Mental Health of College Students

MENTAL HEALTH OF COLLEGE STUDENTS

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MENTAL HEALTH OF COLLEGE STUDENTS

KATHERINE N. MORROW EDITOR

Nova Science Publishers, Inc. New York

Copyright © 2009 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Library of Congress Cataloging-in-Publication Data Mental health of college students / Katherine N. Morrow (editor). p. ; cm. Includes bibliographical references and index. ISBN 978-1-60876-333-7 (E-Book) 1. College students--Mental health. I. Morrow, Katherine N. [DNLM: 1. Stress, Psychological. 2. Adaptation, Psychological. 3. Mental Health. 4. Students-psychology. 5. Universities. WM 172 M5488 2008] RC451.4.S7M435 2008 616.8900835--dc22 2007051994 ISBN: 978-1-60456-394-8

Published by Nova Science Publishers, Inc.    New York

CONTENTS

Preface Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

vii Trait Anger, Anger Expression, and Themes of Anger Incidents in Contemporary Undergraduate Students Sandra P. Thomas

1

Social Anxiety in the College Student Population: The Role of Anxiety Sensitivity Angela Sailer and Holly Hazlett-Stevens

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Coping, Mental Health Status, and Current Life Regret in College Women Who Differ in their Lifetime Pregnancy Status: A Resilience Perspective Jennifer Langhinrichsen-Rohling, Theresa Rehm, Michelle Breland and Alexis Inabinet

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Sexual Behavioral Determinants and Risk Perception Related to HIV among College Students Su-I Hou and Joseph M. Wisenbaker

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The Impact of a Lecture Series on Alcohol and Tobacco Use in Pharmacy Students Arjun P. Dutta, Bisrat Hailemeskel, Monika N. Daftary, and Anthony Wutoh

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The Gould versus Heckhausen and Schulz Debate in the Light of Control Processes among Chinese Students Wan-chi Wong, Yin Li and Ji-liang Shen

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Writing your Way to Health? The Effects of Disclosure of Past Stressful Events in German Students Lisette Morris, Annedore Linkemann and Birgit Kröner-Herwig

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vi Chapter 8

Chapter 9

Chapter 10

Chapter 11

Index

Contents Test Anxiety and Its Consequences on Academic Performance among University Students Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock The Prevalence of Depression among Female University Students and Related Factors Fernando L. Vázquez, Ángela Torres, María López, Vanessa Blanco, and Patricia Otero

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Relationships between Mood, Coping and Stress Symptoms Among Students who Work in Schools Dafna Kariv and Tali Heiman

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Examining Anger Expression Reactions and Anger Control Behaviors of Turkish Students Ibrahim Kisac

217 233

PREFACE College students have always been subject to a massive input of stresses. These stresses include inside and outside pressures by the world to succeed, financial worries, concerns about uncertain future, social problems and opportunities since college is often the meeting place for future mates, and homework and tests in multiple and complex subjects requiring preparation and focus with often conflicting priorities. Unsuccessful coping often results in anxiety, heavy drinking, depression and a host of other mental health problems. The ready availability of weapons of all sorts has added a new dimension to the problem. This new book presents new analyses which detail the depth of the issues involved. Chapter 1 - Guided by Trait-State Anger Theory (Spielberger et al., 1983), trait anger, anger expression, and written narratives of anger incidents were examined in 305 undergraduate students. Fischer et al.’s (2004) coding scheme was used to assess reasons for anger, the relational context of the incident, methods of expressing anger, and outcomes. The chief provocateur for all students was a non-romantic intimate, but important differences were observed when comparing 3 subgroups: (1) students scoring high on angry temperament, (2) those scoring high on angry reaction, and (3) those scoring low on the entire trait anger scale. Interventions for dysfunctional anger are proposed. Chapter 2 - Most college students experience some degree of social anxiety on occasion. However, many suffer chronic anxiety across social situations coupled with a strong fear of negative evaluation. In addition to impaired occupational and social functioning, severe social anxiety or social phobia can carry profound consequences for college students. Social anxiety is a prominent motivation for college student drinking (Burke and Stephens, 1999). In addition to social isolation, social anxiety is associated with depressogenic cognitions, both of which leave socially anxious students at an increased risk for depression (Johnson et al., 1992). Anxiety sensitivity – fear of anxiety-related sensations due to perceived consequences of physical, mental, or social harm – might play an important role in the development of social anxiety (Hazen et al., 1995). Unlike panic disorder, in which individuals typically fear anxiety symptoms out of fear of physical harm or loss of mental control, socially anxious individuals fear perceived social consequences of others noticing their anxiety. Socially anxious college students also judge others who appear anxious more negatively than do college students without social anxiety (Purdon et al., 2001). Although panic disorder treatments target anxiety sensitivity directly with interoceptive exposure strategies, this approach is just beginning to receive attention for the treatment of social anxiety. After a brief review of the literature describing the nature of social anxiety among college students, this

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chapter will examine the specific role of anxiety sensitivity in its development and maintenance. Finally, results from a preliminary investigation comparing the effects of interoceptive exposure delivered in a social context to social context exposure without the interoceptive component will be presented and discussed. Chapter 3 - This study examined the current mental health status, coping strategies, and perceived life regret of three types of female college students (n = 277): those who had never been pregnant (67.9%, n= 188); those who became pregnant at or before age 18 who were a priori considered to be resilient (14.8%, n = 41); and those who had experienced a pregnancy after age 18 (17.3%, n = 48). Data were collected at a diverse urban public university in the Southeast. This university has a significant number of commuter and non-traditional students. Results indicated that college women who had experienced an adult pregnancy reported significantly fewer maladaptive coping strategies than never-pregnant college women and those who had experienced a teenage pregnancy. Surprisingly, both groups of ever pregnant college women expressed significantly more life regret than never pregnant college women. Among the college women who had experienced a teenage pregnancy, two groups were delineated: those who were “thriving” versus those who were “at-risk” with regards to their current symptoms of depression, hostility, and hopelessness. Women in the “at-risk” group were significantly less likely to be simultaneously parenting and attending college than those in the “thriving” group. One potential implication is that identifying and intervening with these potentially at-risk college women may help improve retention rates and student morale at universities with a diverse student body. Chapter 4 - Young adults such as college students are known to engage in frequent and unprotected sexual activities, the primary route for HIV transmission, yet their risk perception towards HIV infections have been low. This study aimed to examine the extent to which HIV risk perception among college students may be explained by behavioral factors (number of partners and condom use by type of sexual activity, and partner’s risk) and selected background variables (sexually transmitted infections history, sexual orientation, age, and gender). A web-survey was administered in a major university in the Southeastern U.S. (N=440). Study information with survey website address and login password were disseminated through flyers, colored mini-handouts, classroom announcements, student newspaper advertisements, and several e-mail listserv student organizations. Informed consent was obtained as part of the login process. The innovation of the study is to assess a comprehensive array of sexual behaviors and their relationships on risk perceptions via the Internet. Bivariate analyses were used to first examine the relationships between individual behavioral or background variables and students’ perceived HIV risk. Multiple logistic regressions were then performed to investigate how well the various behavioral determinants and background variables together distinguished between students with higher or lower perceived risk of HIV infection. Data showed that, after considering all the variables together, number of partners for oral (OR=1.293), vaginal (OR=1.255), and anal (OR=1.846) sex were the three variables which revealed significant predictions to perceived risk. Results support the use of the Intent in obtaining sensitive behavioral information and suggest that public health messages addressing multiple partners in conjunction with type of sexual activity can be important in influencing HIV risk perception among college students. Chapter 5 - Studies related to alcohol and drug use in healthcare students, namely nursing, pharmacy, and medicine suggest that drug and alcohol abuse continues to be a growing problem among health profession students. A review of the more recent literature

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involving pharmacy students, has noted higher levels of alcohol and drug use when compared to the undergraduate student population. Interestingly, the use and/or abuse of tobacco have largely been overlooked in studies involving substance abuse in pharmacy students. This study documented the current alcohol and tobacco use in pharmacy students and conducted a lecture series on the use and abuse of alcohol and tobacco. The lecture series was successful in increasing the awareness of the use and potential abuse of alcohol in the students. Attitudinal changes in students following the lecture series were also assessed. Chapter 6 - In response to the Gould versus Heckhausen and Schulz debate (1999) on the claim to universality of the life-span theory of control, the present study aims to examine the theoretical formulation of Heckhausen and Schulz in the context of contemporary China, with specific reference to the control processes applied by Chinese students in their academic pursuits. A new instrument, the OPS-Scales in the Domain of Academic Achievement (OPSAA), was constructed and examined in the pilot study. The main part of the research program consists of three studies. Study One and Study Two respectively investigated the control processes endorsed by Chinese students in the pre-deadline and post-deadline situations relating to two important public examinations, namely the University Entrance Examination and the Test of English as a Foreign Language (TOEFL). Study Three examined the application of control strategies among junior and senior high school students in a less critical situation (i.e., before an internal school examination). The results of the studies lend support to the thesis about the primacy of primary control. As predicted, the Chinese students made extensive use of selective primary control, selective secondary control, and compensatory primary control in the urgent pre-deadline situation. The control strategies applied in the post-deadline situation continued to be characterized by primary control striving in both the success and the failure conditions. Such primary control striving also demonstrated its adaptive value by significantly correlating to the positive affect subscale of the Positive and Negative Affect Schedule (PANAS). On the other hand, the endorsement of compensatory secondary control in the failure condition did not show its adaptive value. In integrating the results of Study One, Study Two and Study Three, differences were found across the compared age groups. The ascending slope in the application of compensatory secondary control was confirmed among the subjects who ranged from pre-adolescents through adolescents to young adults. For further development of the research program, it is suggested that Lakatos’s idea of sophisticated falsification would be worth considering. Attempts are made to define the “hard core” of the research program, and to propose new auxiliary hypotheses on the basis of the present study. Several lines for future research are also discussed. Chapter 7 - In 1986 Pennebaker and Beall published their renowned study on the longterm beneficial health effects of disclosing traumatic events in 4 brief sequential writing sessions. Their results have been confirmed in various studies, but conflicting results have also been reported. The intent of our study was to replicate the experiments from Pennebaker and Beall (1986), Pennebaker et al. (1988), and Greenberg and Stone (1992) using a German student sample. Additionally, essay variables that point to the emotional processing of events (e.g., depth of self-exploration, number of negative/positive emotions, intensity of emotional expression) were examined as potential mechanisms of action. Trait measures of personality which could moderate the personal consequences of disclosure (alexithymia, selfconcealment, worrying, social support) were also assessed. In a second study the experimental condition (disclosure) was varied by implementing “coping” vs. “helping”

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instructions as variations of the original condition. Under the coping condition participants were asked to elaborate on what they used to do, continue to do, or could do in the future to better cope with the event. Under the helping condition participants were asked to imagine themselves in the role of a adviser and elaborate on what they would recommend to persons also dealing with the trauma in order to better cope with the event. The expected beneficial effects of disclosure on long-term health (e.g., physician visits, physical symptoms, affectivity) could not be corroborated in either the first or the second study. None of the examined essay variables of emotional processing and only a single personality variable was able to explain significant variance in the health-related outcome variables influence. Nevertheless, substantial reductions in posttraumatic stress symptoms (e.g., intrusions, avoidance, arousal), were found in both experiments. These improvements were significantly related to essay variables of emotional expression and self-exploration and were particularly pronounced under the activation of a prosocial motivation (helping condition). Repeated, albeit brief, expressive writing about personally upsetting or traumatic events resulted in an immediate increase in negative mood but did not lead to long-term positive health consequences in a German student sample. It did, however, promote better processing of stressful or traumatic events, as evidenced by reductions in posttraumatic stress symptoms. The instruction to formulate recommendations for persons dealing with the same trauma seems more helpful than standard disclosure or focusing on one's own past, present, and future coping endeavours. Overall, expressive writing seems to be a successful method of improving trauma processing. Determining the appropriate setting (e.g., self-help vs. therapeutic context) for disclore can be seen as an objective of future research. Chapter 8 - Some educators have failed to acknowledge the prevalence of test anxiety and its effect on academic performance among university students. This study addresses this issue at the university level using data collected through the Revised Test Anxiety (RTA) instrument and Sarason’s four-factor model as a basis for measuring test anxiety. The study also investigates the effect of demographic factors on test anxiety. Findings reveal that test anxiety is significantly and negatively related to academic performance. Reasons for these findings are addressed. Chapter 9 - In many countries, university students now constitute a significant proportion of their age group. As in the general population, depression is relatively frequent in this group, and affects women more than men. In the study described here we evaluated the prevalence of depression, depressive symptoms and associated factors among 365 young women sampled randomly, with stratification by year and discipline, from among the 18,180 female students attending a Spanish university (65.9% of its total student roll). The prevalence of current major depressive episode was 10.4% (95% CI 7.5-14.0%). Among students with current depression, the commonest symptoms were depressed mood (86.5%) and alteration of sleep (78.9%). Some 52.6% of depressed students had suffered one or more previous depressive episodes (M = 1.2; SD = 1.5), and 13.2% had attempted suicide, but the existence of previous depressive episodes did not increase the risk of a current episode. Increased risk was associated with recent problems, which multiplied the odds of depression by 2.31 (95% CI 1.26-4.26), and with smoking in the past month, which multiplied the odds of depression by 2.01 (95% CI 1.09-3.89), but not with the use of alcohol, cannabis or cocaine in the past month. Nor was there any significant association between depression and declared social class, monthly family income, university course level, geographical

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background (urban or rural), persons lived with during term time (family, friends, etc.), whether all the previous year's exams had been passed, sports activity, or academic discipline. Chapter 10 - The study examined the mood states of 229 men and women who are simultaneously full-time students and school staff when coping with their dual-demanding stressful environments. A causal model was developed to demonstrate that the dualdemanding stressors that the respondents faced affected their moods; these moods are prebehavioral factors that affected their coping strategies. Results of multilevel analyses indicated that men and women differ in the magnitude of their experienced moods, but both genders experience vigorous moods as a prime emotional reaction to the dual-demanding environment. Moods were found to affect both male and female coping strategies, in all categories except social support. The genders differed in the coping strategies adopted, except for task-oriented strategies. In addition, the analyses revealed gender differences in expressing angry and depressed moods, where females reported experiencing higher levels. These results reinforce our assumption that coping with dual-demanding environments, especially by individuals who are employed in stressful occupations, reflects not only a gender-based tendency but also the mood states that derive from the stressors. Results revealed that men and women manifest identical patterns in coping with dual-demanding stressors, and that these patterns are related to their moods. Thus, coping strategies seem to depend on context rather than on gender. Chapter 11 - The aim of this research is to examine anger expression reactions and anger control behaviors with respect to gender and education levels of the students when they are angry. Subjects were recruited from Gazi University, Abidinpasa High School and Aksaray Anatolian Hotel and Tourism Vocational High School and consist of 466 students. Inventory was prepared by the researcher to collect data about demographic qualities and anger behaviors of the students. Data were analyzed by frequency, percent and chi-square techniques. Results indicated that when the students get angry, they “sulk or make sour face”(77%), “try to think that everybody does not have to behave as they want”(76%) and “think that they can handle with the situation which made them angry” (75%). According to gender variable, male students significantly “say nasty things to the others”, but “try to be more intelligent and indulgent”, “to be more coolheaded”, “more think that not being able to control anger is a weakness” and “more think that they will not let others make them angry” than female students. On the other hand, it was found that female students more “sulk or make sour face”, “feel helpless, feel cry” and “say sarcastic words to the person who made them angry” than male students when they are angry. According to educational status, it was determined that while female high school students significantly “yell or scream more”, “argue with the person who made them angry” and “say nasty things to the others” more than female university students, female university students “express their anger in a more suitable way”, “try to see pozitif sides of the case”, “try to convince themselves not to be angered” more and “think that everybody does not have to behave as they want” when they feel angry. It was seen that while male high school students “make fun of the person who made them angry” more, male university students “do nothing at all, quite; suppress their their anger” more, “sulk or make sour face” and “withdraw from the people”.

In: Mental Health of College Students Ed: Katherine N. Morrow

ISBN: 978-60456-394-8 ©2009 Nova Science Publishers, Inc.

Chapter 1

TRAIT ANGER, ANGER EXPRESSION, AND THEMES OF ANGER INCIDENTS IN CONTEMPORARY UNDERGRADUATE STUDENTS Sandra P. Thomas University of Tennessee, Knoxville Knoxville, Tennessee, USA

ABSTRACT Guided by Trait-State Anger Theory (Spielberger et al., 1983), trait anger, anger expression, and written narratives of anger incidents were examined in 305 undergraduate students. Fischer et al.’s (2004) coding scheme was used to assess reasons for anger, the relational context of the incident, methods of expressing anger, and outcomes. The chief provocateur for all students was a non-romantic intimate, but important differences were observed when comparing 3 subgroups: (1) students scoring high on angry temperament, (2) those scoring high on angry reaction, and (3) those scoring low on the entire trait anger scale. Interventions for dysfunctional anger are proposed.

INTRODUCTION In the lively realm of emotion research in the early 21st century, investigations are ranging from the micro-level (neurons) to macro-levels (societies, cultures) and across several of the subspecialties of psychology (clinical, developmental, and health psychology, to name only a few) (Salovey, 2001). The emotion of anger is compelling increased attention from researchers because its dysfunctional manifestations surround us in our daily lives. As we travel, work, and play, we frequently encounter out-of-control anger behavior (publicized in the media as “air rage,” “desk rage,” and “road rage”). In addition to its social consequences, mismanaged anger has serious consequences for personal health. Deservedly, anger is

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occupying the attention of a number of health psychologists because of its effects on both physical and mental health. My own program of research on anger, now approaching the 20-year mark, began with an intense interest in women’s anger. Amazed at the void in research literature, despite seminal theoretical and clinical papers (e.g., Bernardez-Bonesatti, 1978; Miller, 1983; Lerner, 1977), I formed a research team of psychologists and nurses and undertook the Women’s Anger Study, which included both clinical and community samples (Thomas, 1993). Women’s anger was examined in relation to their self-esteem, stress levels, social support, and social role responsibilities as mothers, wives, and workers, as well as indicators of their physical health (such as blood pressure) and mental health (such as depression and substance abuse). During the first phase of the Women’s Anger Study, data were mainly quantitative, derived from well-established, valid and reliable instruments. However, women also were invited to write responses to open-ended questions about their stress and anger. These brief narratives were enlightening, but left us wanting to know more about the situational context in which anger episodes are embedded, and the deeper meaning of these experiences. A woman’s anger at her mother was not like anger at her husband or her teenage daughter. Hence, more recently, I (along with various members of my research team) have conducted phenomenological studies involving in-depth, face-to-face interviews with participants, including both men and women (e.g., duMont, Droppleman, Droppleman, & Thomas, 1999; Fields et al., 1998; Mozingo, Davis, Thomas, & Droppleman, 2002; Thomas, 2003; Thomas, Smucker, & Droppleman, 1998). I turned to existential phenomenology, using a procedural approach developed at the University of Tennessee (Pollio, Henley, & Thompson, 1997; Thomas & Pollio, 2002), because I wanted a way to grasp the meaning of participants’ anger, not merely its correlates. The phenomenological approach involves entrance into the participant’s world in a humble manner to obtain “a direct description of…experience as it is” (Merleau-Ponty, 1962, p. vii). Qualitative approaches have been slow to gain acceptance in psychology. In fact, Fischer (2006, p. xiv) contends that “among the social sciences, especially in North America, psychology has been slowest to veer from its natural science model to explore events as lived rather than as measured.” Only using the qualitative approach, however, did I learn how much painful inner conflict anger produces, for both men and women. Through the qualitative studies, I became convinced that very few people feel good about the way they manage their anger. Few study participants report ever having role models whose anger behavior they wanted to emulate. Regret, shame, and guilt are acknowledged by most. The primary impetus for my continuing work is my conviction that effective and health-promoting anger management modalities must be identified and then widely disseminated, especially to young people whose emotional habits are still in the formative stages. In this chapter, I report findings of a new study of college students, in which I continue to include a qualitative component (written narratives of anger incidents), while also employing well-known quantitative measures to permit comparability to previous college samples. Before proceeding to discuss the study design and findings, I review the literature documenting anger’s importance to health, the literature that lends urgency to my research agenda. Additionally, I review several theoretical perspectives on anger before introducing Trait-State Anger Theory (Spielberger, Jacobs, Russell, & Crane, 1983), which has guided much of my work, including the present study.

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ANGER’S CONNECTION TO DISEASE RISK AND DISEASE OUTCOMES Anger’s importance to physical and mental health has been demonstrated in numerous studies within health psychology and behavioral medicine over the past 30 years. Since anger arousal is a common occurrence in daily life, unlikely to be eradicated even if people attempted to do so, investigators have sought to identify which aspects of it are pathogenic. Complicating research efforts is the multidimensional nature of the anger construct, (i.e., cognitive, affective, and behavioral dimensions) presenting substantial measurement challenges. Further complicating matters for researchers is lack of clarity and specificity in definitions of anger, hostility, and aggression (terms that are often used interchangeably by researchers).

Issues Regarding Definitions of Anger-related Terms Spielberger and his colleagues, because of the overlap among anger, hostility, and aggression, decided to refer to the constructs collectively as the “AHA! Syndrome” (Spielberger, Johnson, Russell, Crane, Jacobs, & Worden, 1985). Although there is undoubtedly overlap and intercorrelation among anger, hostility, and aggression, a number of scholars (including Spielberger) have been trying to delineate distinctions among the terms. Presently, there is general agreement among psychologists that hostility refers to a characteristic attitude of cynicism and mistrust, an attitudinal set that predisposes a person to frequent bursts of anger. The hostile person could be said to approach the world with a chip on the shoulder, ready to be offended. Anger is the emotion that is felt when an offense takes place. Anger and hostility are correlated but not synonymous, because not all anger is fueled by hostile cognitions. Nor is all anger irrational, as Ellis (1973) and others have contended. Research by Thomas (1995, 2003) indicates that everyday anger can be a justifiable, healthy, and rational response to a violation (e.g., of one’s rights, values, or expectations of reciprocity in significant relationships). There is an old notion that there is an anger continuum, with aggression or violence as the endpoint after angry feelings continue to escalate. This is not supported by research, however. In nonclinical populations, most anger is relatively short-lived and does not involve hurtful actions toward others (Averill, 1982). Anger expression can even prevent aggression, because it may elicit a contrite apology from the other person (Izard, 1993). Aggression, on the other hand, involves verbal or physical actions designed to inflict harm on another; it can be “cold” (enacted in a premeditated fashion) or “hot,” enacted in a sudden rage.

Styles of Anger Expression Of critical importance to health is what a person characteristically does with anger once it has been aroused (often called the “anger expression style”). In early research on anger expression, a unidimensional conceptualization dominated, with low scores indicating that anger was kept inside (Anger-In) and high scores indicating anger directed outwardly (AngerOut) (Funkenstein, King, & Drolette, 1954). In subsequent studies, conducted with an anger

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expression instrument developed by Spielberger et al. (1983), Anger-In and Anger-Out proved to be independent dimensions; correlations between the two were essentially zero (Spielberger et al., 1985; Thomas & R.L. Williams, 1991). Furthermore, Anger-In and AngerOut are not the only choices available when anger has been provoked. Spielberger (1988), realizing that his Anger-In and Anger-Out scales did not capture all possible anger expression modes, developed an Anger Control scale that measures behaviors such as calming down quickly when anger is aroused and stopping oneself from losing one’s temper. Another possibility is discussion with the provocateur, or with a supportive confidant (termed AngerDiscuss in the research literature). Anger-Discuss was included in a research instrument for the first time in the Framingham Heart Study (Haynes, Levine, Scotch, Feinleib, & Kannel, 1978).

The Big Question: Which Anger Dimensions are Salient to Heath Outcomes? Which aspects of the complex AHA! phenomenon are risk factors for, or precursors of, deleterious health outcomes? Is a hostile attitudinal set the pathogenic predictor variable? Or is aggressive behavior the dangerous factor? If only some types of angry thoughts and behaviors are maladaptive, can these be identified by clinicians with confidence? Is the frequency of anger arousal a predominant concern? Or is the intensity or duration of a person’s response more important? What are the effects on health of venting anger in an outburst (Anger-Out) or seething silently (Anger-In) for hours after an altercation? Answers to these questions have been emerging from the behavioral medicine and health psychology studies, and we will review key findings shortly. Before examining this literature, I need to point out that I will use often use the generic term “anger” as I discuss the research findings. Unfortunately, researchers still fail to be precise in specifying whether they are investigating hostility, anger, and aggression. Even when they are purportedly studying anger, closer scrutiny reveals that they did not use an anger instrument (e.g., “anger” appears in the title of a journal article, but perusal of the instrumentation section reveals that the researchers used the Cook-Medley Hostility Scale [Cook & Medley, 1954]--a measure of cynical hostility, not anger). As Averill (1994) has noted, anger has become a synecdoche (common figure of speech) for all kinds of aggressive syndromes. Thus, readers should bear in mind that some of the cited studies actually focused more so on hostility or aggression than on anger, despite the use of the word anger in the title (or elsewhere). Seeking out the original research reports is strongly encouraged to examine the instrumentation more closely.

Anger and Cardiovascular Disease (CVD) Considerable attention has been devoted to anger’s effects on the cardiovascular system, because anger is known to evoke the greatest cardiovascular responses (i.e., heart rate, blood pressure) of any emotion, even greater than fear (Schwartz, Weinberger, & Singer,1981). Anger is associated with increases in both cardiac output and peripheral vascular resistance (Sinha, Lovallo, & Parsons, 1992). It logically follows that an emotion producing such a powerful physiological arousal could eventually contribute to disease processes,

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especially if it is experienced frequently, intensely, and for significant amounts of time during the work day and/or during the conflictual interactions of family and community life. Cardiovascular disease (CVD) is the leading cause of death in the United States (Anderson & Smith, 2005) and causes significant decrements in the quality of life for millions who live with the disease. Not surprisingly, psychologists have joined with our colleagues in medicine who seek to develop effective preventive and ameliorative interventions for CVD. The new field of psychocardiology was featured on the cover of the January 2007 issue of Monitor on Psychology, and several articles within the issue highlighted the efforts of researchers who are studying psychosocial risk factors for CVD, such as hostility and anger (Clay, 2007; Geipert, 2007; Meyers, 2007). While the etiology of cardiac disease is multifactorial, hostility is an established risk factor, independently and in combination with other factors such as obesity, smoking, and alcohol consumption (Bunde & Suls, 2006). Anger is an independent risk factor as well (e.g., J.E. Williams, Nieto, Sanford, & Tyroler, 2001). Particularly impressive are the prospective studies, in which initially healthy young people fill out anger questionnaire and disease outcomes are measured much later. As an example, consider the Precursors Study. Male medical students at Johns Hopkins from the graduating classes of 1948 to 1964 have been tracked for a median follow-up period of 36 years. Those who exhibited a high level of anger as students were significantly more likely at follow-up to have premature cardiovascular disease, particularly premature myocardial infarction (Chang, Ford, Meoni, Wang, & Klag, 2002). To briefly summarize other key research findings regarding anger, hostility, and CVD: •

•

•

•

•

A hostile, distrusting attitude toward other people has been linked to cardiovascular symptoms, such as chest pain, as well as structural changes in the blood vessels of the heart and the peripheral circulation, including coronary artery calcification and coronary atherosclerosis, and carotid atherosclerosis (Iribarren et al., 2000; Pollitt et al, 2005) A volatile, overt anger expression style is associated with coronary heart disease, myocardial ischemia in daily life, and myocardial infarction (Gabbay et al., 1996; Kawachi, Sparrow, Spiro, Vokonas, & Weiss, 1996; Krantz et al., 2006; Mittleman et al., 1995). In fact, a single explosive outburst of anger can be fatal to someone with advanced CVD (Mayne, 2001) Even re-living an anger incident at the request of an experimenter in the laboratory can cause significant reduction in left ventricular ejection fraction (an indicator of myocardial ischemia) in patients with coronary artery disease (Ironson et al., 1992) Habitual suppression is just as problematic as the tendency to have explosive outbursts. Actively suppressing emotion heightens the sympathetic activation of the cardiovascular system (Gross & Levenson, 1997). Anger that is felt but not overtly expressed is associated with higher blood pressures and with diagnosed hypertensive disease (Perini, Muller, & Buhler, 1991; Thomas, 1997a) and incident heart disease (Gallagher, Yarnell, Sweetnam, Elwood, & Stansfeld, 1999) Suppressed anger was an independent predictor of coronary heart disease at 8-year follow-up in the longitudinal Framingham Heart Study (Haynes, Feinleib, & Kannel, 1980)

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Anger and other Disease Conditions The same maladaptive anger patterns that are linked to CVD (i.e., hostility, excessive anger-out, excessive anger-in) appear to predispose individuals to other conditions as well. Anger affects many interacting organ systems. In the burgeoning empirical literature are studies implicating anger in conditions ranging in severity from the common cold to cancer: Among the studies are these: • •

•

•

• •

Hostility predicted not just CVD, but poorer general health and earlier mortality, in a meta-analytic review of research (Miller, Smith, Turner, Guijarro, & Hallet, 1996). Research by immunologists showed that intensely hostile interactions, such as arguments with an intimate partner, lower one’s immunocompetence (Kiecolt-Glaser et al., 1993). On the other hand, stifling anger and engaging in resentful rumination about grievances can be equally detrimental to health. Anger suppression has been linked to decreased function of the immune system (Petrie, Booth, & Pennebaker, 1998; Larson, Ader, & Moynihan, 2001) and to a variety of common illnesses or conditions (Forgays, Richards, Forgays, & Sujan, 1999). Extremely low anger scores have been noted in numerous studies of patients with cancer, suggesting suppression, repression, or restraint of anger. Although additional longitudinal studies are needed, suppressed anger is thought to be a factor both in development of cancer and in its progression after diagnosis (Temoshok, 1987; Thomas et al., 2000). Anger suppression was associated with early mortality in a 17-year prospective study conducted by Harburg, Julius, Kaciroti, Gleiberman, and Schork (2003). Anger suppression and depression were associated with increased death rates in elderly clergy studied over a 4-year period (independent of age, sex, education, smoking, alcohol use, and obesity (Wilson, Bienias, Mendes de Leon, Evans, & Bennett, 2003).

It is beyond the scope of this chapter to elucidate the explanatory mechanisms of these anger-disease linkages; in fact, researchers are still identifying contributing and mediating factors, such as catecholamine levels, lipid levels, serotonin levels, and platelet physiology (see discussions by Iribarren et al., 2000; Lovallo & Gerin, 2003; Pert, 2002; Sloan et al., 2001; J.E. Williams et al., 2000; R.B. Williams, 1994). In addition to the direct effects of anger on health through physiological arousal and immune system inhibition, anger impacts health indirectly through cognitions and behaviors (Mayne, 2001). Behaviors that are often used to alleviate or diminish angry emotion are overeating, smoking, drinking, and using drugs (including over-the-counter, prescription, and illicit drugs) (Arnow, Kenardy, & Agras, 1995; Everson et al., 1997; Grover & Thomas, 1993; Scherwitz & Rugulies, 1992). Further research is necessary to fully delineate the complex relationships among a host of variables. Moreover, there are gaps in the extant literature. Women were excluded from many of the pioneering studies (e.g., an Israeli study of anger and blood pressure in 10,000 male civil service workers [Kahn, Medalie, Neufeld, Riss, & Goldbourt, 1972]; the Western Collaborative Group Study of coronary heart disease [Rosenman, Brand, Jenkins, Friedman,

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Strauss, & Wurm, 1975]). Recently, studies are revealing gender differences that deserve further examination (e.g., Hogan and Linden’s [2005] finding of curvilinear relationships of expressed anger and blood pressure in women but not in men; Suarez’s [2006] finding of associations between depressive symptoms, hostility, anger expression, and insulin resistance in women but not in men). Despite some gaps in the literature, the aggregated evidence is strong that dysfunctional anger can negatively impact physical health. What about anger’s effects on mental health?

ANGER’S RELEVANCE TO MENTAL HEALTH AND INTERPERSONAL RELATIONSHIPS Anger and Mental Health Beyond anger’s significance for physical health, it has obvious relevance to mental health. Poorly regulated anger is characteristic of several personality disorders (e.g., borderline, paranoid), and, when coupled with impulsivity, is known to increase the risk of suicide (Plutchik, Van Praag, Conte, & Picard, 1989). Anger’s link to depressive illness is well known, although it is not clear whether maladaptive anger is a precursor or a byproduct of depression (e.g., Koh, Kim, & Park, 2002).

Anger and Interpersonal Relationships Individuals exhibiting greater anger and hostility are known to have greater frequency and severity of daily hassles and less social support (Siegler et al., 2003; Smith & Frohm, 1985; Thomas, 1993). During the course of a typical day, hostile people have more tense, angry, and confrontational interactions with other people than nonhostile people do (Brondolo, Rieppi, Erickson, Sloan, & Bagiella, 2002). Understandably, chronically angry people have more occupational problems (Caspi, Elder, & Bem, 1987). High anger participants (in comparison to low anger participants) change jobs more frequently, report more conflict at work, and say they are less satisfied with their current jobs (Lench, 2004). Further, studies show that high anger individuals report more conflict with friends (Lench, 2004) and higher rates of divorce (Caspi et al., 1987). Lest the reader conclude that anger should be suppressed to preserve harmony in relationships, (a belief expressed by many women), there is evidence that suppressed anger is significantly correlated with a number of negative consequences, including damaged friendships and feeling dumb, embarrassed, ashamed, or depressed (Deffenbacher, Oetting, Lynch, & Morris, 1996; Thomas et al., 1998; Thomas, 2003).

Summary In summary, what does the health psychology literature tell us? On the one hand, explosive anger is deleterious to health. On the other hand, suppression and rumination are

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detrimental as well. Clearly, achieving more effective management of anger is necessary for optimal health and satisfying relationships. Is there any indication in the research literature of a type of anger behavior that could be health-promoting rather than health-damaging? In 1979, Harburg, Blakelock, and Roeper described a reflective anger coping style that was associated with lower blood pressure. Around the same time, the anger expression style called Anger-Discuss was identified as a better option for cardiac health than Anger-In or AngerOut in the Framingham Heart Study (Haynes, Feinleib, & Kannel, 1980). Subsequent research has shown that Anger-Discuss is correlated with better general health and lower blood pressure levels, as well as greater self-efficacy and optimism (Davidson, et al., 1999; Hogan & Linden, 2004; Thomas, 1997b). Discussing anger can be useful in sorting out what happened during the confusion of a heated exchange. Additionally, it facilitates the formulation of ideas to solve problems. Used constructively, anger can alert intimate partners that something needs to be corrected and can mobilize social activism to combat injustices such as racism and sexism. In situations where anger cannot be expressed (because of power imbalance, social disapproval), vigorous physical exercise or calming procedures are efficacious. But many people have not mastered the skills of anger diffusion or constructive anger expression. In fact, people have fewer strategies for managing anger than for any other emotion (Tice & Baumeister, 1993), and some people formed very unhealthy anger patterns during childhood and adolescence. In the next section, we will explore how unhealthy anger patterns form.

