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Review of General Psychology 2001, Vol. 5, No.

3, 187-212

Copyright 2001 by the Educational Publishing Foundation 1089-2680/01/$5.00 DOI: 10.1037//1089-2680.5.3.187

How and When Does Emotional Expression Help?


Eileen Kennedy-Moore
Westfield, New Jersey

Jeanne C. Watson
University of Toronto

The paradox of distress expression is that expression of negative feelings is both a sign of distress and a possible means of coping with that distress. This article describes research illustrating the paradox of distress expression. It reviews evidence concerning 3 possible mechanisms by which expression might alleviate distress, focusing on the role of expression in (a) reducing distress about distress, (b) facilitating insight, and (c) affecting interpersonal relationships in a desired way. The authors conclude by highlighting the circumstances under which expression is most likely to be adaptive. Overall, the authors argue that expression of negative feelings is adaptive to the extent that it leads to some kind of resolution involving the source or significance of distress.

The Paradox of Distress Expression


The paradox of distress expression1 is that expression of negative feelings is both a sign of distress and a possible means of coping with that distress. On the one hand, chronic or intense expression of distress is a symptom of most mood disorders. Expression can intensify distress (e.g., Ebbesen, Duncan, and Konecni, 1975), interfere with active coping efforts (Carver, Scheier, & Weintraub, 1989; NolenHoeksema, 1991), and have a destructive influence on interpersonal relationships (Tavris, 1984, 1989). On the other hand, expression can be a means of alleviating distress (Stanton, Danoff-Burg, Cameron, & Ellis, 1994; Stanton, Danoff-Burg, et al., 2000). In daily life, people seek out opportunities to talk about their feelings (Rime, Mesquita, Philippot, & Boca, 1991), and in psychotherapy, expression can play a key role in helping clients to process their

emotional experience (Horowitz, 1986; KennedyMoore & Watson, 1999). In this article, we briefly describe research on personality, trauma or loss, and disclosure in psychotherapy illustrating the paradox of distress expression. We then explore the issues of how and when emotional expression can be adaptive, focusing on three possible mechanisms by which expression might alleviate distress. We conclude by outlining circumstances under which expression is most likely to be adaptive.

Expression-Related Personality Traits


One line of evidence for the paradox of distress expression comes from research on expression-related personality traits. This research (discussed later) shows that both traits involving expression and traits involving deliberate efforts to refrain from expressing tend to be linked to worse psychological functioning. The key to interpreting these contradictory findings may involve distinguishing between expression-related traits that reflect characteristic distress proneness and expression-related
1 We define emotional expression as observable verbal and nonverbal behaviors that communicate or symbolize emotional experience. Emotional experience is the subjective, felt sense of emotional responses. Expression and experience do not necessarily correspond. For example, one person might refrain from expressing even though she or he is experiencing a great deal of emotion. Another person might express vociferously, while experiencing only a minor degree of emotion.

Eileen Kennedy-Moore, independent practice, Westfield, New Jersey; Jeanne C. Watson, Department of Counseling Psychology, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada. Portions of this article are based on Eileen KennedyMoore and Jeanne C. Watson's book Expressing Emotion: Myths, Realities, and Therapeutic Strategies (1999, Guilford Press, 1-800-365-7006). CoiTespondence concerning this article should be addressed to Eileen Kennedy-Moore, 104 Nelson Place, Westfield, New Jersey 07090. Electronic mail may be sent to eileenkm@att.net.

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traits that reflect habitual efforts to cope with distress. Gross (1998; Gross & John, 1997) argues that individual differences in expressivity stem from two major determinants: (a) the initial activation of emotional response tendencies and (b) the subsequent modulation of emotional response tendencies. This distinction between emotional activation versus modulation is supported by research looking at both self-ratings and peer ratings. It suggests that people might be very expressive because they tend to have strong responses to emotional stimuli or because they generally express their feelings openly. Conversely, people might be very inexpressive because they have a high threshold for distress elicitation or because they tend to inhibit their expression. In terms of emotional activation, personality research shows that people who express a lot because they have a low threshold for the elicitation of distress tend to be less well-adjusted than their more sanguine peers. A key example of this comes from research on negative affectivity (NA), which involves a disposition to experience unpleasant emotional states. High-NA individuals have a propensity to feel a wide variety of negative moods, including anxiety, frustration, sadness, irritability, and anger, even in the absence of obvious stressors (see L. A. Clark & Watson, 1991; D. Watson, 2000; D. Watson & Clark, 1984, for reviews). These individuals seem to see the world and themselves through a negative microscope, which heightens their sensitivity to negative information and leads them to perceive situations as stressful even when other people might not regard the situations as threatening. They are especially sensitive to the ordinary frustrations and irritations of everyday life, and they are more likely than low-NA individuals to respond to these hassles with greater and more enduring distress. High-NA individuals tend to dwell on their personal flaws and failures, as well as negative aspects of other people and the world in general. Because they tend to experience a great deal of distress, high-NA individuals also tend to express a great deal of distress. However, this expression seems to reflect or even compound their distress, rather than alleviate it. Interpersonally, they often behave in hostile and demanding ways, and they report experiencing a lot of social conflict (L. A. Clark & D. Watson, 1991). Their tendency to express many negative

feelings and few positive or friendly ones tends to evoke negative reactions from others (cf. Segrin, 1998). Therapeutically, the relevant goal for high-NA clients is not to have them vent their negative feelings but rather to address their propensity to feel distress in the first place. On the other hand, in terms of emotional modulation, personality traits involving a tendency to deliberately refrain from emotional expression have been linked to poorer psychological and physical well-being. These traits include rationality-antiemotionality (GrossarthMaticek, Bastiaans, & Kanazir, 1985; see discussions by Eysenck, 1991a, 1991b), emotional control (Rogers & Jamieson, 1988; Rogers & Nesshoever, 1987), and self-concealment (Larsen & Chastain, 1990). Research with these and other related personality traits is consistent with the idea that deliberately holding in one's feelings is unhealthy and, by extension, that expressing one's feelings is beneficial. It may be that effortful preoccupation with avoiding expression is physically or psychologically taxing.

Trauma or Loss
A second line of evidence for the paradox of distress expression comes from research on coping with trauma and loss. Consistent with the idea of expression as a sign of distress, a longitudinal study of coping with midlife conjugal bereavement by Bonanno and his colleagues (e.g., Bonanno, Keltner, Holen, & Horowitz, 1995; Bonanno, Znoj, Siddique, & Horowitz, 1999; see review by Bonanno & Kaltman, 1999) indicates that more distress expression is associated with worse outcomes. These investigators conducted interviews about grief with widows and widowers 6 months after the loss. Those people who were most expressive during the initial interview exhibited the most grief symptoms at 14- and 25-month follow-ups. In contrast, people who showed emotional avoidance during the interview, measured as low self-rated experience of distress coupled with heightened cardiovascular arousal, showed minimal grief symptoms 8 months later. Although emotional avoidance was linked to initially high levels of self-reported physical symptoms, by 14 and 25 months it was associated with low levels of physical symptoms. Bonanno and his colleagues interpret these findings as an indication that emotional avoidance can sometimes

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serve adaptive functions. Emotional avoidance Disclosure in Psychotherapy may enable individuals to regulate their emoA third line of evidence for the paradox of tional pain or to cope effectively with personal distress expression comes from clinical reor professional responsibilities. It is possible that the emotional avoiders had already done search. Stiles (1987, 1995) describes a "fever sufficient expression during the 6 months prior model" of disclosure in psychotherapy. He to the study. It is even possible that prior ex- defines disclosure as first-person statements pression enabled the avoiders to accept or re- concerning subjective information (e.g., "I solve their feelings sufficiently so that they were think . . .", "I feel . . ."). By this definition, able to be (relatively) less expressive during the disclosure includes verbal forms of expresinterview. However, Bonanno's work clearly sion but also includes other statements, such shows that more expression is not necessarily as thoughts or wishes. Stiles argues that like a better, and having the capability to sometimes fever in physical illness, disclosure is associrefrain from expressing and experiencing dis- ated with both illness and recovery. On the one hand, Stiles cites a number of correlatress is adaptive. On the other hand, consistent with the idea tional studies showing that people who are of expression as a coping strategy, Penne- experiencing a great deal of distress, such as baker and his colleagues have conducted a anxious or depressed clients, tend to disclose series of studies indicating that writing or a great deal. On the other hand, he notes that talking about feelings related to traumatic therapists tend to rate high levels of client events is physically and psychologically ben- disclosure as evidence of good therapeutic eficial (e.g., see reviews by Pennebaker, process. Stiles argues that psychotherapy out1997; Smyth & Pennebaker, 1999). Typically, come studies do not show clear benefits of these studies involve having volunteers write disclosure because process-outcome correlafor 20 min each day for several days. Some tions muddle disclosure as a sign of distress participants are instructed to write about triv- versus disclosure as a means of recovery. ial matters (e.g., a description of their shoes), More distressed clients disclose more. More whereas others are told to express their deep- distressed clients, on average, have worse est thoughts and feelings about some trau- psychotherapy outcomes. Yet, by disclosing, matic experience. Participants in these studies clients may be using therapy effectively to have included college students, unemployed process and assimilate their experience. Stiles workers, bereaved spouses, patients with suggests that disclosure may positively premedical illnesses, and even Holocaust survi- dict movement toward health rather than abvors. Expressing trauma-related feelings us- solute levels of well-being. ing Pennebaker's procedure (or variations) If expression of negative feelings is both a has been linked to better psychological well- sign of distress and a possible means of copbeing, better objective functioning (e.g., ing with distress, how and when does expresgrade point average, employment status), bet- sion help to alleviate distress? We contend ter self-reported health, and even better im- that expression of negative feelings is adapmune responses. Interestingly, the benefits of tive to the extent that it leads to some kind of written expression only emerge over time. resolution involving the source or signifiImmediately after expressing, participants ac- cance of distress. tually feel worse and are more physiologiIn the next sections, we describe three key cally aroused. A statistical review of studies mechanisms by which expression might alleviinvolving written expression of trauma-re- ate distress: (a) Expression can reduce distress lated feelings (Smyth, 1998) concludes that about distress; (b) expression can facilitate inthe overall magnitude of improvements asso- sight; and (c) expression can affect interperciated with the writing intervention (across sonal relationships in a desired way. various measures of well-being) is 23%, We focus on these three mechanisms bewhich is similar to or larger than the general cause, on the basis of available evidence, they magnitude of improvement produced by other seem to be the most promising explanations psychological interventions. of how emotional expression can enhance

