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Expressing Negative Emotions: Healthy Catharsis or Sign of Pathology?

by Milton Spett

The Ventilation Hypothesis

In the past year, a number of publications have argued convincingly for a paradigm shift in our view of expressing negative emotions. In "Expressing Emotion" (New York: the Guilford Press, 1999), Eileen Kennedy-Moore and Jeanne Watson carefully review the empirical research on the "ventilation hypothesis," the widely-accepted belief that expressing negative emotions, such as anger, sadness, or fear, is good for our mental health, our physical health, and our interpersonal relationships. The authors draw the surprising conclusion that expressing negative emotions tends to increase rather than decrease the emotions, and does not necessarily improve our mental or physical health.

The authors point out that expressing negative emotions is particularly likely to intensify distress when expressing these emotions evokes feelings of guilt or shame, or when the listener responds critically rather than empathically. The authors also cite research suggesting that emotional expression may be psychologically and physically harmful to individuals who are not comfortable expressing emotions and who tend not to express emotions.

The Benefits of Expressing Negative Emotions

Kennedy-Moore and Watson argue that expressing negative emotions is beneficial only if it leads to reappraising the maladaptive cognitions associated with the emotions. Expressing negative emotions might foster adaptive cognitions such as "These feelings are unpleasant but not unbearable" or "I've felt guilty about this for years, but it's really not my fault."

The authors cite research suggesting that suppressing the experiencing of emotions and inhibiting emotional expression can be harmful because these processes require energy, impeding our coping ability, impairing our immune functioning, and preventing us from reappraising the associated maladaptive cognitions.

The authors also point out that patients who show little emotionality may be neither suppressing their feelings nor inhibiting the expression of their feelings. These patients may simply not have intense feelings. People vary in the intensity of their emotional reactivity, so when treating patients who express little emotion, it is important to assess whether these patients are suppressing their emotions or simply do not experience intense emotional reactions. For those patients who suppress emotions, expressing and exploring their emotions would improve their coping ability, as well as their mental and physical health.

Kennedy-Moore and Watson argue that the ideal is to experience moderate emotions while feeling competent and in control. Psychotherapy outcome research has found that emotional expression plus cognitive reappraisal is superior to either alone for reducing anger, so the most effective therapeutic interventions should include both moderate emotional expression and cognitive reappraisal. It is very difficult to modify a maladaptive schema when the individual is not experiencing the emotional component of that schema, or when the emotion component is overwhelming.

Kennedy-Moore and Watson also point out that the listener's reaction sometimes determines the effects of expressing emotions. Tom, a 35 year-old depressed patient, had felt devalued and neglected by his father for as long as he could remember. He expressed these feelings in therapy, and he also expressed them to his two sisters. His sisters rejected his feelings, claiming that they had all been treated well by their father. In spite of experiencing and expressing these feelings, Tom remained depressed and continued to ruminate about the many times his father had rejected him. Tom was finally able to dissipate these feelings and overcome his depression and rumination when he described several incidents in detail to one sister, and she acknowledged the accuracy of Tom's memories of mistreatment by their father. This external validation enabled Tom resolve any doubts and eliminate any conflicts he may have had about his relationship with and his feelings toward his father. I would argue that external support or validation is beneficial only when it lead to cognitive change.

Grief After The Loss of a Loved Person

Among both mental health professionals and the general public, it is almost universally accepted that after the loss of a loved person, it is normal and healthy for the bereaved to experience a period of intense mourning: feeling sad, crying, recalling shared experiences, and mentally processing their feelings toward the lost person. This bereavement process is often referred to as "working through" the loss. It is also widely assumed that failing to experience the "working through" process will cause the bereaved to remain fixated on the lost person, and this will impede establishing a new life after the loss.

In the November, 1999 issue of Psychological Bulletin, Bonanno and Kaltman review the research on grief after loss, and draw some conclusions which are startlingly similar to the conclusions of Kennedy-Moore and Watson. Bonanno and Kaltman conclude that decades of research have failed to find any empirical support for the "working through" hypothesis. When studies have found statistically significant effects, the effects have been the opposite of what the theory predicts: those who grieve the most immediately after a loss exhibit the highest psychological distress one and two years later. And this relationship remains true when initial levels of mental health are statistically controlled. These findings suggest that intense grieving is not only a sign of psychopathology, but also a cause additional psychopathology.