HOW UNHEALTHY ANGER PATTERNS FORM Although developmental and psychodynamic theories offer richly detailed postulations about early childhood influences on emotional development, many theories are not buttressed by empirical evidence, nor are they applicable specifically to the emotion of anger. Only in recent years has a small cadre of researchers turned to the study of anger in young children. While some researchers focus on the child’s temperament, others focus more on the child’s interactions with significant others.

Nature versus Nurture? We have known since the 1960s, from landmark studies by Chess, Thomas, and Birch (1965) and others, that babies have unique temperaments from birth, with a genetic basis. Both reactivity and self-regulation are dimensions of temperament (Rothbart, 1994). A child’s basic temperament displays considerable stability over time (Caspi & Silva, 1995) and is obviously influential in his or her emotional tendencies (Zawadzki, Strelau, Oniszcenko, Riemann, & Angleitner, 2001). An irritable toddler is likely to be a moody teenager. However, basic temperament can be modified by interactions with parents, teachers, and peers. Rewards and punishments, as well as the anger management style of admired role models, help to shape the growing child’s repertoire of anger behaviors. Several anger-related studies have highlighted the importance of the infant having secure attachment to the mother. “Difficult” children are less likely than children perceived as “easy”

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to become securely attached (Calkins & Fox, 1992; Fox & Calkins, 1993). Observational studies suggest that children who do not form secure attachments to their mothers tend to “develop an internal view of the world…as threatening and hostile, [in which] other people are seen as unavailable” (Grunbaum, Vernon, & Clasen, 1997, p. 187). These children tend to exhibit angry behavior; their targets may respond angrily and/or punitively, thus perpetuating their perception of a hostile world. Woodall and Matthews (1989) broadened the focus beyond the maternal-infant relationship to the family environment (as measured by the Moos and Moos [1981] Family Environment Scales). Anger of schoolchildren in grades 2-12 was assessed by several scales, including the Spielberger Trait Anger Scale (Spielberger, Jacobs, Russell, & Crane, 1983). In familial environments characterized by low supportiveness and cohesiveness, children were more chronically and openly angry. Parental conflict can be quite distressful and frightening to children, especially when disputes are handled by yelling and cursing (Cummings & Davies, 1994). Further, children cannot always remain bystanders when parents fight: they can be recruited into parental conflicts, serving as allies or scapegoats. Divorce of parents does not necessarily terminate family conflicts, which may continue for years over financial settlements, child custody, and visitation arrangements. In one study, high expressed anger of the custodial parent (mother, in this case) was related to poorer adjustment of adolescent children (Dreman, 1995). Notably, the mothers had been divorced for an average of 9 years by the time of Dreman’s data collection. Harsh physical punishments are known to foster the development of aggressive behavior in children (W. McCord, J. McCord, & Howard, 1961; Miller, 1980; Olweus, 1980). Physical assault was the number one precipitant of anger in a study of children from first, third, fifth, and seventh grades (Rotenberg, 1983). Parents, siblings, and peers were the main provocateurs, with siblings topping the list. Sibling interactions, which may be as important as transactions with parents, have not received adequate attention from the researchers who are trying to understand anger in children and adolescents (Ewart, 1991). Peer interactions have been extensively studied by Dodge and colleagues (e.g., Dodge & Coie, 1987). In brief, angry behavior may accrue rewards from peers in the short-term, but continued angry, aggressive behavior leads to peer disapproval and rejection (Lemerise & Dodge, 1993). Facility with language is a determinant of children’s anger behavior. Children who learn to verbalize “I’m angry” are less likely to engage in physical aggression (hitting, biting) (Brody & Hall, 1993). Level of exposure to media violence is another factor. A steady stream of aggressive role models in American television, movies, and videogames depict explosive anger behavior that is rewarded, not punished. Many of these role models are greatly admired and emulated. The greater the exposure to media violence, the greater the aggressive behavior in children and adolescents (Bushman & Anderson, 2001). There is some evidence that anger coping styles are becoming routinized as early as middle school or high school. For example, one longitudinal study measured students as high school freshmen and then as seniors using Siegel’s (1984) multidimensional Anger Index; there was no change in anger scores over time (Kollar, Groer, Thomas, & Cunningham, 1991). Faulty emotion regulation habits developed as children may continue through adolescence and adulthood, unless modified by education or counseling. College may be an optimal time for delivery of psychoeducational anger management interventions. Upon entrance, college students are still adolescents (Elliott & Feldman, 1990), and their

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personalities can change markedly during their years at college. Longitudinal studies show that personality is more fluid in adolescents and young adults (Roberts & DelVecchio, 2000). What is presently known about anger in college students? Let us turn to the extant research.

Anger in College Students There is actually quite a lot of research on anger in college students, perhaps because they comprise such convenient samples for their professors to study. However, a great deal of this research is conducted in the artificial environment of the laboratory. Study participants may be asked to keep their hands in painfully cold water as they administer rewards and punishments to their fellow students (e.g., Berkowitz, 1990). This body of anger research is not reviewed here because it fails to inform about emotional experience in the real world. Descriptive research on college student anger began in 1926. Two very early studies elucidated causes of anger in Barnard College women, who were asked to record anger incidents for a week (Anastasi, Cohen, & Spatz, 1948; Gates, 1926). The average number of incidents ranged from 3 per week to 16 per week (with some women reporting as many as 42 incidents). People, not things, provoked anger in the majority of cases (45.8% in Anastasi et al., 79.3% in Gates). The primary cause of anger in both studies was termed thwarting (of self-assertion in the Gates study, of plans in the Anastasi study). The women in the Gates sample reported the most violent reactions to “domineering attitude of other persons” (1926, p. 332). It should be noted that the word “violence” is not used in the way we use it today, because shaking or slapping a provocateur was only reported in 3 of 145 anger incidents. Violence apparently referred to verbal behaviors (i.e.,“excited talking or making an angry exclamation”) that would be considered mild today. The women admitted, however, to impulses to slap, pinch, scratch, and choke their provocateurs, as well as making verbal responses. Shame, irritability, and weariness often followed anger incidents (Gates, 1926). This line of research lagged for a number of years, in part because there was little research of any kind being conducted on emotions. Lazarus (1991, p. 4) has commented on the “perplexing resistance to emotion in mainstream academic psychology until the 1960s,” noting that only an occasional monograph on emotion appeared in the literature between 1920 and 1960. In a revelatory emotion study of the 1980s designed to identify the prototypical features of all the basic emotions, Shaver, Schwartz, Kirson, and O’Connor (1987) asked 120 psychology students to write accounts of emotional experiences. For each emotion, coders identified antecedents, responses, and self-control procedures. The anger prototype of the college students included features of attack, such as “Loud voice, yelling, screaming, shouting,” “Attacking something other than the cause of anger, e.g., pounding on something, throwing things,” and “Incoherent, out-of-control, highly emotional behavior” (p. 1078). In 95% of the students’ written accounts of their anger, a judgment had been made that “the frustration, interruption, power reversal, or harm is illegitimate” (p. 1077). Anger caused a narrowing of attention, such that the students reported they could think of nothing else but the injustice that occurred. Self-control procedures included attempts to redefine the situation or “view it in such a way that anger is no longer appropriate” (p. 1078). Other important studies of college students during the 1980s and 1990s, conducted by Averill (1982), Deffenbacher (1992), Scherer (1997), and others, will be discussed, in detail, a bit later in the paper.

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Is the Current Generation Angrier? There is speculation that contemporary college students are angrier than those of previous generations. Several writers have described the sense of “specialness” or entitlement displayed by the children of the baby boomer generation who populate college classrooms today. A 1998 article in The Chronicle of Higher Education revealed concerns of professors across the nation about student incivility, insubordination, and intimidation of faculty (Schneider, 1998). The following examples were cited: “When a chemistry professor at Virginia Tech asked his class how to solve an equation, a student in the back of the room shouted, ‘Who gives a s---?’ When a scholar at Utah State University refused to change a grade, a student screamed at her, ‘Well, you goddamned bitch, I’m going to the department head, and he’ll straighten you out!’ …A historian at Washington State University was challenged to a fight when a student disliked the grade he’d received” (Schneider, 1998, p. A 12).

Because this literature suggests higher levels of anger (and more overtly expressed anger) in today’s college students, one of the aims of the present study is to compare the present sample to previous samples of students. One basis of comparison will be scores on trait anger, a construct from Trait-State Anger Theory (Spielberger et al., 1983), the theory that is perhaps the most widely used by health psychologists. Before elaborating on this theory, a brief overview of other prominent theories is presented.

CONCEPTUALIZATIONS OF ANGER IN THE PSYCHOLOGICAL LITERATURE Theory comes from a Greek word meaning “I behold;” therefore, the purpose of theory is to enlarge our observation (Coles, 1989). Anger research has been framed within several emotion theories, each illuminating a particular aspect of the anger experience, while failing to shed light on other aspects. Evolutionary theories of emotion emphasize biology; other theories emphasize cognitive appraisals or the situational context in which anger is provoked. There is not much evidence that the theorists aligned in different camps read each other’s works, although cross-fertilization would appear to be fruitful. Only those theories that have been used in major anger studies are reviewed in the following pages.

Anger from the Perspective of Evolutionary Theories In 1872, Darwin proposed that (a) humans are genetically programmed with certain emotions; (b) these emotions, having evolved because of selection factors in the species, have adaptive value for survival; and (c) emotions are universal, not culture-specific. Darwin conducted observational studies that supported these propositions. Several contemporary researchers tested various tenets of evolutionary theory, including Ekman (1972), Izard

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(1971), Plutchik (1980), and Tomkins (1963, 1980, 1991). Plutchik (1980) built upon Darwin’s idea of the emotions as adaptive for survival of the species. For each of the 8 emotions he deemed “primary,” he proposed its origin and function. The origin of anger was said to be meeting an obstacle viewed as enemy; its function, destruction of that enemy. Because blood goes to the hands in anger, the autonomic nervous system is preparing the individual for fighting (Ekman, 1994). Supportive of Darwin’s assertion that emotions are universal are studies such as Ekman’s (1972), in which people in both Eastern and Western cultures—even preliterate cultures such as New Guinea—could correctly identify all of the primary emotions (anger, fear, sadness, surprise, disgust, and joy) in photographs of faces. Considerable attention continues to be devoted to facial expressions. The role of facial muscle movement in activating and regulating emotional experience has been a central focus in Izard’s (1980) emotion theory, which is tested using electromyography. Coding systems designate the facial muscles involved in each emotion, and electrodes are placed accordingly. According to Izard (1990), substantial evidence has accumulated regarding congruence among facial, behavior, physiological function, and individuals’ self-reports of emotion experiences. Facial muscle movements do appear to elicit or alter feeling states. Another scholar within the Darwinian tradition, Tomkins, views the skin of the face as more essential than its musculature in providing feedback for emotions. Among his research methods over the years is high-speed photography of the face. Tomkins’s (1980) propositions include the following: (1) affects are muscular and glandular responses triggered by innate mechanisms; (2) affect is primarily facial behavior; (3) when people become aware of their facial (or visceral) responses, they are aware of their affects; (4) people learn to generate from memory images of these responses; (5) affect amplifies not only its activator but also the response to the activator and to itself. Tomkins considered anger among the 9 innate affects, readily evident to observers by a red face, frown, and clenched jaw. Further, he considered anger the most urgent of all affects and the most problematic in human interaction (Tomkins, 1991).

Anger from the Social Constructivist Perspective Quite different from the evolutionary theories is the social constructivist point of view. Constructivism refers to the “imposition of meaning or structure on events…This imposed meaning or structure can come from social, cultural, or biological forces. However, the social constructivist position suggests that feelings are more social than biological constructions” (Kassinove, 1995, pp. 21-22). The social constructivist perspective is exemplified by Averill (1982), who conducted an oft-cited and comprehensive study of anger in college students and community-dwelling adults. Averill used a diary method to collect descriptions of anger as it occurred in everyday life, discovering that most anger was provoked within intimate relationships, by misdeeds that were potentially avoidable. The most frequent responses during anger episodes were calming activities and talking over the incident. Direct physical aggression against another person was very rare. Averill’s research demonstrated that anger is a highly interpersonal emotion that cannot be understood without consideration of the social context.

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Anger from the Perspective of Appraisal Theorists The basic premise of appraisal theories of emotion is that emotions are generated by a person’s subjective appraisal of a situation; the appraisal involves cognitive processing of the significance of the event (Scherer, 1997). Put simply, an event could evoke anger in one individual (who perceives an insult) and laughter in another (who perceives a harmless practical joke). Magda Arnold (1960) is considered the first modern theorist to propose that appraisals determine the particular emotion that a person will experience. In her conceptualization, anger is generated when a harmful object is present and appraised as difficult to overcome. Newer theories have been posited by Scherer (1982), Roseman (1984), Lazarus (1991),and others, and tested in both laboratory and questionnaire studies. In most of the appraisal theories, anger is said to occur when an incident of injustice is caused by an external agent, providing the aggrieved individual with impetus to attack. Discrepant in some respects from the other theories is the theoretical model developed by Berkowitz (1990). The Berkowitz model (termed cognitive-neoassociationistic) integrates automatic arousal processes and higher-order cognitive concepts such as appraisals. He described a series of stages in the formation of anger. First, primitive associative processes are dominant and then more complicated cognitive processes become involved. There is an initial rudimentary angry reaction, and then the person makes causal attributions and considers alternative courses of action. The person could decide that the provocation is too trivial for anger, thereby moderating the arousal. Another possibility is evaluating the provocation in a way that escalates or prolongs the initial arousal. Berkowitz acknowledged a limitation in the model, in that it has “nothing to say about the kinds of interpersonal relationships that give rise to angry feelings, even though these interpersonal relationships are the source of much of the anger that occurs in everyday life” (Berkowitz, 1990, p. 494). According to Berkowitz, an external agent (such as another person) is not necessary for anger to be generated; internal physical discomforts such as headaches--or general unpleasantness-can evoke anger. In his most recent writing, he reiterates that the crucial determinant of anger is unpleasantness (Berkowitz & Harmon-Jones, 2004a). In response to Berkowitz and Harmon-Jones (2004a), Roseman (2004) has vigorously asserted that appraisals, not unpleasantness, are the primary determinants of anger. In Roseman’s own study of anger, subjects wrote narratives about emotional experiences that had actually occurred, then responded to researcher questions about their appraisals at the time of the events. Key elements in experiences of anger were: (1) situations that were unwanted, (2) caused by someone else, (3) characterized by low power, and (4) beliefs that one deserved a more positive outcome (Roseman, Spindel, & Jose, 1990). Scherer (1997) contends that the appraisal mechanism is universal across cultures, with different emotions being elicited by differentiated appraisals. Because Scherer’s 37-study is perhaps the most extensive cross-cultural study of emotions ever attempted, it deserves closer attention. The Intercultural Study on Emotional Antecedents and Reactions (ISEAR) involved 2,921 university students (55% women, 45% men, mean age 21.8). For reasons of comparability, data were always collected during classes at universities located in major cities. Over an 8-year period, data were collected in industrialized and affluent countries such as France, Japan, Australia, and the Netherlands, as well as less affluent, developing countries in Africa and Latin America. Anger was one of the 7 emotions studied. For each emotion, participants were asked to freely describe an incident in which they had most recently

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experienced that emotion. After completion of this portion of the task, participants were asked specific questions about appraisals, physiological symptoms, expressive reactions, and other aspects of the incident. Generally consistent with the findings of Roseman et al. (1990), anger was generated by appraisals of situation as unexpected, unfair, obstructive of goals, and caused by other people. Germane to the present paper is a secondary analysis of the ISEAR data conducted by Fischer, Rodriguez Mosquera, van Vianen, and Manstead (2004). A coding scheme was developed for the above-mentioned written descriptions of anger incidents. Only those situation descriptions which could be translated by a native speaker to English were used in the analysis. 1,028 student anger stories (representing 16 countries) were translated and coded. The coders identified the target toward whom anger was directed (intimates, strangers, or no specific target) and the reason for the anger (relational, attack on one’s status, personal or general injustice, or minor frustration). Several gender differences were found (e.g., men targeting anger at strangers more so than women), but the number one reason for anger (personal or general injustice) was constant across gender and countries. Gender and culture can have profound impact on appraisals (and subsequent behaviors), and a sizeable body of literature has accumulated on gender and cultural differences in anger. For example, many studies show men are more likely than women to exhibit cynical hostility and aggressive behavior (Stoney & Engebretson, 1994), and individualistic Westerners are more likely to overtly express anger than Easterners in collectivistic cultures valuing interdependence and harmony (Thomas, 2006). This literature, while interesting and important, is not reviewed here, for two reasons: (1) it was not an aim of the present study to explore gender differences; and (2) the cultural homogeneity of the college student sample prevented any examination of cultural differences. See Shields (2002) for delineation of differences between men and women in anger experience and expression; also see Thomas (2006) for an extensive review of the literature on cultural and gender differences as they relate to the assessment and treatment of anger disorders.

Anger from the Perspective of a Personality Trait Theory (Trait-State Anger Theory) A trait is defined as “a characteristic or quality distinguishing a person…, especially a more or less consistent pattern of behavior that a person possessing the characteristic would be likely to display in relevant circumstances” (Colman, 2001, p. 750). Gordon Allport (1937) studied traits for his doctoral dissertation and spurred tremendous interest in these enduring predispositions to behavior. Lines of research developed around trait anxiety, trait curiosity, and trait hope, among others (e.g., Ellsworth & Smith, 1988; Spielberger, 1998). Although traits were attacked during the hegemony of behaviorism, they are receiving fresh attention because of the personality-health associations discovered in recent years. It is clear that personality traits affect both health and longevity (Caspi, Roberts, & Shiner, 2005; Leclerc, Rahn, & Linden, 2006). Theorizing that anger is both a personality trait and a transient emotional state, Spielberger and colleagues (Spielberger et al., 1983; Spielberger, et al., 1985) developed the first questionnaire to measure both, the State-Trait Anger Scale (STAS), (later expanded to become the STAXI, which included the anger expression modes, i.e., Anger-In, Anger-Out,

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Anger Control). Trait anger refers to an individual’s overall propensity to become aroused to anger, a stable aspect of the personality over the long term. Spielberger et al. (1983, p. 169) hypothesized that persons scoring high on the trait anger questions of the STAS (T-anger scale) tended “to perceive a wide range of situations as anger-provoking (e.g., annoying, irritating, frustrating), and to respond to such situations with elevations in state anger.” Moreover, it was hypothesized that these individuals would experience more intense anger arousal than persons scoring low on the scale. Examples of T-anger scale items are “I have a fiery temper” and “I am a hot-headed person.” State anger refers to emotional experience at a particular moment, consisting of “subjective feelings of tension, annoyance, irritation, fury, and rage, with concomitant activation or arousal of the autonomic nervous system” (Spielberger et al., 1983, pp. 168169). Examples of items in the State Anger subscale of the STAS (S-anger) are: “I am furious” and “I am burned up.” The S-anger scale proved especially useful in measuring angry responses of participants in laboratory experiments. Commonly, these studies involved various anger-provoking stimuli, such as harassment by the experimenter while completing a frustrating task. Thousands of college students, military recruits, junior and senior high school students, and working adults were tested during the initial psychometric evaluations of the new StateTrait Anger Scale. As expected, the trait anger subscale was highly correlated with hostility measures such as the Cook-Medley Hostility scale (Cook & Medley, 1954) and the BussDurkee Hostility Inventory (Buss & Durkee, 1957). Factor analysis revealed a two-factor solution for the 10-item Trait Anger Scale: a 4-item factor labeled Angry Temperament, a 4item factor called Angry Reaction, and two other items. We will elaborate on the importance of these two components of trait anger a bit later. First, we discuss empirical evaluation of Trait-State Anger Theory by several research teams. Our discussion emphasizes Trait Anger because of its relevance to the present study. Deffenbacher, with various colleagues, conducted a series of studies during the 1980s and 1990s designed to test Trait-State Anger Theory (Deffenbacher, 1992). Typically, the subjects were college students who completed the STAS along with other self-report tools, including daily anger logs; subsequently, comparisons of high T-anger and low T-anger students were made. Findings strongly supported Trait-State Anger Theory and identified correlates of trait anger, such as lower self-esteem. To wit, Deffenbacher (1992) found that people scoring high in trait anger exhibit: •

• • • • • •

Greater anger responsiveness to a wide range of provocations, more frequent and intense daily anger reactions, and more severe physiological arousal and somatic symptoms (clenched jaw, shakiness) Tendency toward irrational beliefs (e.g., need for perfection) Lower self-esteem Tendency to be more tense, high-strung, irritable Poorer coping with chronic stressors Higher trait anxiety Strong tendency to express anger in maladaptive ways (i.e., outwardly in an antagonistic, less constructive manner, or inwardly)

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Later, Deffenbacher and colleagues (2003) adapted Trait-State Anger Theory to the specific situation of driving while angry, again recruiting a college student sample. Predictions derived from the theory were generally supported: higher anger drivers (compared to low anger drivers) scored significantly higher on Spielberger’s (1999) Trait Anger Scale and reported more risky and aggressive driving behavior, traffic tickets, and minor accidents. The tendency of persons high in trait anger to make risky choices was also shown in a series of studies conducted by Lerner and Keltner (2001). Faulty appraisals regarding degree of risk and personal vulnerability influenced respondents’ proclivity for making risky choices. Other research teams have provided further support for Trait-State Anger Theory and the construct validity of the Trait Anger Scale. High Trait Anger (HTA) subjects in a nonclinical adult sample surveyed by Tafrate, Kassinove, and Dundin (2002) were significantly more prone to exaggeration of the triggering event and cognitive distortions about it, as compared to Low Trait Anger (LTA) individuals. Consistent with earlier studies, HTA adults reported more frequent and more intense anger episodes than did LTA adults. They were more likely to vent their anger through verbal and/or physical aggression and to medicate it by misusing chemical substances. Furthermore, they were four times more likely than low LTAs to experience negative consequences in their interpersonal relationships. Strong correlations were found between Trait Anger scores and scores on Cognitive and Somatic Anger scales (Contrada, Hill, Krantz, Durel, & Wright, 1986) in Thomas’s (1993) study. Women scoring high on trait anger in Thomas’s study acknowledged faulty cognitions (e.g., “they are deliberately provoking me”) and difficulty letting go of anger (“I keep thinking about what happened over and over again”) as well as numerous somatic symptoms of anger, such as headaches, a tight knotted feeling in stomach, and faster respirations. As in Deffenbacher’s (1992) study, higher trait anger was associated with lower self-esteem.

Component Analysis: A Gap in the Literature What is missing in this growing body of trait anger research is teasing apart the temperament component and the reaction component. Some people who score high on trait anger truly have an angry temperament; they are hyperresponsive to a multitude of diverse stimuli, even trivial provocations. The Angry Temperament subscale of the STAS appears to measure a genetic propensity to be a “hot reactor.” Other people may react strongly to particular situations of criticism and injustice (i.e., score high on Angry Reaction), although they are not customarily so anger-prone (i.e., they do not score high on Angry Temperament). Carefully examining the two components of trait anger has implications for achieving greater conceptual clarity as well as for tailoring anger management interventions. One early study alerting researchers to the importance of component analysis was conducted by Crane (1981). Hypertensive patients were compared to medical patients who had no history of hypertension. As predicted, hypertensives scored higher than the comparison group on trait anger. Interestingly, differences in Trait Anger scores between the two groups were not because they differed in angry temperament but because the hypertensive patients scored high on angry reaction (i.e., the items assessing anger in situations of criticism by other people). Crane also found that the hypertensives suppressed their strong feelings about unfair criticism, rather than expressing them overtly to the other parties involved in the interactions.

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Another study suggesting there is value in looking at angry temperament and angry reaction separately was that of J.E.Williams and colleagues (2000), who examined the development of cardiac disease over a period of 6 years in a large sample (n=12,990) of initially healthy men and women. Those with higher levels of trait anger (measured by Spielberger et al.’s [1983] scale) were more likely to ultimately suffer heart attacks and sudden death than those with lower trait anger. Closer scrutiny of the data in 2001 revealed that it was the angry temperament component of trait anger, not angry reaction to criticism or unfair treatment, that predicted heart disease risk. In the new analysis, the association between each trait anger component and coronary heart disease was determined by Cox proportional hazards regression. Having a high score on angry temperament conferred more than twice the risk of cardiac events (compared to low angry temperament). Results of the proportional hazards regression analysis for angry reaction were not statistically significant (J.E. Williams, Nieto, Sanford, & Tyroler, 2001). Despite the foregoing evidence that it is valuable to examine the components of trait anger, few researchers have done so. Further, few trait anger researchers have invited study participants to describe their anger episodes in detail, including situational precipitants, relational context, behaviors, and outcomes. To understand an emotion, we must understand what it is about (Sartre, 1939/1948). What are contemporary college students angry about?

PURPOSE OF THE STUDY The purposes of this descriptive study were to (1) survey levels of trait anger and styles of anger expression in contemporary undergraduate students; (2) analyze their written narratives of anger incidents, with regard to situational precipitants, relational context, behaviors, and outcomes; and (3) contribute to Trait-State Anger Theory by identifying any differences between anger narratives of high scorers on angry temperament, high scorers on angry reaction (but not temperament), and low scorers on the entire trait anger scale. The study method was modeled after Averill (1982), Roseman et al. (1990), and Scherer (1997), who pointed out that cognitive appraisals of emotion situations and subjective feeling states are accessible only through self-report. Despite the disadvantages of self-report data, Scherer and Wallbott (1994, p. 312) argued that “Rather than not studying emotion episodes in real life at all, it is preferable to have access to real, and often intimate, emotions through verbal report on recalled emotion experiences in anonymous questionnaires (even though some of the reports might be biased).”

METHOD Participants Study participants were 305 undergraduate students at a large southeastern university (126 males, 175 females, 4 not reporting sex). Racial composition of the sample was 88% white, 7.5% black, 5% other (e.g., Asian, Hispanic, Native American). Mean age was 19.6 (range 18-24 years). There were 135 sophomores, 91 juniors, 40 freshmen, 28 seniors, and 5

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fifth-year seniors (missing data for 6 students).

Instruments Spielberger Trait Anger Scale The Trait Anger portion of the Spielberger Trait Anger Scale (STAS) includes 10 angerrelated statements, with a 4-point scale of response options, ranging from almost never (1) to almost always (4). Respondents are instructed to “rate yourself according to how you generally feel.” Sum of all responses is the trait anger score indicating an individual’s general proneness to become angry (possible range 10-40). 4 of the 10 items comprise the Angry Temperament subscale (range of scores 4-16), and another 4 items comprise the Angry Reaction subscale (range of scores 4-16). The Angry Temperament subscale measures “a general propensity to experience and express anger without specific provocation,” while the Angry Reaction subscale assesses “the disposition to express anger when criticized or treated unfairly by other individuals” (Spielberger, 1991, p. 1). As noted previously, the two-factor solution (Angry Temperament and Angry Reaction) of the Trait Anger Scale was established during initial development and validation of the tool (Spielberger et al., 1983). Subsequent factor analytic work has supported the 2-factor structure (e.g., Van der Ploeg, 1988). Concurrent, convergent, and discriminant validity of the STAS, as well as internal consistency reliability, have been well established. Cronbach’s alpha was.70 when the Trait Anger Scale was administered to the normative sample of college students (Spielberger, 1991) and.85 for a college sample tested by Thomas and R.L.Williams (1991). Test-retest reliabilities have ranged from.70 to.77 in various published reports. Demographic Data Form A simple demographic data form requested participants to report their age, year of college, gender, and preferred racial/ethnic designation. Description of Anger Incidents Students were asked to recall an experience of anger and describe it in writing on a blank sheet of paper included in the instrument packet. As in Scherer’s (1997) 37-country study, respondents freely chose the events they reported. Instructions were as follows: “Think of a time when you became angry. Describe this experience in as much detail as you can. Where were you and what happened? Include your thoughts and actions as well as any after-effects of the incident (e.g., how you felt, how your relationship with another person was affected). When speaking about other people you interacted with while angry, be sure to give them pseudonyms. Type your story or write legibly. Add other pages if necessary.”

Procedure 310 instrument packets were distributed by 31 undergraduate students in the university honors program to classmates who were at least 18 years of age and enrolled in undergraduate

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course work. Data collectors returned the completed instrument packets to the researcher at regular class meetings during the semester. Five packets were erroneously distributed to graduate students or students who were not yet 18; these were discarded before data analysis.

Protection of Human Subjects This study was approved by the university IRB. Potential participants were given full study information to permit informed consent on a cover sheet attached to the questionnaire packet. To preserve anonymity, however, no signature was required on the form. Participants were told that completion of the instruments would take about 30 minutes and conferred neither risks nor benefits. Returning questionnaires to the data collectors (in the sealed envelopes provided) signified their consent to participate.

RESULTS Analysis of Quantitative Data Comparison of Anger Scores to Previous Samples of College Students Overall, the data suggested no trend toward an increasingly angry college population. The full range of possible scores on the Trait Anger Scale (i.e., 10 to 40) was observed in this sample of 305 college students, indicating heterogeneity in anger proneness. The mean Trait Anger score was 19.087 (SD=5.61), slightly less than the mean of 20.53 (SD=5.89) obtained for a large college sample 15 years ago by Thomas and R.L.Williams (1991), but virtually identical to scores obtained in other recent studies using college samples (e.g., O’Neil & Emery, 2002). There was no gender difference in this sample (M = 19.4 for men, 19 for women), consistent with previous studies by Deffenbacher (1992) and Kopper and Epperson (1991). Gender-specific means were slightly less than those reported for the college sample tested by Spielberger (1991) (M = 20.08 for men, 20.35 for women).

Comparison of Anger Scores to Samples in Health-related Studies While the present sample scored similarly to other college samples, scores diverged considerably from those reported for the middle-aged sample participating in the prospective study of cardiovascular disease by J.E. Williams et al. (2000). Williams and her colleagues used cut-points to divide trait anger scores of the participants into 3 levels: high trait anger (scores of 22 to 40); moderate (scores of 15 to 21); and low (scores of 10 to 14). Only 7.7% of the Williams et al. sample scored at the highest level, compared to 29% of the present college sample. Thus, a much greater proportion of the college students scored at a level shown by Williams et al. to confer coronary heart disease risk. Compared to the middle-aged sample, fewer college students scored in the moderate range (49.5% vs. 55.2%) or low range (22% vs. 37.1%) on trait anger.

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Analysis of Qualitative Data A broad-brush preliminary analysis of some of the student anger stories took place during meetings of the honors class over the semester of data collection. Students were provided guidelines for thematizing the stories, and worked in small groups to do so. This phase of the analysis was focused more on student learning than on rigorous data analysis, but proved useful with regard to evaluation of the anger stories by young men and women who were in the same age cohort as the study participants and familiar with pop-culture references in the stories (e.g., names of rappers, athletes, videogames, bars). Notes of the student analysis teams were collected at the conclusion of class and saved for later review. A much more rigorous and systematic analysis of the narrative data took place the following semester, with assistance of two honors students who elected to work with the data more intensively. For the purposes of this paper, we compared the anger narratives of 3 groups of students, categorized according to the percentiles for Spielberger’s (1991) normative sample of college students: (1) subjects scoring high on Angry Temperament, i.e., scores of 10 or above, which are 91st percentile for both men and women (n=35); (2) subjects scoring high on Angry Reaction but not high on Angry Temperament, i.e., scoring 12 and above on Angry Reaction (80th percentile for females, 89th percentile for males), but not scoring at 10 or above on Angry Temperament (n=32); and (3) subjects scoring low on the entire Trait Anger Scale, i.e., less than 13, which is 6th percentile for men, 5th percentile for women (n=41). One student in the latter group did not provide an anger story, stating “Personally, I cannot recall the last time that I got angry at anyone or anything,” leaving 40 stories of the Low Anger group for analysis.

The Coding Scheme Copies of the anger stories were divided among the principal investigator and the student coders, to be coded using forms devised by the PI. As suggested by Waltz, Strickland, and Lenz (2005), existing categorical schemes developed by other anger researchers were evaluated for their applicability to the present project. Ultimately, the coding scheme of Fischer et al. (2004) was used to examine the students’ reasons for anger and the relational context of the incident (i.e., whether the provocateur was an intimate or a stranger). Additionally, coders recorded methods of expressing anger and outcomes of the anger episode on the researcher-developed coding sheet. Throughout the analysis, narratives were examined for emergent categories and themes, using standard content analysis procedures (Waltz et al., 2005). While Fischer et al.’s coding scheme was adequate for categorizing reasons for anger and relational context, the coding sheet for methods of expressing anger and outcomes required expansion to include several new categories. For example, originally 5 methods of expressing anger (derived from literature review) were listed on the coding sheet: (1) kept anger to self; (2) vented anger verbally (yelling, cursing); (3) vented anger by physical act (punching wall); (4) vented anger by hitting another person; (5) talked to the provocateur or a supportive listener about the anger. Space was provided to record “other” expression methods. Among the “other” responses mentioned by participants were withdrawing from the other person for a period of time, taking revenge, and distracting self from anger (playing music, going for a drive). Outcomes of the anger episodes were also more diverse than those listed on the original

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coding sheet. Four possibilities were originally listed: (1) worked things out successfully with the other person(s); (2) let go of the anger, even though no resolution of the issue; (3) still angry at other person; and (4) still angry at self. In addition to these options, participants mentioned alteration or termination of the relationship. Blinded to previous coding, the team members re-coded all of the stories using the expanded form. To ensure intercoder reliability, not only did each student re-code the narratives analyzed by the other student, but the PI also performed frequent random checks of the students’ work. Ambiguities and discrepancies were resolved by discussion among coders at weekly meetings. Notes from these discussions were an important component in the audit trail for the project (Rodgers & Cowles, 1993).

Brief Overview of Findings from the Content Analysis For all of the college students, relational issues were highly salient, and the number one anger provocateur was a non-romantic intimate (e.g., roommate or friend). This finding is consistent with Deffenbacher’s (1992) report that 53% of college student anger situations involved their roommates and friends. However, that study did not involve comparisons between subgroups of the sample. In the present study, important differences were evident when comparing stories of the 3 subgroups (high angry temperament, high angry reaction, and low anger) (See Table 1). Reason for Anger The number one triggering event for the high angry temperament (HT) group was a minor frustration, whereas more substantive violations (injustices, such as betrayal by a significant other) were likely to trigger the ire of the high angry reaction (HR) and low anger (LA) groups. Compared to the other two groups, a higher percentage of HT students were angered by treatment that they perceived as disrespectful. Methods of Anger Expression and Outcomes of Anger Episodes The experience of the anger incident, and the behavior enacted, varied considerably among the 3 groups of students. Both the HT and HR subjects reported that their anger arousal in the moment was intense, and the HT individuals almost always vented their anger verbally or physically (via assault or property destruction). In contrast, HR subjects were more likely to suppress their anger or withdraw from the situation. Little or no verbal or physical aggression was reported by the LA group. The predominant response of LA subjects was constructive anger verbalization, and the most frequently reported outcome was working things out successfully with the other person. LA subjects were more than twice as likely to work things out than were HT subjects and three times as likely to work things out, when compared to HR subjects. Unlike HT and HR individuals, who often remained angry at the other party, only 7.5% of LA subjects held on to their anger after the episode was over.

