Caucasian American university students (r= .44 to .74), which appeared to support the trait model. However, the differences between these correlations were not statistically significant and, thus, failed to provide strong support for the model. We are unsure if the differences between the correlations were due to some systematic measurement error or if they were a result of different functions of trait-related constructs in different cultures. We hope that this study will stimulate further cross-cultural research to empirically test the trait model. This study points to additional directions for future research. Future research may need to focus on the normative equivalence ofthe assessments of anxiety. Although perceived cultural norms may not interact with ethnicity in the reporting of social anxiety symptoms among Asian Americans and Caucasian Americans (Okazaki & Kallivayalil, 2002), it would be interesting to see if a lack of interaction effect can be replicated when using a purer sample of Chinese participants who are more culturally distinct from Caucasian Americans. Moreover, it would be interesting to investigate the tolerance of social anxiety symptoms and the effect of such tolerance on the reporting of these symptoms. Chinese university students in this study reported higher social anxiety than did Caucasian American university students, but they may not be as distressed or bothered by these symptoms as are Caucasian Americans. The high-tolerance hypothesis might also explain the underutilization of mental health services by Asian Americans found in previous studies (Snowden & Cheung, 1990; S. Sue, 1977; A. Y. Zhang, Snowden, & Sue, 1998). Future research may also need to investigate the effects of antecedents of trait anxiety and social anxiety among the Chinese at both the cultural level and the individual level of analyses. For example, among the dimensions of culture (Triandis & Suh, 2002), the tightness (strickness) or looseness of a culture may be related to experience of social anxiety. In China, norms often appear to be imposed more tightly than in the United States, where deviation from the norm is more tolerated. The difference in the tightness of the cultures may be related to the differences in the reporting of social anxiety symptoms. On the other hand, at the individual level of analysis, research may need to identify the culturally specific personality correlates of social anxiety among Chinese.
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This study has a number of limitations that may quahfy its findings. Although the translation and back-translation procedure was used to obtain cross-cultural equivalence of the measures used, the results could also be influenced by the possible differences in response style between Chinese and Caucasian American university students. Second, the Chinese sample and the Caucasian American sample were samples of convenience, which may not be a fair representation of university populations in the two cultures. A third limitation was that the study used a sample of university students but did not include a clinical sample. Therefore, caution should be taken when generalizing the study's findings to clinical populations or to nonuniversity populations.

rpfprpnrps
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