Differences and Similarities in the Use of Nine Emotion Regulation Strategies in Western and East-Asian Cultures: Systematic Review and Meta-Analysis

“Publication bias was checked for strategies where the studies ≥ 10 (Sterne et al., 2011), using the Begg funnel plots and Egger’s regression test (Egger et al., 1997).”

“…the Emotion Regulation Questionnaire (ERQ, k = 13, Gross & John, 2003); one study used the Positive and Negative Affect Schedule (PANAS, k = 1, Watson et al., 1988) to examine how frequently people suppress expressing a broad range of positive and negative emotions when interacting with…”

“…East-Asian individuals with collectivistic orientations are encouraged to be inter-dependent and demonstrate the values self-effacement and self-criticism, and they tend to connect themselves to others and prioritize their interpersonal relationships (Kim & Sherman, 2007; Markus & Kitayama, 1991).”

“…answered by individuals from one culture than those from another culture (Chen et al., 1995; Harzing, 2006), translation quality issues (Behr, 2017; Brislin, 1970), and the reference-group effect that the understanding of oneself might be influenced by context-relevant confounds, which are to…”

“…(American Psychological Association Publications and Communications Board Working Group on Journal Article Reporting Standards, 2008) and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines (Page et al., 2021) for systematic reviews and meta-analysis.”

“…consequences of negative emotional stimuli (McRae & Gross, 2020) Mindfulness Receptive attention to and awareness of present events and experience (Brown & Ryan, 2003) Distraction Directing attention away from emotional stimuli to decrease their emotional impact (McRae & Gross, 2020)…”

“Most included studies evaluated suppression ( k = 14), with the most commonly used measure being the Emotion Regulation Questionnaire (ERQ, k = 13, Gross & John, 2003); one study used the Positive and Negative Affect Schedule (PANAS, k = 1, Watson et al., 1988) to examine how frequently people suppress expressing a br…”

“Publication bias was checked for strategies where the studies ≥ 10 (Sterne et al., 2011), using the Begg funnel plots and Egger’s regression test (Egger et al., 1997).”

“Data were analyzed using R v.4.3.0 (R Core Team, 2023) and the meta package, version 5.5-0 (Balduzzi et al., 2019).”

“…impact (McRae & Gross, 2020) Self-compassion An attitude of kindness and acceptance toward difficult experiences and negative aspects of oneself (Neff, 2003) Expression Conveying emotional states by means of verbal or nonverbal modalities (Kennedy-Moore & Watson, 2001) independent and…”

“Avoidance was evaluated in three studies, with the modified version of the WCQ ( k = 1, Folkman et al., 2000), the Acceptance and Action Questionnaire-II (AAQ-II, k = 1, Bond et al., 2011), and the Maladaptive and Adaptive Coping Style Questionnaire (MAX, k = 1, Moritz et al., 2016).”

“Trying not to accept and experience distressing thoughts, feelings, memories, and other internal events (Hayes et al., 1996)”

“This difference may exist because of the inhibitory “display rules” (Ekman & Friesen, 1969) encouraged by East-Asian culture and not because East-Asians experience less emotion than Westerners (Mesquita & Frijda, 1992).”

“The inter-reliability ratings in both stages were determined using the Prevalence and Bias-Adjusted Kappa ( PABAK ; Byrt et al., 1993).”

“Knapp–Hartung adjustments (Knapp & Hartung, 2003) were used to calculate the confidence interval around the pooled effect.”

“Considering that participants were drawn from different countries, a random-effects model was used since heterogeneity between studies was anticipated (Harrer et al., 2021).”

“…indicated that rumination is more likely to predict maladaptive outcomes in Western individuals than in East-Asian individuals, such as worse mental health and lower life satisfaction (Chang et al., 2010; Schunk et al., 2022) and less social support (Kitayama et al., 1997; Schunk et al., 2021).”

“Specifically, interdependent self-construal that is encouraged in the collectivistic cultural contexts (e.g., East-Asia) values connecting themselves with others and controlling/minimizing emotions of the self to preserve group harmony (Ramzan & Amjad, 2017; Tsai et al., 2006).”

“Some research did not find significant cultural differences in the frequency of using reappraisal between East-Asians and Westerners (Matsumoto, 2006; Schunk et al., 2021, 2022; Soto et al., 2011), whereas inconsistent results emerged that East-Asians are less likely (Nozaki, 2018) or more likely (Matsumoto, 2006; O’C…”

“…from another culture (Chen et al., 1995; Harzing, 2006), translation quality issues (Behr, 2017; Brislin, 1970), and the reference-group effect that the understanding of oneself might be influenced by context-relevant confounds, which are to compare self with others around (Heine et al., 2002).”

