Emotion Regulation and Health

Question 1

Emotion

Answer 1

SHORT, intensely felt affective state, evolved to coordinate responses to specific eliciting circumstances
eg: fear (response to threat), anger (response to hostility), sadness (response to a loss)
-involve subjective experience, expressive behavior (eg smiling, crying) and peripheral physiological responses
adaptive for survival

Question 2

mood

Answer 2

longer-term affective states
“in general, how do you feel today”
not a specific emotion just a general tone of your world

Question 3

affective disorders

Answer 3

pathological forms of affective experience (enough problems with your mood) that can interfere with daily life
-major depressive disorder - 2 weeks of feeling depressed has to impair your activities

Question 4

Emotion regulation

Answer 4

processes that influence which emotions one has, when one has them, and how one experiences and expresses them

coping is something you do when you’re stressed
but this is a type of coping used to manage your emotions that is used all of the time

Question 5

steps in emotion generation

Answer 5

situation (being in class)–>attention (whether you’re paying attention to the lecture or on facebook) —>appraisal (whether you’re bored or enjoying the lecture)—>response (laughing at your professors lecture)

Question 6

places for emotion regulation

Answer 6

situation selection—>situation modification(situation)—>attentional deployment (attention)—>cognitive change (appraisal)—>response modulation (response)

you decide/select your situation and that can modulate your mood (you can decide what classes you take)

Question 7

what are attentional deployment, changing appraisals, and response modulation types of?

Answer 7

coping techniques

Question 8

Emotional Suppression and ANS reactivity (does it have an effect on your physiology)

Answer 8

Gross et al: 180 healthy undergraduates assigned to watch sad, neutral and amusing films under two conditions

• inhibition condition: “watch the film carefully. if you have any feelings as you watch the film clip, please try your best not to let those feelings show.”
• control condition: “watch the film carefully”

suppression leads to INCREASED cardiovascular activity!

disgust gets the strongest response

Question 9

what if you habitually suppress the experience and expression of emotion (real life example of emotional suppression experiment)?

Answer 9

this is called repression

Question 10

Repression

Answer 10

characterized by:

• avoidance of anxiety-provoking stimuli
• low self-reports of anxiety in stressful situations
• low scores on measures of trait anxiety
• high scores on measures of defensiveness and social desirability

presumed to be an unconscious defense as well as a conscious coping style

• suppression to repression : “I prefer not to think about it” becomes “there is nothing to think about”
• ignore the negative things that happen in their lives

Question 11

Repression and Physiology

Answer 11

repressors deny the experience of negative affect but demonstrate heightened physiological reactivity

• disassociation btwn self-reported affect and physiology
• “repressive individuals are hypothesized to be persons who often believe that they aren’t upset despite objective evidence to the contrary”

Question 12

Repression and cancer

Answer 12

Several reviews have concluded that repression is associated with cancer incidence (mechanisms? increases cardiovascular activity which creates an environment conducive to cancer growth - problem with finding the mechanism is that there is no animal model of supression)

Repression has NOT been consistently linked with cancer progression

Mechanisms?
A few studies have shown links with neuroendocrine function
-Higher cortisol levels
-Flatter (less healthy) diurnal cortisol slope
(Flatter cortisol slopes associated with mortality in women with metastatic breast cancer )
Some evidence that repression is associated with alterations in immune function
-Unclear whether these are relevant for cancer

Question 13

Emotional expression and health

Answer 13

Expression of emotions either by yourself or with someone else (or write about your feelings)

• “Talk to someone about how you are feeling”
• “Let your feelings out somehow”

Some evidence that people who endorse more emotional expression show improved health outcomes
-Emotional expression associated with longer-term survival in study of HIV+ men and women (cross-sectional; O’Cleirigh et al., 2003)
-Emotional expression among breast cancer patients predicted reduced distress, enhanced physical health and vigor, and fewer medical appointments (prospective; Stanton et al., 2000)
-Emotional expression associated with better survival in large study of 847 breast cancer patients (prospective; Reynolds et al., 2000 ) - BEST STUDY - survival is always your best outcome
Breast cancer survival among women diagnosed with invasive breast cancer in the Black/White Cancer Survival Study (January 1, 1985–December 31, 1986), by level of emotional expression and emotional support. Data were adjusted for age, race, and tumor stage using Cox proportional hazards models. high support and high expression; mixed levels of support and expression (high support with low/medium expression or low support with high expression); low support and low/medium expression.
-people who are high in emotional expression have the highest proportion surviving

we don’t really know if this the expressio itself or if it is some kind of personality style that we need you to express

Question 14

Experimental emotional expression

Answer 14

Pennebaker disclosure paradigm:
-Individuals randomly assigned to write about their “deepest thoughts and feelings” about a stressful or traumatic experience or about neutral topics (e.g., content of closet) for 15 minutes on 4 consecutive days

Question 15

Effects of writing: psychological and functional outcomes

Answer 15

Positive effects on:

• Distress, depression, anger, anxiety
• Work-related outcomes, school-related outcomes, social relationships, measures of cognitive function

Unreliable effects on:
-Stress, coping

one study:
Writing about upcoming graduate school exam leads to decreased anxiety and improved performance (for MCAT and LSAT) doesn’t seem to matter for the GRE

Question 16

Effects of writing: health-related outcomes

Answer 16

Positive effects on:

