جنسیت، نقش های جنسیتی و اضطراب: تاییدپذیری ادراک شده خود گزارشی، اجتناب رفتاری و حساسیت فیزیولوژیکی

Despite the well-documented gender effect in anxiety, less is known about contributing factors to women's greater risk for anxiety and fears. The present study examined the relationship between gender, gender role orientation (i.e., expressivity/instrumentality) and fear of harmless insects (tarantula), using a multimodal approach of self-report measures, a Behavioral Approach Test (BAT), and physiological reactivity. Participants (144 college students; 67 women, 77 men) completed a questionnaire packet and then were instructed to approach a tarantula. We were unable to replicate Pierce and Kirkpatrick's (1992) findings that men underreport anxiety. Consistent with the literature, women in the study experienced greater anxiety and avoidance compared to men. However, men and women did not differ on physiological reactivity during the first 2 min of the BAT. The concordance across avoidance, anxiety and heart rate reactivity differed by gender, suggesting that men and women have different experiences when faced with a fearful object. Furthermore, instrumentality (masculinity) was negatively related to anticipatory anxiety for women but not for men.

Research has consistently demonstrated that women tend to be at a greater risk for developing anxiety disorders than men (Bourdon et al., 1988 and Weissman and Merikangas, 1986). Data from large epidemiological studies indicate a gender ratio of 2:1 (women:men) for anxiety disorders (Angst and Dobler-Mikola, 1985 and Bruce et al., 2005). Using data from the National Co-morbidity Study, Kessler, Chiu, Demler, Merikangas, and Walters (2005) found lifetime prevalence rates of 36.4% for women and 25.4% for men for anxiety disorders. Furthermore, several cross-cultural studies have reported a gender effect in fear reporting towards harmless animals or disgust-relevant animals, such as spiders, snakes, or worms (Davey et al., 1998). It appears that the extent of this gender effect varies according to specific types of stimuli, with fears of harmless animals (e.g., dogs, spiders) being most pronounced (Arrindell et al., 2003), whereas no gender effect was observed in fears of enclosed spaces, loud noise, or bodily injury (e.g., Tucker & Bond, 1997). Davey et al. (1998) found that women were more fearful of disgust-relevant animals (e.g., worms, spiders) than men, whereas there was no difference in reported fear towards threat-posing animals (e.g., sharks, lions). Despite these findings and the growing body of literature confirming the well-established gender effect, little is known about specific factors that may predispose women to this higher risk. Most researchers reporting a gender effect in anxiety often explain their findings by referring to well known prevalence rates or simply fail to provide an explanation. A recent review by McLean and Anderson (2009) concluded that different socialization experiences, which teach gender-specific expression and acceptable coping styles, might contribute to the gender effect in anxiety and fear. In the literature, the terms gender and sex are often used interchangeably. However, since physiology is not the only factor that separates men from women, it is important to consider other differences such as cultural, economic, and social variations whenever referring to differences between women and men. Thus, the term gender will be used throughout this report to encompass a wide range of behaviors, attitudes and personality traits associated with being a woman or a man. Traditional gender roles are believed to contribute to women's greater vulnerability for anxiety and phobias (Fodor, 1974). Fodor argued that this predisposition was due to gender socialization teaching women to be dependent, fearful, passive, and submissive, whereas men are taught to be courageous, active, and goal and achievement oriented. Although research has consistently demonstrated a relationship between self-reported fear and gender role traits, such as femininity and masculinity, there is less consensus about which gender role contributes to anxiety and fear. Some studies have suggested that femininity was related to elevated fear of harmless animals (Dillon et al., 1985 and Tucker and Bond, 1997), while others have demonstrated that identifying with a more masculine gender role was negatively associated with fear and anxiety (Arrindell, 2000 and Chambless and Mason, 1986). For example, low masculinity (e.g., lack of assertiveness) was associated with anxiety and avoidant behavior, whereas high femininity (e.g., nurturing and kind) was not associated with avoidance and anxiety (Chambless & Mason, 1986). This inconsistent pattern has also been observed in children. While Ginsburg and Silverman (2000) reported that low masculinity was associated with number of fears endorsed among children, others have demonstrated that high femininity was related to anxiousness in children (Muris, Meesters, & Knoops, 2005). This well-established gender effect also might be explained by differential reinforcement boys and girls receive from parents and society. Since it is acceptable for girls to express anxiety and sadness, these emotions tend to be encouraged in girls, whereas boys are expected to act courageously and face their