“Some research did not find significant cultural differences in the frequency of using reappraisal between East-Asians and Westerners (Matsumoto, 2006; Schunk et al., 2021, 2022; Soto et al., 2011), whereas inconsistent results emerged that East-Asians are less likely (Nozaki, 2018) or more likely (Matsumoto, 2006; O’C…”

“This is not surprising since a strong positive association between avoidance and suppression has been found in previous research (Kashdan et al., 2006; Su et al., 2014).”

“…suppression as the “display rule” (e.g., East-Asia), rather than expression (e.g., the West), suppression may have relatively lower costs for East-Asian individuals on social function (Butler et al., 2007; Schunk et al., 2021), and may even benefit them on interpersonal harmony (Wei et al., 2013).”

“…use frequency of suppression, as an emotion regulation strategy, was evaluated in 12 papers involving 14 studies (Han et al., 2022; He et al., 2021; Matsumoto et al., 2008; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022,2023; Soto et al., 2011; Su et al., 2014; Wei et al., 2013; Zhou…”

“…present events and experience (Brown & Ryan, 2003) Distraction Directing attention away from emotional stimuli to decrease their emotional impact (McRae & Gross, 2020) Self-compassion An attitude of kindness and acceptance toward difficult experiences and negative aspects of oneself (Neff, 2003)…”

“Rumination was evaluated in four studies, three of them used the Perseverative Thinking Questionnaire (PTQ, k = 3, Ehring et al., 2011); another study used the Anger Rumination Scale (ARS, k = 1, Sukhodolsky et al., 2001).”

“…as divergent response styles that the midpoint a scale is possible to be answered by individuals from one culture than those from another culture (Chen et al., 1995; Harzing, 2006), translation quality issues (Behr, 2017; Brislin, 1970), and the reference-group effect that the understanding of…”

“Tsai (2007) further found that Chinese Americans valued low-arousal positive affective states more than did Chinese, also, Chinese Americans were more interdependent and more likely to suppress the self to adjust to others.”

“…used the Distress Disclosure Index (DDI, k = 2, Kahn & Hessling, 2001); one of them used the Emotional Expressiveness Questionnaire (EEQ, k = 1, King & Emmons, 1990); another one used the Affect Valuation Index (AVI, k = 1, Tsai et al., 2006) to capture the frequency of expressing positive and…”

“Decades of research explored the use frequency and effectiveness of different emotion regulation strategies (Joormann & Stanton, 2016).”

“…styles that the midpoint a scale is possible to be answered by individuals from one culture than those from another culture (Chen et al., 1995; Harzing, 2006), translation quality issues (Behr, 2017; Brislin, 1970), and the reference-group effect that the understanding of oneself might be…”

“Rumination was evaluated in four studies, three of them used the Perseverative Thinking Questionnaire (PTQ, k = 3, Ehring et al., 2011); another study used the Anger Rumination Scale (ARS, k = 1, Sukhodolsky et al., 2001).”

“…involving a broad range of emotion regulation strategies to examine how different emotion regulation strategies are structurally related to one another (see Naragon-Gainey et al., 2017), but it did not examine the use frequency of these strategies or consider their cultural influences.”

“…magnetic resonance imaging (fMRI), with the interpretation that the activation of TPJ involves understanding others and the preference of connecting self to others whereas the activation of mPFC is associated with self-relevant information (Chiao et al., 2009; S. Han & Ma, 2014; Macrae, 2004).”

“Individuals who use more avoidance may minimize and suppress their emotions more frequently (Campbell-Sills et al., 2006; Hayes et al., 1996).”

“…of suppression, as an emotion regulation strategy, was evaluated in 12 papers involving 14 studies (Han et al., 2022; He et al., 2021; Matsumoto et al., 2008; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022,2023; Soto et al., 2011; Su et al., 2014; Wei et al., 2013; Zhou et al., 2022).”

“Notably, the preference of migrants might depend on the extent to which they engage in and identify with both cultures (Tsai et al., 2000).”

“…East-Asian individuals with collectivistic orientations are encouraged to be inter-dependent and demonstrate the values self-effacement and self-criticism, and they tend to connect themselves to others and prioritize their interpersonal relationships (Kim & Sherman, 2007; Markus & Kitayama, 1991).”