• MD visits (fewer)
• Certain immune measures

Unreliable effects on:

• Cortisol, blood pressure, blood lipids, lung function, body composition
• General physical symptoms

Question 17

Pennebaker, Kiecolt-Glaser, & Glaser study

Answer 17

N = 50 undergraduates
Randomly assigned to one of two conditions:
-“Write about most stressful and traumatic experiences of entire life”
-“Write about specific objects or events in detail without discussing thoughts and feelings”
Provided blood samples and completed questionnaires at baseline, after 4 days, and after 6 weeks (final questionnaire at 3 months)
Also obtained info on health center visits

Results:
Psychological Outcomes
- Trauma group felt worse immediately after writing but this disappeared by the follow-up

Immune outcomes
-Trauma group participants show higher levels of immune cell proliferation
-They also have fewer health center visits
-this is a stressful time but the writing buffers the decrease in the trauma group (the trauma group remains stable and the control does worse)
could also be that the trauma group does better because they are expressing or the control group does worse because they are suppressing

Question 18

Effects of writing in clinical populations : medical conditions

Answer 18

inflammatory Immune-related medical conditions: rheumatoid arthritis, asthma

• Saw reductions in objective indicators of disease severity after trauma writing
• groups are comparable at baseline but for the asthma group, the writing group has significant improvements at 4-month followup
• for arthritis: disease activity is comparable at baseline but writing group does better at follow-up

Question 19

Effects of writing in clinical populations : Cancer patients

Answer 19

• Saw reductions in cancer-related medical appointments and physical symptoms after writing about “deepest thoughts and feelings” about breast cancer (Stanton et al., 2002)
• Benefit finding condition produced similar effects (write about the good things about your cancer)
• Saw reductions in physical symptoms and function after writing about “deepest thoughts and feelings” about renal cell cancer (Milbury et al., 2014)

Question 20

Effects of writing in clinical populations : Heart attack patients

Answer 20

• Saw reductions in medical appointments after writing “deepest thoughts and feelings” about having heart attack (Willmott et al., 2011)
• Also had lower med use, more rehab sessions, fewer cardiac symptoms, lower BP

Question 21

Effects of writing in clinical populations : HIV+ individuals

Answer 21

• 244 HIV+ men and women wrote about “deepest thoughts and feelings” about most traumatic or upsetting experience
• For women ONLY, writing led to reductions in PTSD symptoms, depression, and HIV-related physical symptoms (shingles, oral thrush, fever, etc.)
• No effect on CD4 T cells levels or viral load

Question 22

Effects of writing in clinical populations : Wound healing

Answer 22

-49 healthy older adults wrote about upsetting life events or daily activities for 3 days
-Two weeks later, 4-mm punch biopsy wounds were created on inner, upper arm
-Those in expressive writing condition showed faster wound healing!
27% had full healing vs 10% in the control group

Question 23

Other writing prompts

Answer 23

don’t have to just write about deepest thoughts and feelings

-Writing about “best possible self” is also associated with decreased illness (King, 2001)

Question 24

Why does it work? Mediators

Answer 24

Hypotheses (psychological):

• Catharsis
• Cognitive processing
• Self-regulation
• Social integration

Hypotheses (physiological):
Faster habituation?
-Within session heart rate habituation associated with reduced physical symptoms in Stanton study (Low et al., 2006)

Question 25

Catharsis

Answer 25

you were suppressing and now you’re expressing so there’s a release of the work of suppression
reduces inhibition
not a lot of evidence for this

Question 26

Cognitive processing

Answer 26

facilitates insight (develop insight on your 3rd or 4th experience)
-Some evidence for this – cognitive processing in disclosure essays predicted decreases in health center visits and depression (Hoyt et al., 2014)

Question 27

Self-regulation

Answer 27

gives sense of control over emotions, clarifies goals

Question 28

Social integration

Answer 28

improves interactions with social world

-not dumping all of this stuff on your social environment

Question 29

Maladaptive emotional approach?

Answer 29

• What if you process and express your feelings over and over and over and over?
• What if you are critical of your emotions as you express?

Question 30

What if you process and express your feelings over and over and over and over?

Answer 30

• Processing becomes rumination, which may have negative effects on physiology and health
• not leading to insight or positive habituation

evidence:

• Trait rumination associated with prolonged cortisol response to acute stress
• After anger induction task, trait rumination associated with poor blood pressure recovery without distraction (2 conditions: blank wall or distracting wall - pics on walls)

Question 31

What if you are critical of your emotions as you express?

Answer 31

Evaluation condition:
Remember that emotions can sometimes get in the way of thinking clearly and responding appropriately. First you may want to briefly describe what your emotional response has been. Then notice whether you like or dislike feeling this way. Consider whether these feelings are an appropriate response to the stressor you are experiencing and whether these emotions get in the way of anything. What I am interested in is your judgment and opinion of this emotional response.

Acceptance condition:
Remember that emotions are normal, healthy, and temporary reactions that add richness to experiences and serve as a cue as to what is important to you in life. Just write whatever you are experiencing without judgment or evaluation

this is the basis of mindfulness
acceptance condition does better
Evaluation associated with less efficient heart rate habituation and recovery than acceptance (Low, Bower, & Stanton, 2008)
(if you’re critical you’re not habituating or recovering)