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well-being.2 In discussing these mechanisms, we pull together theory and research from diverse areas in social and clinical psychology. Much of the evidence supporting these mechanisms is piecemeal and preliminary. However, taken as a whole, this work forms a rudimentary framework for understanding the adaptive functions of expression. How Does Expression Help?

Mechanism 1: Expression Can Alleviate Distress About Distress


One mechanism by which expression can resolve distress and enhance well-being is by alleviating distress about distress. People who are intensely distressed, such as those who have experienced traumatic events, are often afraid of their emotional experience (e.g., see Krystal, 1978). They see their feelings as dangerous, and they fear falling apart or being utterly overwhelmed if they allow themselves to express their feelings. Sometimes people interpret their intense emotional reactions as a sign that they are "going crazy" or that something is wrong with them (Thoits, 1985). This can result in an exacerbation cycle wherein worries that distress represents some personal inadequacy compound initial distress, which heightens worries, which further intensifies distress, and so forth (cf. Storms & McCaul, 1976). Fears of intense feelings may lead people to actively attempt to avoid expressing or experiencing these feelings. This effortful avoidance prevents people from learning to tolerate these feelings. Furthermore, it may cause them to feel alarmed by what they perceive as failures of self-control when their feelings spill out through involuntary expression (cf. Baumeister & Exline, 2000). For instance, a widower who is frightened by the intensity of his feelings of loss might try to avoid experiencing or expressing these feelings. When he suddenly starts crying because he remembers a certain incident with his wife, he may interpret these tears as a sign that he is not coping well, feel even more distressed, and redouble his efforts to avoid these feelings. In psychotherapy, expression can be a means of helping clients to revise their fearful beliefs concerning their emotional responses. Voluntar-

ily choosing to express their feelings enables people to select the timing, form, and context of their expression, thereby diminishing their sense of helplessness concerning these feelings. Actively expressing painful feelings also provides an opportunity to perceive their distress as painful but not unbearable (cf. L. S. Greenberg & Safran, 1987; M. A. Greenberg, Wortman, & Stone, 1996). Clients can learn through direct experience that allowing themselves to cry does not meant that they will never be able to stop crying, and that they have the capacity to tolerate talking about painful feelings, even though it is difficult. Expression can also help to resolve distress resulting from ambivalence about expression (cf. King & Emmons, 1990). If people want to express their feelings but are fearful of the consequences of doing so, actually expressing might allow them to learn that the feared consequences either did not occur or were not as unbearable as expected. Pennebaker (1985) comments that nonexpression is not pathogenic in and of itself. Rather, it is the combination of nonexpression plus a desire to express that causes health difficulties. This interpretation is consistent with a study by Ogden and Von Sturmer (1984) that found that (a) individuals who report regularly expressing their negative feelings as well as (b) individuals who say that they do not express their feelings but are not troubled by them are equally healthy both physically and psychologically. Neither of these two groups appears
2 In the 1980s, Pennebaker (e.g., 1985; Pennebaker & Susman, 1988) proposed a theory of disinhibition. According to this theory, deliberately refraining from talking about one's feelings requires physiological work, which is indicated by increased skin conductance level (SCL, a measure of how sweaty one's palms are). However, research routinely shows that the short-term effects of expressions of distress involve greater experience of distress and increased physiological arousal (see Littrell, 1998, and KennedyMoore & Watson, 1999, for reviews). Moreover, physical benefits, psychological benefits, or both can occur after writing about traumatic experiences one has already discussed (M. A. Greenberg & Stone, 1992) or after writing about someone else's traumatic experiences (M. A. Greenberg, Wortman, & Stone, 1996). These findings are not consistent with the idea of expression as a means of undoing the work of inhibition. Consequently, Pennebaker and other emotion researchers and theorists currently focus on other mechanisms, such as the ones described in this article (e.g., Bootzin, 1997; Lepore et al., 2000; Littrell, 1998; Pennebaker, 1997).

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to be bothered by ambivalence about expression or distress about distress. In contrast, individuals who say that they do not express their negative feelings but continue to suffer from them report greater dissatisfaction and more physical symptoms than the other two groups. Immersion plus control. Clinicians emphasize that expression must involve a combination of emotional immersion plus control in order to foster a sense of acceptance and mastery with regard to distressing feelings. For instance, Scheff (1979) argues that therapeutic emotional expression occurs at an optimum psychological distance: Individuals must vividly experience their feelings while in a context of present safety. Similarly, Horowitz (1986) points to the importance of combining distressing material with comforting cues as a means of "dosing" emotional confrontation. This clinical focus on expression involving emotional immersion plus control is consistent with empirical findings from expressive writing studies: Writing about trauma-related feelings causes increases in short-term distress (immersion), but experiencing relatively more short-term distress while writing (i.e., less control) does not lead to greater improvement (Smyth, 1998). Foa and Kozak (1986) invoke similar explanations emphasizing immersion plus control for the fear-reducing benefits of prolonged exposure to threatening stimuli. As clients stay in the presence of the feared object, the intensity of their physiological response gradually dissipates. This physiological habituation provides new information to clients, which they can use to revise catastrophic beliefs regarding their experience of fear. By extension, when trauma survivors are able to "stay with" their feelings by expressing them rather than avoiding them, it gives them the opportunity to revise their view of these feelings. With exposure interventions clients do not stay with their painful feelings continuously or indefinitely, but only under controlled circumstances (e.g., during a therapy session) and for periods long enough to have the intensity of their emotional experience and arousal decrease. This enables them to perceive their distress as tolerable and manageable rather than dangerous (see related findings and discussions by Creamer,

Burgess, & Pattison, 1992; Lepore, Silver, Wortman, & Wayment, 1996). Repeated episodes of expression may be necessary for fostering acceptance or habituation and diminishing distress about distress. Stanton, Kirk, et al. (2000, Study 4) had preselected college students to talk for 5 min with an interviewer regarding either the facts or their feelings concerning their parents' chronic physical or psychological disorders. The students were interviewed again, using the same instructions, 48 hr later. There were no effects of facts versus feelings instructions during or after the first interview. However, after the second interview, students who talked about their feelings showed lower physiological arousal and reported less negative affect. Pennebaker and Beall (1986) found that writing about one's feelings associated with a traumatic event was associated with increased arousal on the first day, but decreased arousal on three subsequent consecutive days. Pennebaker (1990) suggests that "repeatedly confronting an upsetting experience allows for a less emotionally laden assessment of its meaning and impact" (p. 106). Minimizing intrusive thoughts. In addition to general fears about the meaning or personal significance of distress, another key contributor to distress about distress is intrusive thoughts. Intrusive thoughts are repeated, unbidden thoughts or images about stressful experiences. Subjectively, intrusive thoughts seem uncontrollable, unpredictable, and upsetting. For example, experiencing intrusive thoughts can lead trauma survivors to fear being "ambushed" by painful memories and feelings when they least expect it (Horowitz, 1986). Laboratory experiments show that, paradoxically, attempts to deliberately suppress thoughts cause a rebound effect of more frequent or more distressing intrusive thoughts. The more people try not to think about some disturbing topic, the more such thoughts come to mind, and the more distressed they become about their inability to control the intrusive thoughts and their related feelings. An intensifying cycle of intrusive thoughts and suppression efforts has been implicated in the etiology and maintenance of clinical disorders such as posttraumatic stress disorder, obsessive-compulsive disorder, and depression (see reviews by Beevers, Wenzlaff,