fears (Bem, 1981) perhaps providing boys with more opportunity for fear reduction. An example of parents encouraging gender-conforming behaviors in their children is demonstrated in a study conducted by Stevenson-Hinde and Shouldice (1993). In their study, parents approved of their girls’ shyness and disapproved of the same shy behaviors if portrayed by boys. In fact, parents became less accepting of shy behaviors the older the boy was. This differential reinforcement is observed in the school settings as well. Buck (1975) demonstrated that teachers respond differently to the same behavior depending on the gender of the child. It was reported that teachers ignored girls’ active involvement but provided positive attention when girls complied with culturally accepted gender roles, such as being submissive. Overall, boys received more positive reinforcement for being assertive, independent and active, while girls were rewarded for showing empathy and being social (e.g., Keenan & Shaw, 1997). Given that this differential reinforcement begins early in life and continues to be reinforced by society, it is possible that men and women may not be equally motivated to report their anxiety. One could speculate that men might be underreporting their actual fear or distress to be consistent with traditional masculine gender roles and avoid being perceived as vulnerable or weak, while it is more acceptable for women to express their true fears without fearing negative consequences (Craske, 2003 and McLean and Anderson, 2009). Pierce and Kirkpatrick (1992) tested whether men underreport their fear levels by asking participants to complete the same fear survey on two separate occasions. When participants came in for the second session, they were being informed that their answers could be “verified” by measuring their heart rate while they viewed images related to the items on the questionnaire. The authors demonstrated that, by making participants believe that their truthfulness was being verified, men showed significantly higher ratings during the second session compared to responses they provided at the initial meeting, while women's responses did not differ between the sessions. While the study demonstrated that men underreport their fear on self report measures, this reporting bias did not completely account for the gender effect as women still reported higher anxiety levels than men during the second session (Pierce & Kirkpatrick, 1992). To further explore the response bias hypothesis, Egloff and Schmukle (2004) examined participant's responses to both explicit (self-report measures) and implicit (Implicit Association Test and the Emotional Stroop Task) measures of anxiety. Implicit measures are believed to allow for a better exploration of whether or not the gender effect is due to response bias, since they allow for an indirect way of measuring anxiety. Egloff and Schmukle (2004) demonstrated that women reported greater anxiety than men on both implicit and explicit tests. However, the effect size on the implicit measures was half the size of that for the explicit measures. While research has consistently shown that women report greater fear and anxiety on self-report measures (see McLean & Anderson, 2009 for review), and tend to display more anxiety during stressful tasks (e.g., Chaplin et al., 2008 and Kelly et al., 2006), findings about the gender effect on physiological reactivity are rather conflicting. Although there is some indication that women and men experience similar physiological reactivity, such as electrodernal reactivity and heart rate during several CO2 inhalations (Kelly et al., 2006), there is a greater body of literature suggesting that women are physiologically more reactive to a stressful situation than men. Specifically, Kudielka, Buske-Kirschbaum, Hellhammer, and Kirschbaum (2004) reported that women displayed more elevated heart rate response during a stressful task (Trier Social Stress Test) than men. The same pattern of physiological reactivity was demonstrated in an adolescent sample. Anderson and Hope (2009) examined response patterns of socially anxious and non-anxious adolescents during a social situation and found that, regardless of social anxiety, girls had higher heart rate reactivity than boys during the speech. Further, Schmaus, Laubmeier, Boquiren, Herzer, and Zakowski (2008) examined the gender effect on repeated stressor as a measure of habituation. Their results revealed that watching a 7-min Holocaust video on two separate occasions (2 days apart) resulted in an elevated heart rate during the second presentation among women only (Schmaus et al., 2008). While the study suggested that women's greater risk for anxiety disorders may be due to lack of habituation, avoidance behavior during the video was not assessed, which may have contributed to the observed lack of habituation. The gender effect has also been observed in avoidance behavior, such that anxious women displayed more avoidance than anxious men (e.g., Cameron and Hill, 1989 and Thyer et al., 1985). Speltz and Bernstein (1976) examined avoidance behavior among college students who were fearful of snakes. Men, who reported high anxiety and fear, got closer to the snake than did highly fearful women. Behavioral observations indicated that both men and women appeared equally