Are expressive suppression and cognitive reappraisal associated with stress-related symptoms?
Introduction
Emotion regulation, based on Gross (1998a, p. 275), refers to, “the processes by which individuals influence which emotions they have, when they have them, and how they experience or express these emotions.” Although this definition is inherently broad, there is functional utility in distinguishing emotion from emotion regulation. Specifically, strategies individuals use to alter their emotions affect not only their current emotional experience, but also broader emotional, cognitive, and interpersonal functioning (Barlow et al., 2004, Gross, 2002, Gross & John, 2003, Kashdan et al., 2006). Furthermore, inappropriate or ineffective emotion regulation is emerging as a critical component in the development and maintenance of depression and anxiety disorders (Barlow et al., 2004, Campbell-Sills et al., 2006a, Campbell-Sills et al., 2006b, Kashdan & Steger, 2006, Kashdan et al., 2006, Mennin, 2006). Elucidating when and why emotion regulation can be adaptive or harmful is therefore crucial to the understanding of emotional processes and psychological dysfunction.
The empirical examination of emotion regulation grew out of the stress and coping literature, particularly conceptualizations of coping strategies put forth by Lazarus (1966) and Lazarus & Folkman (1984). Building on this long tradition to explain why some regulation strategies might be beneficial while others are detrimental, Gross (1998b) posited a process model of emotion regulation that emphasizes the timing of a regulation strategy as crucial to its impact and consequences. In this model, Gross (1998b) and Gross and Thompson (2006) differentiated between antecedent-focused regulation, in which intervention occurs early and is focused on altering the effect of emotion-generating cues, and response-focused regulation, which acts late in the process and is focused on altering emotional output (e.g., action, expression). Gross postulated that response-focused strategies are more detrimental and less effective in altering current emotional experience compared to antecedent-focused regulation. Specifically, Gross et al. primarily examined correlates and consequences of expressive suppression and cognitive reappraisal, two emotion regulation strategies representative of these points of intervention (e.g., Butler et al., 2003, Gross, 1998b, Gross & Levenson, 1997, Gross & Thompson, 2006, Richards & Gross, 1999, Richards & Gross, 2000). Expressive suppression, a response-focused strategy, refers to the inhibition of external cues to one's internal emotional state (e.g., facial expression), while cognitive reappraisal, an antecedent-focused strategy, involves “construing a potentially emotion-eliciting situation in a way that changes its emotional impact” (Gross & John, 2003, p. 349). Based on Gross' (1998b) model, expressive suppression should be less effective in altering negative emotions compared to reappraisal and also associated with psychopathology, social dysfunction, and depressed mood.
As is predicted based on this process model of emotion regulation, factors associated with expressive suppression and cognitive reappraisal appear vastly divergent. Generally, expressive suppression is associated with reduced positive affect and life satisfaction and with greater depression and social anxiety, and greater negative emotion in response to negative affective stimuli (e.g., Kashdan et al., 2006, Sperberg & Stabb, 1998). In experimental studies, inducing expressive suppression can lead to impaired interpersonal communication (Butler et al., 2003, Gross & Muñoz, 1995), increased sympathetic nervous system arousal (Gross, 1998b, Gross & Levenson, 1997, Harris, 2001), and impaired memory (Richards et al., 2003, Richards & Gross, 1999, Richards & Gross, 2000). Although an accumulating body of research indicates that expressive suppression may have negative short- and long-term consequences, expressive suppression can also be adaptive; for example, the ability to conceal one's emotions is important to maintaining relationships and employment (Gross, 2002, Gross & John, 2003, Gross & Muñoz, 1995). It may be that the habitual and inflexible use of expressive suppression across a variety of contexts contributes to psychopathology when other strategies that are more effective in altering negative emotion and less costly could be used instead of or in conjunction with expressive suppression (e.g., Gross, 2002, Gross & Levenson, 1997, Harris, 2001, Richards & Gross, 1999, Richards & Gross, 2000). However, in examining this literature, it is important to note that in the absence of prospective studies of expressive suppression and psychopathology, the direction of causality cannot be determined.
