Expressing Emotions in Stressful Contexts

Conceptualization of Coping Processes Directed Toward Regulating Emotions

Coping processes are efforts to manage circumstances that people perceive as taxing or exceeding their personal resources. These processes are often classified into two broad domains (Lazarus & Folkman, 1984): direct attempts to modify the problem (problem-focused coping) and strategies for regulating emotions (emotion-focused coping). Historically, research suggested that emotion-focused coping is associated with negative outcomes. Indeed, a review of more than 100 studies revealed a consistent positive association between emotion-focused coping and indicators of maladjustment, such as anxiety and depressive symptoms (see Stanton, 2011). These findings stand in sharp contrast to many psychotherapeutic approaches and to functionalist theories of emotion, which assume that emotions serve to orient and organize effective responses to stressors.

In an attempt to reconcile these contradictory perspectives, we demonstrated that self-report scales used to assess emotion-focused coping contain items reflecting distress (Stanton, Danoff-Burg, Cameron, & Ellis, 1994; Stanton, Kirk, Cameron, & Danoff-Burg, 2000). For example, endorsement of the item “I become very tense” on a scale intended to assess emotion-focused coping is likely to be related to items on an anxiety scale, because it reflects anxiety rather than distinct coping efforts. We also found that emotion-focused coping strategies take many forms, including attempts to avoid feelings as well as attempts to express them. These diverse strategies can carry very different consequences for well-being and must be disentangled before researchers can determine which coping processes are beneficial.

To address these limitations, we developed a measure to assess emotional-approach coping (Stanton et al., 2000), which includes two distinct facets: emotional expression (i.e., verbal or nonverbal expressions of emotions) and emotional processing (i.e., active attempts to acknowledge and understand emotions). In this review, we focus on the effects of coping through emotional expression on psychological and physical health (for more on emotional processing, see, e.g., Stanton, 2011).

It should first be noted that emotionally expressive coping can assume many forms (e.g., writing in a journal, discussing feelings with friends) and that it is usually accompanied by other strategies. Coping efforts do not stop when a person starts to cry or writes in a journal, “I feel so awful.” Instead, that person might go on to label the specific emotions he or she is experiencing, to organize the stressful experience into a coherent story, and to re-evaluate stressor-related thoughts and feelings (or, alternatively, the person might try to squelch the tears and distress). Our focus in this review is on intentional efforts to express emotions in reaction to stressors. However, we acknowledge that real-life coping through emotional expression involves further complexity; indeed, understanding which concomitants of expressive coping promote adaptation is an important goal.

The Utility of Expressing Stressor-Related Emotions

Using assessments of emotionally expressive coping that are free of content reflecting distress or self-deprecation, researchers have examined the utility of stressor-related emotional expression in cross-sectional, longitudinal, and experimental research with several populations, including people with psychological disorders (e.g., panic attacks, bipolar disorder) and individuals undergoing specific stressors (e.g., infertility or a diagnosis of cancer; see Stanton, 2011). The findings from four longitudinal studies illustrate that intentionally expressing emotions in response to stressors can be beneficial. In one study of women who sought medical attention after being sexually assaulted, an increase in emotionally expressive coping was associated with an increased feeling of control over recovery, which was associated with a decline in distress (Frazier, Mortensen, & Steward, 2005). In another study (see Stanton, 2011), couples who coped with infertility by expressing their emotions were protected from depressive symptoms after they received a negative pregnancy test. Moreover, women in the study who were low in expressive coping but whose partners were high in expressive coping were protected from increased depressive symptoms.

The benefits of emotionally expressive coping have also been documented in women with breast cancer. Women who reported more cancer-related emotional expression evidenced an increase in vigor and perceived good health, as well as a decline in distress, and had fewer medical appointments for cancer-related problems over the next three months than did nonexpressive women (see Stanton, 2011). In another study, more emotionally expressive coping in the first month after a diagnosis of breast cancer predicted longer survival over the next 8 years, particularly among women who reported high levels of available emotional support from friends and family (Reynolds et al., 2000).

Such findings are consistent with a body of research catalyzed by Pennebaker (see Pennebaker & Chung, 2011), which has revealed that adults assigned to write about their deepest feelings and thoughts regarding a stressor have more positive outcomes than do adults assigned to a neutral-writing control condition. A meta-analysis of 146 such experiments, most of which included a condition in which participants wrote about emotions for three to five sessions of 15 to 20 minutes each, revealed that writing about stressor-related emotions led to significant improvements in psychological health, physical health, and overall functioning among adults who had experienced trauma or medical illness (Frattaroli, 2006).