distressed during the approach task, suggesting that the observed gender effect in the study might be a result of subjective fear and avoidance. Thus, despite similar levels of fear and distress, men approached the feared object more than did women. Avoidance behavior has been reinforced in girls by society from an early age, while boys have been encouraged to face their fears and control anxiety (see Craske, 2003 for review). This continuous exposure likely allows boys to acquire corrective learning, disconfirming their initial fear to the feared situation or stimuli, which is the main principle of exposure therapy (e.g., Barlow, 2004 and Craske, 1999). The culturally reinforced coping strategy for girl on the other hand, is to avoid or escape from fear-inducing situations, interfering with their opportunity to overcome their fears. The current study follows a previous project in our laboratory which attempted to replicate Pierce and Kirkpatrick's (1992) findings and investigate whether men would report higher subjective fear levels during the task if they were told that their fear ratings would be verified with their heart rate data, as opposed to those who received instructions that the heart rate was not a good measure of fear (McLean & Hope, 2010). Participants were randomly assigned to one of two heart rate conditions (verifiable and irrelevant) prior to attempting the Behavioral Approach Test (BAT). The BAT consisted of 12 steps that culminated in touching the spider for 3 s with 2 fingers. Unlike Pierce and Kirkpatrick's (1992) which found men had a tendency to underreport their anxiety, there was no difference in men's reports, regardless of whether they believed their anxiety level could be verified by a heart rate monitor. Other results indicated that greater fear of spiders was associated with greater subjective anxiety and more avoidance during the BAT. Consistent with results from community and clinical samples, women reported greater anticipatory and peak anxiety ratings and demonstrated more avoidance of the feared object than men. Regardless of gender, low instrumentality, or low masculinity, was associated with more avoidance. Interestingly, greater expressivity, or the identification with a feminine gender role, was associated with more avoidance among men only, but was not related to avoidance or fear among women. However, given that the BAT demonstrated a ceiling effect, it is possible that the study was not able to accurately measure the relationship between gender role and avoidance. Furthermore, there was some indication that participants might have felt pressured to complete the task in order to receive study credits, which may have contributed to the high completion of the BAT. In sum, prior research has consistently demonstrated that women report greater anxiety and fear in both clinical and community samples. Gender socialization practices and cultural expectations provide one possible explanation for the gender effect, socializing children from a young age to conform to gender-specific traits. While the literature has provided support for the importance of gender roles in understanding women's greater risk for anxiety disorders, the results remain mixed regarding which specific gender role traits account for the gender effect. While some studies have demonstrated that high expressivity (femininity) was related to greater fear, others have shown that low instrumentality (masculinity) was associated with more anxiety. Given the inconsistent findings and the fact that most studies have relied on self-report measure, with only a few utilizing behavioral measures to aid in the explanation of the gender effect, it would be important to employ a more comprehensive assessment to further explore the gender role theory as it relates to anxiety. The first goal of the current study was to again attempt to replicate Pierce and Kirkpatrick's (1992) findings that men, who are told their fear ratings will be verified with their heart rate data, report higher subjective fear than those who receive instructions that heart rate is not a good measure of fear. Most studies examining the gender effect in anxiety have relied primarily on self-reported fear, with only a few studies exploring avoidance behavior or physiological arousal. Thus the second goal of the present study was to examine the gender effect across multiple domains – subjective anxiety, heart rate reactivity and behavioral avoidance during an anxiety-provoking behavioral task and on self-report questionnaires. As with previous research, it was expected that women would report higher fear on self-report questionnaires and during a behavioral task, demonstrate greater behavioral avoidance (McLean & Hope, 2010) and experience greater heart rate reactivity when exposed to laboratory stressors (Kudielka et al., 2004 and Schmaus et al., 2008). Given the potential importance of behavioral avoidance, exploratory analyses were also conducted to compare the experience of men and women who avoided or did not avoid touching the tarantula. Finally, based on gender socialization theories, it was hypothesized that high expressive traits would be associated with greater subjective anxiety during the behavioral task but high instrumentality would be associated with lower subjective anxiety and less avoidance.