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Sandra P. Thomas Table 1. Comparison of Three Groups of College Students on Anger Episodes High Angry Temperament (n=33) Anger Provocateur Stranger Authority Non-romantic Intimate Romantic Intimate Other (e.g., videotape) Reason for Anger Minor Frustration Relational Issue Disrespectful Treatment/attack on status Injustice (betrayal, lied to) Other (e.g., unsafe driving) Method of Expressing Anger Vented Verbally, Negatively Suppression Expressed Constructively Took Time-out/Withdrew Vented Physically (breaking object) Vented by Assault of Person Distracted Self (music) Took Revenge on Other Outcome of Anger Episode Worked Things Out With Other Let Go, But No Resolution Still Angry at Other Still Angry at Self Relationship Altered, But Not Ended Relationship Terminated

High Angry Reaction (n=32)

Low Anger (n=40)

15% 6% 42% 18% 18%

19% 22% 31% 16% 19%

7.5% 20% 47.5% 10% 12.5%

33% 30% 24% 18% 3%

19% 28% 9% 50% 16%

15% 32.5% 15% 32.5% 5%

36% 21% 18% 3% 24% 18% 0% 12%

25% 34% 22% 12.5% 12.5% 9% 0% 0%

20% 22.5% 45% 7.5% 2.5% 0% 2.5% 0%

21% 33% 30% 3% 15% 3%

16% 22% 28% 0% 16% 16%

47.5% 25% 7.5% 0% 10% 12.5%

Note. In some instances, percentage totals exceed 100% because a behavior merited two codes (e.g., vented verbally and took revenge).

The heaviest toll on interpersonal relationships was seen in the HR group (i.e., 32% of their relationships were altered or terminated after the anger incident).

Thematic Elements of the Narratives Understanding of these findings deepens when examining thematic elements of the narratives written by the 3 groups of students (See Table 2). Patton’s (2002) approach was used when re-reading the anger stories, searching for recurring patterns or features in their descriptions of the incidents (i.e., themes). Although we used phenomenological analysis in our interview studies (e.g., Thomas et al., 1998; Thomas, 2003), the brevity of these student narratives did not permit phenomenological analysis. A few stories exceeded the one page provided in the instrument packet, but most were a page or less. Nonetheless, the stories were very enlightening. The students were quite candid, readily acknowledging thoughts and behaviors that could be judged as reprehensible, such as shoving one’s mother or driving recklessly. The anonymity afforded by the elicitation of written narratives could have

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decreased the need to give socially desirable responses about anger behaviors. In the following sections, verbatim quotations are used to illustrate each theme. The quotes were chosen to represent the voices of as many participants as possible. Participant identification numbers appear in parentheses after the excerpts from the narratives. Table 2. Thematic Elements of Narratives of Three Groups of Students

1.

2. 3. 4. 5.

High Angry Temperament (n=35) Exaggerated response to provocation: provocation often trivial. Display of physical and/or verbal aggression. Pejorative depiction of the other. Relationships adversely affected by the anger. Little remorse or lessons learned from the incident.

1.

2. 3. 4. 5.

High Angry Reaction (n=32) Exaggerated response to provocation: provocation substantive. Suppression, withdrawal, and rumination. Pejorative depiction of the other. Relationships adversely affected by the anger. Little remorse or lessons learned from the incident.

Low Trait Anger (n=40) 1. Slow to be provoked to anger.

2. Constructive anger verbalization. 3. Ability to see the other side of the issue or conflict. 4. Relationships maintained. 5. Remorse expressed/lessons learned.

Narratives of Subjects Scoring High on Angry Temperament Five themes were identified in the narratives of subjects scoring high on angry temperament: (1) exaggerated response to provocation; (2) display of physical and/or verbal aggression; (3) pejorative depiction of the other; (4) relationships adversely affected; and (5) little remorse or lessons learned from the incident. Theme 1. Exaggerated Response to Provocation, often a somewhat Trivial Provocation HT participants described their response to provocation in colorful terms: “I was boiling hot” (#85); “I was enraged, livid, furious, pissed off” (#184). Given that they were responding to a minor frustration in many cases (e.g., unable to score well on a videogame, recipe wasn’t working out, didn’t like room temperature set by roommate), the volatility of the response does not seem proportionate to the situational context. In the following account, it is unclear why the participant interpreted the other fellow’s behavior as so offensive. The anger escalates rapidly: “I was at a party and a guy complimented my shirt. He put his hand up to give me a five, and I put mine down to receive it. A few seconds passed and he began to take his hand down. I immediately slapped his hand and said ‘Fuck you!’ I was extremely angry and we had a verbal altercation full of curse words. This continued until several of his friends pulled him away. I wanted to kick his ass, but didn’t get to. I don’t take people making fun of me lightly.” (#56)

In the next vignette, the participant views a friend’s behavior as disrespectful, although an observer might come to a somewhat different conclusion: “It was a Friday night, and I had plans to spend an evening with a friend I was just getting to know. We hadn’t known each other for very long…I was in the middle of changing [clothes] to go out when she called. A friend from out of town had called her and wanted to spend time

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Sandra P. Thomas with her that evening. Without even thinking, she told her friend ‘yes’ and told me ‘I’ll talk to you later. Have a good night.’…Immediately I was infuriated that she would disrespect my time.” (# 237)

While disappointment would be a rational response to the canceled plan, and perhaps the cancellation was not handled in the most tactful manner, the participant’s resultant fury seems extreme. She reports crying, using “bitter sarcasm,” and later forcefully confronting the offender about violating the “previous plans honor code.” She accuses her friend of being thoughtless --acting “without even thinking” -- and fails to consider alternative explanations (perhaps the visitor from out of town was a valued old friend who rarely visits). In the final exemplar of this theme of exaggerated response, the participant describes an incident which rapidly escalated from yelling to pushing, although it had started “over nothing”: “I was in an argument with my father. It was over nothing important…I started yelling, then he started yelling. I tried to walk away, but that just made my dad angrier. He stopped me and I pushed him. He pushed me back. Then when I tried to walk past him, he hit me in the shoulder. I came very close to punching him in the face.” (#310)

Theme 2. Display of Physical and/or Verbal Aggression Aggressive acts described in HT narratives ranged from destroying objects (telephone, gameboy console) to road rage (running someone off the road) to engaging in verbal and physical fights (e.g., “I just lost it and raged, picked him up off the couch and threw him out of the house” [#27]). Often a combination of verbal and physical aggression occurred, as in these examples: “I cursed and blasphemed, punched a hole in the wall, threw it [a necklace] in her face” (#90); “I hung up the phone, then threw it against the wall [which] knocked a hanging picture off my wall, which landed on and broke a cologne bottle” (#300). Pride was evident in many accounts when describing aggressive acts. The following narrative is illustrative: “I asked my girlfriend to go to a party with me and she said no. I got so angry because it meant that I had to go alone. I showed up and she was talking to two other guys. They were touching her arms and hugging her and didn’t stop when I walked up. I pulled her over to the side of the house and screamed, ‘You fucking whore, why do you do this to me?” It felt good…I pushed her into the wall. She was crying a little. I think she was impressed with my newfound confidence. I smacked her and told her ‘Shut the fuck up!’ A few guys came around and broke it up. They tried to be tough with me, but she told them to stop. They did and we left together. We are happier now than ever.” (#289)

Theme 3. Pejorative Depiction of the Other Narratives of the HT group contained a strong “I’m right/they’re wrong” flavor. For example, the narrator in the above-cited story seems to believe that he is justified in his physically abusive behavior because his girlfriend was acting like a “whore.” There is no empathy evident for his girlfriend, who must have experienced humiliation when being shoved and hit at a social event. Pejorative terms were often used by other study participants to describe the anger provocateur: “She was jealous” (#85); “He wasn’t a person possessed of many social skills” (#133); “Her reasons were stupid” (#52); “She is a very fake person” (#306); “I hate that bitch” (#184).

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Theme 4. Relationships Adversely Affected by the Anger As depicted in Table 1, only 21% of the anger incidents reported by HT subjects culminated in working things out successfully. In many cases, considerable anger remains (“Up to this moment, the sight of her sickens me and incites intense fury” [#85]); “I still, to this day, have not talked in person to the girl” [#90]). One participant admitted that despite his roommate’s apology (for a minor violation of his hygiene standards) “I am still a little mad about it” (#225). Theme 5. Little Remorse or Lessons Learned from the Incident HT individuals sometimes recognized that they did not manage their anger well (e.g., “My decisions are not always good when I’m angry;” “I get very angry when I don’t get my way;” “I realized I overreacted”). However, they did not tend to express remorse regarding their behavior, nor did they speak in terms of any lessons learned. One participant broke his hand punching a wall after a passing motorist splashed him with puddled rain water, but ended his narrative by saying, “If I see that person again, I still won’t hesitate to punch him” (#177). Another participant who reported destroying a videogame in anger admitted destroying another one since the original incident (#240). Narratives of Subjects Scoring High on Angry Reaction but not Temperament Five themes were identified, exemplifying both commonalities with, and differences from, the high angry temperament subjects. Like the HT narratives, there was (1) an exaggerated response to provocation, but the provocation was quite serious in many cases (not about videogames or minor slights). Aggression was sometimes displayed in property destruction (throwing clock, trying to break door) or by using profanity, but HR subjects did not commonly talk about their angry feelings to others, or find much relief from doing so. Therefore, theme 2 was titled “suppression, withdrawal, and rumination.” The remaining themes were consistent with the HT group: (3) pejorative description of the other; (4) relationships adversely affected; and (5) little remorse or lessons learned from the incident. Theme 1. Exaggerated Response to Provocation Intense bodily arousal was described by HR participants, in vivid language comparable to that of the HT students. Participant 131’s account is richly descriptive: “The first thing I usually feel is a rush, I guess, adrenaline, that floods my skin. Sometimes, if the antagonizer is still in site and being antagonizing, well, I feel dizzy for a second, light-headed, and my jaw clenches.” Other HR participants reported typical cardiovascular symptoms: “blood rushing to my face, heart pounding madly in fury” (#163) and “my heart always races and I get really fidgety” (#254). In contrast to the minor frustrations characteristic of many HT narratives, injustice was the major trigger of the intense anger response in HR stories. The students told stories of being cheated, lied to, betrayed, and unfairly criticized. The following exemplars are illustrative: “My girlfriend told me she was breaking up with me, not only because of me, but for her engineering teacher. AND not only that, she had cheated on me with him.” (#113)

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Sandra P. Thomas “I had to do all the work for a group presentation. I did all the research, all the analyzing, all the writing. When all was said and done, I got the same grade as everyone else. I was pissed off beyond belief.” (#304) “I become quite angry on a fairly regular basis. I suffer from a disease called muscular dystrophy…I have to take the elevator because of having MD. I understand that people don’t know that I have something wrong with me, but they don’t have to yell at me. I literally get yelled at because I use up a few seconds of their time…I personally feel extremely angry because having MD is not my fault and I can’t do anything about it…I would take the stairs if I could.” (#58)

Theme 2. Suppression, Withdrawal, and Rumination Individuals in the HR group seemed to lack skill in assertive anger expression and problem-solving. Despite strong physiological arousal, they apparently took no action in many of the aforementioned situations of unjust treatment. Their anger was suppressed and/or they withdrew from the conflict. Recall the young man with muscular dystrophy. Twice in his narrative he stated that “people don’t know my situation.” Presumably, he has not spoken up to inform his classmates of his physical condition. So they continue to yell at him, and he continues to silently seethe. In the next example, the participant apparently could summon no defense when her grandfather made a hurtful comment, and she was left feeling worthless and “very small”: “One day, my family and I stopped by my grandfather’s house…We started talking about school and he asked me what I was majoring in. I told him accounting, but I wasn’t absolutely positive if that was what I wanted to do. In the most hateful way, he told me that it was absolutely pointless for me to be going to college if I didn’t know what I wanted to be. It made me feel pretty worthless and very small.” (#143) As in the HT group, a sizeable percentage of the HR group admitted that their anger at the provocateur has not abated. Their narratives depict rumination about the grievance, often for a prolonged period. Although a specific temporal referent was not included in all narratives, some HR participants emphasized that they had retained anger about the incident for 6 months or longer. For example, the student (#143) whose grandfather thought it “pointless” for her to be in college stated that she didn’t talk to him for 6 months following their interaction and holds “even more of a grudge towards him since then.” Another student (#267) reported that she did not talk to her sister for about 6 months after her sister called her a whore. For one male student, residual anger about an incident with his roommate resulted in “a very rocky relationship that persisted throughout the entire first year [of college]” (#163). Another participant said, “I feel that in some ways I will never get over this” (#254). There is little evidence in the HR narratives that comfort was sought in ventilating to supportive confidants after the interaction with the provocateur was over. The present data do not indicate whether these participants lacked supportive confidants or simply chose not to avail themselves of opportunities to talk about the incidents. Perhaps some of them shared the view of participant 131, who did not find it helpful to talk and did not want to be questioned: “When others question me about the situation, I usually have to cut them short. Talking about such incidents, especially at length and in detail, often makes me relapse into that anger state.” (#131)

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Theme 3. Pejorative Depiction of the Other As in the HT narratives, the anger provocateur is described in a pejorative way: the professor was “idiotic” (#315); the coworker was a “jerk” (#204); the roommates was “uptight, screaming for no reason” (#134); the customers were “rude, disrespectful” (#148). In the following story, the narrator perceived her mother to be “snooping” in her room, although her mother explained that she had opened a little pouch because she thought it contained jewelry. The reader cannot know if the mother really was prying, but the narrator’s aggressive response is clearly inappropriate in any case (and undoubtedly hurtful to the mother): “As I turned the corner and walked in my room, I immediately saw her standing there holding my bowl. She looked right at me and asked, ‘So this means you’re smoking pot again, doesn’t it?’ I never answered her question; instead, I grabbed the bowl from her and started irrationally asking her why she had been going through my stuff, and to get out of my room. Of course, my temper was flaring and my language was not appropriate…I was pissed because she had violated my privacy…She wouldn’t get out of my room when I told her to, then demanded her to, so I used force to get her out of my room. When I finally got her out the door, I locked it and pounded my hand against it for emphasis…I left the next day to come back to school, instead of 5 days later like I had planned on doing.” (#50) Theme 4. Relationships Adversely Affected by the Anger Within the HR group, the desirable outcome “worked things out with the other” occurred in only 16% of anger episodes, the lowest percentage of the 3 groups. Relationships were usually significantly altered or terminated. Participants reported quitting a job, changing roommates, withdrawing from significant others for long periods, and never speaking again to a person who had lied to them. Theme 5. Little Remorse or Lessons Learned from the Incident Although one student in this group acknowledged the “stupidity” of a road rage incident and two students said they turned their anger into determination to succeed in their studies or sports, the majority neither expressed remorse for anger behavior nor reported any lessons learned. To return to the story of the study participant (#50) who pushed her mother out of her bedroom, there was no remorse for possessing drug paraphernalia nor recognition that she does not have an absolute right to privacy within the home of her parents. Narratives of Subjects Scoring Low on the Entire Trait Anger Scale Five themes were identified in the narratives of subjects scoring low on trait anger: (1) slow to be provoked to anger; (2) constructive anger verbalization; (3) ability to see the other side of the issue or conflict; (4) relationships maintained; and (5) remorse expressed/lessons learned. Theme 1. Slow to be Provoked to Anger Consistent with Trait Anger Theory, students scoring low on the trait anger instrument used self-descriptors such as “not easily angered” and “very laid back.” Students in this group were the least likely of the 3 groups to become angered by minor frustrations. When they did become angry, it was because of a relational issue or injustice (e.g., accused of being on a

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porn site on uncle’s computer; best friend lied and asked someone else to lie to cover his own lie; boyfriend or girlfriend broke off relationship precipitously).

Theme 2. Constructive Anger Verbalization Although there was a fair amount of unexpressed anger within the LA group, constructive anger verbalization occurred in nearly half the narratives. As noted earlier, constructive verbalization can mean talking over an incident with a sympathetic listener or talking directly to the person who provoked it. In the first set of exemplars, anger was expressed directly to the provocateur: (Describing anger verbalization to driver whose recklessness frightened her): “B____ was being completely irresponsible, especially considering 3 of the people in his back seat were not buckled up, since we had one extra person in the car. It made me really mad that he was playing around with the lives of the friends in his car. We stopped for lunch and he asked if I was okay. I said I was not okay, I was mad because of the way he had driven. He apologized…Two days later he came up to me again and said he was really sorry. I normally do not get mad at people, but he really did scare me.” (#238) (Describing assertive action after being lied to and taken advantage of by her friend A____, which deprived her of valuable study time): “I value my time, to study any chance I get…A couple of days later [after she caught A___ in the lie], when I had some free time, I went to A’s [residence] to discuss the issue because it bothered me.” (#8) (Describing resolution of estrangement from friends for a week because of a practical joke): “Our relationship has become a lot better, and [this] brought us closer, after talking about it and telling each other how we felt. Now we are able to respect each other’s feelings and know what we should not do.” (#103) In the following excerpts from the data, anger was not expressed to the provocateur but was shared with confidants, who provided a listening ear and/or advice: “My ex-boyfriend acted completely inappropriate to me in front of a large group at a party…afterwards I talked to two friends about it” (#192). “My friends were going behind my back in a certain situation involving a guy. They knew that I was interested in him, but they were trying to set one of our other friends up with him. I did not confront them…But I did talk to my other friends about it and got advice.” (#264)

Theme 3. Ability to See the Other Side of the Issue or Conflict In contrast to the “I’m right/they’re wrong” stance often taken by high scorers on angry temperament and angry reaction, LA individuals were more likely to see the other side of the issue or conflict. For example, one student (#271) was angry at his roommate’s “rudeness” and “hatefulness,” but realized that this behavior was related to depression about the ending of a significant relationship. Therefore, he resolved to strive for greater tolerance of the roommate’s hateful behavior during this difficult period. Another student became angry about her father’s unwillingness to help with her large auto repair bill. She could take her father’s

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perspective, however. Despite her anger, she admitted, “I understand his thoughts and feelings, but that doesn’t mean I liked them…My dad just wanted to make sure I learned a lesson” (#51).

Theme 4. Relationships Maintained It was important to LA participants that relationships be preserved. As noted previously, the most frequently reported outcome of anger incidents for the LA students was “working things out successfully with the other person.” Rather than let angry feelings fester, these students took action promptly. For example, participant 71, whose anger was provoked by her best friend lying, “confronted him immediately. I let him know I was mad, but I was still controlled.” The students expressed their opinions honestly, even in trying circumstances. Participant 321’s father attempted suicide, which produced mixed emotions of anger, worry, and sadness. While she was visiting her father in the hospital after his overdose, he asked her what she thought “about everything.” She admitted to him that she thought his suicide attempt was selfish, “but I also told him how much I love him…I felt better talking about it.” Narratives frequently concluded with statements like, “our relationship was not hurt,” “everything is fine,” or “we are still friends.” Theme 5. Remorse Expressed/lessons Learned Echoing the words of participant 51 that were cited earlier (see theme 3), narratives of the LA group often included a statement about a lesson learned from the anger incident. Participants wrote about learning to compromise, discuss grievances calmly, and maintain control and dignity in handling distressing situations. An account by participant # 277 is illustrative: “One day, one of my roommates was making a lot of noise when I was trying to sleep. I had repeatedly asked her to stop, but she did not. In this situation, I was very angry…We eventually talked about it. I found out it was better to take naps at other times when she isn’t there. Thankfully, it didn’t really affect the friendship, but we did learn to talk things out.” Participant 153 was blindsided at dinner in a restaurant by her fiance’s sudden request to break their engagement. Despite her hurt and anger, she was able to respond with dignity: “I didn’t say anything mean to him, didn’t insult him, or say anything that I would regret. In the end, I feel that I am a stronger individual for the way that I handled it.” When a situation was not handled well (i.e., sharp language or profanity was used), remorse was evident. Participant 15 became angry when a customer service representative refused to replace a malfunctioning cell phone. His angry comments did not produce a satisfactory outcome, and he said, “I felt kind of bad about the way I handled the situation.” Participant 100 was angry because his parents had not called frequently since he went away to college. So he called to tell them how he felt, and displayed more anger than he had intended: “I think my words were a little too sharp…My eyes teared up as my frustration came out” Although regretting the sharpness of his words, the participant reported that he did feel better “once it was off my chest.” And before hanging up the phone, he assured his father that he loved him.

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CONCLUSION In 1983, Averill asserted that “we know surprisingly little about anger, even in a descriptive sense” (p. 1158). More than 20 years later, DiGiuseppe (2006) contends that we still know much less about anger than we do about anxiety and depression, and “as of yet, we have no clear paradigm in the treatment of dysfunctional anger” (p. xxiii). The cadre of anger researchers within psychology is small, and there are many unanswered questions. Averill (1982) pioneered examination of everyday anger, eliciting written accounts. Unfortunately, only a few psychologists have adopted this approach during the intervening years (most preferring to conduct laboratory experiments). Self-report research has been disparaged, as typified in this criticism from Berkowitz and Harmon-Jones (2004b): “Self-reports and anecdotes are…highly susceptible to distortions…the conclusions drawn from…self-report studies are generally equivocal at best” (pp. 154-155). Lazarus (1991), on the other hand, argued that “if we can’t depend to some extent on what humans tell us, we lose important information about emotions, because behavior alone is not easy to interpret” (p. 29). The present study extends Averill’s work, providing a vivid description of study participants’ thoughts, feelings, and behaviors during episodes of anger occurring in natural settings. The written accounts reveal important elements of the provocation, the response, and nuances of the situational context that are obscured in questionnaire research. Contrary to some literature during the past decade deploring the angry children of the baby boomers, there was no evidence in this study that today’s college students are angrier than those assessed in the 1920s, 1940s, or 1980s and 90s, nor were their provocations substantively different from earlier cohorts. As in the past, college students were mainly angered during interactions with significant others (roommates, friends). Congruent with Averill’s (1982) findings, anger in this college sample was a highly interpersonal emotion. Many of the triggering events were typical of those experienced by people learning to live communally in dormitories or apartments. Of great concern, however, is the subgroup of the sample scoring high on Trait Anger, who may be at risk for cardiovascular disease or other organic pathology. Recall that 29% of the sample scored at a level shown by J.E. Williams et al. (2001) to confer cardiac risk. Consistent with Trait Anger Theory, the HT and HR study participants were markedly different from students scoring low on the trait anger scale. For example, only the HT and HR groups displayed the egocentric “I’m right/they’re wrong” blaming of the provocateur that has been noted in previous research (e.g., Shaver et al., 1987). This stance was not evident in the narratives of the low anger students, who were able to take the perspective of the other and even empathize with the other. The anger of the HT and HR students was clearly maladaptive, both in its intensity and in its duration. Recall that these students often held onto their anger at the provocateur, in contrast to the small percentage (7.5%) of Low Anger participants who did so. Neither HT nor HR study participants were likely to report any lessons learned from conflictual interactions, heightening the probability that they will repeat behaviors that alienate significant others and contribute to occupational problems, as shown in previous research. The study has considerable pragmatic validity (Kvale, 1995), in that implications for appropriate interventions can be readily drawn from the narrative data. The words of the students themselves convey so much more to clinicians than mere test scores do. For example, the tendency of high HT and HR participants to label disputants “bitches” and

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“jerks” obviously calls for an intervention encouraging a more nuanced and benign view of their offenders. As is the case in all research, some limitations must be acknowledged. Narratives of the students tended to be relatively brief, rather concrete, accounts of their anger incidents, containing limited reflection on their own behavior. They told what happened but sometimes ended their stories abruptly, leaving the data coders with questions. Most narratives did not provide the richness of contextual detail that would be available in narratives obtained via interview methodology. For example, an interviewer could have explored the duration and quality of an intimate relationship prior to the angry altercation that ended it. The pre-existing relationship was important in understanding face-to-face conflict in a recent phenomenological study by Graves (2006). Despite its limitations, this study contributes to the psychology of anger. It is perhaps the first study to expand our understanding of the components of trait anger. Important differences were delineated between high scorers on angry temperament and high scorers on angry reaction, both in the provocations that trigger their anger and in their coping responses, suggesting that anger management interventions be tailored accordingly. Different interventions are required for individuals with a volatile outward anger expression style and those with a predominantly suppressive/ruminative style. As shown in the review of health psychology research literature, both volatile outward anger expression and suppression/rumination are deleterious to health. In the following sections of the chapter, I will make suggestions regarding acquisition of specific anger management skills for students with these unhealthy anger expression styles, drawing from my own clinical experience and from the literature.

Interventions for Students with Volatile Anger First, we address the volatile anger of high scorers on the Angry Temperament component of Trait Anger. Despite their innate propensity to be “hot reactors,” anger management (AM), a psychoeducational intervention, could reduce their maladaptive anger behavior, and perhaps, ultimately, their risk of cardiovascular disease. While anger reduction research is said to be in its infancy (Deffenbacher, 2006), and the efficacy of interventions for the primary prevention of CVD has not been established (J.E. Williams et al, 2001), several researchers have reported successful interventions with individuals who already have CVD (Davidson, 2000; Lavie & Milani, 1999). To cite just one example, individuals with diagnosed myocardial infarction or unstable angina pectoris participated in an 8-week cognitive-behavioral treatment program designed to modify their hostility. As hostile, cynical thoughts decreased, constructive anger verbalization increased, which in turn was associated with decreases in blood pressure (Davidson, MacGregor, Stuhr, & Gidron, 1999). Positive outcomes of anger management programs also have been reported for groups as diverse as delinquent adolescents (Feindler, 1995), New York City traffic agents (Brondolo, Hough, & Rabinowitz, 2000), combat veterans (Gerlock, 1994), and incarcerated women (Smith, Smith, and Beckner, 1994) and men (Ireland, 2004). These findings are encouraging, especially considering that AM was mandated, not voluntary, in some of these studies, such as those conducted with incarcerated women and men. Group work is customary in anger management programs because participants need to

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practice new behaviors in an interpersonal context that offers feedback and support. Most AM programs are highly structured, with a balance of didactic and experiential components. The leader of an AM group functions as a teacher and coach, not a therapist. Therefore, screening should take place before enrolling participants, so that referrals can be made for individual psychotherapy when anger is related to extensive abuse or trauma. Other exclusion criteria include paranoia, organic disorders, and severe personality disorders (Thomas, 2001). Candidates for AM should have some motivation to enlarge their behavioral repertoire. Motivation to become involved in anger management training is a significant issue, because (as shown in our data), many individuals with volatile anger do not see themselves as having a problem and do not experience much remorse after their explosive outbursts. Notes Novaco (1996), anger management might be viewed negatively as an attempt to stifle their personality or their sense of mastery and control. Given the heavy toll on relationships reported by the study participants, they may eventually become motivated to engage in AM interventions to preserve significant adult relationships (e.g., marriage, collegial associations in the workplace). Among the skills to be acquired by high angry temperament individuals, both for relationship preservation, and for personal health, are: •

• •

•

•

•

•

•

Calming. Diminishing the strong physiological arousal is the most important initial skill. Becoming less reactive to provocations can be achieved by breathing techniques, relaxation training, meditation, or imagery. Progressive relaxation (Jacobson, 1974) is effective for many people. Learning to use words, not fists. Individuals who express anger through property destruction or fighting must learn to put words to their feelings instead. Lowering the volume and rate of anger verbalization.. Speaking more softly and slowly when angry decreases not only the angry feelings but also the CV arousal (Siegman, Anderson, & Berger, 1990) Linguistic shading (i.e., toning down inflammatory language). For example, one might shade anger by saying “there is tension between us” (McNamee & Gergen, 1999) Thinking differently about power. Having been rewarded, at least at times, for verbal or physical aggression, high HT individuals must learn that controlling their anger means they will actually become more powerful, not less powerful (Novaco, 1996) Differentiating between demands and personal preferences. High HT individuals often demand attention to their needs from other people. They have a right to state their preferences, but others have no obligation to comply. Skills in negotiation and compromise are mandatory for successful communal living and working. Making a greater effort to understand the other person’s point of view or motives. Respectful listening can be quite enlightening and may foster development of empathy. Developing empathy for the intended target of an anger outburst is an inhibitor of that outburst (Knafo & Moscovitz, 2006). Acquiring skill in problem-solving. High anger individuals should avail themselves of problem-solving training. Such training shows how to take discrete steps to address anger-producing situations (e.g., identifying resources and solutions), and the training has proven to be effective with college students (Moon & Eisler, 1983)

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Interventions for Students with the Suppressive/ruminative Anger Coping Style Most AM programs have targeted the overt explosive anger typical of the coronary-prone individual. Less frequently addressed is the suppressive/ruminative anger coping style that is associated more so with the development of diseases such as hypertension and cancer, rather than cardiovascular disease. This suppressive style was observed in a substantial proportion of high scorers on Angry Reaction in the present college sample. These students engaged in avoidant coping when faced with situations of interpersonal conflict; they stopped speaking to the other party or nursed a grudged for a prolonged period (sometimes 6 months, a year, or longer). In addition to the negative consequences for physical health of this long-festering anger, suppressing anger is known to produce sadness and hopelessness (Greenberg & Safran, 1987) as well as intensification of the anger itself (Mao, Bardwell, Major, & Dimsdale, 2003). Rumination about interpersonal transgressions is receiving considerable attention in current health psychology literature because there is some evidence that it is associated with higher blood pressure and adversely affects general health (Hogan & Linden, 2004; Rusting & Nolen-Hoeksema, 1998; Thomsen et al., 2004). Persons who ruminate mentally replay the anger scenario over and over, thinking about what occurred and what they wished they had said or done during the altercation. The outcome, of course, is always the same because no action has been taken. Problems with significant others cannot be solved when they are never verbalized. Although some offenses may be viewed as unforgivable (e.g., infidelity of an intimate partner), many relationships of the students in this sample may have been terminated unnecessarily. Research shows that anger provocateurs often do not even know that they have committed an egregious offense (Baumeister, Stillwell, & Wotman, 1990). Therefore, they have no opportunity to recognize their own faults, to apologize or to make amends. In Averill’s classic 1982 study, 76% of those who were on the receiving end of someone else’s anger reported that they recognized their own faults as a result of the anger incident. Further, they perceived the relationship with the angry person to be strengthened, not weakened. Students who display a suppressive/ruminative anger coping style are not well suited for traditional anger management programs designed to down-regulate explosive anger. Instead, they need an intervention that teaches skills such as assertiveness. They need to effectively utilize the energy that anger provides to take action instead of withdrawing. Skills that anger suppressors should acquire include: •

•

•

Taking constructive action to address injustices and grievances wherever possible rather than passively stewing about them or holding grudges. Barriers to constructive action must be identified, such as high anxiety, low self-confidence, or perhaps early inculcation of notions that anger expression is sinful or selfish Learning to verbalize anger in a tactful, assertive manner at the time it is provoked (habitual suppressors may need to role-play and practice assertive anger statements in a supportive group setting) Realizing that expressing one’s anger to significant others will not have catastrophic consequences. Both men and women sometimes fear hurting the other person or relationship termination if they express angry feelings. But targets of anger often gained rather than lost respect for the angry person in Averill’s (1982) study.

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Interventions Applicable to All Students Some strategies have general applicability, regardless of one’s customary anger “titer” and preferred expression style. Most everyone could benefit from careful scrutiny of residual issues and patterns from the family of origin that are hampering effectiveness in anger regulation. Many conflictual interactions could be avoided by recognizing times of one’s own vulnerability to excessive angry emotionality, such as when one is highly stressed, hungry, tired, or sleepless. Discussions of substantive interpersonal issues should be postponed until a more opportune time. Self-assessment may also reveal a need to simply avoid or limit interactions with certain individuals who have irritating characteristics or values discrepant from one’s own. In situations when contact with these individuals cannot be avoided, and anger is rising, distraction is a possible strategy. Research shows that distraction after anger provocation can accelerate physiological recovery (Schwartz, Gerin, Christenfeld, Glynn, Davidson, & Pickering, 2000). Distraction can be accomplished by engaging in activities that are absorbing and entertaining (e.g., Zillmann, 1988) or by finding humorous elements of anger-provoking situations, a tactic which is known to decrease angry emotion (Baron, 1976). Another strategy that may be useful in a variety of situations is undoing negative emotion by deliberately generating positive emotion. In experiments by Fredrickson and colleagues, positive emotions (such as joy) down-regulated the undesirable cardiovascular aftereffects of negative emotions (Fredrickson, Mancuso, Branigan, & Tugade, 2000). Subsequently, Fredrickson suggested interventions to cultivate positive emotions in daily life to optimize health and well-being. Along these lines, a treatment (Coping Effectiveness Training) delivered to persons living with HIV/AIDS and cancer involved tallying positive events at the end of the day, describing these positive events to others, and identifying how the events were meaningful with regard to their values and goals. Outcomes included decreased stress, greater coping efficacy, positive states of mind, and personal growth (Chesney, Darbes, Hoerster, Taylor, Chambers, & Anderson, 2005). At this writing, it is not known if any existing anger management programs have included a comparable emphasis on positive events. It is logical to assume, however, that deliberately keeping track of the positive events of a day could reduce rumination about the negative interactions that occurred. This approach could be particularly useful to individuals with cynical hostility, who may fail overlook good things in their perpetual focusing on snubs and slights. There was scant mention of forgiving provocateurs in this set of college student narratives. The topic of forgiveness is receiving much current attention within health psychology, with nearly 200 studies on the topic being published in the past decade (Harris et al., 2006). Research shows that forgiveness reduces trait anger (Harris et al, 2006) and has salutary effects on health (Lawler, Younger, Piferi, Jobe, Edmondson, & Jones, 2005). Students who lack tools in changing a grievance narrative could benefit from a psychoeducational program like the one conducted at Stanford. Participants in the 6-week Stanford Forgiveness Project reported interpersonal transgressions similar to those reported by college students in the present study (being cheated, lied to, betrayed). Compared to a no-treatment control group, the treatment group reduced their negative thoughts and feelings about the grievance 2 to 3 times more effectively.

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Of specific relevance to the present study, trait anger (measured with the Spielberger tool) was significantly reduced. See Wade, Worthington, and Meyer (2005) for a recent metaanalysis of group interventions to promote forgiveness.

