Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors

Among individuals coping with cancer, emotional approach coping—expressing and processing emotions following negative events—has been identified as a potentially adaptive form of emotion regulation. However, its mental health benefits may depend on social-cognitive factors and on how it is implemented. This study examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Loneliness was examined as an implicit social-cognitive phenomenon (i.e., automatic views of oneself as lonely), and emotional expression and processing were examined as both explicit and implicit processes. Approximately 11 months after diagnosis, 390 women completed explicit measures of coping through cancer-related emotional expression and processing; an implicit measure of expression and processing (an essay-writing task submitted to linguistic analysis); and an implicit association test measuring loneliness. Depressive symptoms were assessed 3 months later. Regardless of implicit loneliness, self-reported emotional expression (but not emotional processing) predicted fewer depressive symptoms, whereas implicit expression of negative emotion during essay-writing predicted more symptoms. Only among women high in implicit loneliness, less positive emotional expression and more causal processing during the writing task predicted more depressive symptoms. Results suggest that explicit and implicit breast cancer-related emotion regulation have distinct relations with depressive symptoms, and implicit loneliness moderates effects of implicit emotional approach. Findings support implicit processes as influential mechanisms of emotion regulation and suggest targets for intervention among breast cancer survivors.