Furthermore, when applied inflexibly, habitual suppression of thoughts and emotion is thought to contribute to depression and anxiety disorders (Campbell-Sills et al., 2006a, Campbell-Sills et al., 2006b, Kashdan et al., 2006, Lynch et al., 2001, Mennin, 2006, Moses & Barlow, 2006, Roemer & Salters, 2004). Although expressive suppression may differ from direct suppression of emotional experiencing or thoughts, physiological responding to stress may be intensified or prolonged by expressive suppression (e.g., Gross, 1998b), and exposure to traumatic events, particularly interpersonal trauma, is thought to reduce emotion regulation capacity, leading to difficulties in emotion regulation not entirely captured by the diagnosis of posttraumatic stress disorder (PTSD; Frewen & Lanius, 2006, Pelcovitz et al., 1997, van der Kolk et al., 2005). Furthermore, in stress-related reactions such as PTSD, it has been suggested that suppression of thoughts or emotions may potentially contribute to the maintenance of posttraumatic reactions, leading to chronic PTSD (e.g., Foa & Riggs, 1993, Purdon, 1999, Roemer et al., 2001, Shipherd & Beck, 1999). Indeed, initial work in this area by Roemer et al. (2001) suggests that individuals with PTSD report suppressing emotions more frequently and more intensely than those without PTSD. On the other hand, even less work has specifically examined expressive suppression and psychopathology nor has it examined it in trauma-exposed samples. As noted above, the correlational nature of much of this literature, however, leaves the direction of causality uncertain.
Unlike response-focused expressive suppression, habitual antecedent-focused reappraisal appears to lack the detrimental cognitive consequences associated with suppression and may actually be protective (for reviews, see Gross, 1998a, Gross, 2002). Reappraisal is associated with less depression, less negative affect, and increased life satisfaction (Garnefski & Kraaij, 2006, Garnefski et al., 2004, Kashdan et al., 2006), and induced reappraisal decreases negative emotion, neither impairs memory nor increases arousal (Egloff et al., 2006, Gross & Thompson, 2006, Richards & Gross, 2000, Richards et al., 2003), and may actually lessen physiological arousal (Dandoy & Goldstein, 1990). The use of reappraisal is also higher in healthy controls compared to individuals with clinical levels of anxiety and/or depression (Garnefski et al., 2002, Garnefski et al., 2004). In addition, like expressive suppression, reappraisal may be particularly relevant to the study of trauma reactions. Following trauma, initial negative cognitions and beliefs are prospectively associated with later posttrauma reactions including depression, anxiety, and PTSD (e.g., Dunmore et al., 1999, Ehring et al., 2006, Mayou et al., 2002); accordingly, the use of cognitive reappraisal may prevent or relieve stress-related difficulties. Further, in trauma survivors with acute stress disorder, increased cognitive reappraisal is associated with reductions in trauma-related symptoms following therapy (Bryant, Moulds, & Guthrie, 2001).
In order to better understand the role of expressive suppression and cognitive reappraisal, new measures have begun to emerge. Probably most prominent in the personality literature is the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003), measuring the habitual use expressive suppression and cognitive reappraisal. Initial studies of this questionnaire (Gross & John, 2003, Kashdan et al., 2006) have limited their sampling to undergraduates and examined few measures of psychopathology, instead including mostly broader personality and mood measures. Further, it is unclear whether relationships between the ERQ subscales of expressive suppression and cognitive reappraisal and psychopathology such as depression could be accounted for by known psychopathology vulnerability factors such as rumination (e.g., Holeva et al., 2001, Nolen-Hoeksema, 2000) and anxiety sensitivity (e.g., Reiss et al., 1986, Schmidt et al., 2006). Specifically, rumination describes a process where individuals focus on their symptoms of depression and the possible meaning of them without taking action to overcome them (e.g., Nolen-Hoeksema, 2000). Similarly, and more relevant to anxiety-based disorders, anxiety sensitivity describes a process where individuals focus on their arousal-related symptoms and interpret them as dangerous (e.g., Reiss & McNally, 1985). Thus, it is entirely possible that these vulnerability factors actually mediate the relationship between expressive suppression/cognitive reappraisal and psychopathology. That is, rumination and anxiety sensitivity emphasize content or meaning related to emotions being regulated, particularly focusing on symptoms and their meaning, and may be more important to psychopathology than how emotion is regulated (e.g., through expressive suppression or cognitive reappraisal).