Interventions for Individuals who Merit the Diagnosis of an Anger Disorder Some individuals may need more intensive intervention than a psychoeducational program, especially those who experienced adverse childhood circumstances, such as harsh discipline or parental divorce, and those who cannot control their aggressive impulses. At present, there is only one anger-related disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (American Psychiatric Association, 2000): Intermittent Explosive Disorder (IED). Once thought to be rare, Intermittent Explosive Disorder is reported to affect 16 million Americans, only 28% of whom ever receive any treatment for their anger (Kessler, 2006). To establish a diagnosis of IED, the clinician should be alert for descriptions of aggressive episodes as “spells” or “attacks,” during which there is inability to resist aggressive impulses that result in serious assault or property damage. The critical criterion is the degree of aggressiveness during the “attacks,” which is “grossly out of proportion to any precipitating psychosocial stressors” (American Psychiatric Association, 2000, p. 667). The clinician must also ascertain that the aggressive episodes are not accounted for by another mental disorder (such as antisocial personality disorder, borderline personality disorder, or psychotic states) or caused by drug abuse, head trauma, or other organic pathology. Scholars (Eckhardt & Deffenbacher, 1995) have proposed inclusion of additional anger disorders in the DSM: (1) adjustment disorder with angry mood; (2) situational anger disorder without aggression; (3) situational anger disorder with aggression; (4) general anger disorder; and (5) general anger disorder with aggression. These additional diagnoses would be useful, because anger is the primary affective disruption for some clients who undertake therapy; they are not concurrently depressed, nor do they meet the criteria for a personality disorder. For example, a clinician could apply a diagnosis of “situational anger disorder without aggression” when anger is not a chronic problem, but generated by an acutely painful situation (e.g., impending divorce, job loss). Feindler’s (2006) volume is an excellent compendium of therapies for individuals whose anger merits the diagnosis of an anger disorder. Among the therapies included in this volume are psychoanalytic, cognitive-behavioral, emotion-focused, Adlerian, Buddhist, and dialectical behavior therapy. Length of recommended treatment for an anger disorder is variable, sometimes as long as two to four years (e.g., Knafo & Markowitz, 2006)..

Evidence for Efficacy of Psychological Interventions for Maladaptive Anger Do psychological interventions for maladaptive anger work? Longitudinal studies such as the Precursors Study (Chang et al., 2002) and the North Carolina Alumni Study (Siegler et al., 2003), showing that anger/hostility in young adulthood persists over time, beg the question, “Can trait anger really be modified?” Yes, there is evidence that trait anger—although a relatively stable aspect of the personality—can be modified. For example, Deffenbacher,

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Story, Stark, Hogg, and Brandon (1987) recruited college students who scored in the upper 25% of the Trait Anger Scale (Spielberger et al., 1983) for a comparison of the efficacy of two treatments (cognitive-relaxation therapy and social skills training) versus a no-treatment control condition. Both treatments, delivered in small groups for 8 weeks, reduced Trait Anger scores. The above-cited forgiveness intervention delivered by Harris et al. (2006) produced a decrease in trait anger from 72nd percentile to 55th percentile at 4-month followup. Given research findings such as these, perhaps we should begin to view trait anger as a bias or predisposition to behave in a certain way, but susceptible to modification through learning. A characteristic way of responding is not an immutable way of responding. Four meta-analytic reviews have shown that anger treatments are superior to no-treatment control conditions, and that treatment recipients show moderate to strong improvement (Tafrate & Kassinove, 2006). To date, cognitive and cognitive-behavioral therapies have the most extensive empirical evidence of efficacy (Deffenbacher, 2006), but interventions based on other theoretical models have not been sufficiently investigated. In a recent critique of the state of the science with regard to psychological interventions for anger, Deffenbacher (2006) pointed out that there is little research comparing individual and group interventions. He also urged assessment of the need for relapse prevention strategies (i.e., do clients need booster sessions to maintain their healthier anger behaviors?) Based on the present study findings, I recommend evaluation of the effectiveness of delivering anger management interventions differently to the volatile high scorers on Angry Temperament and those with the suppressive/ruminative style more characteristic of high scorers on Angry Reaction.

A Final Thought about Emotional Development in Young Adulthood Might not some of college students’ youthful volatility naturally decline over time, even without treatment? It does appear that some of the intense anger of youth naturally begins to decline as individuals move from late adolescence into adulthood. Spielberger (1999) has reported that the frequency with which anger is experienced and expressed decreases, and the control of anger increases, as people grow older. Caspi, Roberts, and Shiner (2005) assert that most people become more agreeable and emotionally stable over the life course. Further, they assert that the majority of personality change occurs in young adulthood. A recent study by Galambos, Barker, and Krahn (2006) offers some support for these assertions. Galambos et al. followed 920 students from the senior year of high school until age 25, reassessing selfesteem, depression, and anger. Their anger measure focused on overtly expressed anger (losing temper, yelling, and fighting). On average, anger and depression decreased across the 5 waves of data collection, while self-esteem increased. (Individual trajectories varied, depending on variables such as unemployment, family conflict, and marital status). In sum, at 25, the young adults exhibited greater psychological well-being. Psychology now recognizes that emotional development continues throughout life (Malatesta & Izard, 1984). People learn about themselves (and about themselves in relation to others) in each new situational context. Changes in partners, jobs, and geographic residence, revisions in values or spiritual orientations, and life crises involving illness and loss, all help to bring about personal growth and transformation. Thus, there is reason for optimism that the dysfunctional anger observed in a subsample of these American college students will diminish, so that their lives may be happier and healthier.

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REFERENCES Allport, G. (1937). Personality: A psychological interpretation. New York: Holt. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association. Anastasi, A., Cohen, N., & Spatz, D. (1948). A study of fear and anger in college students through the controlled diary method. The Journal of Genetic Psychology, 73, 243-249. Anderson, R.N., & Smith, B.L. (2005). Deaths: Leading causes for 2002. National vital statistics reports (Vol. 53, no. 17). Hyattsville, MD: National Center for Health Statistics. Arnow, B., Kenardy, J., & Agras, W.C. (1995). The Emotional Eating Scale: The development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders, 18, 79-90. Averill, J.R. (1982). Anger and aggression: An essay on emotion. New York: SpringerVerlag/ Averill, J.R. (1983). Studies on anger and aggression: Implications for theories of emotion. American Psychologist, 38, 1145-1160. Averill, J.R. (1984). The acquisition of emotions during adulthood. In C. Malatesta and C. Izard (Eds.), Emotion in adult development (pp. 23-43). Beverly Hills: Sage. Baron, R.A. (1976). The reduction of human aggression: A field study of the influence of incompatible reactions. Journal of Applied Social Psychology, 6, 260-274. Baumeister,R.F., Stillwell, A., & Wotman, S.R. (1990). Victim and perpetrator accounts of interpersonal conflict: Autobiographical narratives about anger. Journal of Personality and Social Psychology, 59, 994-1005. Berkowitz, L. (1990). On the formation and regulation of anger and aggression: A cognitiveneoassociationistic analysis. American Psychologist, 45, 494-503. Berkowitz, L., & Harmon-Jones, E. (2004a). Toward an understanding of the determinants of anger. Emotion, 4, 107-130. Berkowitz, L., & Harmon-Jones, E. (2004b). More thoughts about anger determinants. Emotion, 4, 151-155. Bernardez-Bonesatti, T. (1978). Women and anger: Conflicts with aggression in contemporary women. Journal of the American Medical Women’s Association, 33, 215219. Brody, L.R., & Hall, J.A. (1993). Gender and emotion. In M. Lewis & J.M. Haviland (Eds.), Handbook of emotions (pp. 447-460). New York: Guilford. Brondolo, E., Hough, P., & Rabinowitz, D. (2000, April). Conflict resolution for traffic agents. Paper presented at the Society of Behavioral Medicine, Nashville, TN. Brondolo, E., Rieppi, R., Erickson, S., Sloan, R., & Bagiella, E. (2002, April). Hostility and ambulatory diary measures of mood and interpersonal interactions. Poster presented at the meeting of the Society of Behavioral Medicine, Washington, DC. Bunde, J., & Suls, J. (2006). A quantitative analysis of the relationship between the CookMedley Hostility Scale and traditional coronary artery disease risk factors. Health Psychology, 25, 493-500. Bushman, B.J., & Anderson, C.A. (2001). Media violence and the American public. American Psychologist, 56, 477-479.

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Thomas, S.P., & Pollio, H.R. (2002). Listening to Patients. New York: Springer. Thomas, S.P., Smucker, C., & Droppleman, P. (1998). “It hurts most around the heart:” A phenomenological exploration of women’s anger. Journal of Advanced Nursing, 28, 311322. Thomas, S.P., & R.L. Williams (1991). Perceived stress, trait anger, modes of anger expression, and health status of college men and women. Nursing Research, 40, 303-307. Thomsen, D.K., Mehlsen, M.Y., Olesen, F., Hokland, M,. Viidik, A., Avlund, K., & Zachariae, R. (2004). Is there an association between rumination and self- reported health? Journal of Behavioral Medicine, 27, 215-231. Tice, D.M., & Baumeister, R.F. (1993). Controlling anger: Self-induced emotion change. In D.M. Wegnder & J.W. Pennebaker (Eds.), Handbook of mental control (pp. 393-409). Englewood Cliffs, NJ: Prentice Hall. Tomkins, S.S. (1963). Affect, imagery, and consciousness. New York: Springer. Tomkins, S.S. (1980). Affect as amplification: Some modifications in theory. In R. Plutchik & H. Kellerman (Eds.), Emotion: Theory, research, and experience Vol. 1, Theories of emotion (pp. 141-164). New York: Academic Press. Tomkins, S.S. (1991). Affect, imagery, and consciousness, Vol.3 The negative affects, Anger and fear. New York: Springer. Van der Ploeg, H.M. (1988). The factor structure of the State-Trait Anger Scale. Psychological Reports, 63, 978. Wade, N.G., Worthington, E.L., Jr., & Meyer, J.E. (2005). But do they work? A metaanalysis of group interventions to promote forgiveness. In E.L. Worthington (Ed.), Handbook of forgiveness (pp. 423-440). New York: Routledge. Waltz, C., Strickland, O., & Lenz, E. (2003). Measurement in nursing and health research. New York: Springer. Williams, J.E., Nieto, F.J., Sanford, C.P., & Tyroler, H.A. (2001). Effects of an Angry temperament on coronary heart disease risk: The Atherosclerosis Risk in Communities Study. American Journal of Epidemiology, 154, 230-235. Williams, J.E., Paton, C.C., Siegler, I.C., Eigenbrodt, M.L., Nieto, F.J., & Tyroler, H.A. (2000). Anger proneness predicts coronary heart disease risk: Prospective analysis from the Atherosclerosis Risk in Communities (ARIC) Study. Circulation, 101, 2034-2039. Williams, R.B., Jr. (1994). Basic biological mechanisms. In A.W. Siegman & T.W. Smith (Eds.), Anger, hostility, and the heart (pp. 117-125). Hillsdale, NJ: Erlbaum. Wilson, R.S., Bienias, J.L., Mendes de Leon, C.F., Evans, D.A., & Bennett, D.A. (2003). Negative affect and mortality in older persons. American Journal of Epidemiology, 158, 827-835. Woodall, K.L., & Matthews, K.A. (1989). Familial environment associated with Type A Behaviors and psychophysiological responses to stress in children. Health Psychology, 8, 403-426. Zawadzki, B., Strelau, J., Oniszcenko, W., Riemann, R., & Angleitner, A. (2001). Genetic and environmental influences on temperament. European Psychologist, 6, 272-286. Zillmann, D. (1988). Mood management: Using entertainment to full advantage. In L. Donohew, H.E. Sypher, & E.T. Higgins (Eds.), Communication, Social cognition, and affect (pp. 147-171). Hillsdale, NJ: Erlbaum.

In: Mental Health of College Students Ed: Katherine N. Morrow

ISBN: 978-60456-394-8 ©2009 Nova Science Publishers, Inc.

Chapter 2

SOCIAL ANXIETY IN THE COLLEGE STUDENT POPULATION: THE ROLE OF ANXIETY SENSITIVITY Angela Sailer and Holly Hazlett-Stevens* University of Nevada, Reno Nevada, USA

ABSTRACT Most college students experience some degree of social anxiety on occasion. However, many suffer chronic anxiety across social situations coupled with a strong fear of negative evaluation. In addition to impaired occupational and social functioning, severe social anxiety or social phobia can carry profound consequences for college students. Social anxiety is a prominent motivation for college student drinking (Burke and Stephens, 1999). In addition to social isolation, social anxiety is associated with depressogenic cognitions, both of which leave socially anxious students at an increased risk for depression (Johnson et al., 1992). Anxiety sensitivity – fear of anxiety-related sensations due to perceived consequences of physical, mental, or social harm – might play an important role in the development of social anxiety (Hazen et al., 1995). Unlike panic disorder, in which individuals typically fear anxiety symptoms out of fear of physical harm or loss of mental control, socially anxious individuals fear perceived social consequences of others noticing their anxiety. Socially anxious college students also judge others who appear anxious more negatively than do college students without social anxiety (Purdon et al., 2001). Although panic disorder treatments target anxiety sensitivity directly with interoceptive exposure strategies, this approach is just beginning to receive attention for the treatment of social anxiety. After a brief review of the literature describing the nature of social anxiety among college students, this chapter will examine the specific role of anxiety sensitivity in its development and maintenance. Finally, results from a preliminary investigation comparing the effects of interoceptive exposure delivered in a social context to social context exposure without the interoceptive component will be presented and discussed. *

Correspondence concerning this article should be addressed to Holly Hazlett-Stevens, University of Nevada, Department of Psychology/298 Reno, NV 89557, or the author can be reached via email at: [email protected]

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INTRODUCTION Many college students find interpersonal relationships stressful (Santiago-Rivera, Gard, and Bernstein, 1999) and anywhere from twenty to fifty percent of college students report shyness (Durand and Barlow, 2006). A smaller percentage of students suffer from a more serious clinical condition known as social phobia. Lifetime prevalence estimates for this anxiety disorder are as high as 13.3% in the general population (Kessler et al., 1994). Diagnostic criteria for social phobia, generalized type (also known as social anxiety disorder) include a “marked and persistent fear” of social situations in which the individual fears acting in a way that will be humiliating or embarrassing (DSM-IV-TR; American Psychiatric Association, 2000). Exposure to feared social situations almost always provokes an anxiety response. These situations are either endured with intense discomfort or avoided altogether, resulting in significant functional impairment and/or distress. Social anxiety is maintained by unreasonably high standards for social performance coupled with views that others perceive oneself as inadequate and that such perceptions are valid (Clark and Wells, 1995; Rapee and Heimberg, 1997). Individuals with social phobia also tend to rely heavily upon internal cues as an indication of whether or not a social situation is going well (Clark and Wells, 1995). Thus, individuals assume that if they feel anxious in a social interaction, this is indicative of poor performance. When compared to control samples, individuals with social anxiety disorder experience higher negative affect and judge their quality of life lower (Davidson, Hughes, George, and Blazer, 1994; Safren, Heimberg, Brown, and Holle, 1997). Ineffective coping strategies such as drinking and social isolation may be especially problematic in the college setting. We begin this chapter with a literature review examining the nature and impact of social anxiety among college students. We then turn to an important construct in the anxiety disorders literature, anxiety sensitivity, which may play an important role in the development and maintenance of social phobia. An original research investigation comparing two different exposure approaches for socially anxious college students will be described, and suggestions for treatment and future research will be discussed.

LITERATURE REVIEW Social Anxiety among College Students Purdon, Antony, Monteiro, and Swinson (1999) investigated the nature of social anxiety in the college student population. In addition to the frequency of social anxiety symptoms experienced, they examined how the perception of anxiety in others influences immediate impressions of personal characteristics such as attractiveness and intelligence. A total of 81 undergraduate college students completed self-report measures of social anxiety and social desirability and rated how much their impressions of others are influenced when the other person appears anxious. Of the 81 college students surveyed, 15 reported elevated levels of social anxiety on clinical social phobia scales. Thirteen percent of the student participants experienced all 24 social anxiety symptoms listed on the Social Anxiety Symptoms Scale at least “rarely.” In addition, a substantial majority of students experienced many of these

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anxiety symptoms in social situations at least once. Stomach “butterflies,” general tension, desire to avoid the situation, trouble expressing oneself, and blushing were the most frequently reported social anxiety symptoms. When asked about specific personal characteristics of those appearing anxious, most students indicated that if they noticed someone was anxious, their perception of the other’s attractiveness, intelligence, compassion, ambition, reliability, and mental health would not be influenced. Over half the student participants did, however, indicate that their perception of an individual’s leadership abilities and strength of character would be negatively influenced if the person in question was visibly anxious. Interestingly, the students reporting elevated social anxiety themselves were more likely to perceive others who show signs of anxiety as having less strength of character and as less attractive. Students with high levels of social anxiety also indicated that other individuals appearing anxious would be more compassionate than individuals who did not appear anxious. Overall, results from this investigation suggested that most college students experience social anxiety symptoms now and then and that negative attitudes towards those with social anxiety are prevalent, even among socially anxious individuals (Purdon et al., 1999). These authors also noted that individuals who are highly socially anxious may underestimate how often others become anxious as well as how visible the signs of anxiety are in others. Another self-report study of social anxiety in college students was conducted by LesureLester (2001). Questionnaire measures of social anxiety, dating competence, and social assertion were collected from 217 college students from different ethnic groups (African American, Asian American, European American, Mexican American, and multiracial). Relationships between dating competence, social assertion, and social anxiety as well as ethnic differences in these constructs were examined. Measures included the Dating and Assertion Questionnaire (DAQ; Levenson and Gottman, 1978), the Social Anxiety Thoughts Questionnaire (SAT; Hartman, 1984), and the Social Avoidance and Distress Scale (SAD; Watson and Friend, 1969). College students reporting greater competence at dating also reported a tendency to be more assertive in social situations and less socially anxious. No differences in reported dating competence and dating assertion were found among the various ethnic groups. Although these results suggested that low levels of social anxiety were associated with improved social assertiveness and competence, the relationship between social anxiety and actual social performance was not addressed with behavioral measures. Nevertheless, these results are consistent with previous research finding a negative relationship between self-reported social anxiety and self-reported assertiveness among college students (Chambless, Hunter, and Jackson, 1982). It is important to note that Chambless et al. also found that this observed relationship was weaker in their college student sample than their clinical social phobic sample. Kashdan and Roberts (2004) investigated the impact of self-focused attention on affective, cognitive, and motivational disturbances during a reciprocal self-disclosure task. College students reporting either high or low levels of social anxiety were included to determine if high levels of self-focused attention and social threat would have more detrimental effects for students with high levels of social anxiety than for students reporting low levels of social anxiety. Ninety-one college students completed social anxiety measures prior to their participation in a reciprocal self-disclosure social interaction task. Participants were required to answer personal questions with a video camera pointed at them as well as to ask such questions while the camera pointed at a confederate. Results indicated that students

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reporting high levels of social anxiety experienced more negative and less positive affect than students with low social anxiety during both phases of the task. These group differences were greater when the camera was pointed at the participant. These findings suggested that the level of social threat as well as the degree of self-focused attention may contribute to the cognitive and affective difficulties reported by so many socially anxious individuals (Kashdan and Roberts, 2004). The nature of “irrational” anxiety-provoking thoughts about social situations was examined with a small sample of socially anxious (n = 8) and nonanxious control (n = 15) undergraduate college students (Davison and Zighelboim, 1987). Socially anxious students articulated more irrational thoughts during a simulated social situation task than during a neutral task, and these students articulated more irrational thoughts than control participants during the experiment. Social anxiety among college students may also be associated with more general cognitive distortions. Johnson, Johnson, and Petzel (1992) collected self-report measures of social anxiety as well as the Cognitive Distortion Questionnaire (CDQ; Krantz and Hammen, 1979) from 114 undergraduate psychology students. Results indicated that students reporting high levels of social anxiety endorsed more distressed-distorted responses than less socially anxious students even after depression and trait anxiety measures were used as covariates. Thus, cognitive disturbances for socially anxious college students may not be limited to the domain of social performance and interpersonal relationships. Depressed thinking about other areas of one’s life, such as achievement, also appears to be elevated for these students. Not surprisingly, Johnson et al. concluded that social anxiety among young college students may be an important risk factor for the later development of clinical depression. Results from these studies suggest that while most college students experience some symptoms of social anxiety from time to time, socially anxious college students exhibit negative beliefs about social situations and their social performance to a greater degree than their less socially anxious peers. Although it is unclear to what degree these beliefs reflect actual social performance deficits, socially anxious students may also hold more general negative beliefs about themselves and others. These students may be vulnerable to depression, not only because of the social isolation resulting from avoidance of social situations but also due to elevated general cognitive distortions associated with the development of depression. One additional consequence of social anxiety may be particularly problematic for the college student population. In their review of the literature on social anxiety and drinking among college students, Burke and Stephens (1999) found that social anxiety is indeed a prominent motivation for college student heavy drinking. This relationship appears to be moderated by cognitive variables such as alcohol expectancies and social situation selfefficacy. As a result, these authors outlined a social cognitive model of college student drinking in which expectations about the effects of alcohol and beliefs in one’s ability to avoid heavy drinking in the face of anxiety-provoking social situations are central. This model also suggests that social anxiety treatments may be crucial to the prevention and reduction of excessive drinking on college campuses. In this next section, we discuss an important construct in anxiety disorders research known as anxiety sensitivity. A widely used self-report measure of this construct, the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, and McNally, 1986), will be described. Anxiety sensitivity has received the most attention in panic disorder research. However, anxiety sensitivity may play a pivotal role in other anxiety disorders as well, including social

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anxiety disorder. We therefore review empirical investigations of anxiety sensitivity and social anxiety among college students before presenting our own empirical investigation.

Anxiety Sensitivity Anxiety sensitivity – fear of anxiety-related sensations due to perceived consequences of physical, mental, or social harm – is considered an imperative factor in the maintenance and development of anxiety disorders (Reiss and McNally, 1985). This construct is much more specific than the previously proposed anxiety-related construct of trait anxiety. There is much variability in how prone people are to experience anxiety. Some individuals experience anxiety when minimally provoked, and others require much more stressful circumstances. Individual differences in how prone one is to experience anxiety is considered trait anxiety (Taylor, 1999). The tendency to see the world as dangerous or threatening or the tendency to become anxious across situations sums up the broad definition of trait anxiety (Beck and Emery, 1985). A more sophisticated conceptualization was offered in a hierarchical model of trait anxiety (Lilienfeld, Turner, and Jacob, 1993). In this model, anxiety consists of one higher-order factor, the general concept of trait anxiety, and three lower-order factors: anxiety sensitivity, fear of negative evaluation, and fear of illness or injury sensitivity. This model later received empirical support (Taylor, 1995). Anxiety sensitivity is conceptually different from trait anxiety in that anxiety sensitivity represents the tendency to fear or respond anxiously to arousal symptoms whereas trait anxiety refers to the tendency to have an anxious response to any stressor or stressors in general (Holloway and McNally, 1987). In sum, the development and severity of a variety of anxiety conditions is determined by three fundamental fears: negative evaluation, fear of injury or death, and anxiety sensitivity (Reiss and McNally, 1985; Reiss, 1991). According to the sensitivity theory of motivation, anxiety sensitivity is a genetically based aversion to anxiety that is combined with beliefs about the negative consequences of anxiety (Reiss and Havercamp, 1996). Similar to how individuals vary in their proneness to experience anxiety, there is also variability in their fear of experiencing these symptoms. The construct of anxiety sensitivity represents the individual differences associated with the fear of anxiety (Reiss and McNally, 1985). Anxiety sensitivity is considered a predisposition that is a stable and trait-like characteristic (Taylor, 1999). Anxiety sensitivity refers to a fear of anxiety-related symptoms resulting from distressing thoughts or beliefs about the possible negative consequences of experiencing anxious sensations (Scott, Heimberg, and MacAndrew, 2000). For example, an individual with high anxiety sensitivity may view heart palpitations as an indication that he or she is having a heart attack, while an individual with low anxiety sensitivity would consider such an experience to be just uncomfortable or unpleasant (Taylor, 1999). In addition to fearing anxiety-related sensations because of feared imminent physical or mental complications, other individuals may fear these sensations out of social evaluative concerns.

Anxiety Sensitivity Index The Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, and McNally, 1986; Peterson and Reiss, 1992) was developed to measure and test the theory of anxiety sensitivity.

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The ASI consists of 16-items asking about the degree to which an individual finds anxiety sensations fearful or catastrophic in outcome (Peterson and Reiss, 1992). Individuals respond to each question on a five-point Likert scale ranging from 0 (“very little”) to 4 (“very much”). A recent psychometric analysis of the ASI was conducted by Zinbarg, Barlow, and Brown (1997). They found that the ASI is made up of a hierarchy of subscales. The lowest first-order factors assess three areas: physical concerns, mental incapacitation concerns, and social concerns. Most of the items on the ASI address the fear of physical harm resulting from anxious sensations, as reflected in the first factor. Examples of items targeting an individual’s beliefs about mental incapacitation include “When I cannot keep my mind on a task, I worry that I might be going crazy” and “When I am nervous, I worry that I am mentally ill.” Finally, items measuring the feared social consequences of anxiety sensations include “Other people notice when I feel shaky” and “It is important to me not to appear nervous.” Taylor (1995) expressed concern that this third lower-order social concerns ASI factor may be conceptualized more appropriately as negative evaluation sensitivity than anxiety sensitivity. However, Zinbarg, Mohlman, and Hong (1999) argued that the social concern items of the ASI are conceptually different from negative evaluation sensitivity. These authors proposed that the construct of anxiety sensitivity taps into negative evaluation concerns resulting from publicly displaying observable symptoms of anxiety whereas negative evaluation sensitivity refers to fears of negative evaluation resulting from a wide variety of other behaviors. The question of where the social concerns component of the ASI belongs was investigated by McWilliams, Stewart, and MacPherson (2000). An exploratory factor-analytic approach was used to determine if this third ASI component would be better conceptualized in the domain of negative evaluation sensitivity or in the domain of anxiety sensitivity. Factors were obtained that represented the construct of negative evaluation sensitivity as well as the three lower-order constructs that make up the ASI (i.e., physical, psychological, and social concerns). Subscales derived from these four factors were positively correlated with one another within the ASI and the Brief Fear of Negative Evaluation scale (BFNE; Leary, 1983). Contrary to the speculation that ASI social concerns belong to a higher-order anxiety sensitivity factor that is separate from a higher-order negative evaluation sensitivity factor, anxiety sensitivity and negative evaluation sensitivity were positively and significantly correlated with a single higher-order factor labeled Threat Sensitivity. Thus, the social concerns component of the ASI does appear distinct from the other two components of anxiety sensitivity (i.e., physical and psychological) as well as from negative evaluation sensitivity. However, results from correlation and higher-order principal components analyses suggested that the ASI social concerns factor represents a blend of anxiety sensitivity and negative evaluation sensitivity in addition to something unique and separate from global negative evaluation sensitivity and anxiety sensitivity constructs (McWilliams et al., 2000). The ASI has been used to study a range of anxiety disorders, including the development of panic attacks and anxiety. Anxiety sensitivity as measured by the ASI is elevated in individuals with anxiety disorders when compared to normal control groups (Reiss et al., 1986; Taylor, Koch, and Crockett, 1991). Furthermore, ASI scores are often elevated among individuals with panic disorder compared to individuals with other anxiety disorders (Taylor, Koch, and McNally, 1992). For this reason, anxiety sensitivity has received the most attention in panic disorder research.

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Anxiety Sensitivity and Panic Disorder Anxiety sensitivity appears to predispose individuals to panic disorder. Lilienfeld (1997) found that anxiety sensitivity predicts a history of panic attacks above and beyond indicators of more general trait anxiety or negative affect. Anxiety sensitivity measures differentiated individuals who experience panic attacks but do not have panic disorder from those who have never had a panic attack (Norton, Cox, and Malan, 1992). Individuals high in anxiety sensitivity are considered to be at greater risk to experience panic attacks and develop panic disorder than individuals with low levels of anxiety sensitivity. Anxiety sensitivity may develop from direct experience with aversive events such as serious illness or injury. Alternatively, exposure to the serious illness or death of a family member or the influence of an overprotective parent may also contribute to an individual’s vulnerability to anxiety sensitivity (Craske, 1999). Anxiety sensitivity is associated with a heightened level of attention paid to internal physical cues. Individuals who experience panic appear to have an elevated awareness or an increased ability to identify and detect bodily sensations associated with arousal. This increased ability to detect physical cues may predispose an individual for the development of panic disorder (Craske, 1999). Initial panic attacks occur in a variety of settings. These locations are often outside of the home (Craske, Miller, Rotunda, and Barlow, 1990), such as while at work or school, while driving, on a plane or bus, in public in general, or in a situation that is socially evaluative (Craske, 1999). Craske and Rowe (1997) proposed that initial panic attacks are most likely to occur in situations where feared physical sensations are perceived as especially threatening because of possible impairment. Examples include driving, fear of being trapped, fear of negative evaluation, or fear of being in an unfamiliar location. Certain situations or contexts are more likely to be linked with negative personal consequences of experiencing anxiety (Craske, 1999). An intense fear of specific bodily sensations related to panic attacks often develops after an individual experiences the initial panic attack. Following a panic attack, this “fear of fear” is considered a sensitization of the individual’s predisposing trait of anxiety sensitivity. Reiss (1991) described a vicious cycle in which anxiety sensitivity increases the risk of panic attacks and panic attacks increase the levels of anxiety sensitivity. There is considerable evidence demonstrating that panic disordered individuals hold powerful beliefs and fears of mental or physical harm occurring from bodily sensations associated with panic attacks (Craske, 1999). One study looked specifically at anxiety sensitivity as a predictor of panic attacks. Struzik, Vermani, Duffin, and Katzman (2004) reasoned that if anxiety sensitivity is an intrinsic and independent factor in panic development as opposed to a learned fear of earlier panic (Goldstein and Chambless, 1978), then anxiety sensitivity should be a predictor of panic that is both provoked and unprovoked. Struzik et al. tested the predictive value of the ASI when panic was induced in the laboratory. Participants with panic disorder as well as healthy nonanxious volunteers were included. Only two items on the ASI (“It is important to me not to appear nervous” and “It is important to me to stay in control of my emotions”) correlated with panic attacks experienced by the group with panic disorder. Total ASI scores as well as subscale scores and individual ASI item scores were not effective in predicting the elicitation of panic in either population. Thus, the hypothesis that anxiety sensitivity plays a causal role in the elicitation of panic attacks was not supported by Struzik et al. Nevertheless,

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anxiety sensitivity appears to predict a number of process variables involved in both physiological and psychological panic symptoms (Brown, Smits, Powers, and Telch, 2003; Perna, Romano, Caldirola, Cucchi, and Bellodi, 2003; Shipherd, Beck, and Ohtake, 2001; Rassovsky, Kushner, Schwarze, and Wangensteen, 2000). Holloway and McNally (1987) examined the effects of anxiety sensitivity on the response to hyperventilation. They predicted that anxiety sensitivity would increase responses to the biological challenge of hyperventilation. Individuals with low and high anxiety sensitivity were selected for participation. Results indicated that participants with high anxiety sensitivity reported more frequent and intense hyperventilation and anxiety sensations in response to the hyperventilation challenge than those with low anxiety sensitivity. Interestingly, individuals with high anxiety sensitivity also reported a greater number of other sensations not related to the physiological effects of hyperventilation. These results suggested that anxiety sensitivity may intensify the anxious responses of individuals who experience panic during biological challenge tests (Holloway and McNally, 1987).

Anxiety Sensitivity and Other Anxiety Disorders The role of anxiety sensitivity has been in examined in other anxiety disorders, particularly social anxiety. However, anxiety sensitivity appears to play a different role in the maintenance of social anxiety disorder than it does in panic. Different anxiety disorders are associated with different patterns of responding on the ASI. For example, Hazen, Walker, and Stein (1995) compared ASI scores of individuals with social phobia to those of individuals with panic disorder. Results suggested a different manner of responding between the two groups, with the social phobia group having significantly higher scores than the panic disorder group on three items (“Other people notice when I am shaky”, “It is important to me not to appear nervous”, and “It embarrasses me when my stomach growls”), all of which reflect concern for social consequences. Along similar lines, Taylor et al. (1992) examined how anxiety sensitivity varies across anxiety disorders. A total of 313 patients recruited from a medical school and hospital completed the ASI. All participants received an anxiety disorder diagnosis according to DSM-III-R criteria (American Psychiatric Association, 1987). Diagnostic groups consisted of panic disorder (PD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), social phobia, and simple phobia. As expected, ASI scores were elevated for all anxiety disorder groups when compared to normal controls with the exception of simple phobia. Taylor et al. noted that simple phobia participants may not have shown elevated levels of anxiety sensitivity because their panic was situationally bound and thus more predictable. ASI scores were significantly higher for individuals with PD than those of all other anxiety disorders with the exception of PTSD. There was a nonsignificant trend in which the PD group had higher scores than the PTSD group. The PD group also scored significantly higher than the PTSD group on 7 out of 16 items assessing fears of fainting, heart palpitations, unusual body sensations, and the subjective experience of anxiety. There were no differences between the groups on items targeting fears of difficulty concentrating or trembling. Taylor et al. (1992) conducted further analyses by grouping together the remaining anxiety disorders for comparison with panic disorder patients. The PD group had higher ASI

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item scores than the other anxiety disorder patients except for two items, suggesting that PD is characterized by greater anxiety sensitivity than the other anxiety disorders. However, this difference may simply reflect the amount of distress associated with each anxiety disorder (Taylor et al., 1992). The direction of the relationship between anxiety sensitivity and anxiety disorder symptoms is not entirely clear. Anxiety sensitivity is viewed by some as a risk factor for panic disorder as well as other anxiety disorders. This causal interpretation of the data was articulated by Reiss and McNally (1985; Reiss, 1991). In contrast, earlier views of a related construct known as “fear of fear” proposed that a fear of anxious bodily sensations resulted from panic attacks through the process of interoceptive conditioning (Goldstein and Chambless, 1978). Indeed, Donnell and McNally (1990) found that individuals with high anxiety sensitivity were more likely to report both a personal and a family history of panic when compared to individuals with low anxiety sensitivity. However, they also found that two thirds of the individuals with high anxiety sensitivity had never experienced a panic attack. Thus, anxiety sensitivity is not only a consequence of panic but also precedes the onset of panic attacks in a number of cases (Donnell and McNally, 1990).