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Hayes, & Scott, 1999; Purdon, 1999; Wenzlaff & Wegner, 2000). Several studies suggest that emotional expression can enhance well-being by diminishing the frequency or painfulness of intrusive thoughts. Lutgendorf and Antoni (1999) found that volunteers who disclosed a traumatic experience to an experimenter had fewer intrusive thoughts over time compared with volunteers who did not have the opportunity to express. Lepore, Ragan, and Jones (2000) also found that volunteers who were able to talk about their feelings after watching a brief film about the Holocaust had fewer intrusive thoughts than did volunteers in a nonexpressive comparison group. Other studies suggest that expression can lessen, if not the quantity, at least the emotional impact of intrusive thoughts. In a study involving college students preparing for graduate entrance exams, Lepore (1997) found that expressive writing did not decrease the frequency of intrusive thoughts about the exam, but it did decrease how depressing students found these thoughts. Lepore et al. (1996) conducted a correlational study of mothers who had lost a child to Sudden Infant Death Syndrome. They found an association between higher initial levels of intrusive thoughts and subsequent more severe depressive symptoms only among mothers who felt that their social environment constrained their ability to talk about their loss. Major and Gramzow (1999) found that women who expressed their feelings about having an abortion to other people were less distressed by intrusive thoughts than women who did not express these feelings. Similar results were obtained in studies of men with prostate cancer (Lepore & Helgeson, 1998) and of children exposed to inner-city violence (Kliewer, Lepore, Oskin, & Johnson, 1998). Taken together, these studies suggest that emotional expression allows people to fear intrusive thoughts less, to stop struggling to suppress these thoughts, and instead to acknowledge and accept these thoughts and their related feelings. Summary. In summary, one way that expression can enhance well-being is to reduce distress about distress by helping people to perceive their feelings as less frightening or unbearable. This is most likely to occur when expression involves immersion in painful feelings coupled with a sense of personal control. Repeated instances of expression may be nec-

essary to foster acceptance of painful feelings. Expression may also be useful for diminishing the frequency or emotional impact of intrusive thoughts about stressful events.

Mechanism 2: Expression Can Facilitate Insight


A second mechanism by which expression can diminish distress is by fostering insight concerning either the feelings themselves or the source of distress. Expression makes covert emotional experience overt. Putting emotional experience into words can help people to recognize, understand, and interpret their inner subjective states. Symbolizing feelings through verbal expression both represents and creates feelings: In the process of describing their experience, people come to understand it in ways not possible before they articulated their feelings (Lane & Schwartz, 1987; J. C. Watson & Greenberg, 1996; J. C. Watson & Rennie, 1994). For instance, whether a woman characterizes her inner experience as feeling "lost" or feeling "abandoned" carries very different implications for how she perceives herself and her environment. Sometimes expression can lead to emotional epiphanies, which are striking moments of affective insight (Kuiken, Carey, & Nielsen, 1987). Such moments are often described as pivotal events in literature, existential philosophy, and psychotherapy. They are most likely to occur during intensive self-reflection and involve a profoundly felt shift in self-understanding. During moments of affective insight, initially vague feelings are suddenly felt with clarity and certainty. There is a sense that the feelings were always there, but only now recognized and fully acknowledged. The individual experiences a sense of newly emerged self-knowledge and vitality accompanied by a perception of an increased capacity for self-direction. Other times, the insight fostered by expression may be less dramatic but still useful. If people understand their emotional experience, they are in a better position to know how they need to respond to environmental demands. Emotional insight can help people to draw on their feelings to guide their thoughts and actions (Mayer & Salovey, 1997; Salovey, Bedell, Detweiler, & Mayer, 1999; Salovey, Hsee, &

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Mayer, 1993; Salovey & Mayer, 1990; J. C. Watson & Greenberg, 1996) and to regulate or change negative affect (Kennedy-Moore, 1999; Mayer & Gaschke, 1988; Mayer & Salovey, 1997; Mayer, Salovey, Gomberg-Kaufman, & Blainey, 1991; Salovey et al., 1993; Salovey, Mayer, Goldman, Turvey, & Palfai, 1995). In general, the better people understand their emotional experience, the better they are able to cope with it. Creating meaning. Talking or writing about one's feelings usually involves structuring and organizing one's thoughts about these feelings. These thoughts become more orderly and less perseverative. The process of trying to explain one's feelings to someone else necessarily involves clarifying these feelings in one's own mind. L. F. Clark (1993) points out that to effectively convey their experience to another person, speakers have to step out of their own perspective enough to be able to consider the listener's viewpoint, which means that they look at their own experience from a new perspective. Linguistic studies of conversations show that in trying to express their feelings to another person in a coherent way, speakers clarify, elaborate, explain, note causes and effects, offer background information, highlight themes, draw connections, and group particular instances into categories. All of this can lead expressers to understand their feelings in a new way, thereby creating new meaning. Pennebaker (1993a) notes that across the various studies conducted by his research group, over 75% of the trauma-expression participants mentioned that their writing yielded long-term benefits involving insight. During debriefing, these participants made statements such as "It made me think things out," "It helped me look at myself from the outside," and "It was a chance to sort out my thoughts" (p. 110). Content analyses of the trauma-expression essays or discussions support participants' beliefs that expression of traumatic feelings is helpful when it fosters self-understanding (Pennebaker, 1993b; Pennebaker & Francis, 1996; Pennebaker, Mayne, & Francis, 1997). For instance, Pennebaker (1993b) combined the data from trauma-expression participants in several of his studies and selected the top and bottom third of participants on the basis of a composite outcome measure. The bottom-third participants had composite outcomes that were comparable

with control participants. Computer linguistic analysis showed that the essays of the top-third participants, who had the most positive outcomes following the intervention, had two distinctive insight-related characteristics compared with the essays of the bottom-third participants. First, the top-third participants used words reflecting insight (e.g., realize, understand, thought, knew) and causal reasoning (e.g., because, why, reason) at increasing rates across the 3 or 4 days of the study. They started out with very low rates of these words on the first day of writing and ended up with very high rates of these words by the last day of the study, suggesting that they acquired insight over the course of writing. In contrast, the bottom-third participants, although showing the same overall rate of insight words, used these words at consistent rates over time. Second, the top-third participants' essays became more focused over time. They showed a decrease over time in the percentage of different words in each essay, indicating that they started out with more scattered content and increasingly focused on a single topic. Judges' ratings of the essays corroborate these computer analysis findings concerning expression-related increases in self-understanding (Pennebaker, 1993b). Ratings by college student judges showed no differences in the overall extent to which the top-third and bottom-third participants accepted the events described in their essays, nor in the overall organization or narrative quality of the two groups' essays. However, these ratings indicate striking differences in changes over time. The essays of the top-third participants showed increasing organization, acceptance, and optimism. In contrast, the essays of the bottom-third participants started out with relatively clearly organized stories and gradually deteriorated. These results are consistent with theoretical perspectives emphasizing the importance of constructing narratives about experience (e.g., Meichenbaum & Fong, 1993). It seems that the process of creating such narratives is more important than simply having a narrative. This emphasis on expression leading to self-understanding is echoed by other investigators in both clinical and laboratory settings. Several studies show that being able to structure thoughts and feelings about past

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traumatic experiences is associated with better adjustment in a variety of clinical populations (e.g., Burgess & Holmstrom, 1979; Fairbank, Hansen, & Fitterling, 1991; Silver, Boon, & Stones, 1983). Chafe (1977) observed that personal stories become markedly more integrated (less fragmented) on subsequent retellings, compared with the initial account. It may be that people's tendency to talk about their feelings not just once but repeatedly (Rime et al., 1991) reflects a meaning-making process of constructing an account for these feelings. What kinds of new meaning might expression create? Expression can lead to clearer understanding of what one is feeling and why (J. C. Watson & Rennie, 1994; KennedyMoore, 1999). It can also lead to new appraisals of past or present circumstances. Creating a story about painful events might provide some sense of control over uncontrollable events (S. C. Thompson, Sobolew-Shubin, Galbraith, Schwankovsky, & Cruzen, 1993), provide a sense of resolution (Pennebaker & Seagal, 1999), or enable people to perceive some benefit from their suffering, such as personal growth (Janoff-Bulman, 1992; McFarland & Alvaro, 2000). They may see their suffering as imparting some important lesson. For instance, spelling out the implications of trauma-related feelings may help survivors to realize with sudden clarity and certainty what truly matters to them in life (e.g., "I almost died without telling my wife how much I love her"). They may also gain a new appreciation for their own courage, dignity, or resilience in response to the trauma (e.g., "This experience let me see what I'm capable of when I'm pushed to my limits"). Alternatively, trauma survivors may perceive that their suffering was worthwhile because it helped others or brought them closer to people they care about (e.g., "My father's death was a tragedy, but it brought me closer to my brother"). Such efforts to create meaning out of experience are central to constructivist psychotherapies (e.g., Neimeyer, 1993; Rosen & Kuehlwein, 1996). In a longitudinal study of bereaved family members, Davis, Nolen-Hoeksema, and Larson (1998) found that making sense of the loss helped minimize distress during the first year following the loss, whereas finding benefit from the experience was

