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Emotion regulation and health: an overview

Emotional influence on health has been recognized as early as the advent of psychosomatic paradigm of health and illness and attempt to suppress negative emotions was thought as the central element in the development of various physical illnesses (Alexander, 1939, Alexander, & French, 1946; Dunbar, 1954). Approximately after two decades of the Alexander's psychosomatic paradigm, the construct of alexithymia (the core feature is the difficulty in identifying and communicating emotions and feelings) was introduced by Sifneos (1972) that emerged as an alternative paradigm for linking emotion with health. The continuing efforts of psychologists to link emotion and health lead to the identification of several other affect related constructs that can explain a significant proportion of variance in the health status of an individual. For example, the affective disposition to experience positive and negative emotions (hereafter referred to as positive and negative affectivity), the disposition to experience extremes of emotional states irrespective of the emotional valence (hereafter revered to as affect intensity), the tendency to control the experience and expression of emotions (emotion regulation), the tendency to socially share and verbally express traumatic emotional experiences (emotional disclosure), and the ability to perceive, express, understand, monitor and manage emotions (emotional intelligence) have been identified as certain affect related variables that might influence the health status of an individual.

In this paper we have made an attempt to present an overview of the findings related to the role of the aforesaid affect related variables in health and illness.

Emotion regulation and health

Emotion regulation, that is, the conscious effort to be less influenced by emotion arousing situation by controlling the experience and expression of emotions has also been found to exert significant influence on the health status of an individual. Researchers in this area make a distinction between the conscious effort to suppress expression of emotion and the effort to cognitively restructure the situation or its interpretation so that the situation no longer produces emotional responses (e.g., Gross, 1998). The former is labeled as emotion regulation at response or output level and the latter as emotion regulation at input level in which the antecedents of emotions are cognitively regulated to reduce the emotional influences. This distinction is important for health researchers inasmuch as empirical evidences suggest that the emotion regulation at response level may have detrimental effect on health but the cognitive regulation of emotion at the input level may have beneficial effect on health (e.g. Gross, 1998).

The emotion regulation at response level (i.e., suppression of emotion) has been found to have deleterious effect on health. For example, the chronic inhibition of sadness and crying has been linked with such respiratory disorders as asthma (Alexander, 1950; Halliday, 1937). Similarly, the chronic inhibition of affiliative tendencies was linked to gastrointestinal disorders, such as ulcers (Alexander, 1950); and the chronic inhibition of anger was associated with cardiovascular disorders, such as hypertension (Alexander, 1939). The view that chronic hostility and anger inhibition may be linked to hypertension and coronary heart disease is still popular among health psychologists (e.g., Dembroski, Mac-Dougal, Williams, Haney, & Blumenthal, 1985; Friedman & Booth-Kewley, 1987; Jorgensen, Johnson, Kolodziej, & Schreer, 1996; Julkunen, Salonen, Kaplan, Chesney, & Salonen, 1994; Manuck & Krantz, 1986; Smith, 1992; Steptoe, 1993). In addition, new hypotheses involving emotion regulation have emerged, suggesting that emotion inhibition may exacerbate minor ailments (Pennebaker, 1990) and that inexpressiveness may accelerate cancer progression (Fawzy et al., 1993; Gross, 1989; Spiegel, Bloom, Kraemer, & Gottheil, 1989).

The foregoing studies extend the hypothesis that suppression of negative emotions has a harmful effect on health. The mechanism that link emotion regulation and health is still not clear but one popular hypothesis is that suppression of negative emotions enhances the physiological responses which in long term may produce bodily damage Krantz & Manuck, 1984). Researchers have shown that emotional suppression leads to acute increases in sympathetic activation of the sort postulated by the aforesaid hypothesis (Gross & Levenson, 1993, 1997).

The abovementioned empirical evidences, though, suggest that controlling the negative emotions (by consciously suppressing them) can lead to a number of physical health problems, the same is not true for regulating the negative emotions using cognitive strategies. For example, Beck, Rush, Shaw, and Emery (1979) and Seligman (1991) have argued that cognitive strategies may be used to prevent or alleviate depression. From this perspective it is assumed that cognitive regulation of emotion might have beneficial effect on health whereas the dysregulation of emotion might give rise to a number of physical and psychological health problems. For example, emotion dysregulation has been found to be associated with such mental health problems as binge eating (e.g., Lingswiler, Crowther, & Stephens, 1989), alcohol abuse (e.g., M. L. Cooper, Frone, Russell, & Mudar, 1995; Marlatt, 1985; Sayette, 1993), and anxiety and the mood disorders (e.g., Barlow, 1986; Beck, Rush, Shaw, & Emory, 1979).