Anxiety Sensitivity and Social Anxiety in College Students Given that anxiety sensitivity was elevated in individuals with social anxiety (Taylor et al., 1992), researchers have begun to examine anxiety sensitivity and social anxiety in the college student population. Gore, Carter, and Parker (2002) collected self-report measures including the Social Interaction Anxiety Scale and the Social Phobia Scale (SIAS and SPS; Mattick and Clarke, 1998), Anxiety Sensitivity Index-Physical Scale (ASI; Peterson and Reiss, 1992), and the State-Trait Anxiety Inventory (STAI-T; Speilberger, Gorsuch, and Lushene, 1970) from 37 university students enrolled in psychology courses. All participants were also presented with a laboratory social challenge task instructing them to ask an “aloof” confederate on a date. Gore et al. (2002) found that while trait anxiety significantly predicted anxiety responses to the social challenge task, social anxiety measures were better predictors than either the ASI-physical subscale or the STAI-T. Thus, the SIAS and SPS combined accounted for more variance than either the STAI-T or the ASI-physical scale when predicting all social challenge task-related state measures. In addition, the higher the individual’s social anxiety measure scores, the greater the state social anxiety as well as physical symptoms reported after interacting in the social challenge. In regards to anxiety sensitivity, individuals with higher ASI-physical scores did report greater fear during the social challenge. A surprising finding noted by Gore et al. was that the ASI-physical scale was nearly as good at predicting anxiety response as the SIAS and SPS combined. The ASIphysical scale significantly predicted all dependent measures, including the Beck Anxiety Inventory (BAI; Beck, Brown, Epstein, and Steer, 1988), the Fear of Physical Sensations Questionnaire (FPSQ) which is a modified version of the Agoraphobic Cognitions Questionnaire (ACQ; Chambless, Caputo, Bright, and Gallagher, 1984), and Social State (SocS) which is a state measure adapted from a version of the Fear of Negative Evaluation scale (Watson and Friend, 1969). Roth, Coles, and Heimberg (2002) investigated the relationship between memories for childhood teasing and anxiety and depression in college students. These researchers examined

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the impact of childhood teasing on later social anxiety exhibited during the college years, whereas most of the previous research on “bullying” examined immediate effects on depressive symptoms and social anxiety among children. This line of research has found that children experiencing higher levels of victimization by their peers displayed higher levels of social anxiety (Craig, 1998; Walter and Inderbitzen, 1998) and depression (Callaghan and Joseph, 1995), as well as lower levels of social acceptance (Callaghan and Joseph) than children with lower levels of victimization. Victimized children may learn to perceive the world as a dangerous place in which they always need to be on alert, thereby leading to problems with anxiety, especially in social situations. Direct experience with such situations reinforces the perception that social situations are dangerous and are expected to end in failure, a well-known characteristic of social anxiety (Clark and Wells, 1995; Rapee and Heimberg, 1997). Avoidance of social situations often results and prevents individuals from having experiences that disconfirm their beliefs (Francis and Radka, 1995). Roth et al. (2002) measured social anxiety, worry, and anxiety sensitivity in a college student sample to investigate the relationship between memory for teasing in childhood and levels of depression and anxiety in early adulthood. A Teasing Questionnaire was developed to measure the extent to which participants remembered having been teased about 20 different topics during childhood. Positive correlations between scores on the Teasing Questionnaire and anxiety and depression measures were predicted. In addition, social anxiety was expected to have the strongest relationship with memories of teasing. Finally, the authors predicted that the stronger the memories of teasing as a child, the higher the levels of anxiety and depression as an adult. As expected, statistically significant and positive correlations were found between the Teasing Questionnaire and all of the anxiety and depression measures. Anxiety sensitivity and social anxiety were more strongly related to a reported history of childhood teasing than was worry. The authors noted surprise that the strength of the link between childhood teasing and social anxiety did not differ from the strength of association between teasing and anxiety sensitivity. A couple of research studies have examined relationships between social anxiety, anxiety sensitivity, and alcohol consumption in the college setting. Consistent with the tension reduction hypothesis, Lewis and Vogeltanz-Holm (2002) proposed that individuals often consume or abuse alcohol out of an expectation that drinking will reduce unpleasant sensations and cognitions, thus serving as a way to self-medicate anxious feelings. This view is consistent with the Burke and Stephens (1999) model described above and is supported by research showing that socially anxious individuals are more likely to report alcohol-related problems than nonanxious individuals (Kessler, Crum, Warner, Nelson, Schulenberg, and Anthony, 1997; Kushner, Sher, and Beitman, 1990) and that both placebo and alcoholic drinks reduced speech anxiety in a diagnosed social phobia sample (Himle, Abelson, Haghightgou, Hill, Nesse, and Curtis, 1999). Lewis and Vogeltanz-Holm (2002) also suggested that this tension-reduction effect of alcohol differs among individuals with varying levels of anxiety sensitivity. Lewis and Vogeltanz-Holm examined the interaction between anxiety sensitivity, social anxiety, and the effects of alcohol by measuring subjective and physiological responses to a social stressor. ASI (Peterson and Reiss, 1992) scores were obtained from a sample of college women who were subsequently separated into groups of low or moderate anxiety sensitivity. All participants performed a “body image speech” social stressor task in which they presented a speech about what they liked and disliked about their bodies in front of a mirror. Results

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indicated that participants in the moderate anxiety sensitivity group who consumed alcohol experienced a greater dampening of heart rate compared to participants who did not consume alcohol during the anticipatory phase. This result suggested that individuals with elevated levels of anxiety sensitivity are highly responsive to the stress-reduction effects of alcohol when anticipating a stressor. Results from this Lewis and Vogeltanz-Holm study were consistent with a previous investigation in which a burst of loud noise served as the stressor (Stewart and Pihl, 1994). Stewart and Pihl assigned female college students to low, moderate, and high anxiety sensitivity groups based on their Anxiety Sensitivity Index scores (ASI; Peterson and Reiss, 1992). All participants were presented with the loud burst of noise when they were sober and again after they had consumed alcohol. All experienced lower anxiety levels when intoxicated than when sober. Greater anxiety reductions were displayed by the participants in the high anxiety sensitivity group when compared to the low anxiety sensitivity group (Stewart and Pihl, 1994). Thus, anxiety sensitivity may heighten the tensionreducing effects of alcohol in both social and nonsocial stressful situations. Anxiety sensitivity, particularly the fear of negative social consequences resulting from anxiety sensations, appears to be an important component of social anxiety. However, social anxiety treatments rarely address this facet directly. In this next section, we describe original research investigating whether an additional interoceptive exposure component provides any additional clinical benefit over social situation exposure alone.

RESEARCH INVESTIGATION Effects of Interoceptive Exposure on Social Anxiety Interoceptive exposure was originally developed to treat the fears of anxious bodily sensations seen in panic disorder. This treatment involves repeated exposure to feared bodily sensations (Barlow, Craske, Cerny, and Klosko, 1989) and effectively reduced the number of panic attacks as well as the fear of bodily sensations when delivered as a sole treatment (Beck and Shipherd, 1997; Beck, Shipherd, and Zebb, 1997). As discussed above, panic disorder individuals typically fear anxiety-related sensations because they misinterpret these sensations as signs of imminent physical or mental complications. However, individuals may also fear these sensations based on concerns of negative social evaluation. Indeed, socially anxious people tend to report high anxiety sensitivity due to feared social consequences rather than perceived physical harm such as a heart attack (Hazen et al., 1995). Individuals with social phobia interpret the same anxiety-related sensations as a sign of embarrassment or social rejection. For example, a socially anxious individual with high anxiety sensitivity might consider sensations of feeling hot or flushed dangerous because others will see that he or she is anxious and therefore judge them negatively. In contrast, an individual with low anxiety sensitivity would not interpret these sensations as problematic. This conceptualization of social anxiety has led clinical researchers to study interventions that target feared bodily sensations directly. A couple clinical studies have investigated exposure to bodily sensations as a treatment component for social phobia. For example, socially anxious participants exposed to somatic symptoms in a paradoxical treatment showed improvement (Mersch, Hidlebrand, Lavy et al.,

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1992). However, it was unclear whether improvements resulted from exposure to feared physiological sensations or other treatment factors. Similarly, Plotkin (2002, unpublished dissertation) investigated the effects of interoceptive exposure on public speaking anxiety compared to guided imagery relaxation in a sample of socially anxious college students. While some empirical support for the efficacy of interoceptive exposure was found, again it was not clear if exposure to physiological sensations was the active treatment component responsible for decreases in anxiety. Alternatively, some other component of the intervention, such as social exposure to the group setting, may have accounted for treatment effects. The current study investigated whether interoceptive exposure effectively reduced speech anxiety for college students reporting general social phobia. Unlike these previous studies, we controlled for exposure to the group setting by including a control treatment in which participants performed tasks that did not directly induce specific physiological sensations. We predicted that socially anxious students receiving a group session of interoceptive exposure would display greater reductions in distress during a public speaking behavioral assessment test than socially anxious students receiving only social situation exposure. We also expected that students randomized to the interoceptive exposure condition would experience greater reductions in self-report measures of anxiety sensitivity and fear of bodily sensations than students randomized to the social exposure only condition.

Method Approximately 600 undergraduate college students completed the Anxiety Sensitivity Index (ASI; Reiss et al., 1986) and the Social Phobia Diagnostic Questionnaire (SPDQ; Newman et al., 2003) during a mass screening session conducted in their psychology courses. The SPDQ is a 15 item self-report diagnostic questionnaire of social phobia according to DSM-IV criteria. Participants also rated their fear of giving a speech and their fear of anxiety symptoms during a speech. Students endorsing DSM-IV diagnostic criteria for generalized social phobia on the SPDQ, reporting moderate to extreme fear of giving a speech as well as of their heart racing, sweating, shaking, or some other physical sign of anxiety during a speech were eligible for participation. A total of 41 eligible students agreed to participate in the two-hour experimental session for extra credit in their psychology class. Students were randomly assigned to either the interoceptive exposure (IE) condition or the social exposure only condition. In order to ensure that these randomly assigned groups were equivalent on a number of measures before the exposure intervention, all participants completed the following measures both beforehand and afterward: the Anxiety Sensitivity Index (ASI; Reiss et al., 1986), the Body Sensations Questionnaire (BSQ; Chambless et al., 1984), the Social Avoidance and Distress Scale (SADS; Watson and Friend, 1969), the Brief Fear of Negative Evaluation ( BFNE; Leary, 1983), and the Personal Report of Confidence as a Speaker Personal Report of Confidence as a Speaker (PRCS; Paul, 1966). These measures were administered at the beginning of the experimental session prior to the intervention and immediately following the intervention at the end of the experimental session. In addition to these self-report measures, all participants completed a behavioral assessment test (BAT) of speech anxiety before and after the exposure intervention. Participants were instructed to speak for one minute in front of two other participants and a

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video camera, choosing from one of three topics: “Your favorite foods and restaurants”; “How you would like to spend your next vacation”; or “What you like to do for fun when you are not studying”. Subjective units of distress (SUDS; 0-100) were recorded immediately before and after this public speaking BAT task. Participants randomized to the interoceptive exposure (IE) condition were led through three interoceptive exposure exercises conducted in small groups. The interoceptive exposure treatment exercises of overbreathing (i.e., hyperventilation), running in place, and muscle tension were conducted as described by Barlow and Craske (2000). Next, these participants selected the interoceptive exposure exercise that was most anxiety provoking for them and most similar to what they typically experience in feared social situations. IE participants then repeated the selected exercise until habituation occurred, operationally defined as a SUDS rating of 25 or less on two consecutive trials. All of these interoceptive exposure exercises were performed in front of the other group members as well as in front of a video camera. The second condition involved tasks not designed to directly induce physiological arousal. To control for the performance of novel physical tasks in front of a group seen in the IE condition (e.g., hyperventilating and running in place), similar tasks not expected to induce sensations of physiological arousal were developed for this control condition. Specifically, students randomized to this control condition were instructed to stick out their tongue, say ahhh, and stand awkwardly in lieu of the interoceptive exposure exercises performed by IE participants. Following the same procedure as the IE condition, participants chose which task was most anxiety provoking for them and performed this exercise repeatedly until habituation occurred. These tasks were also performed in the presence of the other group members as well as a video camera. For both conditions, participants rated how willing they were to perform each exercise immediately after the exercise was described. After the participants performed each exercise, a SUDS rating, two state measures, and two social anxiety ratings were collected. State measures consisted of autonomic arousal scale items from the Mood and Anxiety Symptom Questionnaire-Anxious Arousal Scale (MASQ-AA; Watson and Clark, 1991) and an abbreviated state version of the State-Trait Anxiety Inventory (STAI-S; Marteau and Bekker, 1992) consisting of 6 statements reflecting one’s level of anxiety “at the moment.” The first social anxiety rating was collected in response to the question “How embarrassed were you during this task?” Level of embarrassment was rated from 0 (“not embarrassed at all”) to 8 (“extremely embarrassed”). The second social anxiety rating was collected in response to the question “How self-conscious did you feel during this task?” Participants rated how selfconscious they felt on a scale of 0-8, with 0 indicating “not at all self-conscious” and 8 indicating “extremely self-conscious.”

Results A one-way MANOVA including all pre-experimental measures yielded no significant group differences before the exposure intervention (all univariate p’s greater than .22), suggesting that random assignment was successful. A series of between-group repeated measures ANOVAs were then conducted on each of the outcome measures. Means and standard deviations for SUDS ratings collected during each BAT as well as for ASI, BSQ,

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and BFNE scores collected at baseline and following the exposure intervention are presented in Table 1. Table 1. Means and Standard Deviations for Measures Collected Pre and Post Exposure Intervention Measure

BAT SUDS ASI BSQ BFNE

Interoceptive Exposure Condition

Pre 58.45 (34.64) 21.30 (11.44) 43.15 (13.74) 39.40 (8.93)

Post 43.55 (30.28) 21.10 (11.11) 44.90 (15.47) 41.25 (8.55)

Social Exposure Only Condition

Pre 72.01 (31.54) 21.38 (12.23) 42.05 (14.75) 38.40 (12.00)

Post 57.18 (41.53) 18.48 (10.71) 37.76 (14.50) 26.75 (11.63)

A between-group repeated measures ANOVA was conducted on SUDS ratings collected during the baseline BAT performed before the exposure intervention and on SUDS ratings collected during the post-intervention BAT performed after the exposure intervention. A main effect for time reflected that BAT SUDS ratings decreased after the exposure intervention for the participants overall, F(1, 39) = 10.87, p < .01. No main effect for group F(1, 39) = 1.89, ns, or interaction effect F(1, 39) = 0, ns was found. A between-group repeated measures ANOVA was also conducted on total ASI scores collected at baseline and after the exposure intervention. A main effect for time showed that total ASI scores reduced for the sample as a whole, F(1, 39) = 5.09, p < .05, but no main effect for group, F(1, 39) = .13, ns was found. An interaction effect approached significance, F(1, 39) = 3.86, p = .057, reflecting a greater decrease in ASI scores for the social exposure only group than the IE group. A between-group repeated measures ANOVA was then conducted on pre and post exposure intervention BSQ scores. A significant interaction effect was found F(1, 39) = 3.86, p < .01, in which only the social exposure control group exhibited a decrease. No main effects of time F(1, 39) = 1.47, ns, or of group F(1, 39) = .86, ns were found. A between-group repeated measures ANOVA conducted on pre and post exposure intervention BFNE scores also yielded a significant interaction effect F(1, 38) = 10.05, p < .01, in which only the social exposure control group showed a decrease. No main effect of time F(1, 38) = .03, ns, or of group F(1, 38) = .72, ns were found. Between-group repeated measures ANOVAs conducted with SADS and PRCS scores yielded no significant main or interaction effects for either measure. Given the unexpected nature of these results, we conducted a series of post-hoc group comparisons. Independent samples t-tests between the two groups were performed on three task variables. No significant group differences were found for ratings of how embarrassing the tasks were, t(39) = .30, p < .76, or for ratings of how self-conscious participants felt while performing the tasks, t(39) = -.53. p < .60. The MASQ-AA, our self-report measure of physiological arousal, was significantly higher for the IE group than the social exposure only control group t(36) = 3.27, p 0.50) on each extracted factor, we found that these five factors are highly interpretative, and define them as follows: Factor 1: Readiness to seek advice and help from others in varied situations of academic pursuits (explaining 16.57% of the total variance)

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5 4.5 4

Candidates for the University Entrance Examination

3.5 3 2.5 2 1.5 1 0.5 0 SPC

SSC

CPCa

CPCb

CSCa

CSCb

Figure 2. The mean ratings (per item) of the OPSAA control subscales among candidates for the University Entrance Examination (n=666) in the pre-deadline situation

Factor 2: Mobilization of resources such as time and effort (selective primary and selective secondary control inclusive) (explaining 11.56% of the total variance) Factor 3: Consoling oneself by social comparison, intra-individualized comparison, and inter- domain comparison (explaining 6.51% of the total variance) Factor 4: Finding new and/or effective ways of learning, and developing one’s abilities and skills (explaining 5.42% of the total variance) Factor 5: Goal disengagement, and self-protective external attribution of the difficulty level of the unfulfilled goal (explaining 4.56% of the total variance) [The factor loadings and the mean scores of the response items are presented in Appendix B] Factor 1, Factor 2 and Factor 4 reflect the hypothesized adaptive control strategies in a pre-deadline situation. The high mean scores of the items that loaded heavily on these factors imply that these adaptive control strategies were frequently endorsed by the present sample. Both Factor 3 and Factor 5 fell into the category of compensatory secondary control. The mean scores of the items loading on these two factors are relatively low (in particular for Factor 5 which highlights goal disengagement), reflecting an infrequent endorsement of such types of control processes in the pre-examination situation. The five extracted factors were further subjected to a second order factor analysis (with principal component analysis using promax rotation). It yielded two higher-order factors that explained 60.57% of the total variance (eigenvalues = 1.73 and 1.30). Table 2 below illustrates the loadings of the extracted factors on the higher-order factors:

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Wan-chi Wong, Yin Li and Ji-Liang Shen Table 2. Second order factor analysis of the control processes among the candidates for the University Entrance Examination (n=666)

Factor 1 Factor 2 Factor 3 Factor 4 Factor 5

Higher-order Factor one 0.73 0.71

Higher-order Factor two

0.81 0.76 0.88

A clear two-factor structure is revealed in Table 2. With Factors 1, 2 and 4 falling substantially onto the first higher-order factor, and Factors 3 and 5 substantially onto the second one, we can define the former as “Engaging”, and the latter as “Disengaging and selfprotective”. Noteworthy is the negative significant correlaton between the two higher-order factors (r= -0.12).

Group Differences in the Endorsement of Control Strategies In order to assess group differences among the students graduating from the three different tiers of high schools, one-way ANOVA was applied to the factor scores (pertaining to individual subjects) of the five extracted factors on control processes. It is noteworthy that no significant difference was found, despite the fact that students from different tiers had varied academic backgrounds. They would probably have different results in the forthcoming University Entrance Examination. By means of a t test, significant gender differences were found among the candidates for the University Entrance Examination in Factor 1 [ t (451.39) = -6.61, p .10 VA(2) *: F (1,59) = .04, p > .10 VA(3) *: F (1,59) = .48, p > .10 VA(4) *: F (1,59) = .01, p > .10 VA(5) *: F (1,59) = .47, p > .10 VA(6) *: F (1,59) = 1.87, p > .10 PSS-SR § 7. Re-experiencing (m, sd)

8. Avoidance (m, sd) 9. Arousal (m, sd) 10. Total severity score

Period

1.78 (0.65) 1.75 (0.67) 3.17 (0.61) 3.14 (0.71)

Statistics df=38 t=4.52 p=.000** t=1.16 p=.127 t=3.38 p=.001** t=3.50 p=.001**

* Period x condition + Mean frequency § Only assessed in disclosure group

All essay variables were examined for their influence on short- or long-term outcome. Only 4 of the 108 correlations examined reached significance (p < .001, see tab. 5). The results indicate that autonomic arousal is reduced to a larger extent when essays include more positive emotions and when the positive emotions are of greater intensity. Reductions in avoidance and total posttraumatic stress symptoms are greater, when self-exploration increases from day 1 to day 3. The moderating effect of personality variables on short- and long-term outcome was also examined. Of the 48 correlation coefficients, only one reached significance (tab. 5): The long-

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term reduction of physical symptoms was more attenuated, the greater the extent of selfconcealment. In a last step of analysis, the influence of personality variables on the manner of writing, as assessed with the essay variables, was examined. The only personality variable that correlated significantly with the examined essay characteristics was “worrying”. Essays written by habitual worriers contained relatively more emotional expressions on the whole (r = .435, p = .005) and more negative emotional expressions in particular (r = .511, p = .001) than non-worriers’ essays. Also, the stronger the tendency to worry, the deeper the selfexploration exhibited in the essays (r = .378, p = .016) Table 5. Significant correlations (p ≤ 0.01) between moderator variables (essay or personality variables) and outcome variables (short- and long-term) in the disclosure group (study I) Moderator variable Frequency of positive emotions in essay Intensity of positive emotions in essay Increasing self-exploration day 1 to day 3

Increasing self-exploration day 1 to day 3 Self-Concealment

Outcome Reduced arousal (PSS-SR) Reduced arousal (PSS-SR) Reduced posttraumatic stress symptoms (PSS-SR) Reduced avoidance (PSS-SR) Physical symptoms (PILL)

Correlation: r .452 (p = .002) .421 (p = .004) .424 (p = .004)

.376 (p = .009) -.366 (p = .01)

STUDY II: METHOD Because of the unexpected negative outcome regarding the postulated long-term beneficial effect of expressive writing on physical health, a second study was conducted to examine whether disclosure instructions modified to promote self-efficacy and coping would produce more positive effects. Therefore, in addition to the standard disclosure condition, two further experimental conditions, “coping” and “helping”, were implemented, in which modifications were made to the writing instructions given on day 3. In the “coping” condition, Ss were instructed on to reflect upon what they have done in the past, continue to do, or could do in future to better cope with the traumatic experience they wrote about during the first 2 sessions. This instruction aimed at increasing Ss’ awareness of their past, present, and future coping behaviour and thereby at increasing their sense of self-efficacy in dealing with the traumatic experience. It was postulated that the instruction could elicit a constructive reappraisal of the experience which would, in turn, facilitate emotional resolution (see Murray et al, 1989). In the “helping” condition, Ss were asked to imagine themselves in the role of an adviser and to elaborate on what they would recommend to persons dealing with the same trauma they experienced in order to better cope with the event. Midlarsky & Kahana (1994) as well as Berking (1998) have presented data indicating that adopting a prosocial role can

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have positive cognitive and emotional consequences. A control condition analogous to study I was also implemented, in which Ss were asked to write about their daily routine and time management in a detailed and factual manner. 22 Ss were randomly assigned to each of the four conditions. This time a different set of instruments, selected based on the psychometric quality of the validated German versions, was used for the assessment of long-term effects. The circumstance that the study I instruments were, for the most part, translations of questionnaires originally developed for Anglo-American samples and not yet psychometrically evaluated for German samples was seen as a limitation worthy of amelioration in study II. Physical symptoms (prior PILL) were assessed via the Complaints Schedule (Beschwerden-Liste, von Zerssen, 1976), affectivity (prior PANAS) through a validated German version of the Profile of Mood States (McNair et al, 1971), and PTSD symptoms via the tested German version of the Impact of Event Scale (Horowitz et al, 1979). The individual health-related items from study I (e.g., illness days) were implemented, as was a questionnaire scale tapping satisfaction with one's health (Fahrenberg et al, 1986). To assess the effect of writing on mood regulation, which is posited as one of the mechanisms underlying health improvement, the questionnaire “Generalized Expectancy for Negative Mood Regulation” (Catanzaro & Mearns, 1990, Catanzaro & Greenwod, 1994) was administered. Furthermore, an item assessing self-efficacy regarding coping with the critical event was added. The conductance of study II was similar to study I in all other aspects.

STUDY II: RESULTS The sample comprised a total of 84 Ss, the majority of which were female and whose average age varied in the four conditions between 21 and 24 years (see tab. 6). Four Ss dropped out of the study (i.e., did not return follow-up data). Like in study I, most of the participants were students majoring in psychology. No significant differences between groups were found with regard to sociodemographic variables. Analysis of the essay contents in the three experimental conditions (disclosure, coping, helping) indicates that Ss wrote about experiences similar to those in study I. Problems with boyfriend / girlfriend were, however, more frequently written about in study II, while problems with friends and peers, and own severe illness or deformity were less frequent than in study I. Two two-factorial analyses of variance (condition x period) on the short-term effects of writing showed significant differences between groups regarding physical symptoms (PPSS) and negative mood (PNMS, see tab. 7). A post-hoc Scheffé test revealed that this effect can be attributed to differences between the disclosure and control conditions: The disclosure group reported more physical symptoms and greater negative mood directly after writing. The postulated long-term effect of improvements in physical health could not be corroborated in this study. None of the analyses of variance on the health-related variables yielded significant interaction effects, reflecting the absence of health differences between the controls and the three experimental groups, in which the Ss had written in an emotionally expressive manner about traumatic experiences (see tab. 8).

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Table 6. Characteristics of study II sample

Age (m,sd)

Disclosure n = 20* 24.1 (5.7)

Condition Coping Helping n = 21 n = 22 21.8 (2.4) 22.2 (3.2)

Control n = 21 21.2 (2.6)

Sex (n, % female)

13 (65%)

14 (67%)

15 (64%)

14 (67%)

Psychology

50%

76.2%

45.5%

57.1%

Law

5%

4.8%

13.6%

19%

Other

35%

19.0%

40.9%

19.0%

Non-students

10%

Variable

Major

4.8%

* deviation from n = 22: drop-outs at follow-up

Table 7. Short-term effects of writing in study II: Item means (m), standard deviations (sd), and results from analysis of variance (interaction terms) and post-hoc Scheffé-tests

Variables

Period

Condition

1. PPSS (m,sd)

pre post

Disclosure 1.41 (.40) 1.64 (.40)

2. PNMS (m,sd)

pre post

1.56 (.64) 1.98 (1.05)

Coping 1.36 (.32) 1.35 (.37)

Helping 1.49 (.39) 1.54 (.39)

Control 1.60 (.57) 1.42 (.33)

1.67 (.97) 1.79 (1.16)

1.65 (.70) 1.72 (.78)

1.51 (.58) 1.41 (.48)

VA (1)* F (3,80)= 3.75, p = .014 VA (2)* F (3,80) = 4.16, p = .009 Post-hoc Scheffé (1): control / disclosure, p = .016 Post-hoc Scheffé (2): control / disclosure, p = .010

Analyses of variance conducted on the long-term effects of writing on affectivity and yielded significant differences between groups regarding depression, fatigue and vigour. A post-hoc Scheffé test revealed that this interaction reflects differences between the helping and coping conditions: Ss in the coping condition reported feeling less vigorous and more fatigued than Ss in the helping group. Analysis of variance of PTSD symptoms (IES) revealed a significant interaction effect for intrusion and a marginally significant interaction effect for avoidance. These effects can be attributed to the expected lack of change in the control group and reductions in intrusions and avoidance found in the disclosure and helping conditions, respectively. The post-hoc Scheffé test supported this interpretation (see tab. 8). Overall, the highest average effect on symptoms of posttraumatic stress was found in the helping group (d = .71), while the other experimental conditions yielded somewhat attenuated effects (disclosure: d = .52, coping: d = .43) and no change occurred in controls (d = .07).

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Table 8. Long-term effects of writing in study II: Means (m), standard deviations (sd), and results from analysis of variance (interaction terms) and post-hoc Scheffé-tests Variable

Period

Disclosure

Condition Coping Helping

Control

Health 1. Symptoms

2. Satisfaction with health 3. Visits to physician+ 4. Activity restriction+ 5. Illness days+

pre follow-up pre follow-up pre follow-up pre follow-up pre follow-up

0.77 (.43) 0.80 (.36) 2.91 (1.12) 2.89 (1.01) 0.05 (.22) 0.40 (1.57) 1.75 (3.16) 3.16 (6.83) 2.05 (4.57) 2.65 (6.47)

0.78 (.33) 0.77 (.49) 2.92 (1.23) 3.29 (1.29) 0.05 (.22) 0.10 (.44) 1.11 (1.70) 1.53 (2.32) 1.43 (2.01) 1.95 (4.77)

0.78 (.33) 0.65 (.39) 3.13 (.97) 3.24 (1.02) 0.14 (.35) 0.05 (.21) 0.77 (2.19) 0.86 (1.49) 1.45 (2.46) 0.77 (1.60)

0.84 (.42) 0.76 (.35) 3.02 (.96) 2.82 (.70) 0.33 (.73) 0.00 (.00) 1.19 (2.32) 0.91 (1.76) 2.19 (6.49) 0.71 (1.68)

pre follow-up pre follow-up pre follow-up prä follow-up

0.89 (.85) 0.81 (.63) 1.22 (.88) 1.36 (.80) (1.09) 1.10 (.96) 1.86 (.83) 1.47 (.79)

(.69) 1.23 (1.21) 1.07 (.67) 1.68 (.65) 0.94 (.71) 1.05 (.87) 1.85 (.70) 1.24 (.71)

0.86 (.69) 0.55 (.45) 1.22 (.72) 1.10 (.70) 0.77 (.51) 0.72 (.57) 1.49 (.79) 1.70 (.81)

1.10 (.65) 0.90 (.68) 1.25 (.79) 1.37 (.58) 0.94 (.72) 1.20 (.85) 1.61 (.76) 1.63 (.90)

Affectivity: POMS 6. Depression α = 0.92*

7. Fatigue α = 0.89 8. Anger α = 0.90 9. Vigor α = 0.90 IES (scale 0 - 3) 10. Intrusion pre 1.36 (.76) 1.24 (.82) 1.22 (.73) 0.99 (.60) follow-up .79 (.63) 1.00 (.91) 0.69 (.68) 0.92 (.75) α = 0.82 11. Avoidance pre 1.06 (.70) 0.84 (.59) 1.08 (.66) 0.92 (.60) follow-up 0.89 (.61) 0.63 (.50) 0.65 (.61) 0.93 (.63) α = 0.75 VA (1)* F (3, 80) = 1.22 p > .10 VA (2)* F (3, 80) = 2.56 p = .061 VA (3)* F (3, 80) = .58 p > .10 VA (4)* F (3, 80) = .65 p > .10 VA (5)* F (3, 80) = 2.02 p > .10 VA (6)* F (3, 80) = 2.91 p = .04 VA (7)* F (3, 80) = 5.40 p = .002 VA (8)* F (3, 80) = .51 p > .10 VA (9)* F (3, 80) = 5.56 p = .002 VA (10)* F (3, 80) = 3.23 p = .027 VA (11)* F (3, 80) = 2.29 p = .084 Post-hoc Scheffé: (2) control / helping, p = .071 Post-hoc Scheffé: (6) helping / coping, p = .055 Post-hoc Scheffé: (7) control / coping, p=.083; helping / coping, p = .003 Post-hoc Scheffé: (9) control / coping, p=.060; disclosure / helping p=.082; helping / coping, p = .005 Post-hoc Scheffé: (10) control / disclosure, p = .076 Post-hoc Scheffé: (11) control / helping, p = .086 * Cronbach's Alpha + Mean frequencies

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While analysis of variance yielded no significant long-term effects of expressive writing on mood regulation (assessed with the NMR), a significant interaction effect (period x condition) was found for Ss’ perceived coping self-efficacy. On the descriptive level, the increase in self-efficacy was most pronounced in the helping condition followed by the coping condition. Inquired as to the positive and negative long-term effects of writing, Ss in the helping group reported significantly more positive consequences than controls. No other differences were found. Table 9. Mood regulation and coping competency in study II: Item means (m), standard deviation (sd), and results of analysis variance (interaction terms*) Variables 1.

Mood regulation (m,sd) α = 0.85+ Coping competency (m,sd) α = 0.82+

Period

pre follow-up 2. pre post§ follow-up VA (1)* F (3,80) = 1.14, p > .10 VA (2pre - post)* F (3,80) = 1.79, p > .10 VA (2pre - follow-up)* F (3,80) = 2.71, p = .05

Disclosure 3.40 (.40) 3.52 (.40) 1.70 (.73) 1.85 (.99) 1.75 (1.07)

Condition Coping Helping 3.31 (.43) 3.41 (.42) 3.31 (.50) 3.59 (.48) 1.55 (1.06) 1.74 (.87) 2.09 (.68) 2.16 (.96) 2.10 (1.02) 2.10 (1.07)

Control 3.35 (.39) 3.43 (.47) 1.81 (1.08) 1.76 (.83) 1.81 (.93)

+

Cronbachs Alpha After 3rd writing session *period x condition §

STUDY I: DISCUSSION In many studies a relative increase in negative mood directly after writing about upsetting events has been observed, an effect which Pennebaker (1993) has postulated as being a prerequisite for the long-term positive effects of disclosure. This negative effect on mood was corroborated in our study, though inspection of means revealed the effect to be attributable to an improvement of mood in the control group and a comparable deterioration of mood in the disclosure group. It is important to emphasise that the disclosure Ss wrote about truly upsetting and traumatic events, as shown by the analysis of essay contents and the self-rating of the extent to which the experience was troubling at occurrence and now. The expected short-term increase in physical symptoms due to the emotional impact of expressive writing, which has been observed at least in some prior studies, was not shown in our data. This may be due to inadequacies of the German version of the PPSS, an interpretation supported by the relatively low internal consistency of the scale (α = .59 vs. α = .75 reported by Pennebaker, 1982). Data of the second study should decide on this interpretation. The positive long-term effect of expressive writing on physical health could not be found at 6-week follow-up for any of the health-related variables assessed in the study. Thus, the beneficial effects of disclosure on physical health reported by Pennebaker and colleagues

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(1986, 1988) could not be replicated in our German sample. In fact, increases in both illness days and days with illness-related restriction of activity were found in the disclosure condition at follow-up. Such increases, however, were also observed in the control group and seem quite likely due to the seasonal influence of follow-up taking place during winter. The very high variance within Ss (see e.g. “illness-related restriction of activities”) indicates the presence of heterogeneous health trajectories, especially in the disclosure group. It should be pointed out that all health-related variables in our study were of a subjective nature. Unlike American universities, Germany universities do not operate student health care centres, a source from which objective health data was obtained in prior studies. Though possible that health improvement not apparent in subjective measures might be found in objective health data, the likelihood of such a divergence of health measures is small. Furthermore, it bears attention that our study was not unique in being unable to corroborate health improvement: Significant health-related differences between conditions were also absent in other studies (Greenberg & Stone, 1992; Murray et al, 1989; Murray & Segal, 1994; Gidron et al, 1996). The results concerning long-term effects of expressive writing on psychological wellbeing are contradictory. Though no improvement relative to controls was found for positive or negative affectivity, significant reductions were found in maladaptive processing 6 weeks after writing: Re-experiencing, autonomic arousal and posttraumatic stress symptoms on the whole occurred less frequently. The study also focussed on potential mechanisms of written disclosure by examining the relationship between a number of essay variables and the postulated short- and long-term effects of disclosure. The essay characteristics were assessed by self-report (e.g., rating of extent to which the essay was emotionally revealing) as well as by independent judges’ rating (e.g., depth of self-exploration). Despite the overall lack of significant long-term effects of disclosure on health status and affectivity, meaningful correlations between essay characteristics and outcome variables could have been found that would lend support to Pennebaker’s theory of inhibition and confrontation. However, only 4 out of 108 calculated correlations reached significant and the few significant correlations were all related to the domain of posttraumatic stress symptoms, the only outcome variables for which significant effects were found. Interestingly, the significant correlations were not exclusive to the scales for which long-term effects were found: Re-experiencing, though significantly reduced at follow-up, was not associated with any of the examined essay characteristics, while avoidance, though not significantly changed following disclosure, was. Associations were found between the more frequent and intense expression of positive emotions in essays and a higher the reduction in arousal. This effect, though not predicted by inhibition theory, seems quite plausible in light of Lazarus' stress coping model, in which positive reappraisal reduces the stress response. Associations were also found between increasing self-exploration (day 1 to day 3) and reductions in avoidance as well as posttraumatic stress symptoms on the whole. Surprisingly, the assessed personality variables were of little to no relevance for shortand long-term consequences of disclosure. The constructs of personality variables like alexithymia (lack of ability to perceive and express emotions) and self-concealment (conscious inhibition of expressing emotions to others) made the hypothesis of their influence on the disclosure process and its outcome highly probable. Nevertheless, only one significant correlation was found regarding self-concealment and long-term change of physical

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symptoms. The unexpected absence of these theoretically highly plausible associations may be indicative of a weakness in the theory of inhibition and confrontation.