associated with better adjustment 13 and 18 months after the loss. Combining thinking and feeling. Expression-related insights are not the product of either cold-hearted analysis of the situation or simple venting. Instead, this kind of insight stems from a combination of thinking and feeling. Pennebaker and Beall (1986) found that writing only about the facts of a traumatic experience was not helpful. In another study, Krantz and Pennebaker (1995) compared verbal and nonverbal expression of traumatic feelings. They found that expressive movement alone did not yield health benefits, but expressive movement combined with written expression did. Thus, accessing feelings, putting them into words, and building a coherent cognitive story are all important components of Pennebaker's interventions. Emotion theorists suggest that people have two different ways of processing information: experiential or rational (Epstein, 1990; Gendlin, 1974, 1981; Greenberg, Rice, & Elliott, 1993; Zajonc, 1980). The experiential processing system is global and holistic. It draws on affect and imagery. It processes information quickly, in an integrative way, but once activated, its impressions are slow to change. In contrast, the rational processing system is analytic, dominated by logic and fact. It processes information more slowly, in a more differentiated way, but its conclusions can change quickly. Both rational and experiential processing of information are important for well-being: Relying solely on rational processing means that one is cut off from a rich source of information about oneself and the impact of the environment, whereas relying solely on experiential processing entails being driven blindly by diffuse affective responses. An integration between thinking and experiencing is both a sign and a result of adaptive emotional expression. Research by Sappington and Russell (1979; Sappington, 1990) also points to the difference between cognitive and emotional processing. They distinguish between intellectually based beliefs, which are subjectively perceived as rational and based on facts, versus emotionally based beliefs, which are subjectively perceived as nonrational and supported only by feelings or

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intuitions rather than facts.3 Laboratory experi- their voices are soft and hesitant with ragged ments show that intellectually based beliefs can pauses and emphasis in unexpected places. be altered by obtaining more information. In Their language is often poignant and vivid, crecontrast, emotionally based beliefs are not af- ating a sense of immediacy and aliveness. When fected by objective information but can change clients are in touch with their feelings in this under conditions of increased levels of emo- way, they are inwardly focused on their tional experience and arousal. People often note thoughts and feelings, actively experiencing the distinction between intellectually and emo- their feelings in the session, and intensely entionally based beliefs. They may make remarks gaged in examining and evaluating their expesuch as "Rationally I know X, but I feel as if Y." rience to create new meaning. In contrast, less Writing or talking about their feelings enables productive processing and expression is characpeople to access and perhaps revise their emo- terized by more distant and disengaged descriptionally based beliefs. tions and analysis of experience and feelings. At Clinicians emphasize that exploring feelings these times, clients often have an outward focus, in a helpful way requires a combination of cog- describing the events and people in their lives in nitive and emotional processing that involves a a rehearsed and lifeless manner. Clients may "middle distance" from inner experience (e.g., talk about what is happening in their lives but Rice & Kerr, 1986; Scheff, 1979; see also Mer- pay little attention to its impact on them and genthaler, 1996). Scheff argues that beneficial their own inner responses. They may talk in a catharsis occurs when one is able to participate well-modulated, rhythmic tone, as if they were in and also observe one's own distress. If indi- presenting a well-rehearsed speech or chatting viduals are overdistanced from their emotional to a friend. They are not in touch with their experience, they are unaware of it and unable to feelings but seem distant from them and appear access it as a source of information to guide to be talking about them rather than experienctheir thoughts and behavior. If they are un- ing or expressing them in the moment. derdistanced, they are so flooded by feelings Research on anger expression also points to that they cannot reflect on their emotional ex- the benefits of combining cognitive and emoperience or modulate it. They express their tional processing. Murray (1985) described a emotions, but in an unfocused, spilling-over series of laboratory experiments showing that manner. For example, Jones, (Humming, and the combination of emotional ventilation and Horowitz (1988) observed that clients with high cognitive reinterpretation was more effective in levels of initial distress during a first therapy reducing subsequent anger and aggression than session were less able than other clients to talk either ventilation alone or cognitive reinterpreabout their experience from multiple perspectation alone. In one of these studies (Green & tives. L. F. Clark (1993) also notes that when people are extremely distraught they are unable Murray, 1975), college students were angered to "step back" and make sense of their experi- by receiving a derogatory personal critique of ence as they express it. Instead their expression themselves that was supposedly written by aninvolves "a stream of unorganized ruminations other student they had just met, who was actuthat perpetuates a narrow perspective on the ally the experimenters' confederate. After readproblem" (p. 48). To gain emotional under- ing the derogatory critique, study participants standing individuals need to be aware of their received one of three different interventions, inner experience but not overwhelmed by it. They need to experience and express their feel3 Sappington and Russell's distinction between intellecings vividly, but with enough distance that they tually and emotionally based beliefs is similar to Freud's can thoughtfully examine and interpret these (1921) distinction between intellectual and emotional insight, Zajonc's (1980) distinction between "hot" and "cold" feelings. What does this combined cognitive-experiential processing look like? Psychotherapy process research (Rice, Watson, & Greenberg, 1993; J. C. Watson & Greenberg, 1996) suggests that when clients are engaged in productive exploration and expression of emotion,

cognitions (the former having a strong emotional component), and Epstein's (e.g., 1994) distinction between the rational and experiential information-processing systems. Sappington (1990) noted that emotionally based beliefs are not the same as emotional experience: Emotionally based beliefs are derived from emotional experience but they can influence behavior even when a person is not currently experiencing emotion.

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involving different anger-coping strategies. In the expression condition, the experimenter got participants to express their resentment concerning the derogatory critique. In the reinterpretation condition, the experimenter explained that the other student had misunderstood the instructions. He thought he was supposed to write a nasty critique, but he did not really mean what he said. In the combination condition, participants first expressed their feelings and then heard the "it was just a misunderstanding" explanation. In addition to these three intervention conditions, there were also two comparison conditions, one involving no induction of hostility and one involving hostility induction but no intervention. Results showed that only the combination of expression and reinterpretation was effective in reducing later aggression toward the other student. The combination condition also prompted a significantly greater shift to positive feelings toward the experimenter's assistant than the two single-component intervention conditions. In this study, reinterpretation alone was not a very powerful way to reduce aggression or angry feelings. The expression-alone condition also did not appreciably decrease aggression, and it left participants feeling even more negative toward the experimenter's assistant than the no-intervention condition. The anger-provoking incident in Murray's studies is somewhat contrived. However, another series of studies by Bohart, involving naturally occurring anger-arousing incidents, also suggests that anger expression is not helpful in and of itself but that it can be adaptive when it leads to or is accompanied by cognitive changes (see Bohart, 1980, for a review). For instance, Bohart (1977) asked college students to recall and mentally rehearse an anger-arousing incident in order to induce feelings of anger. Study participants were then given one of four sets of instructions. Intellectual-analysis participants were told to "coldly and rationally analyze" events, motives, and feelings pertaining to the event. Discharge participants were told to verbally express their angry feelings as if the person who angered them was in the room. Roleplay participants were told to switch chairs as they conducted a dialogue expressing both their own feelings and the feelings of the person who angered them. Finally, to provide a comparison for the other groups, detail participants were

asked to recall physical details of the incident. Self-report measures of angry feelings were taken before and after the intervention. Additionally, as a measure of behavioral aggression, participants were told to choose a level of aversive noise with which to "punish" a person in another room who supposedly made errors on a learning task. These interventions lasted only a few minutes, but they produced notable group difference. Discharge participants showed increases in anger and hostile attitudes. In contrast, roleplay participants showed reductions in anger, hostile attitudes, and behavioral aggression. On the basis of this and other similar analog studies, Bohart (1980) argues that the combination of emotional expression and insight is more helpful than simple venting of emotion. He suggests that anger expression merely sets the stage for resolving a conflict situation. He argues that anger expression is helpful only if it leads to positive cognitive or interpersonal changes such as compromise, reinterpretation, or restoration of self-esteem. Both Murray's and Bohart's studies involved students rather than therapy clients, and the interventions were brief. However, similar results were obtained in a clinical study of processes and outcomes in encounter groups by Lieberman, Yalom, & Miles (1973). Seventeen groups, employing a variety of therapeutic approaches, each met for 30 hr. Outcome measures included ratings by participants themselves, other group members, group leaders, and friends of group members. Many of the groups in this study emphasized the therapeutic importance of venting intense emotions, including anger. Results suggest that expression of emotion alone was not therapeutic, but expression accompanied by some cognitive process was helpful. The groups focusing on expression of intense emotions were not more successful than other groups. To the investigators' surprise, higher levels of anger expression in the encounter groups were associated with poorer outcomes. More recently, Littrel (1998) concluded from her review of the role of emotional expression and experience in psychotherapy that accessing intense feelings without having the opportunity to cognitively process them actually can be harmful to clients.