Taken together, the findings of the studies linking emotion regulation to health suggest that emotion regulation might have beneficial and harmful effect on health depending on the strategy used to regulate emotions. If the emotions are regulated by suppression of experience and expression then it is likely to deteriorate health whereas the attempt to regulate the emotional experience and expression by cognitively restructuring or positively reappraising the emotion arousing situation might lead to beneficial effect on health.

Disclosure and social sharing of emotions and health

The preceding section reviewed evidences indicating the adverse effect of emotion suppression on health. If emotion suppression leads to poor health then as a corollary it can be postulated that emotional expression will be associated with better health and well-being. During the past few decades researchers have made attempt to test this hypothesis by examining the effect of emotional expression (both written and oral) on health.

For example, Cole, Kemeny, Taylor, and Visscher (1996) observed that gay men who hide their homosexual status are more likely to suffer from major illnesses such as cancer if they are HIV-negative and to die more quickly from AIDS if they are HIV-positive than men who are more open about their homosexuality. Similarly, in a study of college students Pennebaker and Susman (1988) found that inhibition of verbal expression of traumatic experiences was associated with a variety of health problems, On the other hand talking about the tramatic experience has been linked better followed by the traumatic experience. For example, researchers have noted that the if bereaved individuals are able to talk more about their spouses' death, the healthier they are in the year following the death (Pennebaker & O'Heeron, 1984).

Affect intensity and health

Another affect related trait that has recently been linked with health is affect intensity (AI). Affect intensity refers to the degree to which individuals experience the strength of emotions; it is a stable dimension of personality that pertains to all emotions, regardless of content or hedonic tone (Larsen & Diener, 1987). For example, individuals high in affect intensity are theorized to exhibit stronger emotional responses than individuals low in affect intensity. Research has supported this conceptualization in that individuals high compared to low in affect intensity rate their emotions as greater in intensity, regardless of the severity or hedonic tone of those events (Flett, Boase, McAndrews, Pliner, & Blankstein, 1986; Larsen, Diener, & Emmons, 1986).

The definition of the construct of affect intensity suggest that individuals high on this dimension are likely to experience extremes of emotions and therefore a direct corollary to it is that high affect intensity individuals will also experience intense stress and therefore would likely to suffer from more health problems.

Several empirical efforts have been made to examine the relationship of AI with health. For instance, Larsen and Diener (1987) reported that greater affect intensity is associated with greater somatic symptoms and neurotic symptoms. Williams (1989) also reported a significant positive relation between affect intensity and neuroticism. The relationship between affect intensity and somatic disturbances, such as nauseas, headaches, muscle soreness, shortness of breath, has been demonstrated by other researchers also (e.g., Salovey, Detweiler, Steward, & Bedell, 2001). The high AI has been found to be associated with a number of somatic problems (e.g., Deiner, 1984; Larsen, Deiner, Emons, 1987) and symptoms of mental ill health such as depression and other problem behaviours (Silk, Steinberg, & Morris, 2003).

Researches suggest that it is the experienced intensity of emotion and not the valence (positive versus negative) of emotions that influences health. For example, Mayne (1999) argued, "short bursts of emotion-associated sympathetic activation can stimulate parts of the immune system, whereas more chronic activation can cause ''wear and tear'' on the cardiovascular system. Anxiety and guilt have been associated with preventive health behaviours and care-seeking, whereas distress and depression increase symptom sensitivity, accuracy of illness perception, and can facilitate care-seeking and receipt of support. However, intense and chronic negative affects may lead individuals to engage in risky health behaviours, such as substance abuse, overeating, and high risk sex, as a coping mechanism to regulate negative emotion. They may also undermine social support systems, leading to a self-perpetuating cycle of conflict and isolation". (Cited from abstract).

It is evident from the preceding review that high affect intensity is associated with somatic problems and symptoms of mental illness, Further, the review also suggest that high AI is also associated with such factors that may predispose an individual for developing health problems. For example, it has been noted by several researchers that high affect intensity may predispose to substance abuse and addiction (Thorberg & Lyvers, 2006), suicidal ideation (Lynch, Cheavens,  Morse,; & Rosenthal, 2004). Similarly, high AI has been linked with a variety of phenomena that may lead to depression such as negative cognitive operations (Larsen et al., 1987), self- consciousness (Flett et al., 1986a), and dysfunctional attitudes (Dance, Kuiper & Martin, 1990). To sum up, the available research findings suggest that high AI may lead to health compromising behaviours such as drug abuse and consequently increase the risk for physical and mental health problems.

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