STUDY II: DISCUSSION The second study was conducted to determine whether the negative results of study I might be due, in part, to inadequacies in the German versions of the selected assessment instruments. More importantly, however, was the study’s aim of examining whether modified disclosure instructions promoting self-efficacy and coping would be more successful in producing the postulated positive effects on physical health and psychological well-being. Negative short-term effects of expressive writing were found in study II for both mood and physical symptoms. Interestingly, the increases in both were most pronounced in the disclosure condition, which differed significantly from the control condition. The coping and helping conditions, on the other hand, evidenced only slight, if any, increases in physical symptoms and negative mood. As in study I, positive long-term effects of writing on physical health were conspicuously absent. Not only were there no effects with regard to the Complaints Schedule, an instrument specifically validated for German samples, none of the subjective health measures indicated a beneficial effect of expressive writing on physical health. The observed long-term effects on mood were unexpectedly attributable to differences between the helping and coping conditions, controls were not involved. Nevertheless, the deterioration of mood in the coping Ss, relative to the helping Ss, merits comment. The only predicted long-term improvements of psychological well-being were found with the Impact of Event Scale. A marginally significant interaction effect was revealed for “avoidance” and a significant interaction effect for “intrusion”. Altogether the helping group showed the largest reduction in posttraumatic stress symptoms, The newly explored variable “expectancy of negative mood regulation” did not respond to expressive writing, either in its standard or modified form. Self-rated coping competency did, however, as evidenced by the significant interaction effect in the analysis of variance on follow-up data. Though the post-hoc Scheffé-test did not reveal any significant pairwise differences, inspection of means showed that the largest increase in perceived coping competency was found in the helping condition, marginal increases were found in the other experimental groups, while the controls evidenced no change. Regarding global estimate of positive effects of writing by the Ss, the helping group gives the highest rating and the control the lowest.

SUMMARY In both of our studies, the main assumption made by Pennebaker that confronting personally upsetting experiences via a brief writing intervention, can lead to positive longterm health consequences could not be corroborated. The vision of being able to achieve improvements in physical health and psychological well-being by writing in an emotionally expressive way about negative experiences does not seem to be warranted by the results of

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the present study. Thus, our findings contradict not only the early disclosure studies but also the results of a metaanalysis from Smyth (1998), in which medium effect sizes were reported for both physical health (d = .42) and psychological well-being (d = .66). We want to point, however, that the effects reported in some studies did not reflect improvement in the disclosure condition, but rather a deterioration of health in the control group (Pennebaker & Beall, 1986; Pennebaker & Francis, 1996; Greenberg et al, 1996). Taken together with our negative results on health improvement and the lack of substantial correlations between theoretically fitting personality constructs and outcome variables, a more sceptical view of disclosure seems warranted. On the other hand, however, we found substantial changes in symptoms of post traumatic stress. In the first experiment re-experiencing and autonomic arousal were reduced after disclosure and a decrease in posttraumatic stress symptoms on the whole was found. In the second experiment, the positive effect of disclosure on these symptoms could be replicated using an instrument that was psychometrically validated for German samples. A significant reduction in intrusions was found as well as a marginally significant reduction of avoidance. These effects (reduction of symptoms) were most pronounced in the helping group. It seems that taking on the role of an adviser and recommending coping strategies to others dealing with the same experience can increase perceived coping competency and thereby facilitate improved emotional processing. Contrary to our expectations, the coping instruction was not as effective. It is plausible that the coping instruction may have reactivated the memory of unsuccessful coping endeavours in some of the Ss. On the other hand Cameron & Nicholls (1998) found positive effects in their somewhat different coping intervention. Thus, disclosure had a positive long-term effect on the processing of traumatic experiences but not on physical health or mood. Perhaps the effects on trauma processing, which are of medium size in the helping and disclosure group were not strong enough to have consequences for general health. Conclusions from our studies are that writing about upsetting or traumatic events can be useful as a self-help strategy to improve coping with the trauma but it can not replace more comprehensive professional interventions when the negative impact of the stressful event on the individual is strong. Is there any explanation for the discrepancy between our results and the beneficial health effects reported in the early studies from Pennebaker and Beall (1986) and others? Our samples do not differ from the others with regard to Ss’ status and age. The marginal gender difference between conditions in study I cannot explain the discrepancies, as gender had no moderating effect on outcome. The experiences the Ss wrote about are similar to the essay contents reported by Pennebaker and Beall (1986) or Pennebaker et al (1988). The healthrelated assessment measures and instruments were analogous, with the exception of a lack of objective health data. It seems highly unlikely, however, that self-report measures of health should be less sensitive to change than objective parameters. It could be argued that our follow-up assessment was premature, the time span of 6 weeks being too short for the beneficial effects on health to occur. This argument, however, loses its strength in view of the health improvements reported by Pennebaker et al (1988), who implemented a follow-up of the same length, and found reductions in health centre visits and increased immunocompetence 6 weeks after writing. Improvements in health have even been reported for as short a time span as 4 weeks after writing (Greenberg et al, 1996). It cannot be ruled out that sociocultural factors may play a role in the discrepant results as nearly all supporting

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findings originate from the USA and Canada. What factors these might be, however, is far from clear. Interest in the theory of inhibition and confrontation has not waned over the years: Since the first wave of research in the late eighties and the nineties, numerous new studies using the disclosure paradigm have been conducted. The study samples have grown more diverse ranging from prisoners (Tromp, 1998; Richards et al, 2000), individuals in mourning (Eddins, 1999, Ströbe et al, 2002), persons afflicted with cervical dysplasia (Cook, 2001) and prostate cancer (Rosenberg et al, 2002[prostate cancer]), to patients presenting with somatisation (Schilte et al, 2001), fibromyalgia (Gillis, 2002) and major depression (Hitt, 2001). College students were examined by Marlo & Wagner (1999) and Kloss & Lisman (2002), school children (8-13 years) by Reynolds et al (2000), and Klapow et al (2001) tested the disclosure hypothesis on a sample of primary care patients of an older age (66 years or older). Beneficial effects of disclosure are reported in some of the studies, e.g. by Gillis et al (2002), who found functional improvement in patients with fibromyalgia as well as better sleep quality. Rosenberg et al (2002) reported reductions of physical symptoms and health care utilisation in prostate cancer patients, though no effect was found on psychological variables or disease-related parameters of immunocompetence. Richards et al’s (2000) psychiatric prisoners showed a reduction in postwriting infirmary visits. Reduced health care utilisation was also found in older primary health care patients, though somatic symptoms and distress remained unchanged (Klapow et al, 2001). Whether Tromp's report (1998) of increased mental health care utilization in prisoners points to a positive effect (more sensitivity to psychological symptoms) or a negative effect (more symptoms) remains unclear. In other studies, however, disclosure was less successful in promoting psychological or physical health (Wilson, 2000; Marlo & Wagner, 1999; Schilte et al, 2001; Ströbe et al, 2002; Reynolds et al, 2000; Kloss & Lisman, 2002). Thus, evidence seems to be accumulating that the effects of disclosure are less positive and less dramatic than assumed after the first studies. Unfortunately, outcome variables indicative of the dysfunctional processing of traumatic events were rarely assessed, so that further support for the results of our studies is lacking. Furthermore, the variables mediating and moderating the effect of disclosure are far from clear. Additional research is needed to systematically analyse relevant variables and elucidate the mechanisms of action. The current focus of disclosure research on health-related variables and the neglect of psychological processing seems adversarial to the clarification of the potential utility of written disclosure as a means of self-help or in conjunction with psychotherapy.

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In: Mental Health of College Students Ed: Katherine N. Morrow

ISBN: 978-60456-394-8 ©2009 Nova Science Publishers, Inc.

Chapter 8

TEST ANXIETY AND ITS CONSEQUENCES ON ACADEMIC PERFORMANCE AMONG UNIVERSITY STUDENTS Mohd Ariff Bin Kassim1, Siti Rosmaini Bt. Mohd Hanafi2 and Dawson R. Hancock*3 1

Universiti Tenaga Nasional; 26700 Muadzam Shah; Pahang, Malaysia; Electronic Mail – [email protected]; Telephone – 012-6097503 2 Universiti Tenaga Nasional; 26700 Muadzam Shah; Pahang, Malaysia; Electronic Mail – [email protected]; Telephone – 09-4552043 3 University of North Carolina at Charlotte; 9201 University City Boulevard; Charlotte, North Carolina, U.S.A.; Electronic Mail – DHancock@ uncc.edu Telephone – (704)687-8863

ABSTRACT Some educators have failed to acknowledge the prevalence of test anxiety and its effect on academic performance among university students. This study addresses this issue at the university level using data collected through the Revised Test Anxiety (RTA) instrument and Sarason’s four-factor model as a basis for measuring test anxiety. The study also investigates the effect of demographic factors on test anxiety. Findings reveal that test anxiety is significantly and negatively related to academic performance. Reasons for these findings are addressed.

Although testing is an important and widely used means for evaluating ability and achievement of individuals, many motivated and talented college students suffer from test *

Address for Correspondence: Dawson R. Hancock, Ph.D. University of North Carolina at Charlotte; 9201 University City Boulevard; Charlotte, North Carolina, U.S.A. 28223; Electronic Mail – DHancock@ uncc.edu; Telephone – (704)687-8863

162 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock anxiety (Austin and Patridge, 1995). Students often experience increased testing as they progress from primary school to post-secondary levels. Although most students experience normal nervousness during tests, others experience severe anxiety. Obviously, test anxiety can be considered an important factor in relation to academic performance. It has been proposed that test anxiety is one of the most disruptive factors associated with underachievement of students. Sarason (1984) stated that test anxiety is a debilitating factor at all academic levels. Because of its strong influence on academic achievement, test anxiety has been identified as one of the variables in the motivation and learning strategies model proposed by Pintrich (Paulsen and Gentry, 1995).

RESEARCH PROBLEM Test anxiety is a serious problem for many students. It has been described as the most powerful impediment to learning in an educational setting (Matthew, Tracy and Scott, 2000). Test anxiety has been linked to fears of negative evaluation, dislike of testing, and less effective study skills (Hambree, 1988) and has been identified as one of the factors that impairs academic performance (Everson and Millsap, 1991 and Tobias, 1980; Gregory, 1999). Many educators are disturbed over the trauma experienced by students during test taking time. This study was conducted to examine this issue in college students with the goal of helping students seek appropriate strategies to overcome debilitative test anxiety.

LITERATURE REVIEW The Definition of Anxiety Anxiety is a complex concept and this complexity is illustrated by the various definitions of anxiety in the literature. Anxiety describes cognitive, affective, and behavioral responses that will result in poor performance and possibly failure in an evaluative situation (Ian and Owens, 1996). According to Spielberger (1966), anxiety stems from an individual’s feeling of guilt from committing wrongful acts. Anxiety can also be described as an unpleasant state of tension arising from disapproval in interpersonal relations (Eady, 1999). Anxiety actually arises due to direct threat to some value considered important to an individual’s existence as a personality (Spielberger, 1966). Furthermore, anxiety can be considered as a sense or feeling of discomfort and worry about undefined threat. The threat can be physical or psychological in nature and may involve the anticipation of bodily injury, damage to self-esteem, or harm to personal welfare.

The Definition of Test Anxiety Anxiety is also considered to have an important relation to academic performance, particularly in the form of test anxiety. In this context, test anxiety is viewed as a special part of general anxiety. Test anxiety is a universal phenomenon and has been studied in many

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different cultures (e.g., Morris, Davis and Hutchings, 1981, Spielberger, 1980 and Zeidner, 1992). Test anxiety is an extreme fear of performing poorly on examinations and it is a common form of anxiety among students. Such anxiety arises during evaluation situations or events. It can be explained as an affect or feeling of apprehension or fear and discomfort together with cognitive difficulties (Isaac and Orit, 1997). Test anxiety is closely related to negative emotions. It is because when one’s performances are being evaluated, an emotional reaction will appear. Therefore, during the evaluation, one may feel uneasiness, distress, or fear if one is not prepared and not confident with his or her abilities to perform well. However, if one is well prepared and very confident with himself or herself, the opposite feeling will arise (McDonald, 2001). On the other hand, Sarason and Stoops (1978) view that test anxiety is related to time whereby an individual may develop anxiety a long time prior to the examination. This implies that the preparation for the examination can also be affected. Therefore, such fear of tests may contribute to ineffective preparation for the test. Test anxiety also arises when the evaluative situation is interpreted as threatening (Mwamwenda, 1994).

Test Anxiety and Academic Performance Test anxiety is a major educational problem affecting millions of students in schools and colleges (Everson and Millsap, 1991). It is also widely recognized as a significant contributor to academic performance (Gregory, 1999). Many empirical studies have shown that test anxiety is a major debilitating factor on all academic levels, from the elementary level to the university level (Sarason, 1984). This view is also supported by the finding of Tobias (1980), who reported that test anxiety is one of the variables that are most commonly related to poor performance among students. Test anxiety is found to be negatively related to college students’ performance (Pintrich and Garcia, 1991 and Pintrich and De Groot, 1990). According to Ian and Owens (1996), approximately twenty percent of students consistently suffer from poor performance due to high test anxiety. The effects of test anxiety on academic performance have been thoroughly investigated by many researchers. Generally, the study of the relationship between test anxiety and academic achievement began in the early 1900’s (McDonald, 2001). The comprehensive reviews by Hambree (1988) on the Meta analysis of 562 studies showed that test anxiety caused poor performance. It implied that test anxiety had a negative relationship with students’ performance, where high test anxious students tended to score lower than low test anxious students. This result was supported by the findings of various studies (McDonald, 2001). High test anxiety students may view the testing situation differently compared to their low test anxiety counterparts. Such differing views may be expressed conceptually by variations in the features of the situation that students recognized as important and by the emphasis they replaced on those features (Schutz, Davis and Schwaneflugel, 2002). Studies conducted by Sarason in 1980 show that highly test anxious students perform relatively poor under an evaluative situation and that their performance is hindered by excessive selfpreoccupation with concern about failures and its consequences. Sarason also reported that the influence of test anxiety is most pronounced in those situations when the testing situation is competitive.

164 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock The study of test anxiety was also conducted involving an Arab population. The results showed that Arab students experienced higher test anxiety compared to American students. It was interpreted that Arab students experienced higher levels of test anxiety due to consequences of extreme importance of the test to students in their society (El-Zahhar and Hocevar, 1991). Similarly, it has been reported that college students in Egypt, Turkey and Mexico scored higher on test anxiety than students in America. In addition, test anxiety may also benefit the students in relation to their performance. This is because without any fear of failure, the students may make inadequate preparation for an examination that may lead to poor performance. However, if the level of test anxiety is above optimum level, it may disrupt preparation and create distress during the test and will result in an impairment of students’ performance. Even worse, there are students who resort to an avoidance approach to testing by not sitting for an examination due to extreme fear (McDonald, 2001).

Theoretical Framework In the test anxiety literature, several theories or models measure the test anxiety construct and in explain the effects of test anxiety on academic performance. Among the models suggested are the two-factor model by Spielberger (1980) and the four-factor model proposed by Sarason (1984). In addition, the two most common models used in explaining the effect of test anxiety on academic performance are the Interference and Deficits models. Detailed explanations of the models are discussed in this section.

Dimensionality of Test Anxiety It has been theorised that the construct of test anxiety is multidimensional. Among the various conceptualisations of test anxiety, Spielberger’s (1980) two-factor model (i.e., Worry and Emotionality) and Sarason’s (1984) four-factor model (i.e., Worry, Tension, Test Irrelevant Thinking and Bodily Symptoms) have been discussed widely in many empirical studies (e.g., Benson and Bandalos, 1992; David, et al., 2000; Hodapp and Benson, 1996; Hong, 1998 and Nasser, Takahashi and Benson, 1997). Initially, Liebert and Morris (1967) proposed that test anxiety consisted of Worry (Cognitive) and Emotionality components. Then, Spielberger, Gonzales, Taylor, Algaze and Anton (1978) developed the Test Anxiety Inventory (TAI) that followed the lead of Liebert and Morris (1967) and sought to refine a two-dimensional measure of test anxiety (i.e., twofactor model). Cognitive components refer to the mental activity that revolve around during test situations and will give an impact to the individual. In this two-factor model, Worry is the cognitive activity that accompanies the test anxiety. In contrast, Emotionality components are the psychological components of test anxiety and refer to tension, high heart rate, sweating, feeling sick and shaking (McDonald, 2001). On the other hand, Sarason (1984) and Wine (1982) suggested that test anxiety is consisted of cognitive, emotionality, behavioural and bodily reaction components. This occurs because test anxiety is a multidimensional constructs the separation of cognitive and emotionality should be addressed properly. Mainly due to this reason, Sarason (1984) subsequently categorised test anxiety construct into four components which are Tension,

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Worry, Bodily Symptoms and Test Irrelevant Thinking (i.e., four-factor model). Worry and Test Irrelevant Thinking are considered Cognitive components whereby Tension and Bodily Symptoms are grouped into Emotionality components. For the purpose of the present study, the Sarason (1984) four-factor model will be adopted in assessing test anxiety construct using the Revised Test Anxiety scale (RTA) developed by Benson and El-Zahhar (1994).

The Association between Cognitive Components with Academic Performance Cognition is claimed to be the most consistently and strongly related (i.e., negatively) to academic performance (David et al., 2000). This result was supported by other studies such as Kin and Roklin, 1994; O’Neil and Abedi, 1992; Zeidner and Nevo, 1991 and Liebert and Morris, 1967 (as cited in Hong, 1999). The cognitive test anxiety is hypothesised to have a debilitating effect on academic achievement because it may produce self-depreciating thoughts that will distract a student from thinking about relevant academic problems and cause her to focus on irrelevant thought (Ho, 2000). Worry is described as the unwanted and uncontrollable cognitive activity that relates with negative thoughts that result in emotional discomfort to the individual. Examples of negative thoughts include expecting to perform poorly on a test compared to other students, not being confident or feeling doubtful of one’s ability and the consequences of failing the test. Between the two cognitive components, Worry has a strong inverse relationship with academic performance (Hong, 1998 and 1999; Morris et al., 1981 and Sarason, 1984). The second element of Cognitive component is Test Irrelevant Thinking. This refers to intrusive, distracting and non-evaluative thoughts during the examination. For example, a student thinks of matters unrelated to the questions being asked in the examination. David et al (2000), who conducted a study involving Irish undergraduate students by using the RTA, found that Test Irrelevant Thinking is the strongest predictor of examination performance. This result is actually contradictory with those obtained by Hong (1998; 1999), Morris et al. (1981), and Sarason (1984).

The Association between Emotionality Components with Academic Performance The Emotionality component of test anxiety is comprised of Bodily Symptoms and Tension. The Emotionality component of test anxiety is not too debilitating to students’ performance (David et al. 2000). The above result is supported by Worth, Glazeski, Kirkland, Jones and Van Norman (1979) cited by David et al.(2000) which reported that the main difference between the low and high test anxious student is based on their cognitive reaction but not on physiological arousal (i.e., Emotionality) during the test. It is in line with the study conducted by David et al. (2000) who found that both Emotionality components are less negatively related to student performance as compared to the Cognitive component. Bodily Symptoms refer to the student’s physical reaction before and during test taking such as having a headache, tightening of the muscles and experiencing difficulty in breathing.

166 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock David et al. (2000) found that Bodily Symptoms have less of a negative impact on performance. Tension is the second element of Emotionality in test anxiety model. It refers to the student feeling tense during testing and feeling uneasy just before getting test results. Study indicated that Tension has slightly more negative impact towards student performance as compared to Bodily Symptoms (David et al., 2000).

Academic Performance This study uses students’ marks from final examinations in three courses – Cost Accounting (ACCD 213), Company Accounts II (ACCD 313), and Business Accounting II (ACCF 063) – offered to undergraduates at the Universiti Tenaga Nasional (UNITEN). The maximum mark that a student may achieve is 100 while the lowest is 0.

Test Anxiety Models Among the models that have been suggested for explaining the effect of test anxiety on academic performance are the Interference and Deficit models.

Interference Model The Interference Model describes test anxious student who know or sufficiently understand the content of course material but who went blank during the examination. In such a situation, the particular student is unable to recall prior learning or course materials (Wine, 1980). This model also indicated that students with high levels of test anxiety tend to divide their attention between the task demand (i.e., examination) and personal concerns, particularly negative self-preoccupation. However, students with low levels of test anxiety may devote most of their attention to task demands (Wine, 1980). This implies that the Interference model stresses the detrimental effect of task irrelevant thought during the test taking situation. A study conducted by Morris et al. (1981) supported this model. In addition, the high test anxious students may be involved in more negative thinking which perhaps interferes with the task demand (i.e., focusing on exam) when the students are under evaluative threat (Mwamwenda, 1994). The decline in academic performance caused by high test anxiety is a reflection of self doubt rather than lack of ability (Sarason and Stoops, 1978). The concept of the Interference model of test anxiety was supported by the majority of test anxiety researchers (David et al., 2000). For example, Hambree (1988) supporting the Interference model, concluded from a meta-analysis of 562 studies that test anxiety interferes with students’ recall of prior learning. Deficit Model In the Deficit model two types of factors were taken into consideration which caused poor academic performance due to high test anxiety experienced by students: study skills and test taking skills. Study skills describe student’s behaviours during meaningful learning that are intended to improve the acquisition, retention and retrieval of new knowledge (Tobias, 1985). This model assumes that student performance is reduced due to less initial acquisition

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or storage of the course materials contents rather than interference in retrieving course materials previously learned. According to Jochen and Arndt (1999) high test anxious students had less effective study skills than their low anxious counterparts. Therefore they have less knowledge of the relevant course materials. The model also assumes that poor academic performance is caused by deficiencies in students’ test taking skills. Elevation in test anxiety during testing presumably is caused by students’ awareness of doing poorly. Tobias (1985) stated that test taking skills significantly affected performance on essay and multiple-choice examinations but had a less important effect on calculation (i.e., mathematics examinations). In order to clarify the differences between the Interference and Deficit models in explaining the effect of test anxiety on academic performance, the diagram in figure 1 is referred to. The diagram is composed of three components, which are input, processing and output. Input refers to the presentation of instructional material to student. Processing represents the operations performed by students to encode, organise and store the input (i.e., study skills) and output denotes the performance of students on evaluative measures. Test anxiety affects all three components (Tobias, 1985). Test anxiety at the input stage refers to the apprehension that students experience when they are presented with new learning material. The level of test anxiety depends on the student’s ability to attend to, concentrate on and encode information. Anxiety experienced at this stage may reduce the effectiveness of input by limiting the anxious student’s ability to attend to material presented by the instructor and reducing the student’s ability to represent input internally (Bailey, Ongwuegbuzie and Daley, 2000). Students with high levels of test anxiety at this stage may ask their lecturer to repeat sentences or explain more often than do their low anxious counterparts. Anxiety at the processing stage refers to the apprehension students’ experience when performing cognitive operation on new information. The amount of test anxiety during processing depends on the complexity of the information, the extent to which memory is realised, and the level of organisation of the presented material (Tobias, 1985). At this stage, anxiety can impede learning by reducing the efficiency with which memory processes are used to solve problems. Moreover, high levels of anxiety at the processing stage may reduce a student’s ability to understand messages or to learn new material (Bailey et al., 2000). Finally, anxiety at the output stage involved the apprehension students experienced when required to demonstrate their ability to use previously learned material. Particularly, anxiety at this stage involved interference that appears after processing had been completed, but before it had been reproduced effectively as output. High level of anxiety at this stage might hinder students’ ability to reproduce the learned material when it is required. Bailey et al. (2000) noted that the three stages of test anxiety are interdependent. Each stage depends on the successful completion of the previous one. The major difference between Interference and Deficit can be seen clearly in the post processing. At this point, the Interference model assumes that learning had occurred; however, the evaluative threat posed by the examination situation interferes with the students’ ability to retrieve information. The students are said to “go blank” during examination and therefore are unable to recall prior knowledge. On the other hand, the Deficit model of test anxiety seems to affect the input and processing components. The inadequate initial preparation or poor test taking skills among the students may account for the reduced academic performance (Tobias, 1985). For the purpose of this study, the Interference model is

168 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock the preferred test anxiety model in explaining its effects on students’ performance. This model is adopted as the majority of researchers have supported this concept (e.g., Deffenbecher, 1980; Hambree, 1988; Morris et al., 1981; Mwamwenda, 1994 and Sarason and Stoops, 1978).

Interference Model

Deficit Model

Input

Processing of input to store, retrieve or transfer information

Output

Test Anxiety Figure 1 Theoretical Model of the Current Study. Independent Variables

1

Dependent Variable

Test Anxiety

W orry

Test Irrelevant Thinking

Academic Performance

Bodily Symptoms

Tension

Figure 2. Schematic Diagram.

1

Source: Tobias S. (1985). “Test Anxiety: Interference, Defective Skills and Cognitive Capacity”. Educational Psychologist, 20(3), 135-142.

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Schematic Diagram The schematic diagram in figure 2 summarizes the theoretical framework of the present study. There are four components of test anxiety (i.e., Worry, Test Irrelevant Thinking, Bodily Symptoms and Tension) that serve as independent variables. Performance is the dependent variable in the study, which refers to student’s final examination marks of accounting courses.

RESEARCH DESIGN This section discusses the research questions, type of study, data collection method, and the sample as well as the instrument and its validity. In addition, this chapter also discusses the data analyses, data types, and statistical analyses using Factor Analysis, K-S test, Correlation, One-way ANOVA, and Independent sample T-tests.

Research Questions There are three main research questions that will be addressed in the present study. [1] How do test anxiety variables relate to the academic performance of students? [2] Does the level of test anxiety among students vary between three groups of students? [3] Does the level of test anxiety among the students vary in different demographic and environmental situation?

Data Collection In this study, data were collected using self-reported questionnaires at the end of the semester for each courses offered at UNITEN. The data collection was approximately one month before the final examination. The study involved all the population of students that enrolled in the three courses i.e., Cost Accounting (DBS), Company Accounts II (DIA) and Business Accounting II (Business Foundation). As data were gathered only once, this current study can be considered a cross-sectional study. However, the students’ academic performances (i.e., final examination marks) were obtained from the academic records of the students.

Instrument The students responded to a self-reported questionnaire called the Revised Test Anxiety (RTA) developed and verified by Benson and El-Zahhar (1994). The instrument was developed based on the combination of Test Anxiety Inventory (TAI), created by Spielberger, Gonzalez, Taylor, Algaze and Anton (1978) and Reaction To Test scale (RTT) proposed by

170 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock Sarason (1984). From the combination of 60 items (20 items from TAI and 40 items from RTT), a process of item deletion resulted in 20 items of RTA consisting of the four dimensions of Worry, Test Irrelevant Thinking, Bodily Symptoms and Tension. The RTA is based on the theoretical four-factor dimensionality proposed by Sarason (1994). The goal of RTA is to incorporate the best qualities of each scale, to maintain multiple dimensions as theorised by Sarason, to provide a scale with acceptable precision and to develop valid measure of test anxiety for multinational samples. The instrument consists of 20 questions or items based on a 4-point Likert scale. The scales are 1 = almost never, 2 = sometimes, 3 = often and 4 = almost always. Higher scores reflects higher test anxiety. RTA can be divided into two broad components; Cognitive and Emotionality. The Cognitive component comprises Worry and Test Irrelevant Thinking, while the Emotionality component comprises Tension and Bodily Symptoms. The twenty items in the RTA are distributed among the four components as follows: Worry (6 items), Test Irrelevant Thinking (4 items), Tension (5 items) and Bodily Symptoms (5 items). Benson and El-Zahhar (1994) have demonstrated the stability of the dimensionality estimates of 20 items RTA scale by cross-validation among American and Egyptian samples. In addition, David et al (2000), who conducted a study to validate the RTA by using a sample of Irish students, found that the RTA is a useful cross cultural instrument to measure test anxiety. Therefore, the instrument used in this study is reliable and valid in measuring test anxiety among the UNITEN students in Malaysia.

Analysis In conducting the statistical analysis, SPSS version 12 was used. This section explains the data analysis process.

Data Types Initially, it is important to identify the types of data gathered whether they are ordinal, ratio, nominal or interval. In this study, the data were obtained through self-reported questionnaires received from the students using 4-point Likert scale. According to Keller and Warrack (2000), if data can be ordered or ranked preferentially, those data are considered as ranked data and are said to have an ordinal scale. The responses using a 4-point Likert scale are considered non-quantitative data because the data are ranked based on preferences. In addition, Mason, Lind and Marchal (1999) suggested that we are not able to differentiate the magnitude of the differences between the ranks. For instance, is the difference between “almost never” and “sometimes” the same as the difference between “almost always” and “often?” We can only conclude that rating 1 is better than rating 2 or 3 or 4 but we cannot determine how much better. Thus, it is clear that the data obtained are ordinal data (Keller and Warrack, 2000; Mason et al., 1999).

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Statistical Analysis When the data are ranked, average is not the appropriate measure. Keller and Warrack (2000) proposed the use of non-parametric statistical tests for ranked data. However, this present study utilised factor scores for further analysis as it is considered as ratio data. Hair et al. (1992) recommended the use of factor scores if the instrument used to collect the original data is well constructed, valid and reliable. As the RTA is a reliable and valid instrument to measure test anxiety, factor scores are utilised for analysis involving test anxiety variables. In addition, we can use parametric test if the data are normally distributed. In this study the confidence level of statistical tests is 95%. All the statistical analysis with p-values of 0.05 or less are considered as significant to reject the null hypothesis.

Normality Kolmogorov-Smirnov Test (K-S Test) was used to test the normality of data, which comprise the four test anxiety factors; Tension, Test Irrelevant Thinking, Bodily Symptoms and Worry. Parametric tests are appropriate for normally distributed data and non-parametric are appropriate for data that are not normally distributed. Factor Analysis The study utilised a well-established research instrument (RTA). However, because the data are collected from very different groups of students, factor analysis was performed. In order to determine the number of factors to be extracted from the variables, the common rule was the eigenvalue of more than 1. Correlation With regards to the first research question on the association between test anxiety and academic performance, the bivariate correlation was performed. Pearson correlation is an appropriate measure for normally distributed data and Spearman correlation for data that are not normally distributed. One-Way ANOVA The second research question is to measure the differences in the level of test anxiety among students. ANOVA tests are performed for data that are normally distributed. ANOVA tests were also performed to answer the third research question regarding the effect of demographic factors which involved comparison between more than two groups (i.e., age, reasons for enrolment and study habit). Independent Sample T-Test The study also investigated the effect of demographic factors on the test anxiety level which involved comparison between two groups. Demographic factors include student gender, hometown, secondary school profile and exposure to accounting subjects during SPM. For the test anxiety variables that are normally distributed, independent sample t-tests were performed.

172 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock

RESULTS, INTERPRETATION, AND DISCUSSION Factor Analysis Factor Analysis is a data reduction technique used to reduce a large number of variables to a smaller set of underlying factors, which summarise the important information contained in the variables. The following are the results for the factor analysis test.

Kaiser-Meyer-Olkin (KMO) and Bartlett’s Test In performing factor analysis, the KMO and Bartlett’s Tests were used. These tests measure sampling adequacy. The results of KMO is 0.820 and a good measure should be greater than 0.6. Thus, it indicated good sampling adequacy. In addition, the Bartlett’s test of sphericity was significant with a p-value of 0.000. The anti-image correlation matrices revealed all the measure of sampling adequacy are well above acceptable level of 0.5. The Rotated Factor Matrix Based on the rotated factor matrix table (see table 1), which employed the Varimax rotation method, the results indicate five factors from the total of 20 variables or items used to measure test anxiety. The results are quite inconsistent with the study conducted by Benson and El-Zahhar (1994). All the factors are named accordingly based on their items. The existing four factors are retained with the addition of one new factor. The first factor known as Bodily Symptoms comprises 6 items with factor loading ranging from 0.349 to 0.597. These items assess how much students experienced Bodily Symptoms before taking tests. Such bodily symptoms include headache, trembling, muscle tightening and difficulty in breathing. An example of Bodily Symptoms would be getting a headache during an important test. The second factor, Test Irrelevant Thinking, measures the students’ judgement on how relevant an examination is to them. An example can be seen in the following statement: “During tests I find myself thinking of things unrelated to the material being tested.” There are 4 items that were grouped into this factor with factor loadings ranging from 0.532 to 0.656. The result was consistent with Benson and El-Zahhar (1994). The third factor, Tension, comprises 5 items and the results are slightly inconsistent with what was found by Benson and El-Zahhar (1994). The factor loadings of the 5 items ranged from 0.336 to 0.551. The factor assesses the level of tension experienced by the students before and during testing or examination. An example of this is the statement, “I start feeling very uneasy just before getting a test paper back.” The forth factors, termed as self defeat, measures students’ negative perceptions during testing. The factor comprises two items and loadings range from 0.447 to 0.589. An example of this is the statement, “I seem to defeat myself while taking important tests”. The last factor in test anxiety construct is Worry. It has 2 items that are used to assess the level of worry among students. The factor load ranged from 0.449 to 0.498. An example of Worry can be seen in the statement, “Thinking about my grade in a program interferes with my work on tests.” All of the five factors will be the basis to form further analysis in relation to test anxiety. Item 8 from the RTA was dropped due to a correlation of less than 0.30.