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Some caveats concerning expression-related For instance, an abused wife who confides in a insight. So far in this section we have de- friend about her anger might draw on this anger scribed how expression can diminish distress by to galvanize her resolve to leave her marriage. enhancing insight. Talking or writing about In this case, expression-related insight might their feelings can enable people to perceive their lead to short-term increases in distress followed feelings with greater clarity or to gain new by long-term decreases. Many theorists point to understanding of their feelings or circum- the potentially motivating functions of emotion stances. However, we must mention two caveats (e.g., Carver & Scheier, 1998; Frijda, 1994; L. S. Greenberg & Pavio, 1997). On the other concerning expression-related insight. First, expression-related insight does not nec- hand, expression that involves simply enumeressarily lead to immediate reductions in distress. ating grievances (e.g., "My life is a complete A classic study by Ebbesen et al. (1975) vividly mess") could lead people to feel overwhelmed illustrates the role of expression in shaping and and paralyzed rather than motivated to act. A second caveat is that not all forms of intensifying anger experience. These investigators interviewed laid-off engineers and techni- expression lead to insight. When expression cians about their angry feelings. The inter- involves rumination, or passive brooding viewer subtly directed the focus of the workers' about emotional experience, it does not foster anger expression in one of three directions: to- new understanding but instead intensifies and ward the company, toward their supervisors, or prolongs distress (e.g., Nolen-Hoeksema, toward themselves. The interviewer asked lead- 1991; Nolen-Hoeksema, McBride, & Larson, ing questions, such as "In what ways has the 1997; see discussion by M. A. Greenberg, company not been fair with you?" "What action 1995). Ruminative expression is vague, difmight your supervisor have taken to prevent you fuse, and stagnate. Repetitively expressing from being laid off?" or "Are there things about "I'm miserable; I'm always miserable; I'm yourself that led your supervisor not to give you just plain miserable," does not enhance copa higher performance review?" To provide a ing. Instead it rehearses and intensifies disbasis of comparison, the investigators also tress, and it interferes with the implementaasked some of the laid-off workers neutral, un- tion of active coping strategies. People who emotional questions. Results showed that anger are rigidly preoccupied with how distressed expression in the interview did not dissipate they are feeling do not have the cognitive feelings of anger. Instead, expressing anger to- resources to solve problems, to react flexibly ward the company or toward supervisors in- to changes in environmental circumstances, creased anger toward the specific target dis- or to recognize and respond sensitively to cussed, but not toward other targets. Fortu- other people's feelings. Having an enduring nately, expressing anger toward the self did not tendency to focus on inner experience, includchange anger toward the self or toward the other ing emotional experience, has been implitargets. The laid-off workers in this study cated in virtually all clinical disorders (Ingained expression-related insight in that they gram, 1990). came away with clearer, more targeted underExpression that persists at the lowest levels of standing of their feelings. However, at least in emotional awareness, that is merely a symptom the short-term, this insight heightened, rather of perseverative attention to distress, is not than diminished, their distress. In a related vein, likely to be helpful. In contrast, adaptive expresTice (1990) surveyed people concerning the sion brings a sense of movement and change, strategies they use for controlling or altering involving new, deeper understanding and readitheir emotional states. One of the key strategies ness for action. No amount of saying, "I feel that Tice's respondents reported using to sustain bad" is likely to help, but saying and realizing, their anger was rehearsing one's feelings and "I feel lonely and unfulfilled in this relationtheir perceived cause, especially in the presence ship," could translate directly into adaptive copof a sympathetic other. This involves using ex- ing efforts. (See discussion of levels of emopression as a means of intensifying and prolong- tional awareness by Lane & Schwartz, 1987, ing angry feelings. 1992). Insight-related increases in distress can be Drawing from clinical observation, L. S. adaptive if they motivate active coping efforts. Greenberg and Safran (1987) identified three

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classes of emotional expression. Primary emotional reactions convey biologically based, basic emotions, which provide adaptive information for functioning. Often, clients entering therapy are unaware of these underlying feelings. Secondary emotional reactions are defensive coping efforts aimed at self-protection. These feelings are readily available to consciousness. Expression of such feelings have the quality of a well-rehearsed, often-repeated litany. Even though these feelings may be negative and may motivate clients to seek therapy, there is a sense of comfort and familiarity with these feelings. The third class of emotional expression, instrumental emotional reactions, involves efforts to influence others, such as expressing sadness to gain sympathy or anger to avoid responsibility. This last type of emotional reaction entails a lack of correspondence between overt emotional expression and covert emotional experience. It is easily noticed and controlled by clients. In therapy, expression of secondary emotional reactions is not helpful and often harmful. Presumably, talking about these well-rehearsed feelings is just a form of passive rumination. In contrast, evocation and expression of primary emotional reactions elicits insight and results in therapeutic change. The primary emotions are felt with a profound sense of authenticity. Recognition and expression of these emotions leads to a sense of new understanding and increased motivation to act (L. S. Greenberg & Johnson, 1990). Summary. In summary, a second way that expression can enhance well-being is by facilitating insight. Articulating their feelings can help people understand their feelings with greater clarity and provides the opportunity to spell out the causes and implications of those feelings. Placing painful feelings in the context of a narrative can be a way of resolving those feelings. Expression-related insight is most likely to occur when expression involves a combination of thinking and feeling. Furthermore, expression-related insight is only likely to enhance well-being if it motivates active coping efforts. Expression that merely rehearses old grievances can leave people feeling overwhelmed and paralyzed.

Mechanism 3: Expression Can Affect Interpersonal Relationships in Desired Ways


The final mechanism by which expression can enhance well-being pertains to the interpersonal impact of expression. Emotional expression is usually a social occurrence: Individuals express their feelings to others. Social expression of emotion is extremely common. An overwhelming majority of people report that they discuss their emotions with others, particularly their significant others (Rime, 1995; Rime et al., 1991). Expressing distress to others can enhance the two mechanisms that we have already discussed. For instance, confiding in a friend about frightening or shameful feelings can reduce distress about distress if that friend responds with empathy, acceptance, and containment (cf. Kosmicki and Glickauf-Hughes, 1997). Distressed people often judge themselves quite harshly, interpreting their distress as a sign that they are falling apart or just unable to handle things the way most people can (Thoits, 1985). Validation and reassurance from others can alleviate selfdoubts. Hearing that a friend has had similar experiences, or at least is not horrified or repelled by the expresser's feelings, enables the expresser to form a more benign appraisal of the significance of his or her distress. A study by Donnelly and Murray (1991) offers a comparison of individual versus interpersonal expression of traumatic feelings. These investigators compared the effects of writing essays versus talking with a therapist about traumatic events. In the therapy condition, clinical psychology graduate student therapists reflected and reframed the emotional content of trauma descriptions in a warm and empathic manner. Participants were college students, and the interventions took place over 4 consecutive days. In both trauma-expression groups, positive emotion, self-esteem, and cognitive and behavioral change increased across the 4 days of the study, whereas negative emotion decreased. Both of these groups also felt more positive about their topics and themselves at the end of the experiment, although there were no longterm effects of either intervention on mental or physical health.

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The most interesting results of this study were the differences in mood between the writing versus the talking group immediately following each day of the intervention: Participants who wrote essays about their traumatic experiences showed increases in negative mood and decreases in positive mood after each session, whereas participants who talked about their traumatic experiences in therapeutic interviews showed no increase in negative mood and sometimes a decrease. The therapy participants also maintained their levels of positive mood after the first day. Donnelly and Murray (1991) interpret these findings to mean that expressing feelings about traumatic experiences is an aversive task but that having a therapist respond empathically somehow ameliorates this aversiveness. Expressing distress to others can also lead to greater insight. Recipients of distress expression have a different perspective than expressers and may suggest different ways of understanding feelings or circumstances (cf. Burleson and Goldsmith, 1998). Drawing on research comparing the characteristics of written versus spoken communication, L. F. Clark (1993) speculates that although both writing and speaking about stressful experiences can help make sense of experience, they do so in somewhat different ways. Because writing is more detached and structured, it may be particularly helpful for constructing a coherent explanation, accepting unchangeable situations, minimizing confusion, or providing a sense of control. In contrast, because speaking is more personal, repetitive, fragmented, and contains more ideas, it may be especially useful for reevaluating situations, generating new perceptions, and gaining a broader perspective and a more elaborated understanding. In addition to enhancing these previously mentioned mechanisms, social expression of distress can also serve some unique functions that help to diminish distress. Specifically, it can change the structure of relationships, directly resolve distress stemming from interpersonal interactions, or elicit social support. Social psychologists and emotion theorists note that expression plays a key role in structuring relationships. Keltner and Kring (1998) suggest that facial expressions of emotion serve as ongoing cues that coordinate social interactions by (a) rapidly conveying to other people how the expresser is feeling about his or her