Expressing Stressor-Related Emotions: Moderators of Effects

Like Lazarus and Folkman (1984), we contend that expressing emotions in stressful situations is neither uniformly adaptive nor uniformly maladaptive. The consequences of emotionally expressive coping depend on characteristics of the stressor, the environment, the person, and the coping itself (see Fig. 1). Regarding attributes of expressive coping, public and private expressions of stressor-related emotion, at least in an experimental context, do not appear to yield differential effects (Pennebaker & Chung, 2011; but see below regarding the importance of interpersonal environments). The timing of emotional expression in relation to the onset of a stressor can moderate its utility. Expressive-writing studies have shown that emotional expression is most likely to bolster health when the stressor happened recently, suggesting that emotional expression is less helpful for more distant events (Frattaroli, 2006). However, emotional expression in the immediate aftermath of a collective trauma can predict poor adjustment (Seery, Silver, Holman, Ence, & Chu, 2008). Future research is needed to determine the most adaptive timing of emotional expression in relation to the onset of the stressor and the optimal mode of emotional expression (e.g., private versus public). The manner in which specific emotions (e.g., anger, sadness) are expressed and the degree of expressive coping may also moderate its effects (e.g., both a complete lack of expression and unconstrained, intense expression might be maladaptive).

OPEN IN VIEWER

Fig. 1.

Model representing the mechanisms and moderators by which emotional expression influences health. The effects of coping with a stressful situation through emotional expression may depend on characteristics of the emotional expression (e.g., public vs. private), the stressor (e.g., controllability), the social context (e.g., receptivity of the social network), and the individual (e.g., dispositional tendency to express emotions). Potential pathways through which emotional expression influences well-being include affect labeling, reappraisal of the stressor, provision of information about valued goals, psychological and physiological habituation to stressor-related thoughts and emotions, and the strengthening of interpersonal relationships.

Regarding attributes of stressors, individuals are more likely to engage in and to benefit from expressing emotions in response to uncontrollable stressors than controllable stressors, which are more amenable to problem-focused coping (Stanton et al., 2000). Even when a situation is responsive to problem solving, however, it might have emotionally evocative aspects that benefit from expression. For example, writing openly about one’s feelings and thoughts about an impending exam can boost exam performance (Ramirez & Beilock, 2011)

The social context in which emotional expression occurs undoubtedly influences its utility. For example, adults with cancer who view their interpersonal environments as receptive to cancer-related emotional expression are more likely to reap benefits (e.g., enhanced quality of life, lower distress) from such expression than are adults with cancer whose close others constrain emotional expression (e.g., by changing the subject; Hoyt, 2009; Lepore, Ragan, & Jones, 2000; Stanton, 2011).

Personal attributes (e.g., gender) can also modify the relation between emotionally expressive coping and stressor-related adjustment. Women often report higher levels of emotionally expressive coping than men do, although the difference is not large (see Stanton, 2011). Gender is an inconsistent moderator of effects. Coping with a stressor through emotional expression predicts improvements in life satisfaction and depressive symptoms for young women, but decrements in those outcomes for young men (Stanton et al., 1994). In contrast, research with older samples has revealed that emotionally expressive coping can be adaptive for both sexes. Specific gender-related attributes are likely to influence the relation between coping and adjustment. Hoyt (2009) found that, among men diagnosed with cancer, a greater degree of gender-role conflict (i.e., negative consequences associated with socialized male gender roles) was associated with less emotionally expressive coping, which in turn was linked to greater distress. Identifying the influence of gender on the utility of emotionally expressive coping will likely require research that takes into account gender differences in the meaning and form of emotional expression in specific stressful contexts.

Other personality attributes also influence the utility of expressive coping. Particularly when a stressor demands sustained coping effort, individual differences in emotion regulation can influence the effectiveness of coping strategies. For women who had been dealing with advanced breast cancer for an average of 3 years, undergoing arduous medical treatments predicted an increase in emotionally expressive coping, which in turn predicted improvements in depressive symptoms and life satisfaction over 3 months among women who were dispositionally inclined to experience emotions intensely and to express positive and negative emotions (see Stanton, 2011). Goal-directed determination and confidence can also increase the effectiveness of emotionally expressive coping in women with breast cancer (see Stanton, 2011).

Expressing Stressor-Related Emotions: Mechanisms for Effects

Research has demonstrated that coping through emotional expression is effective under particular conditions, but how does it work? Addressing this question is important because identifying the ways in which expression confers adaptive effects can help professionals and individuals harness those mechanisms to promote useful coping strategies. First, the process of simply labeling the emotion might dampen its disruptive (or pleasurable) power. Putting a feeling into words (e.g., “sad,” “afraid”) can lessen the subjective intensity of the feeling, as well as the magnitude of activation in the amygdala, a part of the brain involved in the automatic processing of emotion (e.g., Lieberman, Inagaki, Tabibnia, & Crockett, 2011). Second, emotional expression can catalyze individuals’ understanding and reappraisal of stressful situations. Expressing emotions provides people with the opportunity to invest a stressful experience with coherence and meaning (Pennebaker & Chung, 2011).