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Table 1. Rotated Factor Matrix Factor 1 .597

Item 16 Item 15

2

3

4

5

.569

Item 18 Item 17 item 10

.520 .497

item 6

.349

.313

.361

item 9 item 14 item 7

.656 .626

item 13

.532

.591

item 5 item 4 item 20

.551 .539 .484

item 12 item 11 item 8 item 3

.339

.360 .336 .327

item 2 item 19 item 1

.589 .447 .498 .366

.449

Extraction Method: Principal Axis Factoring. Rotation Method: Varimax with Kaiser Normalization.

Normality Test The study utilised K-S tests in order to test the normality of variables. There are five main variables in relation to the test anxiety construct; Bodily Symptoms, Test Irrelevant Thinking, Tension, Self-Defeat and Worry. The results illustrated in table 2 indicated that all test anxiety variables were normally distributed. Bodily Symptoms (p-value = 0.130), Test Irrelevant Thinking, (p-value = 0.649), Tension (p-value = 0.320), Self-Defeat (p-value = 0.140) and Worry, (p-value = 0.846). With regards to academic performance (i.e., final examination marks for accounting courses) the results indicated a normal distribution. Table 2. One-Sample Kolmogorov-Smirnov Test

Factor 1

Factor 2

Factor 3

Factor 4

Factor 5

Exam Marks

N

308

308

308

308

308

345

Std. Deviation

.81260873

.83818322

.76977603

.72612033

.71086918

14.109

1.169

.737

.956

1.154

.614

1.003

.130

.649

.320

.140

.846

.266

KolmogorovSmirnov Z Asymp. Sig. (2-tailed)

174 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock

The Association between Test Anxiety and Academic Performance The primary research objective is to measure and determine the associations between test anxiety and academic performance of the DIA, DBS and Business Foundation students. It was hypothesised that the test anxiety construct is inversely related to academic performance. Therefore, it is important to test such relationships as previous studies demonstrated inverse relationships between test anxiety and academic performance. For instance, Hambree (1988) found that test anxiety had negative relationships with academic performance where high test anxiety students tended to score lower than low test anxiety students. The above relationship was tested using the Pearson correlation. The results indicate that Self-defeat was found to have a significant relationship with academic performance (p-value =0.039 and r = - 0.119) for all programs. In relation to individual programs, DIA and Business Foundation programs reported a significant relationship with academic performance. DBS programs showed no significant result. For DIA programs, the result revealed that only the Worry variable was found to be negatively associated with performance (p-value = 0.006 and r = - 0.363). For Business Foundation, Self-defeat (p-value = 0.019 and r = -0.365) and Worry (p-value = 0.006 and r = -0.418) results showed a negative association with academic performance. The other variables indicated no significant result.

Comparison of Test Anxiety Level between Groups The second research objective has been divided into two parts which compare the test anxiety levels among the three cohorts of DBS students (i.e., students from semester 2, 2003/2004, semester 1, 2004/2005 and semester 2, 2004/2005) and compare the test anxiety levels among DIA, DBS and Business Foundation students. Both objectives were tested using one-way ANOVA. For the first objective, it was hypothesised that there was a significant difference in the level of test anxiety construct among the three cohorts of DBS students. The present study involved 117 students from semester 2, 2003/2004, 114 students from semester 1, 2004/2005 and 120 students from semester 2, 2004/2005. Based on the results obtained, there is sufficient evidence to infer that there is a significant different in the level of Worry (p-value = 0.013) among these three groups. The students from semester 2, 2004/2005 experienced the highest level of Worry (mean 0.199) compared to their counterparts from semester 2, 2003/2004 and semester 1, 2004/2005. The other variables showed no significant differences. For the second part of this objective, it was hypothesised that the level of test anxiety between DIA, DBS and Business Foundation students was significantly different. Based on analysis performed, three variables were found to have significant results as presented in table 3. Table 3 shows that the Business Foundation students exhibit lower levels of Bodily symptoms (mean –0.410) while the DBS students exhibit the highest score (mean 0.114). In relation to the Self-defeat variable, the same result is applied. Surprisingly, the Business Foundation students were found to experience the highest level of Tension (mean 0.276) as compared to their counterparts.

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Table 3. Differences in test anxiety level Factor P-value DIA (mean) DBS (mean) B. Foundation (mean)

B. Symptom 0.000 -0.135 0.114 -0.410

Tension 0.012 -0.192 -0.003 0.276

Self-defeat 0.048 -0.102 0.065 -0.203

The Effect of Demographic and Environmental Factors on Test Anxiety The third research objective concerns the effect of demographic and environmental factors towards test anxiety level. Among the demographic factors are the students’ gender, hometown, exposure to accounting subjects during SPM, age, reasons for enrollment and students' study behaviour (i.e., preferred study format, study time, study hours per week and study before test). The above demographic factors were hypothesised to have significant effects on test anxiety level. The results indicated that only student’s study behaviour such as preferred study hours per week and study before test showed the significant effect to the level of test anxiety. The other demographic factors exhibited no significant result. A preferred study hour refers to the amount of hours allocated for reviewing the course material. The three choices given were: more than 10 hours, 5 to 9 hours and less than 4 hours. It was found that only Test irrelevant thinking (p-value = 0.019) did support the hypothesis. The others showed no significant result. It revealed that the students who study less than 4 hours per week experienced high levels of Test irrelevant thinking (mean 1.160). The students who study more than 10 hours per week exhibited the opposite result (mean –0.336). The respondents were asked about their study attitude before they sat for any tests. The three choices given were “consistent study”, “when I feel like it” and “last minute study”. The result reported that Bodily symptom (p-value = 0.023) and Worry (p-value = 0.042) variables have sufficient evidence to infer the hypothesis. It was found that the students who have a consistent study behavior exhibited the highest score (mean 0.094). Surprisingly, the students who studied last minute, indicated the lowest score (mean –0.107). Unlike the Bodily symptom variable, the students who had a consistent study pattern experienced the lowest level of Worry (mean –0.152) while the students who had a last minutes study pattern experienced the highest level of Worry (mean 0.094).

Discussion of the Results This section discusses the association between test anxiety and academic performance as well as the comparison of test anxiety level among the DBS students from different cohorts and students from various programs. It also discusses the effect of demographic and environmental factors towards test anxiety.

176 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock

The Association between Test Anxiety and Academic Performance On the basis of research viewed earlier, it has been reported that there are negative relationships between the levels of test anxiety and academic performance. Those who score high in test anxiety generally performed less well academically than those who have a low level of test anxiety (Hambree, 1988). In the present study, the same pattern of results was replicated. From the findings, Self-defeat was found to have an inverse relationship with academic performance for all programs. Business Foundation students reported a similar pattern of results with the additional Worry variable. The DIA program also indicated a negative relationship between Worry and academic performance. For the current study, Worry was found to have a strong association with academic performance particularly with the students enrolled in the Business Foundation program. Worry refers to uncontrollable cognitive activity that relates to negative thought that results in emotional discomfort to an individual. Examples of negative thought include expecting to perform poorly on test, not being confident or being doubtful of one’s ability and thinking extensively about the consequences of failing the test. Therefore, the students who score high in level of Worry are more likely to have lower academic results. This result was consistent with the study found by Sarason (1984) indicating that Worry is more strongly related to poor performance. In addition, Wine (1980 and 1971) reported that the impairment of performance is due to the cognitive component and Worry is one of the elements in the cognitive component. The results of the present study indicated that Worry is strongly and negatively associated with performance. Thus, it supports the Interference model such as when high anxious students are under evaluative situations, they engage more on cognitive activity (i.e., Worry) that may interfere with their task accomplishment (i.e., answering the examination questions). This result is supported by Mwamwenda (1994). Clearly, the Interference model seems relevant in the present study. Thus, the accounting lecturers in particular have to implement the appropriate test anxiety treatments which focus on reducing the test anxiety that inhibits students from retrieving course contents during examinations.

Comparison of Test Anxiety Level among the Students between Uitm Campuses The current study revealed that the Worry variable showed a significant difference in terms of level of test anxiety among the three cohorts of DBS students. The result suggests that the students from semester 2, 2004/2005 were more likely to be exposed to the negative thought which might have resulted in emotional discomfort as compared to their counterparts. In comparing the level of test anxiety among the DIA, DBS and Business Foundation students, the present study reported that Bodily symptom, Tension and Self-defeat showed a significant difference in the level of test anxiety among these groups of student. The Business Foundation students were found to have the lowest level of Bodily symptoms and Self- defeat while DBS students exhibited the highest score for both variables. Therefore we can infer that DBS students were more anxious and more likely to experience headache, stomachache and shaking during test taking. However, Business Foundation students feel more tension during the test and feel uneasy just before they receive their test paper back.

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The Effect of Demographic and Environmental Factors Towards Test Anxiety Some research suggests that test anxiety can be situationally specific and thus may vary depending on the environmental or demographic factors (Bruce, 1994). There are several environmental and demographic factors considered in this study in order to serve the third research objective. They include student’s gender, hometown, exposure to accounting subjects during SPM, age, reasons for enrollment and student’s study behaviour. This section highlights the significance of the results. The students may relate test anxiety to the preparation done before exams or their study behaviour. Normally, less preparation would seem to lead to higher test anxiety due to the greater chance of poor performance. The result of the present study revealed the relationship between the level of test anxiety and level of preparation (i.e., student’s study behavior). In relation to preferred study hours, the finding suggests that the students should engage in their study for more than 4 hours per week. It is proven that those who studied less than 4 hours per week were more likely to be less prepared, thus more anxious for the tests, particularly for the courses concerned. Unexpectedly, the current findings reported that the students who studied consistently before their tests indicated the highest level of Bodily symptoms and the opposite result was found. However, the students who studied consistently exhibited the lowest score for level of Worry and those who studied last minute experienced high levels of Worry. This finding implies that students should engage in their studies consistently. It is proven that those who study consistently are more likely to be well prepared, thus less anxious for the test. The present study was inconsistent with the result obtained by David (2004) who reported no significant difference in the level of test anxiety and study behaviour.

CONCLUSIONS, RECOMMENDATIONS, AND FUTURE RESEARCH The four-factor model of test anxiety in the RTA scale established by Benson and El Zahhar (1994) can be used as a basis for describing data in the present study. The factorial invariance across diverse population suggests that the RTA scale is potentially a useful crosscultural instrument. In line with previous research, the present study demonstrates an inverse relationship between test anxiety and academic performance. The Cognitive factor (i.e., Worry) has emerged as the strongest predictor of academic performance among the factors. This result suggests that students may be able to reduce test anxiety by addressing the problem of distracting thought during examinations. In examining levels of test anxiety among DIA, DBS and Business Foundation students from UNITEN, the DBS students reported the highest score in the most significant variables. Furthermore, the level of test anxiety varies depending on environmental and demographic factors. Most of the demographic factors exhibit no significant results. From the theoretical standpoint, the effect of test anxiety on academic performance can be explained within the Interference and Deficit models. The current results support the

178 Mohd Ariff Bin Kassim, Siti Rosmaini Bt. Mohd Hanafi and Dawson R. Hancock Interference model which stresses the detrimental effect of negative thoughts during test taking situations. The two models used in explaining the effect of test anxiety on academic performance have been conceptualised by some researchers as being mutually exclusive (Jochen and Arndt, 1999). However, some of the researchers proposed that both Interference and Deficit were complementary rather than contradictory (Naveh-Benjamin, McKeachie and Lin 1981). This implies that lower test score of anxious students can occur either by lack of study skills or interference in the retrieval of prior learning or by the combination of both. This assumption sets the stage for further investigation to test whether both models are contradictory or complementary. In addition, research is also encouraged to investigate the effect of test anxiety on performance with the inclusion of intervening variables such as selfefficacy, personality and learning strategies.

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In: Mental Health of College Students Ed: Katherine N. Morrow

ISBN: 978-60456-394-8 ©2009 Nova Science Publishers, Inc.

Chapter 9

THE PREVALENCE OF DEPRESSION AMONG FEMALE UNIVERSITY STUDENTS AND RELATED FACTORS Fernando L. Vázquez∗a, Ángela Torresb, María Lópeza, Vanessa Blancoa, and Patricia Oteroa a

Faculty of Psychology b Faculty of Medicine, University of Santiago de Compostela, Spain

ABSTRACT In many countries, university students now constitute a significant proportion of their age group. As in the general population, depression is relatively frequent in this group, and affects women more than men. In the study described here we evaluated the prevalence of depression, depressive symptoms and associated factors among 365 young women sampled randomly, with stratification by year and discipline, from among the 18,180 female students attending a Spanish university (65.9% of its total student roll). The prevalence of current major depressive episode was 10.4% (95% CI 7.5-14.0%). Among students with current depression, the commonest symptoms were depressed mood (86.5%) and alteration of sleep (78.9%). Some 52.6% of depressed students had suffered one or more previous depressive episodes (M = 1.2; SD = 1.5), and 13.2% had attempted suicide, but the existence of previous depressive episodes did not increase the risk of a current episode. Increased risk was associated with recent problems, which multiplied the odds of depression by 2.31 (95% CI 1.26-4.26), and with smoking in the past month, which multiplied the odds of depression by 2.01 (95% CI 1.09-3.89), but not with the use of alcohol, cannabis or cocaine in the past month. Nor was there any significant association between depression and declared social class, monthly family income, university course level, geographical background (urban or rural), persons lived

∗

Corresponding author. Universidad de Santiago de Compostela, Facultad de Psicología, Departamento de Psicología Clínica y Psicobiología, Campus Universitario Sur, 15782 Santiago de Compostela, Galicia, Spain. E-mail: [email protected]

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Fernando L. Vazquez, Angela Torres, and Maria Lopez, et al. with during term time (family, friends, etc.), whether all the previous year's exams had been passed, sports activity, or academic discipline.

Keywords: depressive disorder, prevalence, epidemiology, students, cross-sectional study.

INTRODUCTION Depression is one of the commonest psychiatric disorders in the general population, with an estimated prevalence of around 16% (Kessler et al., 2003). It is currently responsible for some 5% of the all-cause burden of disease (Hyman, Chisholm, Kessler, Patel, and Whiteford, 2006), which makes it the leading cause of non-fatal burden and the fourth leading cause overall (Ustün, Ayuso-Mateos, Chatterji, Mathers and Murray, 2004); it is predicted that it will be the overall leading cause of disability and death by the year 2030 (Mathers and Loncar, 2006). It not only affects those who suffer it directly, but also causes great suffering to their families and disrupts everyday activity and productivity; it often complicates the evolution of physical disorders, and increases the risk of suicide (Wang and Kessler, 2006). Women are about twice as likely as men to suffer depression (Marcus et al., 2005). Among adolescents and young adults, the risk of depression is also greater for females than males: about one in three young women have at some time in their lives suffered depression, as against one in five young men (Kessler and Walters, 1998). University students, who in many countries now constitute a considerable proportion of their age-group, share this general trend: depression is a frequent disorder in this population, especially among women (Adewuya, Ola, Aloba, Mapayi, and Oginni, 2006; Allgöwer, Wardle, and Steptoe, 2001; Apfel, 2004; Clark, Salazar-Grueso, Grabler, and Fawcett, 1984; Dahlin, Joneborg, and Runeson, 2005; Eller, Aluoja, Vasar, and Veldi, 2006; Rimmer, Halikas, Schuckit, and McClure, 1978; Schuckit, 1982; Tomoda, Mori, Kimura, Takahashi, and Kitamura, 2000; Vázquez and Blanco, 2006). The risk of emotional disorders increases under stress, and university students can be put under stress not only by accommodation, finance and social problems, but also by academic difficulties (demands and deadlines, exams, grades and competition, uncertainty about career and future success) and by their awareness that they must at this stage make some of the most important decisions in their lives. Such pressures can trigger the onset of depressive episodes in susceptible students and, in turn, depression can negatively affect academic performance by altering memory function and other learning processes (Dyrbye, Thomas, and Shanafelt, 2006; Hysenbegasi, Hass, and Rowland, 2005; Murphy and Archer, 1996). The university has been described as a critical context for studying mental health in youth (Weitzman, 2004). In spite of the evidence of the vulnerability of university students to depression, and the plausibility of the above reasons, the phenomenology of depression in this population has been insufficiently investigated, especially as regards any distinctive characteristics of depression among female university students. In particular, only two studies have been published in which the object of study has been clearly defined by the use of the DSM-IV criteria of depression: a study of first-year students in Japan (Tomoda et al., 2000), and a study of Swedish medical students (Dahlin et al., 2005). There is therefore a need for broader

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studies of well-defined depression among university students, especially considering that depressive episodes can not only disrupt a student’s life during this period that is critical for his or her future, but can also, as in the case of adolescents (Lewinsohn, Clarke, Seeley, and Rohde, 1994), predispose towards further episodes (Franko et al., 2005); hopefully, such studies would help orient the design of preventive strategies. In view of the apparently greater prevalence of depression among female students, and the possibility that depression among female students may have specific characteristics relevant to the design of preventive strategies, the need for studies of female students is particularly urgent. The objectives of the present study of a random sample of female university students stratified by course year and discipline were to determine the prevalence of DSM-IV major depressive episodes (MDEs) among female university students, to characterize the typical symptom profile, and to identify associated factors.

METHOD From among the 18,180 female students on the roll of the University of Santiago de Compostela, Spain (65.9% of all students enrolled in this institution), a sample of 368 was randomly selected, with stratification by course year and discipline. Each student in the sample was personally contacted and invited to participate in the study; its nature, objectives, risks and benefits were explained, confidentiality and anonymity were assured, and any questions they might have about it were answered. Participation was totally voluntary, and no economic, academic or other kind of incentive was offered. Three of the initial sample declined the invitation to participate, leaving a final sample of 365 students who gave written consent prior to participation. The study was reviewed and approved by the Ethics Committee of the University of Santiago de Compostela. Data on depressive symptoms, diagnoses of depression, personal relationships, academic performance and sociodemographic background were obtained from each participant in a 20– 30—minute personal interview with one of three psychologists given specific training for this study. During this interview, Muñoz’s Mood Screener (Miller and Muñoz, 2005; Muñoz, 1998) was administered to determine whether the participant was currently suffering, or had ever suffered, an MDE; these screening results were subsequently used to estimate the prevalence of MDE in the sample. The Mood Screener essentially comprises eighteen items designed to evaluate the nine positive DSM-IV symptoms of MDE (nine items for current MDE and nine for sometime MDE), plus two more to assess satisfaction of the DSM-IV requirement that these symptoms significantly interfere with the subject's life or activities. A positive result for sometime MDE consists in the subject reporting having experienced, over some two-week period during his or her life, at least five of the nine symptoms, including one of the first two (depressed mood and anhedonia), together with satisfaction of the interference requirement. The criterion for current MDE is the same, except that the items now refer to the 2 weeks preceding completion of the Screener. The values of kappa for concordance of the Mood Screener with the Primary Care Evaluation of Mental Disorders scale (PRIME-MD) and with the Structured Clinical Interview for DSM-IV Axis I Disorders - Clinical Version (SCID-CV) have been reported as respectively 0.75 (Muñoz, McQuaid, González, Dimas, and Rosales, 1999) and

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0.758 (Vázquez, Muñoz, Blanco, and López, in press). The sensitivity and specificity of the Mood Screener for detection of MDE in a non-clinical population are 0.969 and 0.967, respectively (Vázquez et al., in press). The interviewers were trained for this study by a psychologist with 14 years’ experience of clinical evaluation who had himself been trained in the use of the Mood Screener by its author. Training consisted of two 90-minute “theoretical” sessions, followed by practice sessions in which the interviewers applied the instrument to subjects similar to those taking part in the main study, but who did not themselves actually participate in the main study. The theoretical sessions involved explanation of the instrument, role play, and practice in the diagnosis of depressive disorders by consideration of 10 cases. Videotapes of the practical sessions were used by the instructor to evaluate deviation from the interview protocol, and to correct the interviewers accordingly until performance was satisfactory; in all, 18 subjects took part in these practice sessions. Statistical analyses were performed using SPSS software (version 14.0). Data are presented as percentages for categorical variables, and as means, standard deviations and medians for continuous variables. The relationship between current MDE and other variables was evaluated using logistic regression (both with and without adjustment for age), for which purpose two age groups were defined (< 20 years and ≥ 20 years) and “number of friends” was split in three groups (0-2, 3-9 and > 9). Since weighting did not significantly influence the estimated odds ratios (ORs), only the results of unweighted analyses are presented. Confidence intervals (CIs) for the values of parameters in the population from which the sample was drawn were estimated by calculation of exact binomial probabilities.

RESULTS Mean student age was 21.9 years (SD = 2.4 years) (see Table 1). Some 99.3% of the sample were single, 40.3% were from families with a monthly income of 960-1,920 €, 74.5% described themselves as middle-class, and 67.9% came from urban localities. 67.4% were studying social sciences, law or humanities, and 66.3% were in the third or subsequent years of their undergraduate course. 47.0% lived with their parents during term time, 58.7% had failed one or more of the subjects taken the previous year, and 57.8% did not take part in regular sports activity. The mean number of friends declared was 8.2 (SD = 10.2). 61.4% of participants had not recently had personal, social or other problems. In the 30 days preceding the interview, the legal psychoactive substance most commonly consumed was alcohol (76.2%), and the illegal substance most commonly consumed was cannabis (19.7%) (see Table 2). The prevalence of current MDE was 10.4% (95% CI 7.5-14.0%). Among students with current depression, the commonest symptoms were depressed mood (86.5%) and alteration of sleep (78.9%) (see Table 3).

The Prevalence of Depression among Female University Students… Table 1. Sociodemographic and academic profile of the final sample (N = 365) Characteristic Age (years) M SD Declared social class Upper Middle Lower NR/NS Monthly family income < 960 € 960-1920 € > 1920 € NR/NS* Geographical background Rural Urban University course level Years 1-2 3rd and subsequent years Kind of discipline Social sciences and humanities Health sciences Natural sciences and mathematics Passed all previous year’s subjects Yes NO NR/NS* Persons lived with during term Parents Friends Others Sports activity Yes No NR/NS* Number of friends M SD Recent problems? Yes No NR/NS* Note. (*) No response or not sure.

n

%

21.9 2.4 52 272 34 7

14.2 74.5 9.3 1.9

35 147 98 85

9.6 40.3 26.8 23.3

117 248

32.1 67.9

123 242

33.7 66.3

216 63 56

67.4 17.3 15.3

145 214 6

39.7 58.7 1.6

171 142 52 145 211 9

47.0 38.7 14.3 39.7 57.8 2.5

8.2 10.2 136 224 5

37.3 61.4 1.3

187

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Fernando L. Vazquez, Angela Torres, and Maria Lopez, et al. Table 2. Substance use in the past 30 days

Substance Tobacco Yes No NR/NS* Alcohol Yes No NR/NS* Cannabis Yes No NR/NS* Cocaine Yes No

n

%

202 162 1

55.3 44.4 0.3

278 86 1

76.2 23.6 0.2

72 291 2

19.7 79.7 0.6

6 359

1.6 98.4

Note. (*) No response or not sure.

Table 3. Frequencies of DSM-IV diagnostic symptoms among the 38 female students who screened positive for MDE

Depressed mood Anhedonia Weight loss or altered appetite Alteration of sleep Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or of excessive or inappropriate guilt Impaired concentration Thoughts of death

n 33 20 20 30 20 22 15

% 86.5 52.6 52.6 78.9 52.6 57.9 39.5

23 8

60.5 21.1

Some 52.6% of depressed students had suffered one or more previous depressive episodes (M = 1.2; SD = 1.5), and 13.2% had attempted suicide, but the existence of previous depressive episodes did not increase the risk of a current episode. Reported age at occurrence of the first episode was on average 17.3 years (SD = 3.4 years); 50.7% of students with current MDE had had their first episode at age 17 years or younger, and the average number of years that had elapsed since the first episode was 4.6 (SD = 3.4). Increased risk was associated with recent problems, which multiplied the odds of depression by 2.31 (95% CI 1.26-4.26), and with smoking in the past month, which multiplied the odds of depression by 2.01 (95% CI 1.09-3.89), but not with the use of alcohol, cannabis or cocaine in the past month. Nor was there any significant association between depression and declared social class, monthly family income, university course level,

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geographical background (urban or rural), persons lived with during term time (family, friends, etc.), whether all the previous year's exams had been passed, sports activity, or academic discipline.

CONCLUSION In this study a substantial proportion of female university students, more than 10%, were currently suffering an MDE. This rate is somewhat higher than the 1-month prevalence among US women (5.8%) (Ohayon, 2007), the average for European women (7.9%) (AyusoMateos et al., 2001), and the 12-month prevalence among young women in a representative nationwide sample of adolescent and young adult Finns (8.1%) (Haarasilta, Marttunen, Kaprio, and Aro, 2001). It is much higher than the average among Spanish women in general (1.8%) (Ayuso-Mateos et al., 2001). However, it is lower than depression prevalences reported in other studies of university students: 11.9% among female Nigerian university students (Adewuya et al., 2006) (although this figure included minor depressive disorder); 12.9% among Swedish female medical students (Dahlin et al., 2005); and 28.4% among firstyear female students in Japan (Tomoda et al., 2000). It therefore seems unlikely to be an overestimated, especially since only 14.2% of the sample were in their first year (when students are probably most vulnerable) and all interviews were carried out at a time of year when there were no exams to cause stress. Furthermore, a positive Mood Screener result requires a positive answer to the question on interference with life or activity; failure to evaluate this or other indications of clinical significance has been pointed to as a significant cause of overestimation by other instruments (Narrow, Rae, Robins, and Regier, 2002). It is well known that women are more prone to depression than men, regardless of whether the criterion employed is the level of depressive symptoms or a diagnosis of unipolar depressive disorder (Kessler et al., 2003; Mazure, Keita, and Blehar, 2002). The prevalence observed in the present study is twice that observed among male students at the same university (Vázquez and Blanco, in press). Similar differences between men and women have been observed in other studies of depression among university students (Adewuya et al., 2006; Dahlin et al., 2005; Tomoda et al., 2000). The typical symptom profile observed in this study among participants who screened positive for MDE was similar to that reported by Haarasilta et al. (2001) for young adult women in that, in both studies, depressed mood and impaired concentration are among the three most prevalent symptoms, and thoughts of death are among the least. Anhedonia, thoughts of death, and weight loss or altered appetite were all more prevalent in Haarasilta et al.’s study, and alteration of sleep in ours, but both studies suggest that physical symptoms of depression (fatigue, alteration of sleep, alteration of appetite) are common in major depressive episodes. A considerable proportion of the participants with current MDE in this study, 52.6%, had suffered previous episodes. This finding is in keeping with those of longitudinal studies in which the peak of first episodes has occurred soon after puberty (Lewinsohn et al., 1994; Newman et al., 1996: Oldenhinkel, Wittchen, and Schuster, 1999). However, the average number of previous episodes, 1.2, was fewer than the figure of about 10 observed in the U.S. National Comorbidity Survey (Kessler, Zhao, Blazer, and Swartz, 1997); average age at the

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time of the first episode, 17.3 years, was younger than figures in the 20s observed in studies of the general female population (Andrade et al., 2003; Marcus et al., 2005; Weissman et al., 1996); and the time elapsed since the first episode was shorter than the 15.5 years reported in one of these latter studies (Marcus et al., 2005). All these differences are of course probably attributable to the youth of our sample. Furthermore, this characteristic of our sample – or, more specifically, the consequent low value of the number of episodes suffered by anyone with sometime MDE (1.3) - also probably explains why we did not find that past MDE significantly increased the probability of current MDE, since the risk of MDE is known to increase with the number of previous episodes (Depression Guideline Panel, 1993). It is striking that five of the 38 participants who screened positive for current MDE, 13.2%, had attempted suicide. This is a very large proportion in comparison with the 2.7% reported by Dahlin et al. (2005) for Swedish medical students of both sexes, but is compatible with reports of 6-13% among adolescents (Garland and Zigler, 1993; Ruangkanchanasetr, Plitponkarnpim, Hetrakul, and Kongsakon, 2005) and less than the 19.7% observed by Marcus et al. (2005) among adult outpatients with depression. Personal problems in the previous 6 months significantly increased the risk of current MDE in this study. This is in keeping with the results of studies that clearly show the relevance of serious adverse personal experiences to the commencement of depression (see, for example, Kendler, Neale, Kessler, Heath, and Eaves, 1993; and Mazure, Bruce, Maciejewski, and Jacobs, 2000). Maciejewski, Prigerson, and Mazure (2001) reported that women are three times more likely than men to suffer depression in response to stressful events. The observed relationship between smoking and depression in this study was not unexpected. It is well known that nicotine is one of the substances related to depression, and similar associations have been observed in a number of other studies of university students and other young people (Adewuya et al., 2006; Allgöwer et al., 2001; Haarasilta et al., 2001). The relationship is two-way: smoking can increase the risk of depression, and vice versa (Choi, Patten, Gillin, Kaplan, and Pierce, 1997; Rao, Daley, and Hammen, 2000). It may be pointed out that because the target population of this study consisted of university students, comparison of its results with those of similar studies carried out in other societies may possibly be more meaningful than for studies of the general population: it has been suggested that cross-cultural comparison of results on depression is more transparent when they concern undergraduate students than when it is necessary to control for confounding factors such as type of job, job-related stress, and marital stress (Iwata and Buka, 2002). The findings of this study suggest that therapeutic resources and preventive measures should target female university students as a population at relatively high risk of major depression, a disorder with possible life-long consequences. Teachers, educational authorities and students themselves should be made more aware of the threat of depression, and measures should be taken to minimize this threat, including measures to promote awareness of depression as a disorder and not a stigma.

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ACKNOWLEDGMENTS This study was supported by grant PGIDT05PXIA21101PR from the Directorate General for Research and Development (Counsellery of Innovation, Industry and Trade) of the Xunta de Galicia (Spain).

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Muñoz, R.F., McQuaid, J.R., González, G.M., Dimas, J., and Rosales, V. (1999). Depression screening in a women's clinic: Using automated Spanish- and English-language voice recognition. Journal of Consulting and Clinical Psychology, 67, 502-510. Murphy, M.C., and Archer, J. (1996). Stressors on the college campus: A comparison of 1985-1993. Journal of College Student Development, 37, 20-28. Narrow, W.E., Rae, D.S., Robins, L.N., and Regier, D.A. (2002). Revised prevalence estimates of mental disorders in the United States. Archives of General Psychiatry, 59, 115-123. Newman, D.L., Moffitt, T.E., Caspi, A., Magdol, L., Silva, P.A., and Stanton, W. (1996). Psychiatric disorder in a birth cohort of young adults: Prevalence, comorbidity, clinical significance, and new case incidence from ages 11 to 21. Journal of Consulting and Clinical Psychology, 64, 552-562. Ohayon, M.M. (2007). Epidemiology of depression and its treatment in the general population. Journal of Psychiatry Research, 41, 207-213. Oldenhinkel, A.J., Wittchen, H.U., and Schuster, P. (1999). Prevalence, 20-month incidence and outcome of unipolar depressive disorders in a community sample of adolescents. Psychological Medicine, 29, 655-668. Rao, U., Daley, S.E., and Hammen, C. (2000). Relationship between depression and substance use disorders in adolescent women during the transition to adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 215-222. Rimmer, J.D., Halikas, J.A., Schuckit, M.A., and McClure, J.N. (1978). A systematic study of psychiatric illness in freshman college students. Comprehensive Psychiatry, 19, 249-251. Ruangkanchanasetr, S., Plitponkarnpim, A., Hetrakul, P., and Kongsakon, R. (2005). Youth risk behavior survey: Bangkok, Thailand. Journal of Adolescent Health, 36, 227-235. Schuckit, M.A. (1982). Prevalence of affective disorder in a sample of young men. American Journal of Psychiatry, 139, 1431-1436. Tomoda, A., Mori, K., Kimura, M., Takahashi, T., and Kitamura, T. (2000). One-year prevalence and incidence of depression among first-year university students in Japan: A preliminary study. Psychiatry and Clinical Neurosciences, 54, 583-588. Ustün, T.B., Ayuso-Mateos, J.L., Chatterji, S., Mathers, C., and Murray, C.J.L. (2004). Global burden of depressive disorders: Methods and data sources. British Journal of Psychiatry, 184, 386-392. Vázquez, F.L., and Blanco, V. (2006). Symptoms of depression and related factors among Spanish university students. Psychological Reports, 99, 583-590. Vázquez, F.L., and Blanco, V. (in press). Prevalence of DSM-IV major depression among Spanish university students. Journal of American College Health. Vázquez, F.L., Muñoz, R.F., Blanco, V., and López, M. (in press). Validation of Muñoz’s Mood Screener in a non-clinical Spanish population. European Journal of Psychological Assessment. Wang, P.S., and Kessler, R.C. (2006). Global burden of mood disorders. In D.J. Stein, D.J. Kupfer, and A.F. Schatzberg (Eds.), The American psychiatric publishing textbook of mood disorders (pp. 55-68). Washington: American Psychiatric Publishing, Inc. Weissman, M.M., Bland, R.C., Canino, G.J., Faravelli, C., Greenwald, S., Hwu, H., et al. (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association, 276, 293-299.

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In: Mental Health of College Students Ed: Katherine N. Morrow

ISBN: 978-60456-394-8 ©2009 Nova Science Publishers, Inc.

Chapter 10

RELATIONSHIPS BETWEEN MOOD, COPING AND STRESS SYMPTOMS AMONG STUDENTS WHO WORK IN SCHOOLS Dafna Kariv1a and Tali Heiman2b 1

School of Business Administration, The College of Management, Israel 2 Department of Education and Psychology, The Open University of Israel, Israel

ABSTRACT The study examined the mood states of 229 men and women who are simultaneously full-time students and school staff when coping with their dual-demanding stressful environments. A causal model was developed to demonstrate that the dual-demanding stressors that the respondents faced affected their moods; these moods are pre-behavioral factors that affected their coping strategies. Results of multilevel analyses indicated that men and women differ in the magnitude of their experienced moods, but both genders experience vigorous moods as a prime emotional reaction to the dual-demanding environment. Moods were found to affect both male and female coping strategies, in all categories except social support. The genders differed in the coping strategies adopted, except for task-oriented strategies. In addition, the analyses revealed gender differences in expressing angry and depressed moods, where females reported experiencing higher levels. These results reinforce our assumption that coping with dual-demanding environments, especially by individuals who are employed in stressful occupations, reflects not only a gender-based tendency but also the mood states that derive from the stressors. Results revealed that men and women manifest identical patterns in coping with dual-demanding stressors, and that these patterns are related to their moods. Thus, coping strategies seem to depend on context rather than on gender. a b

E-mail address: [email protected]. Address: Yizhak Rabin Boulevard, Rishon Le Zion, Israel E-mail address: [email protected]. Address: 108 Ravutski Street., Ranana, 43107, Israel

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Key words: students; school staff; genders; coping; stress; mood. Working-students who are employed as school staff (teachers and principals), probably face higher levels of stress than 'regular' students as teaching is considered one of the most stressful jobs; excessive workload, pressures of school inspections and disruptive pupil behavior are only a partial list of key causes of teachers' stress; in the process of school management, school principals encounter specific stressors such as unnecessary bureaucracy, providing cover for teacher shortages and absences (Brouwers & Tomic, 2000; Griffith, Steptoe & Cropley, 1999; Morton, Vesco, Williams & Awender, 1997). Functioning as a teacher or principal simultaneously with being a full-time student (TP-S) requires coping with such demanding environments by controlling, adjusting, seeking assistance and fighting the variety of stressors encountered. The suggestion that women choose emotion-oriented coping strategies or avoidance, and that men opt for task-oriented strategies (Billings & Moos, 1981; Stein & Nyamathi, 1999) "because of their gender" implies that both women and men expose themselves to risk in the dual-demanding environments by avoiding or minimizing the use of the most potentially beneficial coping strategies for eliminating the stress – or stressors – they face. In this study we propose that male and female TP-Ss cope differently with the variety of stressors they encounter in their dual-demanding environment due to differences in mood states developed among each gender group; moods which are cultivated by the environment's stressors and in turn influence the coping behavior related to these stressors.

