How When Does Express Help 2001

8/3/2019 How When Does Express Help 2001

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Review of General Psychology2001 , Vol. 5, No. 3, 187-212Copyright 2001 by the Educational Publishing Foundation1089-2680 /01/$5.00 DOI: 10.1037//1089-268 0.5.3.187

How and When Does Emotional Expression Help?Eileen Kennedy-MooreWestfield, New Jersey Jeanne C. WatsonUniversity of Toronto

The paradox of distress expression is that expression of negative feelings is both asign of distress and a possible means of coping with that distress. This articledescribes research illustrating the paradox of distress expression. It reviews evi-dence concerning 3 possible mechanisms by which expression might alleviatedistress, focusing on the role of expression in (a) reducing distress about distress,(b) facilitating insight, and (c) affecting interpersonal relationships in a desiredway. The authors conclude by highlighting the circumstances under which expres-sion is most likely to be adaptive. Overall, the authors argue that expression ofnegative feelings is adaptive to the extent that it leads to some kind of resolutioninvolving the source or significance of distress.

The Paradox of Distress ExpressionThe paradox of distress expression1 is thatexpression of negative feelings is both a sign ofdistress and a possible means of coping withthat distress. On the one hand, chronic or in-tense expression of distress is a symptom ofmost mood disorders. Expression can intensifydistress (e.g., Ebbesen, Duncan, and Konecni,

1975), interfere with active coping efforts(Carver, Scheier, & Weintraub, 1989; Nolen-Hoeksema, 1991), and have a destructive influ-ence on interpersonal relationships (Tavris,1984, 1989). On the other hand, expression canbe a means of alleviating distress (Stanton,Danoff-Burg, Cameron, & Ellis, 1994; Stanton,Danoff-Burg, et al., 2000). In daily life, peopleseek out opportunities to talk about their feel-ings (Rime, Mesquita, Philippot, & Boca,1991), and in psychotherapy, expression canplay a key role in helping clients to process their

Eileen Kennedy-Moore, independent practice, Westfield,New Jersey; Jeanne C. Watson, Department of CounselingPsychology, O ntario Institute for Studies in Education, U ni-versity of Toronto, Toronto, Ontario, Canada.Portions of this article are based on Eileen Kennedy-Moore and Jeanne C. Watson's book Expressing Emotion:Myths, Realities, and Therapeutic Strategies (1999, Guil-ford Press, 1-800-365-7006).CoiTespondence concerning this article should be ad-dressed to Eileen Kenned y-Moore, 104 Nelson Place, West-field, New Jersey 07090. Electronic mail may be sent [email protected].

emotional experience (Horowitz, 1986; Kennedy-Moore & Watson, 1999).In this article, we briefly describe research onpersonality, trauma or loss, and disclosure inpsychotherapy illustrating the paradox of dis-tress expression. We then explore the issues ofhow and when emotional expression can beadaptive, focusing on three possible mecha-nisms by which expression might alleviate dis-tress. We conclude by outlining circumstancesunder which expression is most likely to beadaptive.Expression-Related Personality Traits

One line of evidence for the paradox of dis-tress expression comes from research on expres-sion-related personality traits. This research(discussed later) shows that both traits involv-ing expression and traits involving deliberateefforts to refrain from expressing tend to belinked to worse psychological functioning.The key to interpreting these contradictoryfindings may involve distinguishing betweenexpression-related traits that reflect characteris-tic distress proneness and expression-related1 We define emotional expression as observable verbaland nonverbal behaviors that communicate or symbolizeemotional experience. Emotional experience is the subjec-tive, felt sense of emotional responses. Expression andexperience do not necessarily correspond. For example, one

person might refrain from expressing even though she or heis experiencing a great deal of emotion. Another personmight express vociferously, while experiencing only a mi-nor degree of emotion.187


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188 KENNEDY-MOORE AND WATSONtraits that reflect habitual efforts to cope withdistress. Gross (1998; Gross & John, 1997) ar-gues that individual differences in expressivitystem from two major determinants: (a) the ini-tial activation of emotional response tendenciesand (b) the subsequent modulation of emotionalresponse tendencies. This distinction betweenemotional activation versus modulation is sup-ported by research looking at both self-ratingsand peer ratings. It suggests that people mightbe very expressive because they tend to havestrong responses to emotional stimuli or be-cause they generally express their feelingsopenly. Conversely, people might be very inex-pressive because they have a high threshold fordistress elicitation or because they tend to in-hibit their expression.In terms of emotional activation, personalityresearch shows that people who express a lotbecause they have a low threshold for the elic-itation of distress tend to be less well-adjustedthan their more sanguine peers. A key exampleof this comes from research on negative affec-tivity (NA), which involves a disposition toexperience unpleasant emotional states. High-NAindividuals have a propensity to feel a widevariety of negative moods, including anxiety,frustration, sadness, irritability, and anger, evenin the absence of obvious stressors (see L. A.Clark & Watson, 1991; D. Watson, 2000; D.Watson & Clark, 1984, for reviews). These in-dividuals seem to see the world and themselvesthrough a negative microscope, which heightenstheir sensitivity to negative information andleads them to perceive situations as stressfuleven when other people might not regard thesituations as threatening. They are especiallysensitive to the ordinary frustrations and irrita-tions of everyday life, and they are more likelythan low-NA individuals to respond to thesehassles with greater and more enduring distress.High-NA individuals tend to dwell on their per-sonal flaws and failures, as well as negativeaspects of other people and the world in general.

Because they tend to experience a great dealof distress, high-NA individuals also tend toexpress a great deal of distress. However, thisexpression seems to reflect or even compoundtheir distress, rather than alleviate it. Interper-sonally, they often behave in hostile and de-manding ways, and they report experiencing alot of social conflict (L. A. Clark & D. Watson,1991). Their tendency to express many negative

feelings and few positive or friendly ones tendsto evoke negative reactions from others (cf.Segrin, 1998). Therapeutically, the relevantgoal for high-NA clients is not to have themvent their negative feelings but rather to add resstheir propensity to feel distress in the first place.On the other hand, in terms of emotionalmodulation, personality traits involving a ten-dency to deliberately refrain from emotionalexpression have been linked to poorer psycho-logical and physical well-being. These traitsinclude rationality-antiemotionality (Grossarth-Maticek, Bastiaans, & Kanazir, 1985; see dis-cussions by Eysenck, 1991a, 1 991b), emotionalcontrol (Rogers & Jamieson, 1988; Rogers &Nesshoever, 1987), and self-concealment (Larsen& Chastain, 1990). Research with these andother related personality traits is consistent withthe idea that deliberately holding in one's feel-ings is unhealthy and, by extension, that ex-pressing one's feelings is beneficial. It may bethat effortful preoccupation with avoiding ex-pression is physically or psychologically taxing.Trauma or Loss

A second line of evidence for the paradox ofdistress expression comes from research on cop-ing with trauma and loss. Consistent with theidea of expression as a sign of distress, a lon-gitudinal study of coping with midlife conjugalbereavement 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 isassociated with worse outcomes. These investi-gators conducted interviews about grief withwidows and widowers 6 months after the loss.Those people w ho were most expressive duringthe initial interview exhibited the most griefsymptoms at 14- and 25-month follow-ups. Incontrast, people who showed emotional avoid-ance during the interview, measured as lowself-rated experience of distress coupled withheightened cardiovascular arousal, showed min-imal grief symptoms 8 months later. Althoughemotional avoidance was linked to initially highlevels of self-reported physical symptoms,by 14 and 25 months it was associated with lowlevels of physical symptoms. Bonanno and hiscolleagues interpret these findings as an indica-tion that emotional avoidance can sometimes


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EMOTIONAL EXPRESSION 189

serve adaptive functions. Emotional avoidancemay enable individuals to regulate their emo-tional pain or to cope effectively with personalor professional responsibilities. It is possiblethat the emotional avoiders had already donesufficient expression during the 6 months priorto the study. It is even possible that prior ex-pression enabled the avoiders to accept or re-solve their feelings sufficiently so that they wereable to be (relatively) less expressive during theinterview. However, Bonanno's work clearlyshows that more expression is not necessarilybetter, and having the capability to sometimesrefrain from expressing and experiencing dis-tress is adaptive.On the other hand, consistent with the ideaof expression as a coping strategy, Penne-baker and his colleagues have conducted aseries of studies indicating that writing ortalking about feelings related to traumaticevents is physically and psychologically ben-eficial (e.g., see reviews by Pennebaker,1997; Smyth & Pennebaker, 1999). Typically,these studies involve having volunteers writefor 20 min each day for several days. Someparticipants are instructed to write about triv-

ial matters (e.g., a description of their shoes),whereas others are told to express their deep-est thoughts and feelings about some trau-matic experience. Participants in these studieshave included college students, unemployedworkers, bereaved spouses, patients withmedical illnesses, and even Holocaust survi-vors. Expressing trauma-related feelings us-ing Pennebaker's procedure (or variations)has been linked to better psychological well-being, better objective functioning (e.g.,grade point average, employment status), bet-ter self-reported health, and even better im-mune responses. Interestingly, the benefits ofwritten expression only emerge over time.Immediately after expressing, participants ac-tually feel worse and are more physiologi-cally aroused. A statistical review of studiesinvolving written expression of trauma-re-lated feelings (Smyth, 1998) concludes thatthe overall magnitude of improvements asso-ciated with the writing intervention (acrossvarious measures of well-being) is 23%,which is similar to or larger than the generalmagnitude of improvement produced by otherpsychological interventions.