In addition, researchers have begun to examine how emotion regulation strategies such as reappraisal and expressive suppression relate to each other. In the initial study examining psychometrics of the ERQ, Gross and John (2003) found that an independent two-factor model provided the best fit to their data when compared with a negatively correlated specialist model, a positively correlated hierarchical emotion regulation model, and a single-factor general emotion regulation model, suggesting that an individual's tendency to use one strategy had little bearing on use of the other. However, this structural analysis has not yet been replicated, and the results are somewhat counterintuitive. Specifically, if reappraisal is truly a more effective strategy, one might expect that individuals who reappraise frequently would have less need for expressive suppression, a less effective strategy.
In the current study, we examined expressive suppression, reappraisal, and stress-related psychopathology symptoms in two samples. Using a undergraduate sample similar to Gross and John (2003), we sought replicate their work regarding individual differences in the use of suppression and reappraisal and extend it to stress-related psychopathology symptoms. Using a second trauma-exposed, community-based sample, we sought to further extend this work to trauma survivors. Specifically, we focused solely on women given potential gender differences in suppression, as non-clinical samples of women suppress at higher rates than men (Gross & John, 2003) and suppression may be increased in women with affective disorders, but not men, relative to healthy controls (Campbell-Sills et al., 2006a). First, in both the undergraduate and trauma-exposed women, we hypothesized that expressive suppression would be associated with higher scores on measures of posttraumatic stress, anxiety, depression, rumination, and anxiety sensitivity, and, conversely, and that reappraisal would be associated with lower scores on these measures. Second, we hypothesized that rumination and anxiety sensitivity mediate the relationship between emotion regulation and stress-related psychopathology symptoms. Third, we sought to further examine the factor structure of the ERQ, based on Gross and John (2003), comparing four potential models. Based on their previous findings, we hypothesized that an independent two-factor model would provide the best fit for the data across both the undergraduate and trauma-exposed community samples.
Section snippets
Undergraduate sample (Sample 1)
Sample 1 consisted of 292 undergraduate women recruited from two urban universities, one located in the U.S. Pacific Northwest and the other in the Midwest. Thirty-nine percent (39.0%, n = 114) of the sample reported experiencing a DSM-IV Criterion A traumatic event (APA, 2000) based on the Posttraumatic Diagnostic Scale (PDS; Foa, Cashman, Jaycox, & Perry, 1997). Specifically, 25.22% indicated a sexual or non-sexual assault, 29.57% an accident or natural disaster, 15.65% witnessing or hearing
Relationships between emotion regulation strategies of expressive suppression and reappraisal and self-reported stress-related psychopathology symptoms
Neither reappraisal nor expressive suppression was strongly associated with any of the demographic factors such as age, minority status, years of education, or history of trauma exposure (Criterion A status) in either Sample 1 or Sample 2.
As can be seen in Table 2, reappraisal was generally associated with lower self-reported psychopathology symptoms, and expressive suppression was associated with more severe self-reported psychopathology symptoms, particularly in the trauma-exposed community
Discussion
Consistent with our hypotheses, expressive suppression was associated with higher, and reappraisal with lower, self-reported stress-related symptoms overall. Interestingly, expressive suppression was associated with PTSD, anxiety, and depression symptoms in the trauma-exposed community sample, although it was not as strongly associated in the undergraduate sample. Correlations with reappraisal were more limited across both samples, though again mirroring the hypothesized direction, particularly
Acknowledgements
This study was supported in part by a grant from the Anxiety Disorders Association of America awarded to Norah Feeny, Ph.D., and Lori Zoellner, Ph.D. and also by an Individual Predoctoral National Research Service Award from the National Institutes of Health (F31 MH068050) awarded to Sally A. Moore. We would especially like to thank Ryan T. Moore at Harvard University for his assistance with statistical modeling and analysis.
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