Gender and Moods Moods are generally defined as diffuse and long-lasting emotional states that influence rather than interrupt behavior. Moods are assessed through negative mood states of anger, confusion, depression, fatigue, tension (Russel, 2003; Terry, Lane, Lane, & Keohane 1999; Terry, Lane & Fogarty, 2003), as well as positive mood dimensions, such as vigor, happiness, well-being and calmness (Hanin, 2000). Studies of gender and emotionality indicate that among adult samples, men are generally less emotional and tend to lower mood intensiveness than women (Brody, 1997; Manstead, 1992). Moreover, women are usually more selfdisclosing than men (Winstead, Derlega & Wong, 1984), while men are less willing than women to reveal information about their expressive, interpersonal behaviors as well as behavior that may indicate the weaknesses or threats they face in their jobs. Thus, women are more likely to report their moods as affected by stressors they face, while men are less likely to do so, which may result in a certain amount of imprecision in each gender's self-assessment of performance (Snell, 2001) Yet an examination of the specific mood states shows that relationships between moods and gender are inconsistent among college students. While most studies in the area of gender and moods demonstrate that men report less frequent mental distress than women in college (Jones & Cochrane, 1981; Federal Centers for Disease Control and Prevention CDC6, Student

6

U.S. Department of Health, Education and Welfare, Public Health Service, National Center for Health Statistics (1977), A concurrent validation study of NCHS general well-being schedule, series 2, number, 73.

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Mental Health Planning, Guidance and Training Manual7; Shaikh, Kahloon, Kazmi, Khalid, 2004; Surtees, Wainwright, & Pharoah, 2002), as well as stress and fatigue at work (Kariv, Offer, Notzer & Dolev, 2005); others show that male students are more likely than female students to be depressed (Grant, Marsh, Syniar, Williams, et al., 2002), and express more anger; anger is often viewed as "masculine", especially when it involves acting the anger out physically (Thomas, 2003). Other studies report no significant gender differences in mood states of college students (Butler & Nolen-Hoeksema, 1994; Scarbrough & Hicks, 1998); in gender differences regarding expressions of anger at work (Gianakos, 2002); or in experiencing anxiety or fear (Humphrey, Yow & Bowden, 2000). While these findings focus on negative moods of anger, depression and tension (Katz & Bertelson, 1993; Wilson, Pritchard & Revalee, 2005), the exploration of positive moods as manifested by the genders is limited in the research, especially in the context of TP-S. This is probably due to the fact that in the academic world, the result of negative moods is costly for both the students and the college management, as it is related to student dropouts, low academic achievement or students' violent, abusive or suicidal behavior. However, the field of positive psychology (Seligman & Csikszentmihalyi, 2000; Shirom, 2003) does provide evidence that vigorous moods allow individuals to effectively cope with work-related demands (Luthans, 2002), as these moods tend to promote goal-directed behavior likely to increase individuals' personal resources (Hobfoll, 1999). Because positive affective states are indicators of subjective well-being (Katwyk et al., 2000), gender differences that emerge in well-being (Diener, Suh, & Oishi, 1997) may indicate gender differences in experiencing vigorous moods. In this case, women are more likely than men to report on higher positiverelated emotions such as vigor, energy, joy, etc. We postulate that dual-demanding academic and work stressors (Daniels, Brough, Guppy, Peters-Bean & Weatherstone, 1997; Kahn & Byosiere, 1992) elicit moods, both positive and negative, that could be the bridging link between the dual-demanding stressors and the performative aspect: coping strategies employed by male and female TP-Ss.

Coping and Moods Coping is the response that serves to alter the environment to reduce demands or to increase personal resources to address demands (Hobfoll, Dunahoo, Ben-Porath, & Monnier, 1994; Lazarus & Folkman, 1984). Coping strategies that create a positive affect are considered effective and adaptive and may include reframing, problem solving, and infusing events with positive meaning (Folkman & Moskowitz, 2000; Diener, et al., 1997). The choice of coping strategies when facing stressors has been found to relate to individuals' assessment of the demanding situations in terms of controllable or uncontrollable (Folkman & Lazarus, 1985): emotion-oriented coping is more likely in uncontrollable than in controllable situations, and task-oriented coping is more likely in controllable than in uncontrollable situations. In general, the fact that students prefer to chose task-oriented coping strategies, perceiving them as helpful and adaptive relative to the stressors they encounter (Holahan, Moos & Schaefer, 1996) implies that they believe their college lives to be controllable. Yet, the degree of emotional distress reported by students (Butler & Nolen-Hoeksema, 1994; Monk, 2004) 7

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suggests that many students are insufficiently equipped to cope with situations they perceive as demanding. Previous studies found a positive relationship between negative moods and task-oriented coping strategies among samples of college students (Catanzaro & Greenwood, 1994; Kirsch, Mearns & Catanzaro, 1990), while others found positive associations between negative moods and avoidance, and between negative moods and help-seeking strategies (Gellis & Kim, 2005) among students. Different mood categories are related to different coping choices. For example, emotional distress and depressed moods have a strong impact on college students' use of emotionfocused coping and avoidance, and were found negatively related to the use of problemfocused coping (Chang & Strunk, 1999; Coyne, Aldwin & Lazarus 1981); no such evidence is found for anxiety and tension (Edwards & Endler, 1989). Tense individuals seem overall to use more strategies to cope with daily stress (Raffety, Smith, & Ptacek, 1997) as compared to depressed students who are more rigid and more likely to use limited coping strategies. Most of the strategies adopted by tense students were not of the active coping kind (such as planning, taking direct action, or screening out other activities), but rather inactive (such as sleeping, leisure pursuit and relaxation). Angry moods which include expressions of anger including physical assaults on people and objects, verbal assaults and arguing, and other negative behaviors, as well as tension were negatively related to task-oriented coping and to social support (Lane, 2001; Lane & Terry, 2000; Monnier, Stone, Hobfoll & Johnson, 1998; Whatley, Foreman & Richards, 1998), probably because anger and tension increase through frustration with the failure to attain selfset performance goals. Fatigue was found to be related to greater social support as well as to indirect coping, such as sleeping, recreation and leisure time (Shaikh, et al., 2004). Some studies found that people who experience higher levels of stress, anxiety, or depression use more maladaptive coping (Aldwin & Revenson, 1987; Folkman & Lazarus, 1985), suggesting that such mood states influence the choice of irrelevant or inappropriate coping strategies in managing the stressful situations they face. Positive moods, a relatively neglected aspect in research, were found to be related to active coping, less denial, less avoidance and more social support (Brissette, Scheier & Carver, 2002), as well as with more task-oriented coping strategies among undergraduate students (Park, Armeli & Tennen, 2004). Other studies strengthen the findings on positive moods and optimism and their association with avoidance (Martin & Stoner, 1996).

Coping, Moods and Gender Gender differences in use of coping strategies have been reported in a number of studies. Findings suggest that females appear to favor social support, emotion-focused, and avoidant coping strategies relative to males (Billings & Moos, 1981; Ptacek, Smith, & Zanas, 1994; Stein & Nyamathi, 1999), whereas males appear to favor stress release through other activities and tend more often to turn to drugs or alcohol, relative to females (Bird & Harris, 1990; Stein & Nyamathi, 1999). There are inconsistent findings regarding gender differences in the use of problem-focused or active coping strategies. While most studies suggest that males use problem-focused strategies more often than women (Stone & Neale, 1984), others

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indicate that women use them more than men (Billings & Moos, 1981; Ptacek, et al., 1994); while still others find no differences (Hamilton & Fagot, 1988). Depressed moods were found to relate to gender: women report on depressed moods more frequently than men (Murakumi, 2002); and were diagnosed with depression symptoms twice as often as men (Blazer, Kessler, McGonagle & Swartz, 1994; Nolen-Hoeksema, 1994). Women were also more likely to report on tense moods, and their tension was found to increase over time when facing stressful situations, while men's tension remained the same over time (Tobar & Morgan, 2002). Sleep loss intensified negative emotions and fatigue among both men and women, while emotion-oriented strategies were mitigated (Zohar Tzischinsky, Epstein & Lavie, 2005), and vigor and optimism were more likely to relate to social support and emotional well-being perceptions among women in a study that did not assess men’s perceptions (Sumi, 1997). Among college students, female students who reported depressed moods tended more to reach for social support and adopt emotion-oriented strategies as compared to male students (Hammen & Peters, 1978; Heiman & Kariv, 2004). Male students who use task-oriented coping techniques reported experiencing less distress (Higgins & Endler, 1995), while the use of emotion-oriented coping strategies was a significantly positive predictor of distress in both men and women. Certain levels of social support are used by both genders (Wilson & Multon, 2001); with more female students applying for social support than male students (Kariv & Heiman, 2004). Teachers and school principals were found to manifest fatigue moods (Gaziel, 1993), a feeling of ambiguity and tense moods, but their coping enhanced their effectiveness (Chen & Miller, 1997). Other studies showed that teachers generally used more avoidance in coping with stressors (Lazarus & Folkman, 1984), or 'uncontrolled aggression', but these were assessed as negative coping strategies while pro-active-oriented coping was considered an effective way of coping (Austin & Muncer, 2005). School principals and educational executives are increasingly faced with more pressure, aggression, change, and conflict than ever before (Cooper, Sieverding & Muth, 1988; Gmelch, 1983). Studies on a sample of academic institutional executives revealed that females experienced higher levels of work-related stress but appeared to be happier in their jobs (Wolverton, Wolverton & Gmelch, 1998). Other studies showed that executives reporting on high stress that originated from their responsibilities favored the use of problemfocused coping in managing the stressors (Gianakos, 2002; Latack, 1986). The present study proposes an integrative causal model (see Model 1) which shows that stressors of dual-demanding environments (work and college studies) and personal attributes impact TP-Ss’ moods. These moods then engender corresponding coping strategies: taskoriented strategies, emotion-oriented strategies, avoidance and social support.

Hypotheses In our review of the literature dealing with gender and coping strategies, we have shown that empirical research scarcely explored the question of whether men and women TP-Ss develop different experienced moods derived from their dual-demanding environment. Moreover, the results gathered on college students show that 'gender matters', but inconsistent results on gender differences in moods emerge. Therefore, our first hypothesis is:

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Stressors of dual demanding environments a. Conflicting demands, derived from work and academics; b. Limited time for leisure due to overloads at work and/or at the college; c. Limited time dedicate to academic studies inside and/or outside the college hours; d. Long and erratic hours spent at work/college

Personal Attributes Gender Age Being Married

Task-oriented coping strategy

Moods Angry Confused Depressed Fatigue (exhausted) Tense Vigor

Emotion-oriented coping strategy

Avoidance

Social support Family Friends Significant others

Model 1. Stressors of dual-demanding environments (work and academic) and the relationship to moods and coping strategies among men and women.

Hypothesis 1: Male and female TP-Ss differ in their self-reported mood states derived from their dual-demanding environment. The literature shows that moods have an impact on actions, thus on coping strategies, however each mood category affects different coping strategies, differentiated by gender. According to the literature, gender differences are shown in negative moods and positive moods and their effect on the employment of specific coping strategies. Hypothesis 2: Negative moods (depression, fatigue, anger, confusion and tension) of TP-Ss have an impact on avoidance, with depressed moods affecting the use of emotion-oriented coping, and fatigue effecting social support. Positive moods cause TP-Ss to adopt taskoriented coping strategies and social support. The next hypothesis examines indicators that predict the choice of coping strategies among male and female TP-Ss. In order to decipher the significant indicators of coping strategies, we have included stressors of the dual-demanding environment, personal attributes and moods. Hypothesis 3: Emotion-oriented coping strategies are influenced by women's negative moods; task-oriented strategies are influenced by men and women's positive moods and avoidance – by men's and women's negative moods. Social support is more likely to appear among women and in depressed as well as vigorous moods.

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METHOD Participants The target population consisted of students in three Israeli academic institutions, two universities and a college, studying in continuing education programs. Only students who reported that they worked full-time as school staff, i.e., teachers or principals, were included in the study. T-tests and Chi squares show no significant differences between the students of the three academic institutions in terms of gender or age distribution; nor between the teachers versus the principals. Continuing programs in education are graduate programs developed to meet the express needs of teachers and school executives by fostering academic, practical, and professional development. These programs respond to the unique educational requirements of working adults in schools or in other educational areas, who seek to pursue professional and personal development through academic studies. These programs provide high quality relevant content, an advanced level of professional knowledge, and relevant skills for ambitious teachers who wish to be leaders in their schools, communities, and fields.

Participants The sample consisted of 229 students, 133 (58.1%) male and 96 (41.9%) female. The average age of the respondents was 38.72 (S.D. = 10.36); the average age of men was 39.96 (S.D. = 11.09) and women, 37.06 (S.D. = 9.33). Frequencies revealed that 173 (73.6%) were married, of them 57% were men and 43% were women; most of the respondents were parents to 1-3 children. 141 respondents were teachers, of these 71 (53.8%) were male and 70 (72.9%) were female. The rest, 88 (38.4%), reported holding managerial positions in schools.

Measures A four-part questionnaire was employed in this study composed of: (1) Stressors: only stressors representing the combination of work and academic loads in dual-demanding environments (Kariv & Heiman, 2005) were assessed. Our main interest was the focus on the combination of two demanding environments in respondents' lives rather than identifying each stressor as it related to the work or the college environment. Four variables were included: conflicting demands derived from work and academics; limited time for leisure due to overloads at work and/or at the college; limited time dedicated to academic studies within and/or outside of college hours; long and erratic hours spent at work/college; (2) Mood scale: Mood was assessed using the 24-item Brunel Mood Scale (BRUMS) (Terry, et al., 1999). The BRUMS assesses six subscales of anger, confusion, depression, fatigue, tension, and vigor with each containing four items. This scale serves as a brief measure of mood states among adolescent and adult populations, based on mood descriptors on which respondents indicate whether they have experienced such feelings on a 5-point scale. When responses from the four items in each subscale are summed up, a subscale score in the range of 0-16 is obtained.

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The BRUMS was initially developed for use with adolescents, and it is equally valid for use with adults. Terry, Lane & Fogarty (2003) provide evidence of content validity and confirmatory factor analysis results that lend support to a 24-item six-factor structure. The subscales of BRUMS include the following mood descriptors: anger, confusion, depression, fatigue, tension and vigor items. Items are rated on a 5-point scale ranging from 0 ("not at all") to 4 ("extremely"). In this study we classified the mood categories into dichotomous variables in order to sharpen the differences in moods: responses of 3 and 4 were represented by 1, while the other responses (0-2) were represented by 0; (3) Coping strategies were measured using Endler & Parker's (1999) Coping Inventory for Stressful Situations (CISS). This is a 53-item measure of coping styles composed of three factors: (a) Task-oriented coping, (b) Emotion-oriented coping and (c) Avoidance. In this study only the task- and emotion-oriented strategies were examined since most of the literature on managers and coping addresses active (task- and emotion-oriented) rather than a passive (avoidance) coping reactions to stressors they face. The 1–5 scale for these two coping strategies ranges from 1 (seldom used) to 5 (always used). The Cronbach alpha coefficients obtained for the entire scale of coping strategies were: task-oriented, α = 0.89 and emotion-oriented, α = 0.87, indicating that the coping strategies questionnaire is a reliable measure of adult coping orientations for a high-level educated population. A principal components analysis was performed on the items of the CISS. In support of Endler and Parker (1990a), three large components were identified, accounting for 46.9% of the total variance. Most of the items for the task-oriented coping factor had loadings of .60 or greater; and most of the items of the emotion-oriented coping factor resulted in loadings of .50 or greater; and the (4) Social support scale was assessed using the Multidimensional Scale for Social Support (Zimet, Dahlem, Zimet & Parley, 1988). This is a social network support scale focusing on a person’s social network and is broken down into: (1) friends; (2) family; and (3) significant others. The scale for this coping strategy ranges from 1 (never used) to 7 (always used). The Cronbach alpha coefficients obtained for this strategy were: for the social support factor as a whole, α = 0.92; for family, α = 0.91; for friends, α = 0.99; and for significant others, α = 0.90. Additional questions on personal and demographic characteristics (gender, age, and family status) were included as well.

Procedure First, we administered the questionnaires to the entire student population in graduate education programs in each of the three academic institutions. Research assistants distributed the questionnaire through the students' academic e-mail; the response rate was 12%. In light of the low response rate, we turned to a second stage of sampling, based on network sampling. Research assistants contacted the respondents who had completed the questionnaires, by e-mail or telephone, and obtained names of TP-Ss from these respondents, then additional subjects from the second set, and so on. The questionnaires were distributed both by e-mail and face-to-face meetings at the second stage.

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RESULTS Means and standard deviations and graphic representations are shown in Table 1, Figures 1 and 2. The data show that the highest mean self-reported mood categories (anger, confusion, depression, fatigue, tension, vigor) measured dichotomously (0,1) was vigor with a mean of .827 (S.D. = 0.38) for men and .865 (S.D. = 0.34) for women. The findings show that women are higher than men in each mood category, positive and negative. 1 0.8 0.6 0.4 0.2 0 Men angry

confused

Wom en depressed

fatigue

tensed

vigor

Figure 1. Mooods within Each gender group.

M en

vigor

tense

fatigue

depressed*

confused

0 0 0 0

1 ,8 ,6 ,4 ,2 0

angry*

The data also illustrate that in most categories men and women report the same categories of moods and almost in the same order, though to a different extent (Figure 2); the highest mean among both genders is vigor followed by confusion. Among the men, the next category is depression, followed by anger, while among the women, these two moods have the same mean with anger having higher variance (S.D. = .45) as compared to depression (S.D. = .33).

W o m en

Figure 2. Moods categories of men versus women.

To determine if male and female working-students significantly differ in their moods a oneway Anova was conducted for each of the variables of moods and gender; the F and p are shown in Table 1. The purpose of this procedure was to assess whether the means of male and female's self-reported moods were statistically different from each other. The analysis revealed that the differences were statistically significant for anger and depression.

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Table 1. Means, standard deviations, F and p scores of moods and gender Men (n=133) Women (n=96) Variables Means S.D. Means S.D. F (df=1) Angry

.20

.40

.28

.45

2.33*

Confused

.39

.49

.45

.50

.556

Depressed

.23

.39

.28

.33

2.29*

Fatigue

.07

.25

.08

.28

.20

Tense

.19

.39

.21

.41

.145

Vigor

.83

.38

.86

.34

.59

* p .05* Emotion-orientation B Stressors Number of conflicting assignments .03 Limited time for leisure .06 Limited time dedicate to academic studies .31 Long and erratic hours spent at work .07 Moods Anger .44 Confusion .31 Depression 2.03 Fatigue 1.01 Tense -.33 Vigor -.58 Personal attributes Age -.021 Being married -1.157 Women: R = .43; R2 = .38; Adj R 2 = .32; F (13,84) = 11.45; p > .00**. Avoidance B Stressors Number of conflicting assignments -.09 Limited time for leisure -.01 Limited time dedicate to academic studies .10 long and erratic hours spent at work -.05 Moods Anger .380 Confusion .140 Depression .056 Fatigue 1.26 Tense -.06 Vigor .23 Personal attributes Age -.01 Being married -.19 Women: R = .65; R 2 = .42; Adj R 2 = .31; F (13,84) = 3.85; p > .00**

β

T (p)

.17 .096 -.24 .15 -.01 -.12

1.23 -.82 -2.09* 1.24 -.05 -1.06

.04 -.06

.54 -.08

β

T (p)

.01 .02 .12 .02

.07 .12 .83 .16

.08 .06 .26 .10 -.06 -.08

.55 .51 2.16* .75 -.40 -.68

-.072 -.217

-.59 -1.80*

β

T (p)

-.13 -.01 .14 -.07

-.98 -.07 1.18 -.06

.255 .103 .03 .48 -.04 .13

2.13* .99 .27 4.54** -.34 1.16

-.14 -.13

-1.4 -1.26

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Table 4. Continued Social support – applying to Friends B Stressors Number of conflicting assignments .03 Limited time for leisure .06 Limited time dedicate to academic studies .32 Long and erratic hours spent at work .07 Moods Anger .44 Confusion .31 Depression 2.03 Fatigue 1.01 Tense -.33 Vigor -.58 Personal attributes Age -.02 Being married -1.16 Women: R = .37; R 2 = .14; Adj R 2 = .03; F (13,84) = 1.92; p > .05.

β

T (p)

.01 .02 .12 .02

.07 .12 .83 .16

.08 .06 .27 .097 -.06 .-08

.54 .51 2.16* .75 -.40 -.68

-.07 -.22

-.59 -2.0*

DISCUSSION The purpose of this study was to determine what prompts men and women TP-Ss to cope differently with their dual-demanding environment, i.e., work and academic studies, or, specifically, whether the moods shaped through the stressors they encounter differ and, consequently, their coping strategies. Adopting a relevant coping response, that is, employing coping strategies that deal with and manage the dual-demanding environmental stressors will produce different coping behaviors if the stressors themselves are differently experienced and 'translated' into different mood states by each gender. More importantly, full-time students who are employed in stressful and demanding occupations, such as teachers and school principals, face extended levels of conflicting demands from both academic and work environments as compared to non-working students; non-studying employees or workingstudents in less stressful occupations. Descriptive statistics show that women report higher mood states in each mood category as compared to men, supporting previous findings on gender differences in moods, both negative and positive (Hankin & Abramson, 1999; Diener, & et al., 1997; Manstead, 1992). Vigor emerges in our results as the highest-ranked mood state among both men and women, suggesting that working adults who 'go back to school', though they encounter academicrelated stressors, experience positive emotions (Kariv & Heiman, 2005). Fatigue appears to be the loweest-ranked mood state among both men and women in our study, supporting the supposition above as fatigue is negatively related to energy, joy or vigor. The first step in this study was to explore whether moods are differentiated by gender among TP-Ss. The analyses revealed gender differences in angry and depressed moods, where females reported experiencing higher levels. These results support previous findings on female students’ depressed moods (Shaikh, et al., 2004; Surtees, et al., 2002), while contradicting others (Grant et al., 2002). Though inconsistent findings have emerged to date

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in studies on these topics, these studies also indicate that anger is experienced more strongly by female TP-Ss. The present results showed that in dual-demanding and stressful situations, women TP-Ss experience more anger than men are of great importance. These results may imply women's self-disclosure more than men's. Additionally, while facing stressors derived from dual-demanding situations, and in contrast with our empirical knowledge on genderrelated anger moods, female TP-Ss do develop anger. If so, this finding is very relevant to both educational research and practice regarding teachers and executives who are involved in academic studies, in terms of providing the relevant supportive as well as guidance aimed at reducing women's anger in school. The multivariate analysis showed significant differences in coping strategy appearing in each mood state, showing that mood categories have an impact on specific coping strategies. More importantly in the analysis, gender appeared to be significant in differentiating among coping strategies, with the exception of task-oriented strategies and applying to significant others, in which no significant differences appear between men and women TP-Ss. Previous studies showed inconsistencies regarding gender differences in the use of taskoriented strategies (Billings & Moos, 1981; Hamilton & Fagot, 1988; Stone & Neale, 1984), which may explain the insignificance of gender effect on task-oriented coping choices revealed in our findings. Other findings that were partly support applied to a significant other social support which did not emerge as significant among TP-Ss. Insofar, gender-related coping strategies also showed that moods affect coping strategies regardless of gender. The next assumption that moods will affect coping strategies, when incorporating stressors that TP-Ss encounter and their personal attributes to the equations, was confirmed, both among men and women. The analyses revealed specific significant mood states that influenced each gender's coping strategies. Task-oriented coping, which appeared inconsistent in relation to gender in previous studies, was found significantly and positively related to depressed moods among male TP-Ss, but significantly and negatively related to depressed moods among female TP-Ss. Emotion-oriented coping, a strategy found in previous research more likely among women than among men (Billings & Moos, 1981; Stein & Nyamathi, 1999) was significantly and positively related to confused moods among male TP-Ss, and significantly and positively related to depressed moods among female TP-Ss. Avoidance, a typically female-oriented coping strategy (Winstead, et al., 1984) appeared significant in men in specific mood states, i.e., confusion, depression and fatigue, while among women it appeared significant in other mood states. These results reinforce our conception that coping with a dual-demanding environment, especially by individuals who are employed in stressful occupations, reflects not only a gender-based tendency but also the mood states derived from the stressors by each gender group.

Implications and Limitations First, the findings suggest that male and female TP-Ss manifest similar patterns in coping with their dual-demanding environment by adopting a range of coping strategies rather than employing one main gender-related coping strategy for managing most of the stressors encountered, and that the strategies used are determined largely by the moods developed by the stressors. The differences in coping behaviors are thus not a consequence of the different

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tendencies of male and female TP-Ss towards one or another coping strategy but, rather, are the result of proclivities emanating from the different moods developed by the stressors. Secondly, positive mood states, a neglected topic in the higher education and gender research were found here to be a concept associated to task- and emotion-oriented strategies and the use of family as social support. Future efforts should be addressed toward increasing our understanding of gender differences in positive moods. Third, deciphering TP-Ss’ mood reactions to dual-demanding stressors constitutes a significant contribution to both academic research and to stress and coping intervention programs, at work and in academic institutions. Finally, from a gender-related perspective, the findings suggested that male and female TP-Ss cope similarly with stressors, with both manifesting adaptive patterns, may moderate previous inferences as to gender-related coping behaviors. Concluding that female TP-Ss are more likely to implement emotion-oriented coping strategies in encountering academic- and workrelated stressors means categorizing them as less effective, especially in dealing with negative stressful situations, and as managing their emotional reactions rather than coping with the situation. From this perspective, presenting male TP-Ss as favoring task-oriented coping strategies may be seen as neglecting or suppressing their stressor-derived emotional reactions. The results of this study suggested that both men and women’s coping behaviors are seen to be an outcome of the context in which they emerge rather than of gender. The findings of this study have significant potential benefit for higher education and academic institutions in developing institutional stress reduction and anger management programs and in-house supportive and research centers. In understanding some basic differences between the genders in their "translation" of stressors into moods and coping, this input may contribute to the validation and to the relevance of intervention programs in academic institutions for improving male and female students' ability to cope with academic load and stress, especially where working-students are concerned; as well as assisting teachers and educational executives in managing their dual demanding stressors. Reducing students' stress through generic institutional interventions may be effective/ineffective for students, men or women, who developed specific mood states as a result of the stressors they face. For example, programs designed to develop a positive attitude among stressed students or to establish support groups may suit male students who experience confused moods or female students who experience depressed moods. This certainly implies that in the attempt of higher education institutions to develop stress reduction programs designated for working-students, a primary diagnosis should be executed in order to map the mood states as well as other emotional reactions and to assess the role of gender in the relationship between moods and the institutional programs.

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In: Mental Health of College Students Ed: Katherine N. Morrow

ISBN: 978-60456-394-8 ©2009 Nova Science Publishers, Inc.

Chapter 11

EXAMINING ANGER EXPRESSION REACTIONS AND ANGER CONTROL BEHAVIORS OF TURKISH STUDENTS Ibrahim Kisac* Gazi University, Ankara / Turkey

ABSTRACT The aim of this research is to examine anger expression reactions and anger control behaviors with respect to gender and education levels of the students when they are angry. Subjects were recruited from Gazi University, Abidinpasa High School and Aksaray Anatolian Hotel and Tourism Vocational High School and consist of 466 students. Inventory was prepared by the researcher to collect data about demographic qualities and anger behaviors of the students. Data were analyzed by frequency, percent and chi-square techniques. Results indicated that when the students get angry, they “sulk or make sour face”(77%), “try to think that everybody does not have to behave as they want”(76%) and “think that they can handle with the situation which made them angry” (75%). According to gender variable, male students significantly “say nasty things to the others”, but “try to be more intelligent and indulgent”, “to be more coolheaded”, “more think that not being able to control anger is a weakness” and “more think that they will not let others make them angry” than female students. On the other hand, it was found that female students more “sulk or make sour face”, “feel helpless, feel cry” and “say sarcastic words to the person who made them angry” than male students when they are angry. According to educational status, it was determined that while female high school students significantly “yell or scream more”, “argue with the person who made them angry” and “say nasty things to the others” more than female university students, female university students *

Gazi University, Vocational Education Faculty, Department of Educational Sciences, 06500 Besevler – Ankara / Turkey, [email protected]

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Ibrahim Kisac “express their anger in a more suitable way”, “try to see pozitif sides of the case”, “try to convince themselves not to be angered” more and “think that everybody does not have to behave as they want” when they feel angry. It was seen that while male high school students “make fun of the person who made them angry” more, male university students “do nothing at all, quite; suppress their their anger” more, “sulk or make sour face” and “withdraw from the people”.

Keywords: anger expression, anger control, gender, educational status

INTRODUCTION Anger is one of the most experienced emotions in daily life. When stresses and troubles of daily life are regarded, anger is an unavoidably experienced emotion. However, when it gets out of control, it can lead to many problems in personal relationship, at work and in other aspects of life. Anger is commonly destructive of social relationships (Kennedy, 1992). Moreover, anger is associated with a variety of psychological and social problems in adolescents and adults. High general anger individuals experience considerable distress and problems, with some of the anger significantly impacting their physical, social, educational and vocational well-being (Deffenbacher, Lynch, Oetting and Kemper, 1996; Vecchio and O’Leary, 2004; Phillips, Henry, Hosie and Milne, 2005; Dahlen and Martin, 2005; Dahlen and Martin, 2006). The individuals who have greater intensities and frequencies of anger reactivity usually cope less well with anger and express themselves in less positive and constructive ways (Deffenbacher et al., 1996). Consequently, anger control frequently appears as a primary or secondary problem for some people (Deffenbacher, 1988). Anger control is directly related to better psychological and physical health. At the same time, anger control is associated with lower psychological distress and less physical illness. Diong et al.’s (2005) study showed that individuals who can easily control their angry feelings create a more favorable interpersonal environment compared to those individuals who have difficulty in anger control. Therefore, what is anger control or how can anger be controlled? There are some approaches about controlling anger. One of them was the catharsis of anger. This opinion was based on the view that suppressing anger may cause several problems. Squelching or suppressing anger does not get an individual anywhere and unexpressed rage will do far more harm (Ellis, 1992). Suppressing anger costs too much (Tavris, 1982), or has many unpleasant side-effects for the people (Walters, 1983). So, anger should be released. However, Green, Stonner and Shope (1975) found that a catharsis lead to an increase in anger rather than a decrease (Cited in Lewis and Bucher, 1992). Ebbesen et al. (1975) showed that the catharsis of anger is ineffective at reducing it, and may very well increase it (Cited in Lewis and Bucher, 1992). Anger feeds anger. Rage which is not restrained by intelligence will turn into violence (Goleman, 1998). As a result, “the expression of anger leads to increased anger; the anger response is reinforced rather than drained” (Lewis and Bucher, 1992). Tice points out that vomiting anger is one of the worst ways to calm down. Rage bursts strongly arouse the brain, and make the individual angrier (Cited in Goleman, 1998).

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The second approach is suppressing anger. This happens by holding in anger. The aim of this is to inhibit anger. The danger of this approach is that if anger is not allowed outward expression, it can turn inward. Anger turned inward may cause stomach ulcers, high blood pressure, hypertension, depression, (Ellis, 1992; Sharkin, 1996) or pathological expression of anger such as passive-aggressive behavior, sarcastic behavior or making fun of people. The third approach about anger control is to calm down first, then to express it in a constructive way so that resolve the conflict by confronting the other person. This opinion is consistent with Asian and East cultures. One of the anger management techniques is “being silent” in these cultures. It is advised that “if one of you gets angry, let him be silent” (Beshir and Beshir). People are born with the potential to feel and to express anger. However, the things that make people angry, how they feel angry and what people do when they are angry are not the same for all people (Rubin, 1969). “Anger and its expression are result of biology and culture, mind and body” (Tavris, 1982). Individual’s thoughts, beliefs remain extremely important factors in determining both individual’s feelings and responses to any given situation (Berkowitz, 1990; Ellis, 1992). There is not enough study about socio-cultural context of anger. Anger is a highly interpersonal emotion. It can not be fully understood apart from the social context in which it occurs (Averill, 1983, Kassinova and Shuckhudolsky, 1995). It is fact that anger is a universal experience, but the experience and expression of anger may be influenced by one’s cultural heritage and world view. Culture may not only influence what are considered appropriate and inappropriate forms of anger expression, but also what makes people angry, what is perceived as anger and how people feel about their own anger (Sharkin, 1996). In another term, social constraints on the expression of anger are very effective (Kennedy, 1992). Few studies have investigated socio-cultural differences (such as race, ethnicity, and religion) in expressing and controlling anger (Ohbuchi, et al., 2004; Marby and Kiecolt, 2005; Bishop, Pek and Ngau, 2005). This research tries to find out the anger expression and control behaviors of the students in Turkish culture. The aim of this research is to examine anger expression reactions and anger control behaviors of the students with respect to gender and education levels when they are angry. In this study, it is attempted to define how the students react or express their anger, and what they do to control their anger.

METHOD Subjects were recruited from Gazi University (n=268), Abidinpasa High School (n=130) and Aksaray Anatolian Hotel and Tourism Vocational High School (n=68) and consist of 466 students. Sample contains 334 female and 132 male students. Anger Description Form was prepared by the researcher to collect data about demographic qualities and anger expression reactions, and anger control behaviors of the students. To develop that form, theories and studies in related literature were investigated. Anger Description form consisted of five sections. The first section is about demographic qualities of the participants such as gender, school type. The second section aims to collect data about which situations get individuals angry. The third section is about what individuals do when they are angry. The fourth section reveals experienced physical clues or reactions of

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the individuals when they are angry. Finally, the last section is examining to whom the people are expressing their anger. The form consists of “yes and no” statements. SPSS 13.0 was used to analyze findings. Data were analyzed by frequency, percent and chi-square techniques. The least significant level was considered p