Disclosure in PsychotherapyA third line of evidence for the paradox ofdistress expression comes from clinical re-

search. Stiles (1987, 1995) describes a "fevermodel" of disclosure in psychotherapy. Hedefines disclosure as first-person statementsconcerning subjective information (e.g., "Ithink . . .", "I feel . . ." ). By th is definition,disclosure includes verbal forms of expres-sion but also includes other statements, suchas thoughts or wishes. Stiles argues that like afever in physical illness, disclosure is associ-ated with both illness and recovery. On theone hand, Stiles cites a number of correla-tional studies showing that people who areexperiencing a great deal of distress, such asanxious or depressed clients, tend to disclosea great deal. On the other hand, he notes thattherapists tend to rate high levels of clientdisclosure as evidence of good therapeuticprocess. Stiles argues that psychotherapy out-come studies do not show clear benefits ofdisclosure because process-outcome correla-tions muddle disclosure as a sign of distressversus disclosure as a means of recovery.More distressed clients disclose more. Moredistressed clients, on average, have worsepsychotherapy outcomes. Yet, by disclosing,clients may be using therapy effectively toprocess and assimilate their experience. Stilessuggests that disclosure may positively pre-dict movement toward health rather than ab-solute levels of well-being.

If expression of negative feelings is both asign of distress and a possible means of cop-ing with distress, how and when does expres-sion help to alleviate distress? We contendthat expression of negative feelings is adap-tive to the extent that it leads to some kind ofresolution involving the source or signifi-cance of distress.In the next sections, we describe three keymechanisms by which expression might allevi-ate distress: (a) Expression can reduce distressabout distress; (b) expression can facilitate in-sight; and (c) expression can affect interper-sonal relationships in a desired way.We focus on these three mechanisms be-cause, on the basis of available evidence, theyseem to be the most promising explanationsof how emotional expression can enhance


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190 KENNEDY-MOORE AND WATSONwell-being. 2 In discussing these mechanisms,we pull together theory and research fromdiverse areas in social and clinical psychol-ogy. Much of the evidence supporting thesemechanisms is piecemeal and preliminary.However, taken as a whole, this work forms arudimentary framework for understanding theadaptive functions of expression.

How Does Express ion He lp?Mechanism 1: Expression Can AlleviateDistress About Distress

One mechanism by which expression canresolve distress and enhance well-being is byalleviating distress about distress. People whoare intensely distressed, such as those whohave experienced traumatic events, are oftenafraid of their emotional experience (e.g., seeKrystal, 1978). They see their feelings asdangerous, and they fear falling apart or beingutterly overwhelmed if they allow themselvesto express their feelings. Sometimes peopleinterpret their intense emotional reactions as asign that they are "going crazy" or that some-thing is wrong with them (Thoits, 1985). Thiscan result in an exacerbation cycle whereinworries that distress represents some personalinadequacy compound initial distress, whichheightens worries, which further intensifiesdistress, and so forth (cf. Storms & McCaul,1976). Fears of intense feelings may leadpeople to actively attempt to avoid expressingor experienc ing these feelings. This effortfulavoidance prevents people from learning totolerate these feelings. Furthermore, it maycause them to feel alarmed by what they per-ceive as failures of self-control when theirfeelings spill out through involuntary expres-sion (cf. Baumeister & Exline, 2000). Forinstance, a widower who is frightened by theintensity of his feelings of loss might try toavoid experiencing or expressing these feel-ings. When he suddenly starts crying becausehe remembers a certain incident with his wife,he may interpret these tears as a sign that heis not coping well, feel even more distressed,and redouble his efforts to avoid thesefeelings.

In psychotherapy, expression can be a meansof helping clients to revise their fearful beliefsconcerning their emotional responses. Voluntar-

ily choosing to express their feelings enablespeople to select the timing, form, and context oftheir expression, thereby diminishing theirsense of helplessness concerning these feelings.Actively expressing painful feelings also pro-vides an opportunity to perceive their distress aspainful but not unbearable (cf. L. S. Greenberg& Safran, 1987; M. A. Greenberg, Wortman, &Stone, 1996). Clients can learn through directexperience that allowing themselves to cry doesnot meant that they will never be able to stopcrying, and that they have the capacity to toler-ate talking abou t painful feelings, even though itis difficult.

Expression can also help to resolve distressresulting from ambivalence about expression(cf. King & Em mo ns, 1990). If people want toexpress their feelings but are fearful of theconsequences of doing so, actually expressingmight allow them to learn that the fearedconsequences either did not occur or were notas unbearable as expected. Pennebaker (1985)comments that nonexpression is not patho-genic in and of itself. Rather, it is the combi-nation of nonexpression plus a desire to ex-press that causes health difficulties. This in-terpretation is consistent with a study byOgden and Von Sturmer (1984) that foundthat (a) individuals who report regularly ex-pressing their negative feelings as well as (b)individuals who say that they do not expresstheir feelings but are not troubled by them areequally healthy both physically and psycho-logically. Neither of these two groups appears

2 In the 1980s, Pennebaker (e.g., 1985; Pennebaker &Susman, 1988) proposed a theory of disinhibition. A ccord-ing to this theory, deliberately refraining from talking aboutone's feelings requires physiological work, which is indi-cated by increased skin conductance level (SCL, a measureof how sweaty one's palms are). However, research rou-tinely shows that the short-term effects of expressions ofdistress involve greater experience of distress and increasedphysiological arousal (see Littrell, 1998, and Kennedy-Moore & Watson, 1999, for reviews). Moreover, physicalbenefits, psychological benefits, or both can occur afterwriting about traumatic experiences one has already dis-cussed (M. A. Greenberg & Stone, 1992) or after writingabout someone else's traumatic experiences (M. A. Green-berg, Wortman, & Stone, 1996). These findings are notconsistent with the idea of expression as a m eans of undoingthe work of inhibition. Consequently, Pennebaker and otheremotion researchers and theorists currently focus on othermechanisms, such as the ones d escribed in this article (e.g.,Bootzin, 1997; Lepore et al., 2000; Littrell, 1998; Penne-baker, 1997).


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to be bothered by ambivalence about expres-sion or distress about distress. In contrast,individuals who say that they do not expresstheir negative feelings but continue to sufferfrom them report greater dissatisfaction andmore physical symptoms than the other twogroups.Immersion plus control. Clinicians empha-size that expression must involve a combina-tion of emotional immersion plus control inorder to foster a sense of acceptance andmastery with regard to distressing feelings.For instance, Scheff (1979) argues that ther-apeutic emotional expression occurs at an op-timum psychological distance: Individualsmust vividly experience their feelings whilein a context of present safety. Similarly,Horowitz (1986) points to the importance ofcombining distressing material with comfort-ing cues as a means of "dosing" emotionalconfrontation. This clinical focus on expres-sion involving emotional immersion plus con-trol is consistent with empirical findings fromexpressive writing studies: Writing abouttrauma-related feelings causes increases inshort-term distress (immersion), but experi-encing relatively more short-term distresswhile writing (i.e., less control) does not leadto greater improvement (Smyth, 1998).