“…to be answered by individuals from one culture than those from another culture (Chen et al., 1995; Harzing, 2006), translation quality issues (Behr, 2017; Brislin, 1970), and the reference-group effect that the understanding of oneself might be influenced by context-relevant confounds, which…”

“…should be aware that the prerequisite of observing true cultural differences is to confirm the instrument has the same measurement properties across cultural samples, for instance, conducting CFA and/or EFA to test cultural measurement invariance (Boer et al., 2018; Fischer & Karl, 2019).”

“Expression was evaluated in four studies, two of them used the Distress Disclosure Index (DDI, k = 2, Kahn & Hessling, 2001); one of them used the Emotional Expressiveness Questionnaire (EEQ, k = 1, King & Emmons, 1990); another one used the Affect Valuation Index (AVI, k = 1, Tsai et al., 2006) to…”

“In the present systematic review and meta-analysis, we focus on the comparison between East-Asian and Western individuals because it has dominated the literature on emotion regulation, cross-culturally (Ford & Mauss, 2015; Hampton & Varnum, 2018).”

“For example, Zeng and Greenfield (2015) observed a declining tendency in col-lectivistic cultural values in China, by reviewing the Chinese corpus to summarize the frequency of words related to collectivism (e.g., “sacrifice” and “obedience”) from 1970 to 2008.”

“…should be aware that the prerequisite of observing true cultural differences is to confirm the instrument has the same measurement properties across cultural samples, for instance, conducting CFA and/or EFA to test cultural measurement invariance (Boer et al., 2018; Fischer & Karl, 2019).”

“…of suppression, as an emotion regulation strategy, was evaluated in 12 papers involving 14 studies (Han et al., 2022; He et al., 2021; Matsumoto et al., 2008; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022,2023; Soto et al., 2011; Su et al., 2014; Wei et al., 2013; Zhou et al., 2022).”

“The effect of culture on the spontaneous use frequency of expression was examined in four papers involving four studies (Kahn et al., 2017; Kang et al., 2003; Krys et al., 2022; Wei et al., 2013).”

“…(the United States, Canada, Australia, New Zealand, and countries in Europe) but not “ex-Com-munist” countries (such as Poland, Croatia, and the Czech Republic), as Inglehart (2006) has pointed out, these countries differ significantly on a range of cultural variables from the rest of Europe.”

“…magnetic resonance imaging (fMRI), with the interpretation that the activation of TPJ involves understanding others and the preference of connecting self to others whereas the activation of mPFC is associated with self-relevant information (Chiao et al., 2009; S. Han & Ma, 2014; Macrae, 2004).”

“It is a possibility that differences in strategy usage could emerge, depending on the valence of the emotion being controlled, in both East-Asians and the Westerners (Kitayama et al., 2000; Miyamoto & Ma, 2011; Sang et al., 2014).”

“Furthermore, differences in the patterns of neural activity have also been linked with cultural values (see S. Han & Ma, 2014, for a review).”

“…individual goals over group goals and encourages asserting authentic emotions of the self, while suppressing/minimizing emotions may lead to the lack of consistency between the emotional experience and response (Markus & Kitayama, 1991; Ramzan & Amjad, 2017; Soto et al., 2005; Tsai & Lu, 2018).”

“Some research did not find significant cultural differences in the frequency of using reappraisal between East-Asians and Westerners (Matsumoto, 2006; Schunk et al., 2021, 2022; Soto et al., 2011), whereas inconsistent results emerged that East-Asians are less likely (Nozaki, 2018) or more likely…”

“Existing evidence suggests that East-Asian and Western individuals may differ in their indi-vidualism/collectivism orientations, which may be associated with their emotion regulation choice (Butler et al., 2007; Cheung & Park, 2010; Ford & Mauss, 2015; Hofstede et al., 2010; Matsumoto et al., 2008).”

“For instance, Pennebaker and Smyth (2016) argue that putting our emotional experiences into language and words can help people understand and deal with emotional upheavals to promote positive emotion regulation.”

“…not have a chance to include neural relevant studies in the present systematic review since such studies are often conducted in a single country (e.g., Roberts et al., 2008) or did not provide relevant data (e.g., Kim et al., 2011), which did not meet the inclusion criteria of the current study.”

“…suppression (Gross & John, 2003; Han et al., 2022; Matsumoto, 2006; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022; Soto et al., 2011; Su et al., 2014; Zhou et al., 2022), avoidance (Nishiguchi et al., 2022; O’Connor & Shimizu, 2002; Su et al., 2014) compared with Western individuals.”