Bonanno and Kaltman also discuss reaction to loss in terms of the cognitive appraisal theory proposed by Lazarus (Richard, not Arnold) and Folkman. According to this theory, stress results from the cognition that a situation exceeds an individual's ability to cope with that situation. Bonanno and Kaltman cite research confirming that those individuals who positively appraise their ability to function after a loss, not those individuals who "grieve appropriately," are less depressed one year later. This association remains significant after controlling for initial levels of depression.

The conclusion I draw from the Bonanno and Kaltman review is that as therapists, we should encourage most of our bereaved patients to focus on their competencies, and to prepare for life after the loss of a loved person. I do believe, however, that patients who suppress their emotions would benefit from expressing and exploring their feelings toward the lost person. This process may enable these patients to develop a more coherent and adaptive understanding of their feelings and their relationship with the lost person. But these patients would also have benefited from this process if the loved person had not been lost.

Conclusion: Expressing Emotions or Experiencing Emotions?

Kennedy-Moore and Watson discuss the effects of expressing emotions, but fail to note that expressing emotions intensifies the experiencing of emotions. All of the benefits they attribute to expressing emotions could actually result from experiencing and reprocessing emotions and the associated cognitions. Research using emotional expression as an independent variable could actually be studying the effects of emotional experiencing. Supporting this re-interpretation of Kennedy-Moore and Watson's conclusions, Taylor et al. (American Psychologist, April, 1998) have found that simply thinking about emotional events has many of the same benefits Kennedy-Moore and Watson attribute to expressing emotions.

Smyth (Journal of Consulting and Clinical Psychology, February, 1998) reports that writing about past traumatic events reduces negative affect, probably by converting disorganized thoughts and feelings into an organized, logical, linguistic understanding of the traumatic event. I believe Symth's research also lends support to the theory that it is experiencing emotions rather than expressing emotions that can lead to cognitive reappraisal and improved mental and physical health. Any activity - talking, writing, or thinking - that enables the patient to reprocess suppressed, negative, conflicting, or confusing cognitions and emotions provides the opportunity to experience, reappraise, clarify, and/or organize those emotions.

Summary

Intense negative emotions are usually a sign, and probably a cause, of psychopathology. Experiencing emotions can be beneficial if it leads to:

1. Experiencing previously suppressed emotions and cognitions.

2. Changing negative cognitions to positive or neutral cognitions.

3. Clarifying and organizing confused or conflicting cognitions and emotions.

Expressing moderate emotions to others can bring us closer to others and elicit support which enables us to organize and reappraise negative emotions and the associated cognitions.

In the February, 1998 Journal of Consulting and Clinical Psychology, Smyth argues that traumatic memories are stored as disorganized jumbles of sensory perceptions and negative affect, leading to obsessional ruminations and behavioral reenactments. An additional benefit of expressing emotions appears to be enabling the individual to clarify and organize cognitions and emotions which were previously confusing and conflicting.

Tavris, C., (1982). Anger: the misunderstood emotion. New York: Simon and Shuster.

Among both mental health professionals and the general public, it is widely assumed that expressing anger reduces that anger, just as letting the steam out of a tea kettle reduces the pressure inside that kettle. But this assumption is not correct. Research has found that expressing anger usually increases rather than decreases the anger. Expressing anger can reduce that anger if one of the following conditions is met:

If expressing the anger eliminates the situation that is causing the anger. For example, criticizing your subordinate may cause the subordinate to stop doing whatever is angering you, but criticizing your boss usually creates more trouble and thereby increases your frustration and anger.

If expressing anger appropriately punishes the person who has mistreated you. For example, winning a lawsuit against someone who slandered you.

If expressing anger causes others to respect you. or increases your own self-respect.

Other methods for reducing anger without expressing it are:

Ignoring whatever provoked the anger.

If someone has mistreated you, understanding why the person mistreated you. For example, he or she was upset over the death of a close relative. [Of course this will also change your cognition that you were mistreated due to your inadequacy.]

When an individual is angry, reacting in the way that makes that person comfortable reduces their blood pressure. Responding in a conciliatory or even submissive manner reduces blood pressure for some people, while responding an in angry manner reduces blood pressure for others.

Expressing the anger usually increases rather than decreases the anger [at least in the short run]. Communicating about the anger in a calm voice is most likely to ameliorate the cause and thereby reduce the anger.

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