Foa and Kozak (1986) invoke similar ex-planations emphasizing immersion plus con-trol for the fear-reducing benefits of pro-longed exposure to threatening stimuli. Asclients stay in the presence of the feared ob-ject, the intensity of their physiological re-sponse gradually dissipates. This physiologi-cal habituation provides new information toclients, which they can use to revise cata-strophic beliefs regarding their experience offear. By extension, when trauma survivors areable to "stay with" their feelings by express-ing them rather than avoiding them, it givesthem the opportunity to revise their view ofthese feelings. With exposure interventionsclients do not stay with their painful feelingscontinuously or indefinitely, but only undercontrolled circumstances (e.g., during a ther-apy session) and for periods long enough tohave the intensity of their emotional experi-ence and arousal decrease. This enables themto perceive their distress as tolerable andmanageable rather than dangerous (see re-lated findings and discussions by Creamer,

Burgess, & Pattison, 1992; Lepore, Silver,Wortman, & Wayment, 1996).Repeated episodes of expression may benecessary for fostering acceptance or habitu-ation and diminishing distress about distress.Stanton, Kirk, et al. (2000, Study 4) had pre-selected college students to talk for 5 minwith an interviewer regarding either the factsor their feelings concerning their parents'chronic physical or psychological disorders.The students were interviewed again, usingthe same instructions, 48 hr later. There wereno effects of facts versus feelings instructionsduring or after the first interview. However,after the second interview, students whotalked about their feelings showed lowerphysiological arousal and reported less nega-tive affect. Pennebaker and Beall (1986)found that writing about one's feelings asso-ciated with a traumatic event was associatedwith increased arousal on the first day, butdecreased arousal on three subsequent con-secutive days. Pennebaker (1990) suggeststhat "repeatedly confronting an upsetting ex-perience allows for a less emotionally ladenassessment of its meaning and impact"(p . 106).

Minimizing intrusive thoughts. In additionto general fears about the meaning or personalsignificance of distress, another key contributorto distress about distress is intrusive thoughts.Intrusive thoughts are repeated, unbiddenthoughts or images about stressful experiences.Subjectively, intrusive thoughts seem uncon-trollable, unpredictable, and upsetting. For ex-ample, experiencing intrusive thoughts can leadtrauma survivors to fear being "ambushed" bypainful memories and feelings when they leastexpect it (Horowitz, 1986). Laboratory experi-ments show that, paradoxically, attempts to de-liberately suppress thoughts cause a reboundeffect of more frequent or more distressing in-trusive thoughts. The more people try not tothink about some disturbing topic, the moresuch thoughts come to mind, and the moredistressed they become about their inability tocontrol the intrusive thoughts and their relatedfeelings. An intensifying cycle of intrusivethoughts and suppression efforts has been im-plicated in the etiology and maintenan ce of clin-ical disorders such as posttraumatic stress dis-order, obsessive-compulsive disorder, and de-pression (see reviews by Beevers, Wenzlaff,


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192 KENNEDY-MOORE AND WATSONHayes, & Scott, 1999; Purdon, 1999; Wenzlaff& Wegner, 2000).Several studies suggest that emotional ex-pression can enhance well-being by diminishingthe frequency or painfulness of intrusivethoughts. Lutgendorf and Antoni (1999) foundthat volunteers who disclosed a traumatic expe-rience to an experimenter had fewer intrusivethoughts over time compared with volunteerswho did not have the opportunity to express.Lepore, Ragan, and Jones (200 0) also found thatvolunteers who were able to talk about theirfeelings after watching a brief film about theHolocaust had fewer intrusive thoughts than didvolunteers in a nonexpressive comparisongroup. Other studies suggest that expression canlessen, if not the quantity, at least the emotionalimpact of intrusive thoughts. In a study involv-ing college students preparing for graduate en-trance exams, Lepore (1997) found that expres-sive writing did not decrease the frequency ofintrusive thoughts about the exam, but it diddecrease how depressing students found thesethoughts. Lepore et al. (1996) conducted a cor-relational study of mothers who had lost a childto Sudden Infant Death Syndrome. They foundan association between higher initial levels ofintrusive thoughts and subsequent more severedepressive symptoms only among mothers whofelt that their social environment constrainedtheir ability to talk about their loss. Major andGramzow (1999) found that women who ex-pressed their feelings about having an abortionto other people were less distressed by intrusivethoughts than women who did not express thesefeelings. Similar results were obtained in stud-ies of men with prostate cancer (Lepore &Helgeson, 1998) and of children exposed toinner-city violence (Kliewer, Lepore, Oskin, &Johnson, 1998). Taken together, these studiessuggest that emotional expression allows peopleto fear intrusive thou ghts less, to stop strugglingto suppress these thoughts, and instead to ac-knowledge and accept these thoughts and theirrelated feelings.

Summary. In summary, one way that ex-pression can enhance well-being is to reducedistress about distress by helping people to per-ceive their feelings as less frightening or un-bearable. This is most likely to occur whenexpression involves immersion in painful feel-ings 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 diminishingthe frequency or emotional impact of intrusivethoughts about stressful events.Mechanism 2: Expression Can FacilitateInsight

A second mechanism by which expressioncan diminish distress is by fostering insightconcerning either the feelings themselves or thesource of distress. Expression makes covertemotional experience overt. Putting emotionalexperience into words can help people to rec-ognize, understand, and interpret their innersubjective states. Symbolizing feelings throughverbal expression both represents and createsfeelings: In the process of describing their ex-perience, people come to understand it in waysnot possible before they articulated their feel-ings (Lane & Schwartz, 1987; J. C. Watson &Greenberg, 1996; J. C. Watson & Rennie,1994). For instance, whether a woman charac-terizes her inner experience as feeling "lost" orfeeling "abandoned" carries very different im-plications for how she perceives herself and herenvironment.Sometimes expression can lead to emotionalepiphanies, which are striking moments of af-fective insight (Kuiken, Carey, & Nielsen,1987). Such moments are often described aspivotal events in literature, existential philoso-phy, and psychotherapy. They are most likely tooccur during intensive self-reflection and in-volve a profoundly felt shift in self-understand-ing. During moments of affective insight, ini-tially vague feelings are suddenly felt withclarity and certainty. There is a sense that thefeelings were always there, but only now rec-ognized and fully acknowledged. The in-dividual experiences a sense of newly emergedself-knowledge and vitality accompanied bya perception of an increased capacity forself-direction.Other times, the insight fostered by expres-sion may be less dramatic but still useful. Ifpeople understand their emotional experience,they are in a better position to know how theyneed 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, Det-weiler, & Mayer, 1999; Salovey, Hsee, &


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Mayer, 1993; Salovey & Mayer, 1990; J. C.Watson & Greenberg, 1996) and to regulate orchange 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). Ingeneral, the better people understand their emo-tional experience, the better they are able tocope with it.

Creating meaning. Talking or writing aboutone's feelings usually involves structuring andorganizing one's thoughts about these feelings.These thoughts become more orderly and lessperseverative. The process of trying to explainone's feelings to someone else necessarily in-volves clarifying these feelings in one's ownmind. L. F. Clark (1993) points out that toeffectively convey their experience to anotherperson, speakers have to step out of their ownperspective enough to be able to consider thelistener's viewpoint, which means that theylook at their own experience from a new per-spective. Linguistic studies of conversationsshow that in trying to express their feelings toanother person in a coherent way, speakers clar-ify, elaborate, explain, note causes and effects,offer background information, highlight themes,draw connections, and group particular in-stances into categories. All of this can leadexpressers to understand their feelings in a newway, thereby creating new meaning.

Pennebaker (1993a) notes that across the var-ious studies conducted by his research group,over 75% of the trauma-expression participantsmentioned that their writing yielded long-termbenefits involving insight. During debriefing,these participants made statements such as "Itmade me think things out," "It helped me lookat myself from the outside," and "It was achance to sort out my thoughts" (p. 110).Content analyses of the trauma-expressionessays or discussions support participants' be-liefs that expression of traumatic feelings ishelpful when it fosters self-understanding (Pen-nebaker, 1993b; Pennebaker & Francis, 1996;Pennebaker, Mayne, & Francis, 1997). For in-stance, Pennebaker (1993b) combined the datafrom trauma-expression participants in severalof his studies and selected the top and bottomthird of participants on the basis of a compositeoutcome m easure. The bottom-third participantshad composite outcomes that were comparable

with control participants. Computer linguisticanalysis showed that the essays of the top-thirdparticipants, who had the most positive out-comes following the intervention, had two dis-tinctive insight-related characteristics comparedwith the essays of the bottom-third participants.First, the top-third participants used wordsreflecting insight (e.g., realize, understand,thought, knew) and causal reasoning (e.g., be -cause, why, reason) at increasing rates acrossthe 3 or 4 days of the study. They started outwith very low rates of these words on the firstday of writing and ended u p with very high ratesof these words by the last day of the study,suggesting that they acquired insight over thecourse of writing. In contrast, the bottom-thirdparticipants, although showing the same overallrate of insight words, used these words at con-sistent rates over time.