current relationship or circumstances, (b) evoking corresponding emotional responses in others, and (c) rewarding or deterring other people's behavior. Both verbal and nonverbal expression help define a relationship by influencing participants' intimacy and relative status (see discussion by Derlega, Metts, Petronio, & Margulis, 1993). Confiding in someone about one's painful feelings can decrease distress by creating a new sense of intimacy in a relationship. Expressions of distress sometimes help a partner get to know the expresser better and communicate that the expresser trusts the partner. It also creates a normative demand or expectation that the partner will reciprocate this self-revelation, further enhancing intimacy. Specific types of expression can change the relative status of relationship partners and their patterns of interaction. Expressing fear or sadness is a sign of vulnerability, which tends to disarm and elicit compassion, whereas expressing anger or disgust is a sign of strength, which tends to assert independence and delineate interpersonal boundaries (L. S. Greenberg & Johnson, 1990). Expression can also directly resolve distress stemming from interpersonal interactions. For instance, Tice and Baumeister (1993) point out that people who fail to express their anger may find that their problems recur. With no information concerning the problem, an offender is likely to repeat the provoking action. The offended party becomes increasingly angry, not because their anger builds up, but because they accumulate a list of grievances with each repeated offense. They may end up having a strong outburst of anger expression in response to multiple provocations, whereas the offender may perceive this as overreacting to a single incident (Baumeister, Stillwell, & Wotman, 1990). It seems plausible that a constructive expression of anger early on might prevent this escalation of anger. Tavris (1984, 1989) suggests that anger expression is most likely to be adaptive when it is directed at the appropriate target (i.e., the person one is mad at), and it results in the clarification of anger-arousing misunderstandings or misperceptions (e.g., "It was an accidentI would never do that to you deliberately") or prompts a desired change in another person's behavior (e.g., "I had no idea that bothered you so muchof course I won't do it anymore").

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Finally, social expression of distress can also elicit social support. Expression can serve as a cue for significant others to provide coping assistance (e.g., Thoits, 1986; R. A. Thompson, 1994). Communicating distress is a means of eliciting tangible aid or new information that can enhance coping efforts. An individual is more likely to get help from others if others know the individual needs help. There is ample evidence of the benefits of having social support (e.g., Brown & Harris, 1978; Cohen & Wills, 1985; Sarason, Sarason, & Pierce, 1990). Correlational studies indicate that having emotional support is consistently associated with health and well-being. Experimental studies involving laboratory stressors show that active efforts by a significant other to provide emotional comfort and reassurance are reliably associated with diminished cardiovascular responses to stressful events and sometimes with decreased experience of distress (see reviews by Lepore, 1998; Uchino, Cacioppo, & Kiecolt-Glaser, 1996). Presumably, in most cases, some form of distress expression is necessary to elicit social support. For instance, several theorists have suggested that crying serves a help-seeking function by acting as a signal to others that the individual is no longer able to manage the situation alone (e.g., Averill, 1968; Labott, Martin, Eason, & Berkey, 1991; Sadoff, 1966). Cornelius (1984) had volunteers provide detailed descriptions of a time when they had cried in the presence of another person. Although study participants insisted that their tears were involuntary rather than deliberately manipulative, they perceived crying to be quite effective in changing the interpersonal context in a positive direction, from conflict toward support. Crying got the attention of the other individual and frequently elicited attempts to comfort the crier (especially a female crier). The risks of expressing distress to others. So far in this section, we have focused on the possible benefits of expressing distress to another person. All of these benefits presume that the recipients of distress expression respond with warmth and understanding. However, this is far from guaranteed. Expressing negative feelings to another person is risky (e.g., Derlega et al., 1993; Fisher, Goff, Nadler, & Chinsky, 1988; Nolen-Hoeksema & Davis, 1999; see also related discussion by Kelly & McKillop, 1996, concerning the risks of confiding personal se-

crets). If recipients of distress expression respond negatively, the expresser may feel rejected, misunderstood, embarrassed, or betrayed. For example, Major et al. (1990) found that those women who told a significant other about their abortion but felt they received a response that was less than fully supportive were more distressed than women who did not tell anyone about their abortion. Sometimes recipients respond to distress expression in less than helpful ways because they misread expressers' intent. L. F. Clark (1993) implies that the helpfulness of other people's responses depends on the extent to which they are "in tune" with the expresser's goals. Sometimes expressers are seeking advice or action from others; sometimes they merely want to "gripe." Similarly, Miller and Berg (1984) define responsiveness as "the extent to which and the way in which one participant's actions address the previous actions, communications, needs, or wishes of another participant in the interaction" (p. 191). They distinguished between "conversational responsiveness," which involves behaviors indicating interest in and understanding of another person's communication, and "relational responsiveness," which involves behaviors addressing another person's needs. When responsiveness is low, expressers can feel frustrated and misunderstood. Sometimes other people, either out of caring for the expresser or because of their own discomfort with intense feelings, respond to expressers by dismissing or minimizing their distress or prematurely offering a positive interpretation concerning the source of distress (e.g., "It's for the best"). These responses are experienced by the expresser as showing a lack of acceptance or understanding, leaving the expresser feeling dismissed or rejected (e.g., Lehman, Ellard, & Wortman, 1986; Silver et al., 1983; Silver & Wortman, 1980; Silver, Wortman, & Crofton, 1990). Numerous studies have found that individuals experiencing intense or enduring distress are discouraged by significant others from expressing their feelings (Coates & Winston, 1987; Coyne, Wortman, & Lehman, 1988; Gottlieb & Wagner, 1991; Wortman & Dunkel-Schetter, 1979). It is distressing for others to see someone they care about suffering. When expressers show a great deal of distress, listeners may feel overwhelmed. They may feel confused or helpless about how to respond.

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They may either avoid the expresser or insist that the expresser "cheer up." In particular, the intensity of the trauma victim's distress may be alarming for others and may lead them to conclude that talking about the trauma just makes things worse. They may end up discouraging the distressed person from expressing their feelings, both to protect the expresser from further distress and to protect themselves from upsetting interactions with the expresser. Sometimes recipients respond quite negatively to distress expression. In dyadic interactions, partners tend to match each other's loudness level and speech rate (Feldstein & Welkowitz, 1987). When one partner starts yelling, the other partner is likely to reciprocate, intensifying both partners' arousal and experience of anger (Siegman, 1994). Angry tirades are more likely to be met with defensiveness or even counterattack than with understanding or acceptance (see review by Tavris, 1989). Marital researchers have identified a pattern of distress expression called negative escalation cycles. During these cycles, each partner's expression of negative emotion elicits an even more negative comment in response. Partners' remarks are aimed at hurting each other rather than understanding or resolving any issues. Negative escalation cycles are very effective discriminators between satisfied and dissatisfied couples and powerful predictors of future distress (Gottman & Levenson, 1986; Julien, Markman, & Lindahl, 1989). Even when recipients respond positively to expressions of distress, seeking support can threaten expressers' self-esteem by making them feel inferior, inadequate, or dependent because they cannot manage on their own. Although the perceived availability of support is related to better well-being, having sought or received support is associated with poorer wellbeing (Coyne & Downey, 1991). This finding could indicate simply that people who are more distressed are more likely to seek help. Alternatively, it may reflect the costs to self-esteem of receiving help, or the inadequacy of the help received. Determinants of others' responses to distress expression. What determines whether distress expression elicits positive or negative responses from others? The interpersonal consequences of distress expression depend on what is expressed, to whom, and how.

One key factor in determining the interpersonal consequences of distress expression is the intensity of emotional expression, experience, and arousal of both the expresser and the receiver. When people are feeling more intensely distressed, they are more likely to express their feelings to others (Luminet, Zech, Rime, & Wagner, 2000). However, Gilbert (1991) maintains that effective communication and conflict resolution are most likely to occur when participants are at intermediate levels of physiological arousal. High levels of arousal generally interfere with cognitive processing. Highly aroused people are less able to effectively process external stimuli because their focus of attention is narrowed to their own experience and the immediate cause of their distress (L. F. Clark, 1993). Their behavior tends to be impulsive and extreme, focused on short-term relief rather than long-term consequences. Zillmann (1993) notes that anger-reducing cognitive strategies such as reappraisal only work at moderate levels of anger experience and arousal. Once people become enraged, laboratory studies show that they are apt to ignore or dismiss mitigating information. Drawing on LeDoux's physiological research with rats (e.g., LeDoux, 1989, 1996), Goleman (1995) coined the term "emotional hijacking" to refer to times when the emotional (limbic) brain takes over control of behavior from the thinking (neocortex) brain. Similarly, Gottman (1993) talks about "emotional flooding," which he defined as occurring when heart rate jumps 10 or more beats per minute above a person's resting rate. While flooded, people feel overwhelmed by intense and subjectively uncontrollable feelings of distress. They are unable to organize their thoughts, communicate clearly, or consider another person's point of view. Jacobson and Holtzworth-Munroe (1986) found that even individuals who know effective communication skills do not feel like using them when they are extremely angry. All of these researchers and theorists suggest that when people are in the throes of high levels of anger experience and arousal they are more likely to lash out through extreme, impulsive, and maladaptive forms of anger expression. Marital researchers suggest that couples' ability to regulate the intensity of negative emotional expression is crucial to their well-being