“…that oxytocin receptor polymorphism (OXTR) rs53576 is associated with collectivistic cultural orientation and the tendency to regulate emotions (Kim et al., 2011; Luo & Han, 2014), although Ishii et al. (2021) found OXTR rs53576 did not moderate cultural differences in emotional expression.”

“Avoidance was evaluated in three studies, with the modified version of the WCQ ( k = 1, Folkman et al., 2000), the Acceptance and Action Questionnaire-II (AAQ-II, k = 1, Bond et al., 2011), and the Maladaptive and Adaptive Coping Style Questionnaire (MAX, k = 1, Moritz et al., 2016).”

“…individual goals over group goals and encourages asserting authentic emotions of the self, while suppressing/minimizing emotions may lead to the lack of consistency between the emotional experience and response (Markus & Kitayama, 1991; Ramzan & Amjad, 2017; Soto et al., 2005; Tsai & Lu, 2018).”

“…indicated that rumination is more likely to predict maladaptive outcomes in Western individuals than in East-Asian individuals, such as worse mental health and lower life satisfaction (Chang et al., 2010; Schunk et al., 2022) and less social support (Kitayama et al., 1997; Schunk et al., 2021).”

“Similarly, the perceived importance of collectivism-related folk beliefs was found to decline in China relative to the past (Xu & Hamamura, 2014).”

“East-Asians reported more rumination usage than Westerners, in some studies (Maxwell et al., 2005; Schunk et al., 2022), but less than Westerners in the study from Schunk et al. (2021).”

“In addition, given that measurement invariance is a condition for conducting meaningful group comparisons, we excluded three studies in which measurement invariance was not observed in the compared cultural groups (Burghart et al., 2023; Hao et al., 2019; Tamir et al., 2023).”

“…individual goals over group goals and encourages asserting authentic emotions of the self, while suppressing/minimizing emotions may lead to the lack of consistency between the emotional experience and response (Markus & Kitayama, 1991; Ramzan & Amjad, 2017; Soto et al., 2005; Tsai & Lu, 2018).”

“For instance, European Americans showed increased activation in the ventrolateral prefrontal cortex (VLPFC) during cognitive reappraisal, while Chinese participants showed decreased VLPFC activation (Qu & Telzer, 2017).”

“Our results showed that East-Asian culture was associated with greater use of suppression, which is consistent with the findings from a previous systematic review (Weiss et al., 2022).”

“…indicated that rumination is more likely to predict maladaptive outcomes in Western individuals than in East-Asian individuals, such as worse mental health and lower life satisfaction (Chang et al., 2010; Schunk et al., 2022) and less social support (Kitayama et al., 1997; Schunk et al., 2021).”

“Based on criteria from a previous study (Sznitman & Taubman, 2016), the total score for each study was considered as “high quality” (if ≥ 75%), “moderate quality” (if 51%-74%), and “poor quality” (if ≤ 50%).”

“…that oxytocin receptor polymorphism (OXTR) rs53576 is associated with collectivistic cultural orientation and the tendency to regulate emotions (Kim et al., 2011; Luo & Han, 2014), although Ishii et al. (2021) found OXTR rs53576 did not moderate cultural differences in emotional expression.”

“First, Westerners and East-Asians may diverge in the degree of interdependent and independent self-construal (Kraus & Kitayama, 2019; Markus & Kitayama, 1991; Tsai & Lu, 2018).”

“This shows that self-reported emotion regulation strategy usage does not always match the emotional reaction at the neural level (Hampton et al., 2021; Soto et al., 2016; Varnum & Hampton, 2017).”

“…of suppression, as an emotion regulation strategy, was evaluated in 12 papers involving 14 studies (Han et al., 2022; He et al., 2021; Matsumoto et al., 2008; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022,2023; Soto et al., 2011; Su et al., 2014; Wei et al., 2013; Zhou et al., 2022).”

“The effect of culture on the spontaneous use frequency of expression was examined in four papers involving four studies (Kahn et al., 2017; Kang et al., 2003; Krys et al., 2022; Wei et al., 2013).”

“It is worth noting that, while expression was viewed as an outcome of emotion regulation in some research (Fischer et al., 2004; McDuff et al., 2021), some studies treat emotional expression as an emotion regulation strategy.”