Second, the top-third participants' essays be-came more focused over time. They showed adecrease over time in the percentage of differentwords in each essay, indicating that they startedout with more scattered content and increas-ingly focused on a single topic.Judges' ratings of the essays corroboratethese computer analysis findings concerningexpression-related increases in self-under-standing (Pennebaker, 1993b). Ratings bycollege student judges showed no differencesin the overall extent to which the top-thirdand bottom-third participants accepted theevents described in their essays, nor in theoverall organization or narrative quality ofthe two groups' essays. However, these rat-ings indicate striking differences in changesover time. The essays of the top-third partic-ipants showed increasing organization, accep-tance, and optimism. In contrast, the essays ofthe bottom-third participants started out withrelatively clearly organized stories and grad-ually deteriorated. These results are consis-tent with theoretical perspectives emphasiz-ing the importance of constructing narrativesabout experience (e.g., Meichenbaum &Fong, 1993). It seems that the process ofcreating such narratives is more importantthan simply having a narrative.

This emphasis on expression leading toself-understanding is echoed by other inves-tigators in both clinical and laboratory set-tings. Several studies show that being able tostructure thoughts and feelings about past


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194 KENNEDY-MOORE AND WATSONtraumatic experiences is associated with bet-ter adjustment in a variety of clinical popula-tions (e.g., Burgess & Holmstrom, 1979; Fair-bank, Hansen, & Fitterling, 1991; Silver,Boon, & Stones, 1983). Chafe (1977) ob-served that personal stories become markedlymore integrated (less fragmented) on subse-quent retellings, compared with the initialaccount. It may be that people's tendency totalk about their feelings not just once butrepeatedly (Rime et al., 1991) reflects a mean-ing-making process of constructing an ac-count for these feelings.

What kinds of new meaning might expres-sion create? Expression can lead to clearerunderstanding of what one is feeling and why(J. C. Watson & Rennie, 1994; Kennedy-Moore, 1999). It can also lead to new apprais-als of past or present circumstances. Creatinga story about painful events might providesome sense of control over uncontrollableevents (S. C. Thompson, Sobolew-Shubin,Galbraith, Schwankov sky, & Cruzen, 1 993),provide a sense of resolution (Pennebaker &Seagal, 1999), or enable people to perceivesome benefit from their suffering, such aspersonal growth (Janoff-Bulman, 1992; Mc -Farland & Alvaro, 2000). They may see theirsuffering as imparting some important lesson.For instance, spelling out the implications oftrauma-related feelings may help survivors torealize with sudden clarity and certainty whattruly matters to them in life (e.g., "I almostdied without telling my wife how much I loveher") . They may also gain a new appreciationfor their own courage, dignity, or resilience inresponse to the trauma (e.g., "This ex periencelet me see what I'm capable of when I'mpushed to my limits"). Alternatively, traumasurvivors may perceive that their sufferingwas worthwhile because it helped others orbrought them closer to people they care about(e.g., "My father's death was a tragedy, but itbrought me closer to my brother"). Such efforts tocreate meaning out of experience are central toconstructivist psychotherapies (e.g., Neimeyer,1993; Rosen & K uehlwein, 1996). In a longitu-dinal study of bereaved family members, Davis,Nolen-Hoeksema, and Larson (1998) found thatmaking sense of the loss helped minimize dis-tress during the first year following the loss,whereas finding benefit from the experience w as

associated with better adjustment 13 and 18months after the loss.Combining thinking and feeling. Expres-sion-related insights are not the product of ei-ther cold-hearted analysis of the situation orsimple venting. Instead, this kind of insightstems from a combination of thinking and feel-ing. Pennebaker and Beall (1986) found thatwriting only about the facts of a traumatic ex-perience was not helpful. In another study,Krantz and Pennebaker (1995) compared verbaland nonverbal expression of traumatic feelings.They found that expressive movement alone didnot yield health benefits, but expressive move-ment combined with written expression did.Thus, accessing feelings, putting them intowords, and building a coherent cognitive storyare all important components of Pennebaker'sinterventions.

Emotion theorists suggest that people havetwo different ways of processing information:experiential or rational (Epstein, 1990;Gendlin, 1974, 198 1; Greenberg, R ice, & El-liott, 1993; Zajonc, 1980). The experientialprocessing system is global and holistic. Itdraws on affect and imagery. It processesinformation quickly, in an integrative way,but once activated, its impressions are slow tochange. In contrast, the rational processingsystem is analytic, dominated by logic andfact. It processes information more slowly, ina more differentiated way, but its conclusionscan change quickly. Both rational and expe-riential processing of information are impor-tant for well-being: Relying solely on rationalprocessing means that one is cut off from arich source of information about oneself andthe impact of the environment, whereas rely-ing solely on experiential processing entailsbeing driven blindly by diffuse affective re-sponses. An integration between thinking andexperiencing is both a sign and a result ofadaptive emotional expression.Research by Sappington and Russell (1979;Sappington, 1990) also points to the differencebetween cognitive and emotional processing.They distinguish between intellectually basedbeliefs, which are subjectively perceived as ra-tional and based on facts, versus emotionallybased beliefs, which are subjectively perceivedas nonrational and supported only by feelings or


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intuitions rather than facts.3 Laboratory experi-ments show that intellectually based beliefs canbe altered by obtaining more information. Incontrast, emotionally based beliefs are not af-fected by objective information but can changeunder conditions of increased levels of emo-tional experience and arousal. People often notethe distinction between intellectually and emo-tionally based beliefs. They may make remarkssuch as "Rationally I know X, but I feel as if Y."Writing or talking about their feelings enablespeople to access and perhaps revise their emo-tionally based beliefs.

Clinicians emphasize that exploring feelingsin a helpful way requires a combination of cog-nitive and emotional processing that involves a"middle distance" from inner experience (e.g.,Rice & Kerr, 1986; Scheff, 1979; see also Mer-genthaler, 1996). Scheff argues that beneficialcatharsis occurs when one is able to participatein and also observe one's own distress. If indi-viduals are overdistanced from their emotionalexperience, they are unaware of it and unable toaccess it as a source of information to guidetheir thoughts and behavior. If they are un-derdistanced, they are so flooded by feelingsthat they cannot reflect on their emotional ex-perience or modulate it. They express theiremotions, but in an unfocused, spilling-overmanner. For example, Jones, (Humming, andHorowitz (1988) observed that clients with highlevels of initial distress during a first therapysession were less able than other clients to talkabout their experience from multiple perspec-tives. L. F. Clark (1993) also notes that whenpeople are extremely distraught they are unableto "step back" and make sense of their experi-ence as they express it. Instead their expressioninvolves "a stream of unorganized ruminationsthat perpetuates a narrow perspective on theproblem" (p. 48). To gain emotional under-standing individuals need to be aware of theirinner experience but not overwhelmed by it.They need to experience and express their feel-ings vividly, but with enough distance that theycan thoughtfully examine and interpret thesefeelings.

What does this combined cognitive-experi-ential processing look like? Psychotherapy pro-cess research (Rice, Watson, & Greenberg,1993; J. C. Watson & Greenberg, 1996) sug-gests that when clients are engaged in produc-tive exploration and expression of emotion,

their voices are soft and hesitant with raggedpauses and emphasis in unexpected places.Their language is often poignant and vivid, cre-ating a sense of immediacy and aliveness. Whenclients are in touch with their feelings in thisway, they are inwardly focused on theirthoughts and feelings, actively experiencingtheir feelings in the session, and intensely en-gaged in examining and evaluating their expe-rience to create new meaning. In contrast, lessproductive processing and expression is charac-terized by more distant and disengaged descrip-tions and analysis of experience and feelings. Atthese times, clients often hav e an outward focus,describing the events and people in their lives ina rehearsed and lifeless manner. Clients maytalk about what is happening in their lives butpay little attention to its impact on them andtheir own inner responses. They may talk in awell-modulated, rhythmic tone, as if they werepresenting a well-rehearsed speech or chattingto a friend. They are not in touch with theirfeelings but seem distant from them and appearto be talking about them rather than experienc-ing or expressing them in the moment.Research on anger expression also points tothe benefits of combining cognitive and emo-tional processing. Murray (1985) described aseries of laboratory experiments showing thatthe combination of emotional ventilation andcognitive reinterpretation was more effective inreducing subsequent anger and aggression thaneither ventilation alone or cognitive reinterpre-tation alone. In one of these studies (Green &Murray, 1975), college students were angeredby receiving a derogatory personal critique ofthemselves that was supposedly written by an-other student they had just met, who was actu-ally the experimenters' confederate. After read-ing the derogatory critique, study participantsreceived one of three different interventions,

3 Sappington and Russell's distinction between intellec-tually and emotionally based beliefs is similar to Freud's(1921) distinction between intellectual and emotional in-sight, Zajon c's (1980) distinction between "hot" and "cold"cognitions (the former having a strong emotional compo-nent), and Epstein's (e.g., 1994) distinction between therational and experiential information-processing systems.Sappington (1990) noted that emotionally based beliefs arenot the same as emotional experience: Emotionally basedbeliefs are derived from emotional experience but they caninfluence behavior even when a person is not currentlyexperiencing emotion.