Third, in line with functionalist theories of emotion, expressive coping allows people to direct attention toward important goals, identify barriers to goal achievement, and generate pathways for accomplishing goals. For example, the expression of cancer-related fears and sadness about anticipated losses signals a potential obstruction to achieving a valued goal (e.g., living to see a son graduate from college) and provides the opportunity to affirm higher-level goals (e.g., the goal of deepening a relationship), to develop plans to reach them (e.g., by carefully attending to health), and to create alternative pathways to goal accomplishment (e.g., by devoting more time to one’s son). Expressing stressor-related emotions does not in itself guarantee successful goal pursuit, but it can set in motion cognitive and behavioral efforts to accomplish goals.

Coping through emotional expression also can provide an opportunity to confront a stressful event and its attendant emotions, which in turn can prompt physiological habituation (i.e., reduced physiological reactivity, or physical responses, to thoughts or emotions about the stressor over time; e.g., Low, Stanton, & Danoff-Burg, 2006; Stanton et al., 2000, Study 4), as well as a reduction in stressor-related intrusive thoughts (Lepore et al., 2000). Such physiological and psychological habituation can promote improvements in physical symptoms (Low et al., 2006) and perceived stress (Lepore et al., 2000).

Although the expression of emotion does not have to occur in the context of an interpersonal relationship in order to be useful, social mechanisms are certainly at work in its effectiveness. Willingness to express emotions can deepen relationships and aid people in regulating their social environments. For example, undergraduates’ willingness to express negative emotions before their arrival at college predicts the development of more relationships, greater intimacy in close relationships, and more support from roommates during the first semester (Graham, Huang, Clark, & Helgeson, 2008, Study 4). Rather than emotional expression being helpful by itself, the social sharing of emotions is likely to prompt a cascade of consequences (e.g., cognitive reappraisal, creation of meaning) that facilitate recovery (Rimé, Paez, Kanyangara, & Yzerbyt, 2011).

Future Directions

When facing a stressful experience, does it help to express emotions? The current body of research suggests that the answer is “It depends.” Attributes of situational, interpersonal, and intrapersonal contexts moderate the consequences of emotionally expressive coping in predictable ways. Coping through emotional expression appears to be most useful for promoting adjustment (a) in situations that are relatively uncontrollable, (b) when used by individuals who are dispositionally inclined to experience emotions intensely and express their emotions, and (c) when expressions of emotion are welcomed by close others.

Additional research on several other facets of emotionally expressive coping, assessed using multiple methods, and the context in which it occurs are required to characterize facilitative conditions. For example, experimental research has demonstrated that adopting an evaluative stance toward emotional expression, rather than an accepting stance, affects physiological arousal and distress in response to stressors (Campbell-Sills, Barlow, Brown, & Hofmann, 2006; Low, Stanton, & Bower, 2008). Comparisons of different studies (e.g., of two studies involving private and socially shared emotional expression, respectively) could contribute to the understanding of moderators of emotionally expressive coping; however, optimal tests of moderators would require their experimental manipulation. In addition, research exploring modifiable factors that condition the effects of coping through emotional expression (e.g., sociocultural context, ambivalence about emotional expression) will be more useful than research examining immutable moderators (e.g., gender).

Of course, coping through emotional expression is only one approach to managing stressors. Individuals who can flexibly express and suppress emotions in response to situational demands are likely to adapt most successfully (Westphal, Seivert, & Bonanno, 2010). Research is needed to develop interventions that help individuals select coping strategies that are responsive to situational demands and to determine the circumstances in which coping through emotional expression is likely to reduce distress, improve relationships, and enhance health (e.g., Chesney, Chambers, Taylor, Johnson, & Folkman, 2003). Further investigation of how emotional expression helps—which is likely to involve physiological, cognitive, behavioral, and social pathways—can contribute to the development of interventions aimed at enhancing emotion-regulation skills.

Over the past two decades, research has countered the “bad reputation” of emotion-focused coping by revealing that expressing emotions surrounding stressors can promote psychological and physical health. Developing an increasingly precise understanding of for whom, under what circumstances, and how coping with stressors by expressing emotions is effective is an essential next step.

Recommended Reading

Gross, J. J. (Ed.). (2007). Handbook of emotion regulation. New York, NY: Guilford Press. A comprehensive edited volume on how humans regulate their emotions.

Lazarus, R. S., & Folkman, S. (1984). (See References). A classic volume on stress and coping theory and research.

Stanton, A. L. (2011). (See References). A review of theory and research on coping through emotional approach (i.e., coping through emotional processing and expression).

Stanton, A. L., Kirk, S. B., Cameron, C. L., & Danoff-Burg, S. (2000). (See References). Describes four studies on development and preliminary validation of self-report scales to assess coping through emotional approach.