“…the spontaneous use frequency of suppression, as an emotion regulation strategy, was evaluated in 12 papers involving 14 studies (Han et al., 2022; He et al., 2021; Matsumoto et al., 2008; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022,2023; Soto et al., 2011; Su et al., 2014; Wei…”

“East-Asian individuals are more likely to use suppression (Gross & John, 2003; Han et al., 2022; Matsumoto, 2006; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022; Soto et al., 2011; Su et al., 2014; Zhou et al., 2022), avoidance (Nishiguchi et al., 2022; O’Connor & Shimizu, 2002; Su et…”

“…suppression (Gross & John, 2003; Han et al., 2022; Matsumoto, 2006; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022; Soto et al., 2011; Su et al., 2014; Zhou et al., 2022), avoidance (Nishiguchi et al., 2022; O’Connor & Shimizu, 2002; Su et al., 2014) compared with Western individuals.”

“…were not observed in the late positive potential (LPP) responses by previous studies that examined suppression using electroencephalography (EEG), although East-Asian participants self-reported more suppression usage compared with Western participants (Hampton et al., 2021; Varnum & Hampton, 2017).”

“It is a possibility that differences in strategy usage could emerge, depending on the valence of the emotion being controlled, in both East-Asians and the Westerners (Kitayama et al., 2000; Miyamoto & Ma, 2011; Sang et al., 2014).”

“The effect of culture on the spontaneous use frequency of expression was examined in four papers involving four studies (Kahn et al., 2017; Kang et al., 2003; Krys et al., 2022; Wei et al., 2013).”

“…were not observed in the late positive potential (LPP) responses by previous studies that examined suppression using electroencephalography (EEG), although East-Asian participants self-reported more suppression usage compared with Western participants (Hampton et al., 2021; Varnum & Hampton, 2017).”

“…indicated that rumination is more likely to predict maladaptive outcomes in Western individuals than in East-Asian individuals, such as worse mental health and lower life satisfaction (Chang et al., 2010; Schunk et al., 2022) and less social support (Kitayama et al., 1997; Schunk et al., 2021).”

“Narrative Synthesis Kahn et al. (2017) found that Chinese (Taiwan) use more mindfulness than European Americans with a small effect size (Cohen’s d = −0.2).”

“In addition, given that measurement invariance is a condition for conducting meaningful group comparisons, we excluded three studies in which measurement invariance was not observed in the compared cultural groups (Burghart et al., 2023; Hao et al., 2019; Tamir et al., 2023).”

“We excluded one study focused on migraine patients because their spontaneous use of emotion regulation strategies may be more affected by headache symptoms and therapy, than culture (Wolf et al., 2020).”

“In the present systematic review and meta-analysis, we focus on the comparison between East-Asian and Western individuals because it has dominated the literature on emotion regulation, cross-culturally (Ford & Mauss, 2015; Hampton & Varnum, 2018).”

“…indicated that rumination is more likely to predict maladaptive outcomes in Western individuals than in East-Asian individuals, such as worse mental health and lower life satisfaction (Chang et al., 2010; Schunk et al., 2022) and less social support (Kitayama et al., 1997; Schunk et al., 2021).”

“…suppression (Gross & John, 2003; Han et al., 2022; Matsumoto, 2006; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022; Soto et al., 2011; Su et al., 2014; Zhou et al., 2022), avoidance (Nishiguchi et al., 2022; O’Connor & Shimizu, 2002; Su et al., 2014) compared with Western individuals.”

“In addition, given that measurement invariance is a condition for conducting meaningful group comparisons, we excluded three studies in which measurement invariance was not observed in the compared cultural groups (Burghart et al., 2023; Hao et al., 2019; Tamir et al., 2023).”

“We also excluded one study that focused on psychotherapists because they may adjust their emotions to achieve therapeutic goals, even though their use of emotion regulation strategies is often sponta-neous (Chui & Liu, 2021).”

“…suppression (Gross & John, 2003; Han et al., 2022; Matsumoto, 2006; Nozaki, 2018; Orkibi et al., 2021; Schunk et al., 2021, 2022; Soto et al., 2011; Su et al., 2014; Zhou et al., 2022), avoidance (Nishiguchi et al., 2022; O’Connor & Shimizu, 2002; Su et al., 2014) compared with Western individuals.”

“…that oxytocin receptor polymorphism (OXTR) rs53576 is associated with collectivistic cultural orientation and the tendency to regulate emotions (Kim et al., 2011; Luo & Han, 2014), although Ishii et al. (2021) found OXTR rs53576 did not moderate cultural differences in emotional expression.”

“Alternatively, in the inverse case, the incapability to adopt harmonious elements with the companies’culture could obstruct the effective integration of AI within HRM roles [24].”