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196 KENNEDY-MOORE AND WATSONinvolving different anger-coping strategies. Inthe expression condition, the experimenter gotparticipants to express their resentment con-cerning the derogatory critique. In the reinter-pretation condition, the experimenter explainedthat the other student had misunderstood theinstructions. He thought he was supposed towrite a nasty critique, but he did not really m eanwhat he said. In the combination condition,participants first expressed their feelings andthen heard the "it was just a misunderstanding"explanation. In addition to these three interven-tion conditions, there were also two comparisonconditions, one involving no induction of hos-tility and one involving hostility induction butno intervention. Results showed that only thecombination of expression and reinterpretationwas effective in reducing later aggression to-ward the other student. The combination condi-tion also prompted a significantly greater shiftto positive feelings toward the experimenter'sassistant than the two single-component inter-vention conditions. In this study, reinterpreta-tion alone was not a very powerful way toreduce aggression or angry feelings. The ex-pression-alone condition also did not apprecia-bly decrease aggression, and it left participantsfeeling even more negative toward the experi-menter's assistant than the no-interventioncondition.

The anger-provoking incident in Murray'sstudies is somewhat contrived. However, an-other series of studies by Bohart, involving nat-urally occurring anger-arousing incidents, alsosuggests that anger expression is not helpful inand of itself but that it can be adaptive when itleads to or is accompanied by cognitive changes(see Bohart, 1980, for a review). For instance,Bohart (1977) asked college students to recalland mentally rehearse an anger-arousing inci-dent in order to induce feelings of anger. Studyparticipants were then given one of four sets ofinstructions. Intellectual-analysis participantswere told to "coldly and rationally analyze"events, motives, and feelings pertaining to theevent. Discharge participants were told to ver-bally express their angry feelings as if the per-son who angered them was in the room. Role-play participants were told to switch chairs asthey conducted a dialogue expressing both theirown feelings and the feelings of the person whoangered them. Finally, to provide a comparisonfor the other groups, detail participants were

asked to recall physical details of the incident.Self-report measures of angry feelings weretaken before and after the intervention. Addi-tionally, as a measure of behavioral aggression,participants were told to choose a level of aver-sive noise with which to "punish" a person inanother room who supposedly made errors on alearning task.These interventions lasted only a few min-utes, but they produced notable group differ-ence. Discharge participants showed increasesin anger and hostile attitudes. In contrast, role-play participants showed reductions in anger,hostile attitudes, and behavioral aggression. Onthe basis of this and other similar analog stud-ies, Bohart (1980) argues that the combinationof emotional expression and insight is morehelpful than simple venting of emotion. He sug-gests that anger expression merely sets the stagefor resolving a conflict situation. He argues thatanger expression is helpful only if it leads topositive cognitive or interpersonal changes suchas compromise, reinterpretation, or restorationof self-esteem.

Both Murray's and Bohart's studies involvedstudents rather than therapy clients, and theinterventions were brief. However, similar re-sults were obtained in a clinical study of pro-cesses and outcomes in encounter groups byLieberman, Yalom, & Miles (1973). Seventeengroups, employing a variety of therapeutic ap-proaches, each met for 30 hr. Outcome mea-sures included ratings by participants them-selves, other group m embers, group leaders, andfriends of group members. Many of the groupsin this study emphasized the therapeutic impor-tance of venting intense emotions, includinganger. Results suggest that expression of emo-tion alone was not therapeutic, but expressionaccompanied by some cognitive process washelpful. The groups focusing on expression ofintense emotions were not more successful thanother groups. To the investigators' surprise,higher levels of anger expression in the encoun-ter groups were associated with poorer out-comes. More recently, Littrel (1998) concludedfrom her review of the role of emotional expres-sion and experience in psychotherapy that ac-cessing intense feelings without having the op-portunity to cognitively process them actuallycan be harmful to clients.


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Some caveats concerning expression-relatedinsight. So far in this section we have de-scribed how expression can diminish distress byenhancing insight. Talking or writing abouttheir feelings can enable people to perceive theirfeelings with greater clarity or to gain newunderstanding of their feelings or circum-stances. How ever, we must m ention two caveatsconcerning expression-related insight.First, expression-related insight does not nec-essarily lead to immediate reductions in distress.A classic study by Ebbesen et al. (1975) vividlyillustrates the role of expression in shaping andintensifying anger experience. These investiga-tors interviewed laid-off engineers and techni-cians about their angry feelings. The inter-viewer subtly directed the focus of the workers'anger expression in one of three directions: to-ward the company, toward their supervisors, ortoward themselves. The interviewer asked lead-ing questions, such as "In what ways has thecompany not been fair with you?" "What actionmight your supervisor have taken to prevent youfrom being laid off?" or "Are there things aboutyourself that led your supervisor not to give youa higher performance review?" To provide abasis of comparison, the investigators alsoasked some of the laid-off workers neutral, un-emotional questions. Results showed that angerexpression in the interview did not dissipatefeelings of anger. Instead, expressing anger to-ward the company or toward supervisors in-creased anger toward the specific target dis-cussed, but not toward other targets. Fortu-nately, expressing anger toward the self did notchange anger toward the self or toward the othertargets. The laid-off workers in this studygained expression-related insight in that theycame away with clearer, more targeted under-standing of their feelings. However, at least inthe short-term, this insight heightened, ratherthan diminished, their distress. In a related vein,Tice (1990) surveyed people concerning thestrategies they use for controlling or alteringtheir emotional states. One of the key strategiesthat Tice's respondents reported using to sustaintheir anger was rehearsing one's feelings andtheir perceived cause, especially in the presenceof a sympathetic other. This involves using ex-pression as a means of intensifying and prolong-ing angry feelings.Insight-related increases in distress can beadaptive if they motivate active coping efforts.

For instance, an abused wife who confides in afriend about her anger might draw on this angerto galvanize her resolve to leave her marriage.In this case, expression-related insight mightlead to short-term increases in distress followedby long-term decreases. Many theorists point tothe potentially motivating functions of emotion(e.g., Carver & Scheier, 1998; Frijda, 1994;L. S. Greenberg & Pavio, 1997). On the otherhand, expression that involves simply enumer-ating grievances (e.g., "My life is a completemess") could lead people to feel overwhelmedand paralyzed rather than motivated to act.

A second caveat is that not all forms ofexpression lead to insight. When expressioninvolves rumination, or passive broodingabout emotional experience, it does not fosternew understanding but instead intensifies andprolongs distress (e.g., Nolen-Hoeksema,1991; Nolen-Hoeksema, McBride, & Larson,1997; see discussion by M. A. Greenberg,1995). Ruminative expression is vague, dif-fuse, and stagnate. Repetitively expressing"I'm miserable; I 'm always miserable; I 'mjust plain miserable," does not enhance cop-ing. Instead it rehearses and intensifies dis-tress, and it interferes with the implementa-tion of active coping strategies. People whoare rigidly preoccupied with how distressedthey are feeling do not have the cognitiveresources to solve problems, to react flexiblyto changes in environmental circumstances,or to recognize and respond sensitively toother people's feelings. Having an enduringtendency to focus on inner experience, includ-ing emotional experience, has been impli-cated in virtually all clinical disorders (In-gram, 1990).