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(Blechman, 1990; Fruzzetti & Jacobson, 1990; Lindahl & Markman, 1990). Engaging in "tolerable doses" of expression of negative emotions toward a spouse is less arousing for both self and spouse than more intense expression. For this reason, it has a number of potential advantages. First, moderately intense expression is less aversive, which makes it more likely that partners will continue to engage in the discussion until a solution is achieved, rather than disengaging prematurely. Second, moderate expression makes it more likely that partners will be able to think constructively and come up with solutions rather than experiencing cognitive deficits due to excessive arousal. Third, tolerable expression makes it more likely that partners will be able to assimilate new information and develop better understanding of each other, which has been linked to satisfaction in long-term relationships (Cahn, 1990). In addition to intensity, the frequency of distress expression is likely to be an important determinant of whether expression is effective in an interpersonal context. One correlational study (Keinan, Ben-zur, Zilka, & Carel, 1992) found that the most adaptive anger expression style involved clear but infrequent anger expression. People who constantly express distress are likely to have other people dismiss their complaints, thinking or saying, "There they go again!" Parents who scream at their children all the time usually find that their children tune them out (Tavris, 1989). The frequency of their distress expression may explain why ruminators have trouble eliciting social support (NolenHoeksema & Davis, 1999). The content of anger expression is also important in determining interpersonal consequences of distress expression. In describing emotionally focused marital therapy, one of the best validated forms of marital therapy, Johnson (1996) emphasizes that the key to adaptive interpersonal expression is active exploration and new awareness of previously unacknowledged feelings:
The indiscriminate ventilation of negative emotion . . . can be detrimental in couples therapy. The repetitive expression of [well-rehearsed] emotions is an essential part of distressed couples' everyday problematic interactions. It is the discovery and development of new or unrecognized emotional experience that is useful in couples therapy, (p. 43)

According to Johnson, when one member of a couple is able to communicate a previously unexpressed feeling, it elicits a new response from the partner and leads to changes in the couple's general pattern of interacting. Behaviorally oriented marital therapists also focus on the content of expression by teaching clients to make distress expressions more palatable to receivers. They emphasize communication skills such as using "I" statements and focusing on specific problematic behaviors rather than general personal inadequacy (e.g., "I feel irritated when you leave your dirty socks in the middle of the floor" rather than "You are a disgusting and completely inconsiderate jerk!"). Being able to communicate one's distress in a socially skilled manner enhances the likelihood of receiving support. A study by Silver et al. (1990) indicates that people are most willing to interact with expressers who disclose distress but also state that they are engaged in coping efforts. People are less willing to interact with expressers who either openly show their distress or downplay their distress. On the other hand, it is possible to overdo efforts to make recipients of distress expression comfortable. Coates and Winston (1987) found that high self-monitors (i.e., people who pay particular attention to how they come across to others) were more effective than low self-monitors in gaining support from others, but unlike low self-monitors, they did not feel less depressed after expressing. Coates and Winston speculate that the high self-monitors downplayed their distress. This strategy made listeners like them more, but perhaps it prevented high self-monitors from getting the understanding or acceptance they needed. Kennedy-Moore and Watson (1999) argue that the interpersonal consequences of distress expression depend on how receivers interpret it. Receivers draw on verbal and nonverbal aspects of their partner's emotional behavior, as well as the general relationship context, to infer the degree of threat that the distress expression entails for them. When receivers perceive that the expression implies personal criticism or that the intent behind distress expression is malicious or manipulative, they feel more threatened and are less likely to respond positively. They may also respond negatively if they perceive that the level of distress shown by the expresser exceeds their current coping capabilities. On the other hand, when receivers view the expresser's in-

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tent as positive or at least benign, and the magnitude of distress does not seem overwhelming, they are more likely to respond warmly to distress expression. Capps and Bonanno (2000) found that strangers were more inclined to avoid and less inclined to comfort people whose bereavement narratives were more negative and contained more helpless or passive themes. Perhaps these people came across as overwhelmingly needy, leading the strangers to feel threatened by their distress expression. Shimanoff (1987) presented married couples with scenarios involving disclosures of negative emotions directed at either the spouse or some other person (e.g., friend, coworker). When spouses received distress disclosures about other people, they felt more intimate with the partner. When the distress disclosures were about themselves, spouses felt less intimate. Alberts (1988) observed that partners' responses to their spouses' complaints are influenced more by partners' global feelings toward their spouses than by the spouses' immediate behavior. In general, satisfied partners tend to make more generous or forgiving attributions for their spouses' negative behavior than do unsatisfied partners (Fincham & Bradbury, 1993). Summary. In summary, expression can alleviate distress by affecting interpersonal relationships in desired ways. Talking about one's feelings with another person can enhance individual functioning by leading to greater selfacceptance or new insight. It can also directly affect relationships by changing patterns of relating, resolving interpersonal misunderstandings, or eliciting social support. However, others do not always respond warmly to expressions of distress, and negative responses from others can intensify expressers' distress. Expressions of distress are most likely to lead to positive responses from others when they are not too intense or too frequent and when they involve new (rather than well-rehearsed) feelings that are sensitively communicated. In general, how other people respond to expressions of distress depends on how threatening they perceive these expressions to be. So far in this article we have highlighted three possible mechanisms by which expression can enhance well-being. These mechanisms involve reducing distress about distress, fostering insight, and affecting interpersonal relationships in a desired way. These three mechanisms are

interrelated. For instance, perceiving feelings as more acceptable and tolerable may enable people to examine them in a way that promotes greater self-understanding, which leads them to alter their interpersonal relationships in a desired way. Alternatively, explaining one's feelings to another person may provide new perspective and the opportunity for increased selfunderstanding, which may lead to greater self-acceptance. When Does Expression Help? The three possible mechanisms by which expression might alleviate distress not only suggest how expression can enhance well-being, they also provide some hints about the conditions under which expression is most likely to be helpful. In this section, we briefly consider the time course and the content of distress expression. We also discuss individual differences in comfort with expression.

Time Course
The optimal timing of expression relative to the experience of a stressful event is an open question for research. Clinicians who use critical incident stress debriefing suggest that it is best for people to talk about their feelings as soon as possible after experiencing a traumatic event (Miller, 1999). However, Pennebaker (1999) suggests that expression-related interventions may be most helpful 8-12 weeks after a traumatic event, when people are still thinking about the event but have less opportunity to talk about it because others are less willing to listen. Although there is no general agreement about when expression should occur, there is consensus among researchers and theorists that the benefits of distress expression often take time to emerge. The mechanisms we described in the previous section, involving expression-related increases in self-acceptance, insight, or positive interpersonal impact, typically are not instantaneous changes. Staying with one's feelings to learn that they are tolerable, constructing a narrative that provides a sense of resolution, and experiencing the benefits of new ways of relating to others are usually processes that take time to develop. A study by Mendolia and Kleck (1993) explicitly demonstrates the delayed benefits of

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expression. These investigators had volunteers watch a stressful film about wood shop accidents, and then talk about either the facts of the film or their emotional reactions to it. When volunteers saw the film a second time immediately after talking, the expression group was more autonomically aroused than the facts group. However, when volunteers saw the film a second time 48 hr after their initial exposure, the expression group was less aroused and had more positive affect than the facts-only group. In Pennebaker's expressive writing studies the immediate consequences of expression are increased arousal and intensified experience of distress. This makes sense given that expressing distress necessarily involves focusing on unpleasant experiences. However, short-term expression-related exacerbation of emotional responses may be worth it if expression leads to some kind of resolution of distress. Within 2 weeks after the writing intervention, Pennebaker's expression volunteers usually felt as good or better than volunteers who did not express (Pennebaker & Seagal, 1999). The intensity of the initial level of distress may determine whether expression-related elevations in distress occur immediately after expression. Pennebaker and Seagal (1999) noted that unemployed engineers, who presumably were generally more distressed than student volunteers, actually felt better immediately after expressing. They postulate that "the better [people] feel before writing, the worse they feel afterwards and vice versa" (p. 1246). Clients often feel better when they begin therapy. Perhaps if one is already very distressed, focusing on feelings through expression does not compound distress but instead provides an immediate sense that one is doing something about it. Whether this immediate relief translates into more long-lasting well-being is likely to depend on whether expression promotes positive changes such as acceptance or insight or deteriorates into unproductive, passive rumination.