“…addition, given fi ndings that individuals from East-Asian cultures tend to rely more on suppression and avoidance as emotion regulation strategies (Song, Chan, & Ryan, 2024), trait mindfulness - conceptually positioned as an antithesis to suppression and avoidance - may operate differently across…”

“Expert commentary emphasizes the need for cross-sectoral collaboration between ministries of health, education, and child development to mainstream ER in adolescent well-being strategies [88].”

“Children who exhibit stronger adaptive regulation skills tend to have better psychological well-being, as they can regulate their emotions and engage in more prosocial behaviors (Calkins et al., 1999; Song et al., 2024; Spinrad et al., 2006).”

“Furthermore, these similarities should be interpreted with caution, as the generalizability of mean scores may be limited since prior studies, for example, suggested ER strategy differences between Western and East Asian cultures [126].”

“…fluctuations aligns with previous research indicating that East Asian cultural contexts foster dialectical emotional approaches, characterized by internal acceptance of negative affect alongside external emotional restraint (Miyamoto & Ryff, 2011; Nagulen-dran & Jobson, 2020; Song et al., 2024).”

“Cross-cultural replications using equivalent methodologies could disentangle universal versus culture-bound aspects of these relationships, particularly concerning emotion regulation strategies 94,95 .”

“In East Asian cultures, compared to Western societies, personal emotions tend to be suppressed in favor of maintaining a balance between positive and negative affect, particularly among women [33].”

“For example, East-Asian samples often show greater use of expressive suppression compared to Western samples (Song et al., 2024).”

“In Chinese cul - tural settings that place a high value on emotional restraint, adolescents may have fewer opportunities to practice and develop more open or confrontational forms of emotional expression (Song et al., 2024).”

“…than European Americans when imagin - ing their partner’s dampening responses (Li et al., 2025), possibly due to dialectical emotion beliefs (e.g., a balance between positive and negative affect) and the frequent use of suppression and distraction to adhere to display rules (Song et al., 2024 ).”

“Despite the rich literature on cultural influences on emotional expression, prior research has predominantly relied on an East–West contrast, characterizing Westerners as expressive and Easterners as restrained (Butler et al., 2007; Kang et al., 2003; Song et al., 2024).”

“In non-WEIRD countries, individuals may prioritize conflict avoidance and group harmony over direct emotion regulation strategies, such as cognitive appraisal (Song et al. 2024).”

“For example, [52] reports that East-Asian cultures are associated with greater use of suppression and avoidance than Western individuals.”

“71 Korean American women may experience competing cultural norms—Korean cultural values that emphasize emotional restraint and self-control, and American cultural values that may promote more open emotional expression.”

“Another explanation may lie in Confucian norms, which discourage emotional expression and encourage suppression and avoidance (Song et al., 2024 ).”

“…not been adapted to the Chinese culture, which emphasizes maintaining calm via contra-hedonic emotion regulation (decreasing positive emotions and increasing negative emotions) and relies more on avoidance and suppression (Song et al., 2024), as compared to Western cultures (Miyamoto et al., 2014).”

“EMQ 20 may also reflect a tendency toward emotion avoidance, which is common among the Chinese (Song et al., 2024).”

“This finding may appear somewhat unexpected, given that expressive suppression is often described as more socially sanctioned in many collectivistic cultural contexts, where emotional restraint is valued for the sake of group harmony [77–79].”

“Specifically, in the Korean sociocultural context, traditional norms often emphasize emotional restraint, which contributes to a persistent stigma against mental illness [33,34].”

“This is a notable limitation given recent evidence that East Asian individuals are more likely to utilize emotional avoidance strategies (Song et al., 2024) and engage in avoidant coping (Yoon et al., 2024) compared to individuals in Western countries (e.g., United States, Canada, Europe).”

“People in East-Asian cultures tend to use emotional regulation strategies, such as suppression and avoidance, more often than people in western cultures (16), which might affect how they express emotional distress.”

“Cultural norms regarding emotional expression, interpersonal relationships, and coping with distress may shape both rumination and nonsuicidal self-injury(Song et al., 2024 ).”

“We speculate that in cultural contexts such as China, where emotional restraint is valued and intense affective expression is often discouraged (Song et al., 2024), the high-arousal demands of standalone imaginal exposure may be particularly challenging.”

“In East Asian cultures, emotional restraint has traditionally been considered a social norm [28], potentially reducing the likelihood that nonoverlapping manic symptoms — such as elevated mood, grandiosity, talkativeness, and decreased need for sleep — are expressed or reported during MDEs [7].”