Expression that persists at the lowest levels ofemotional awareness, that is merely a symptomof perseverative attention to distress, is notlikely to be helpful. In contrast, adap tive expres-sion brings a sense of movement and change,involving new, deeper understanding and readi-ness for action. No amount of saying, "I feelbad" is likely to help, but saying and realizing,"I feel lonely and unfulfilled in this relation-ship," could translate directly into adaptive cop-ing efforts. (See discussion of levels of emo-tional awareness by Lane & Schwartz, 1987,1992).Drawing from clinical observation, L. S.Greenberg and Safran (1987) identified three


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198 KENNEDY-MOORE AND WATSONclasses of emotional expression. Primaryemotional reactions convey biologicallybased, basic emotions, which provide adap-tive information for functioning. Often, cli-ents entering therapy are unaware of theseunderlying feelings. Secondary emotional re-actions are defensive coping efforts aimed atself-protection. These feelings are readilyavailable to consciousness. Expression ofsuch feelings have the quality of a well-re-hearsed, often-repeated litany. Even thoughthese feelings may be negative and may mo-tivate clients to seek therapy, there is a senseof comfort and familiarity with these feelings.The third class of emotional expression, in -strumental emotional reactions, involves ef-forts to influence others, such as expressingsadness to gain sympathy or anger to avoidresponsibility. This last type of emotional re-action entails a lack of correspondence be-tween overt emotional expression and covertemotional experience. It is easily noticed andcontrolled by clients.

In therapy, expression of secondary emo-tional reactions is not helpful and often harmful.Presumably, talking about these well-rehearsedfeelings is just a form of passive rumination. Incontrast, evocation and expression of primaryemotional reactions elicits insight and results intherapeutic change. The primary emotions arefelt with a profound sense of authenticity. Rec-ognition and expression of these emotions leadsto a sense of new understanding and increasedmotivation to act (L. S. Greenberg & Johnson,1990).

Summary. In summary, a second way thatexpression can enhance well-being is by facili-tating insight. Articulating their feelings canhelp people understand their feelings withgreater clarity and provides the opportunity tospell out the causes and implications of thosefeelings. Placing painful feelings in the contextof a narrative can be a way of resolving thosefeelings. Expression-related insight is mostlikely to occur when expression involves a com-bination of thinking and feeling. Furthermore,expression-related insight is only likely to en-hance well-being if it motivates active copingefforts. Expression that merely rehearses oldgrievances can leave people feeling over-whelmed and paralyzed.

Mechanism 3: Expression Can AffectInterpersonal Relationshipsin Desired WaysThe final mechanism by which expressioncan enhance well-being pertains to the interper-sonal impact of expression. Emotional expres-sion is usually a social occurrence: Individualsexpress their feelings to others. Social expres-sion of emotion is extremely common. An over-whelming majority of people report that theydiscuss their emotions with others, particularlytheir significant o thers (Rime, 1995; Rime et al.,1991).Expressing distress to others can enhance the

two mechanisms that we have already dis-cussed. For instance, confiding in a friend aboutfrightening or shameful feelings can reduce dis-tress about distress if that friend responds withempathy, acceptance, and containment (cf. Kos-micki and Glickauf-Hughes, 1997). Distressedpeople often judge themselves quite harshly,interpreting their distress as a sign that they arefalling apart or just unable to handle things theway most people can (Thoits, 1985). Validationand reassurance from others can alleviate self-doubts. Hearing that a friend has had similarexperiences, or at least is not horrified or re-pelled by the expresser's feelings, enables theexpresser to form a more benign appraisal of thesignificance of his or her distress.

A study by Donnelly and Murray (1991) of-fers a comparison of individual versus interper-sonal expression of traumatic feelings. Theseinvestigators compared the effects of writingessays versus talking with a therapist about trau-matic events. In the therapy condition, clinicalpsychology graduate student therapists reflectedand reframed the emotional content of traumadescriptions in a warm and empathic manner.Participants were college students, and the in-terventions took place over 4 consecutive days.In both trauma-expression groups, positiveemotion, self-esteem, and cognitive and behav-ioral change increased across the 4 days of thestudy, whereas negative emotion decreased.Both of these groups also felt more positiveabout their topics and themselves at the end ofthe experiment, although there were no long-term effects of either intervention on mental orphysical health.


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The most interesting results of this studywere the differences in mood between the writ-ing versus the talking group immediately fol-lowing each day of the intervention: Partici-pants who wrote essays about their traumaticexperiences showed increases in negative moodand decreases in positive mood after each ses-sion, whereas participants who talked abouttheir traumatic experiences in therapeutic inter-views showed no increase in negative mood andsometimes a decrease. The therapy participantsalso maintained their levels of positive moodafter the first day. Donnelly and Murray (1991)interpret these findings to mean that expressingfeelings about traumatic experiences is an aversivetask but that having a therapist respond em pathi-cally somehow ameliorates this aversiveness.

Expressing distress to others can also lead togreater insight. Recipients of distress expressionhave a different perspective than expressers andmay suggest different ways of understandingfeelings or circumstances (cf. Burleson andGoldsmith, 1998). Drawing on research com-paring the characteristics of written versus spo-ken communication, L. F. Clark (1993) specu-lates that although both writing and speakingabout stressful experiences can help make senseof experience, they do so in somewhat differentways. Because writing is more detached andstructured, it may be particularly helpful forconstructing a coherent explanation, acceptingunchangeable situations, minimizing confusion,or providing a sense of control. In contrast,because speaking is more personal, repetitive,fragmented, and contains more ideas, it may beespecially useful for reevaluating situations,generating new perceptions, and gaining abroader perspective and a more elaboratedunderstanding.

In addition to enhancing these previouslymentioned mechanisms, social expression ofdistress can also serve some unique functionsthat help to diminish distress. Specifically, it canchange the structure of relationships, directlyresolve distress stemming from interpersonalinteractions, or elicit social support.Social psychologists and emotion theoristsnote that expression plays a key role in struc-turing relationships. Keltner and Kring (1998)suggest that facial expressions of emotion serveas ongoing cues that coordinate social interac-tions by (a) rapidly conveying to other peoplehow the expresser is feeling about his or her

current relationship or circumstances, (b) evok-ing corresponding emotional responses in oth-ers, and (c) rewarding or deterring other peo-ple's behavior. Both verbal and nonverbal expres-sion help define a relationship by influencingparticipants' intimacy and relative status (seediscussion by D erlega, M etts, Petronio, & M ar-gulis, 1993). Confiding in someone about o ne'spainful feelings can decrease distress by creat-ing a new sense of intimacy in a relationship.Expressions of distress sometimes help a part-ner get to know the expresser better and com-municate that the expresser trusts the partner. Italso creates a normative demand or expectationthat the partner will reciprocate this self-revela-tion, further enhancing intimacy. Specific typesof expression can change the relative status ofrelationship partners and their patterns of inter-action. Expressing fear or sadness is a sign ofvulnerability, which tends to disarm and elicitcompassion, whereas expressing anger or dis-gust is a sign of strength, which tends to assertindependence and delineate interpersonalboundaries (L. S. Greenberg & Johnson, 1990).Expression can also directly resolve distressstemming from interpersonal interactions. Forinstance, Tice and Baumeister (1993) point outthat people who fail to express their anger mayfind that their problems recur. With no informa-tion concerning the problem, an offender islikely to repeat the provoking action. The of-fended party becomes increasingly angry, notbecause their anger builds up, but because theyaccumulate a list of grievances with each re-peated offense. They may end up having astrong outburst of anger expression in responseto multiple provocations, whereas the offendermay perceive this as overreacting to a singleincident (Baumeister, Stillwell, & Wotman,1990). It seems plausible that a constructiveexpression of anger early on might prevent thisescalation of anger. Tavris (1984, 1989) sug-gests that anger expression is most likely to beadaptive when it is directed at the appropriatetarget (i.e., the person one is mad at), and itresults in the clarification of anger-arousingmisunderstandings or misperceptions (e.g., "Itwas an accidentI would never do that to youdeliberately") or prompts a desired change inanother person's behavior (e.g., "I had no ideathat bothered you so muchof course I won'tdo it anymore").