Content of Expression
In discussing the mechanisms by which expression can enhance well-being, we noted that expressing different types of feelings is likely to affect relationships in different ways by eliciting different corresponding responses from other people. We also described clinical theo-

ries concerning the importance of expressing primary emotions rather than well-rehearsed secondary emotions, and we pointed out that expression involving moderate levels of intensity is most likely to lead to acceptance, insight, and positive responses from others. Our focus in this article has been expression of distress, but recent research and theory point to the importance of expression of positive emotions (e.g., Bonanno & Keltner, 1997; Fredrickson, 1998; Keltner & Bonanno, 1997). Ideally, expression of distress is accompanied by expression of positive emotions. Positive emotions can counterbalance negative ones: Empathy can diffuse anger; love and humor can diminish sadness; hope and acceptance can make trauma-related feelings more bearable. Pennebaker and Francis (1996) found that expression of both negative and positive emotions was linked to health outcomes. In fact, in this study, use of positive emotion words was a stronger predictor of improved health than use of negative words. Pennebaker et al. (1997, study 1) found that optimum results from writing about traumatic experiences occurred when participants used a moderate number of negative emotion words and a relatively large number of positive emotion words. Pennebaker and Seagal (1999) speculate that this combination entails "acknowledgment of problems with a concomitant sense of optimism" (p. 1249). Other investigators have found that the process of shifting from negative mood to positive mood over the course of written or verbal disclosure is linked to improvements in selfesteem, cognition, and behavior (Donnelly & Murray, 1991; Murray, Lamnin, & Carver, 1989). In psychotherapy, a shift from negative to positive emotions is often an indication of significant emotional processing (L. S. Greenberg & Safran, 1987). Expression of positive feelings along with negative feelings can also make distress expression more palatable to recipients. For instance, Keltner and Bonanno (1997) found that bereaved people who laughed or smiled genuinely (i.e., with their eyes as well as their lips) while talking about their deceased spouses evoked more positive reactions from strangers and reported getting along better in their current relationships. Expression of positive emotion can also be a way of halting negative escalation

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cycles when couples argue (Gaelick, Bodenhausen, & Wyer, 1985).

Individual Differences in Comfort With Expression


Research on individual and cultural differences suggests that expression can carry very different meanings for different people (e.g., Kitayama & Markus, 1996; Mesquita & Frijda, 1992; Porter & Samovar, 1998; Surgenor & Joseph, 2000; see Kennedy-Moore & Watson, 1999, for an extensive discussion of expressive goals and values.) Sometimes people refrain from expressing because of deeply held personal or cultural values. Such people are unlikely to seek out opportunities to express and may view involuntary expression as a shameful lapse in self-control. They are unlikely to benefit from expression unless they can find a way of expressing that is consistent with their values. As Lazarus and Folkman (1984) point out, coping strategies, such as expression, that are inconsistent with one's values "are likely to be used reluctantly or without conviction and are likely to fail" (p. 189). In general, people who want to express thenfeelings and feel comfortable doing so are more likely to benefit from it than people who are reluctant to express. For instance, Labott and Teleha (1996) had women who were either high or low in self-reported crying frequency watch a sad movie with instructions either to try to express their feelings fully or to inhibit completely any overt signs of their feelings. They observed a significant interaction between weeping propensity and expression instructions: Women who typically cried frequently felt most comfortable crying and least comfortable inhibiting their tears, whereas women who rarely cried preferred to inhibit their tears and felt stressed when asked to openly express their emotions. In other words, participants reported feeling least stressed when the experimental instructions matched their usual crying propensity, and they felt most stressed when instructions were contrary to their usual behavior. Similarly, Engebretson, Matthews, and Scheier (1989) found that people's preferred anger expressive strategy tends to be their most adaptive strategy. Stanton, Kirk, et al. (2000, Study 4) also found evidence that students who generally cope through emotional expression showed the best

outcomes (i.e., the least arousal and negative affect) following an emotional expression intervention. Taken together, these findings suggest that the answer to what sort of expression is "best" varies for different people. Sometimes the issue is not whether people express but how they express. Donnelly and Murray (1991) noted individual differences in comfort with different forms of expression. Women and individuals who typically pay a great deal of attention to their inner experience (i.e., those high in a trait called private selfconsciousness) reported better mood following an expressive writing intervention. In contrast, men and individuals who typically do not attend to their inner experience reported better mood after expressing their feelings in the presence of a warm psychotherapist. Perhaps people who are less "in touch" with their feelings have a greater need for support from an empathic other as they struggle to express their feelings. Conclusion The paradox of distress expression is that expression of negative feelings is both a sign of distress and a possible means of coping with that distress. Throughout this article, we have argued that expression of negative feelings is adaptive to the extent that it leads to some kind of resolution involving the source or significance of distress. Our review suggests that resolution of distress does not follow directly or automatically from expression. Instead, the benefits of distress expression stem from cognitive or interpersonal processes. Expression of distress is not an adaptive goal in and of itself, but it can serve as a means of enhancing self-acceptance, fostering self-understanding, or improving social relationships. Emotions are a source of information about the relationship between the self and the environment. Expression is a means of processing and communicating this information, but it can be done in adaptive or maladaptive ways. When it is adaptive, expression of distress can lead to enhanced acceptance of feelings ("These feelings are unpleasant, but not unbearable") or increased understanding ("This is something that really matters to me" or "I've felt guilty about this for years, but it wasn't my fault"). It can also clarify interpersonal misunderstandings or even directly alter another person's be-

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effects of thought suppression. Clinical Psychology: Science and Practice, 6, 133-148. Blechman, E. A. (1990). A new look at emotions and the family. In E. A. Blechman (Ed.), Emotions and the family: For better or for worse (pp. 210-224). Hillsdale, NJ: Erlbaum. Bohart, A. C. (1977). Role playing and interpersonalconflict reduction. Journal of Counseling Psychology, 24, 15-24. Bohart, A. C. (1980). Toward a cognitive theory of catharsis. Psychotherapy: Theory, Research, and Practice, 17, 192-201. Bonanno, G. A., & Kaltman, S. (1999). Toward an integrative perspective on bereavement. Psychological Bulletin, 125, 760-776. Bonanno, G. A., & Keltner, D. (1997). Facial expressions of emotion and the course of conjugal bereavement. Journal of Abnormal Psychology, 106, 126-137. Bonanno, G. A., Keltner, D., Holen, A., & Horowitz, M. J. (1995). When avoiding unpleasant emotions might not be such a bad thing: Verbal-autonomic response dissociation and midlife conjugal bereavement. Journal of Personality and Social Psychology, 69, 975-989. Bonanno, G. A., Znoj, H., Siddique, H. I., & Horowitz, M. J. (1999) Verbal-autonomic dissociation and adaptation to midlife conjugal loss: A follow-up at 25 months. Cognitive Therapy & Research, 23, 605-624. Bootzin, R. R. (1997). Examining the theory and clinical utility of writing about emotional experiences. Psychological Science, 8, 167-169. Brown, G. W., & Harris, T. (1978). Social origins of depression. New York: Free Press. Burgess, A. W., & Holmstrom, L. L. (1979). Adaptive strategies and recovery from rape. American Journal of Psychiatry, 136, 1278-1282. Burleson, R., & Goldsmith, D. J. (1998). How the comforting process works: Alleviating emotional distress through conversationally induced reappraisals. In P. A. Andersen & L. K. Guerrero References (Eds.), Handbook of communication and emotion: Alberts, J. (1988). An analysis of couples' conversaResearch, theory, applications, and contexts (pp. tional complaints. Communication Monographs, 55, 245-280). San Diego, CA: Academic Press. 184-197. Averill, J. R. (1968). Grief: Its nature and signifi- Cahn, D. D. (1990). Confrontation behaviors, perceived understanding, and relationship growth. In cance. Psychological Bulletin, 70, 721-748. D. D. Cahn (Ed.), Intimates in conflict: A commuBaumeister, R. F., & Exline, J. J. (2000). Self-connications perspective (pp. 153-165). Hillsdale, NJ: trol, morality, and human strength. Journal of SoErlbaum. cial and Clinical Psychology, 19, 29-42. Baumeister, R. F., Stillwell, A., & Wotman, S. R. Capps, L., & Bonanno, G. A., (2000). Narrating bereavement: Thematic and grammatical predic(1990). Victim and perpetrator accounts of interpersonal conflict: Autobiographical narratives tors of adjustment to loss. Discourse Processes, about anger. Journal of Personality and Social 30, 1-25. Psychology, 59, 994-1005. Carver, C. S., & Scheier, M. F. (1998). On the Beevers, C. G., Wenzlaff, R. M., Hayes, A. M., & self-regulation of behavior. New York: Cambridge Scott, W. D. (1999). Depression and the ironic University Press. havior in a desired way. When it is maladaptive, expression exacerbates distress by leading to feelings of guilt or shame ("I really lost it!"), rehearsing rather than resolving grievances, or impairing social relationships. Our review of the literature suggests that the benefits of distress expression may take time to emerge. They are most likely to occur when expressions of distress occur in the context of a supportive relationship, involve an intermediate level of intensity, and are accompanied by expressions of positive emotions. Furthermore, expression is most likely to be beneficial to people who want to express and are generally comfortable doing so. This review outlines a rudimentary framework for understanding the mechanisms by which expression can alleviate distress and the circumstances under which it is most likely to do so. The studies we described suggest that whether expression is adaptive depends on what is expressed, to whom, and how. Future research should continue to clarify how and when expression enhances well-being. One area that is quite unclear is the conditions under which expression affects mental versus physical health. Also, although clinical theory and functional views of emotion suggest some ideas, the effects of expressing different types of emotions are not well understood. Clearer delineation of interpersonal patterns of expression also seems like an important direction for future research. We suspect that the meaning of expression for both the expresser and the receiver is central to understanding the individual and interpersonal impact of expression.

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