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200 KENNEDY-MOORE AND WATSONFinally, social expression of distress can alsoelicit social support. Expression can serve as acue for significant others to provide coping as-sistance (e.g., Thoits, 1986; R. A. Thompson,

1994). Communicating distress is a means ofeliciting tangible aid or new information thatcan enhance coping efforts. An individual ismore likely to get help from others if othersknow the individual needs help. There is ampleevidence of the benefits of having social su pport(e.g., Brown & Harris, 1978; Cohen & Wills,1985; Sarason, Sarason, & Pierce, 1990). Cor-relational studies indicate that having emotionalsupport is consistently associated with healthand well-being. Experimental studies involvinglaboratory stressors show that active efforts by asignificant other to provide emotional comfortand reassurance are reliably associated with di-minished cardiovascular responses to stressfulevents and sometimes with decreased experi-ence of distress (see reviews by Lepore, 1998;Uchino, Cacioppo, & Kiecolt-Glaser, 1996).Presumably, in most cases, some form of dis-tress expression is necessary to elicit social sup-port. For instance, several theorists have sug-gested that crying serves a help-seeking func-tion by acting as a signal to others that theindividual is no longer able to manage the sit-uation alone (e.g., Averill, 1968; Labott, Mar-tin, Eason, & Berkey, 1991 ; Sadoff, 1966). Cor-nelius (1984) had volunteers provide detaileddescriptions of a time when they had cried in thepresence of another person. Although study par-ticipants insisted that their tears were involun-tary rather than deliberately manipulative, theyperceived crying to be quite effective in chang-ing the interpersonal context in a positive direc-tion, from conflict toward support. Crying gotthe attention of the other individual and fre-quently 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 thepossible benefits of expressing distress to an-other person. All of these benefits presume thatthe recipients of distress expression respondwith warmth and understanding. However, thisis far from guaranteed. Expressing negativefeelings to another person is risky (e.g., Derlegaet al., 1993; Fisher, Goff, Nadler, & Chinsky,1988; Nolen-Hoeksema & Davis, 1999; see alsorelated discussion by Kelly & McKillop, 1996,concerning the risks of confiding personal se-

crets). If recipients of distress expression re-spond negatively, the expresser may feel re-jected, misunderstood, embarrassed, or be-trayed. For example, Major et al. (1990) foundthat those women who told a significant otherabout their abortion but felt they received aresponse that was less than fully supportivewere more distressed than women who did nottell anyone about their abortion.Sometimes recipients respond to distress ex-pression in less than helpful ways because theymisread expressers' intent. L. F. Clark (1993)implies that the helpfulness of other people'sresponses depends on the extent to which theyare "in tune" with the expresser's goals. Some-times expressers are seeking advice or actionfrom others; sometimes they merely want to"gripe." Similarly, Miller and Berg (1984) de-fine responsiveness as "the extent to which andthe way in which one participant's actions ad-dress the previous actions, communications,needs, or wishes of another participant in theinteraction" (p. 191). They distinguished be-tween "conversational responsiveness," whichinvolves behaviors indicating interest in andunderstanding of another person's communica-tion, and "relational responsiveness," which in-volves behaviors addressing another person'sneeds. When responsiveness is low, expresserscan feel frustrated and misunderstood.

Sometimes other people, either out of caringfor the expresser or because of their own dis-comfort with intense feelings, respond to ex-pressers by dismissing or minimizing their dis-tress or prematurely offering a positive interpre-tation concerning the source of distress (e.g.,"It's for the bes t"). These responses are experi-enced by the expresser as showing a lack of ac-ceptance or understanding, leaving the expresserfeeling dismissed or rejected (e.g., Lehman, El-lard, & Wortman, 1986; Silver et al., 1983;Silver & Wortman, 1980; Silver, Wortman, &Crofton, 1990). Numerous studies have foundthat individuals experiencing intense or endur-ing distress are discouraged by significant oth-ers from expressing their feelings (Coates &Winston, 1987; Coyne, Wortman, & Lehman,1988; Gottlieb & Wagner, 1991; Wortman &Dunkel-Schetter, 1979). It is distressing forothers to see someone they care about suffering.When expressers show a great deal of distress,listeners may feel overwhelmed. They may feelconfused or helpless about how to respond.


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EMOTIONAL EXPRESSION 20 1

They may either avoid the expresser or insistthat the expresser "cheer up." In particular, theintensity of the trauma victim 's distress may bealarming for others and may lead them to con-clude that talking about the trauma just makesthings worse. They may end up discouragingthe distressed person from expressing their feel-ings, both to protect the expresser from furtherdistress and to protect themselves from upset-ting interactions with the expresser.Sometimes recipients respond quite nega-tively to distress expression. In dyadic interac-tions, partners tend to match each other's loud-ness level and speech rate (Feldstein &Welkowitz, 1987). Wh en one partner starts yell-ing, the other partner is likely to reciprocate,intensifying both partners' arousal and experi-ence of anger (Siegman, 1994). Angry tiradesare more likely to be met with defensiveness oreven counterattack than with understanding oracceptance (see review by Tavris, 1989). Mar-ital researchers have identified a pattern of dis-tress expression called negative escalation cy-cles. During these cycles, each pa rtner's expres-sion of negative emotion elicits an even morenegative comment in response. Partners' re-marks are aimed at hurting each other ratherthan understanding or resolving any issues.Negative escalation cycles are very effectivediscriminators between satisfied and dissatisfiedcouples and powerful predictors of future dis-tress (Gottman & Levenson, 1986; Julien,Markman, & Lindahl, 1989).

Even when recipients respond positively toexpressions of distress, seeking support canthreaten expressers' self-esteem by makingthem feel inferior, inadequate, or dependent be-cause they cannot manage on their own. Al-though the perceived availability of support isrelated to better well-being, having sought orreceived support is associated with poorer well-being (Coyne & Downey, 1991). This findingcould indicate simply that people who are moredistressed are more likely to seek help. Alter-natively, it may reflect the costs to self-esteemof receiving help, or the inadequacy of the helpreceived.

Determinants of others' responses to distressexpression. What determines whether distressexpression elicits positive or negative responsesfrom others? The interpersonal consequences ofdistress expression depend on what is ex-pressed, to whom, and how.

One key factor in determining the interper-sonal consequences of distress expression is theintensity of emotional expression, experience,and arousal of both the expresser and the re-ceiver. When people are feeling more intenselydistressed, they are more likely to express theirfeelings to others (Luminet, Zech, Rime, &Wagner, 2000). However, Gilbert (1991) main-tains that effective communication and conflictresolution are most likely to occur when partic-ipants are at intermediate levels of physiologi-cal arousal. High levels of arousal generallyinterfere with cognitive processing. Highlyaroused people are less able to effectively pro-cess external stimuli because their focus of at-tention is narrowed to their own experience andthe immediate cause of their distress (L. F.Clark, 1993). Their behavior tends to be impul-sive and extreme, focused on short-term reliefrather than long-term consequences. Zillmann(1993) notes that anger-reducing cognitivestrategies such as reappraisal only work at mod-erate levels of anger experience and arousal.Once people become enraged, laboratory stud-ies show that they are apt to ignore or dismissmitigating information. Drawing on LeDoux'sphysiological research with rats (e.g., LeDoux,1989, 1996), Goleman (1 995) coined the term"emotional hijacking" to refer to times whenthe emotional (limbic) brain takes over con-trol of behavior from the thinking (neocortex)brain. Similarly, Gottman (1993) talks about"emotional flooding," which he defined asoccurring when heart rate jumps 10 or morebeats per minute above a person's restingrate. While flooded, people feel overwhelmedby intense and subjectively uncontrollablefeelings of distress. They are unable toorganize their thoughts, comm unicate clearly,or consider another person's point of view.Jacobson and Holtzworth-Munroe (1986)found that even individuals who know effec-tive communication skills do not feel likeusing them when they are extremely angry.All of these researchers and theorists suggestthat when people are in the throes of highlevels of anger experience and arousal theyare more likely to lash out through extreme,impulsive, and maladaptive forms of angerexpression.

Marital researchers suggest that couples'ability to regulate the intensity of negative em o-tional expression is crucial to their well-being


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202 KENNEDY-MOORE AND WATSON(Blechman, 1990; Fruzzetti & Jacobson, 1990;Lindahl & Markman, 1990). Engaging in "tol-erable doses" of expression of negative emo-tions toward a spouse is less arousing for bothself and spouse than more intense expression.For this reason, it has a number of potentialadvantages. First, moderately intense expres-sion is less aversive, which makes it more likelythat partners will continue to engage in thediscussion until a solution is achieved, ratherthan disengaging prematurely. Second, moder-ate expression makes it more likely that partnerswill be able to think constructively and co me u pwith solutions rather than experiencing cogni-tive deficits due to excessive arousal. Third,tolerable expression makes it more likely thatpartners will be able to assimilate new informa-tion and develop better understanding of eachother, which has been linked to satisfaction inlong-term relationships (Cahn, 1990).

In addition to intensity, the frequency of dis-tress expression is likely to be an importantdeterminant of whether expression is effectivein an interpersonal context. One correlationalstudy (Keinan, Ben-zur, Zilka, & Carel, 1992)found that the most adaptive anger expressionstyle involved clear but infrequent anger ex pres-sion. People who constantly express distress arelikely to have other people dismiss their com-plaints, thinking or saying, "There they goagain!" Parents who scream at their children allthe time usually find that their children tunethem out (Tavris, 1989). The frequency of theirdistress expression may explain why ruminatorshave trouble eliciting social support (Nolen-Hoeksema & Davis, 1999).

The content of anger expression is also im-portant in determining interpersonal conse-quences of distress expression. In describingemotionally focused marital therapy, one of thebest validated forms of marital therapy, Johnson(1996) emphasizes that the key to adaptive in-terpersonal expression is active exploration andnew awareness of previously unacknowledgedfeelings:

The indiscriminate ventilation of negative emotion . . .can be detrimental in couples therapy. The repetitiveexpression of [well-rehearsed] emotions is an essentialpart of distressed couples ' everyday problematic inter-actions. It is the discovery and d evelopment of new orunrecognized emotional experience that is useful incouples therapy, (p. 43)

According to Johnson, when one member ofa couple is able to communicate a previouslyunexpressed feeling, it elicits a new responsefrom the partner and leads to changes in thecouple's general pattern of interacting.Behaviorally oriented marital therapists alsofocus on the content of expression by teachingclients to make distress expressions more palat-able to receivers. They emphasize communica-tion skills such as using "I" statements andfocusing on specific problematic behaviorsrather than general personal inadequacy (e.g., "Ifeel irritated when you leave your dirty socks inthe middle of the floor" rather than "You are adisgusting and completely inconsiderate jerk!").

Being able to communicate on e's distress in asocially skilled manner enhances the likelihoodof receiving support. A study by Silver et al.(1990) indicates that people are most willing tointeract with expressers who disclose distressbut also state that they are engaged in copingefforts. People are less willing to interact withexpressers who either openly show their distressor downplay their distress. On the other hand, itis possible to overdo efforts to make recipientsof distress expression comfortable. Coates andWinston (1987) found that high self-monitors(i.e., people who pay particular attention to howthey come across to others) were more effectivethan low self-monitors in gaining support fromothers, but unlike low self-monitors, they didnot feel less depressed after expressing. Coatesand Winston speculate that the high self-moni-tors downplayed their distress. This strategymade listeners like them more, but perhaps itprevented high self-monitors from getting theunderstanding or acceptance they needed.

Kennedy-Moore and Watson (1999) arguethat the interpersonal consequences of distressexpression depend on how receivers interpret it.Receivers draw on verbal and nonverbal aspectsof their partner's emotional behavior, as well asthe general relationship context, to infer thedegree of threat that the distress expression en-tails for them. When receivers perceive that theexpression implies personal criticism or that theintent behind distress expression is malicious ormanipulative, they feel more threatened and areless likely to respond positively. They may alsorespond negatively if they perceive that thelevel of distress shown by the expresser exceedstheir current coping capabilities. On the otherhand, when receivers view the expresser's in-


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tent as positive or at least benign, and the mag-nitude of distress does not seem overwhelming,they are more likely to respond warmly to dis-tress expression. Capps and Bonanno (2000)found that strangers w ere more inclined to avoidand less inclined to comfort people whose be-reavement narratives were more negative andcontained more helpless or passive themes. Per-haps these people came across as overwhelm-ingly needy, leading the strangers to feel threat-ened by their distress expression. Shimanoff(1987) presented married couples with scenar-ios involving disclosures of negative emotionsdirected at either the spouse or some other per-son (e.g., friend, coworker). When spouses re-ceived distress disclosures about other people,they felt more intimate with the partner. Whenthe distress disclosures were about themselves,spouses felt less intimate. Alberts (1988) ob-served that partners' responses to their spouses'complaints are influenced more by partners'global feelings toward their spouses than by thespouses' immediate behavior. In general, satis-fied partners tend to make more generous orforgiving attributions for their spouses' nega-tive behavior than do unsatisfied partners (Fin-cham & Bradbury, 1993).

Summary. In summary, expression can al-leviate distress by affecting interpersonal rela-tionships in desired ways. Talking about one'sfeelings with another person can enhance indi-vidual functioning by leading to greater self-acceptance or new insight. It can also directlyaffect relationships by changing patterns of re-lating, resolving interpersonal misunderstand-ings, or eliciting social support. However, othersdo not always respond warmly to expressions ofdistress, andnegative responses from others canintensify expressers' distress. Expressions ofdistress are most likely to lead to positive re-sponses from others when they are not too in-tense or too frequent and when they involvenew (rather than well-rehearsed) feelings thatare sensitively communicated. In general, howother people respond to expressions of distressdepends on how threatening they perceive theseexpressions to be.

So far in this article we have highlightedthree possible m echanisms by which expressioncan enhance well-being. These mechanisms in-volve reducing distress about distress, fosteringinsight, and affecting interpersonal relationshipsin a desired way. These three mechanisms are

interrelated. For instance, perceiving feelings asmore acceptable and tolerable may enable peo-ple to examine them in a way that promotesgreater self-understanding, which leads them toalter their interpersonal relationships in a de-sired way. Alternatively, explaining one's feel-ings to another person may provide new per-spective and the opportunity for increased self-understanding, which may lead to greaterself-acceptance.

When Does Express ion He lp?The three possible mechanisms by which ex-pression might alleviate distress not only sug-

gest how expression can enhance well-being,they also provide some hints about the condi-tions under which expression is most likely tobe helpful. In this section, we briefly considerthe time course and the content of distress ex-pression. We also discuss individual differencesin comfort with expression.Time Course

The optimal timing of expression relative tothe experience of a stressful event is an openquestion for research. Clinicians who use criti-cal incident stress debriefing suggest that it isbest for people to talk about their feelings assoon as possible after experiencing a traumaticevent (Miller, 1999). However, Pennebaker(1999) suggests that expression-related inter-ventions may be most helpful 8-12 weeks aftera traumatic event, when people are still thinkingabout the event but have less opportunity to talkabout it because others are less w illing to listen.

Although there is no general agreement aboutwhen expression should occur, there is consen-sus among researchers and theorists that thebenefits of distress expression often take time toemerge. The mechanisms we described in theprevious section, involving expression-relatedincreases in self-acceptance, insight, or positiveinterpersonal impact, typically are not instanta-neous changes. Staying with one's feelings tolearn that they are tolerable, constructing a nar-rative that provides a sense of resolution, andexperiencing the benefits of new ways of relat-ing to others are usually processes that take timeto develop.A study by Mendolia and Kleck (1993) ex-plicitly demonstrates the delayed benefits of


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204 KENNEDY-MOORE AND WATSONexpression. These investigators had volunteerswatch a stressful film about wood shop acci-dents, and then talk about either the facts of thefilm or their emotional reactions to it. Whenvolunteers saw the film a second time immedi-ately after talking, the expression group wasmore autonomically aroused than the factsgroup. However, when volunteers saw the filma second time 48 hr after their initial exposure,the expression group was less aroused and hadmore positive affect than the facts-only group.

In Pennebaker's expressive writing studiesthe immediate consequences of expression areincreased arousal and intensified experience ofdistress. This makes sense given that expressingdistress necessarily involves focusing on un-pleasant experiences. However, short-term ex-pression-related exacerbation of emotional re-sponses may be worth it if expression leads tosome kind of resolution of distress. Within 2weeks after the writing intervention, Penne-baker's expression volunteers usually felt asgood or better than volunteers who did notexpress (Pennebaker & Seagal, 1999).The intensity of the initial level of distressmay determine whether expression-related ele-vations in distress occur immediately after ex-

pression. Pennebaker and Seagal (1999) notedthat unemployed engineers, who presumablywere generally more distressed than student vol-unteers, actually felt better immediately afterexpressing. They postulate that "the better [peo-ple] feel before writing, the worse they feelafterwards and vice versa" (p. 1246). Clientsoften feel better when they begin therapy. Per-haps if one is already very distressed, focusingon feelings through expression does not com-pound distress but instead provides an immedi-ate sense that one is doing something about it.Whether this immediate relief translates intomore long-lasting well-being is likely to dependon whether expression promotes positivechanges such as acceptance or insight or dete-riorates into unproductive, passive rumination.Content of Expression

In discussing the mechanisms by which ex-pression can enhance well-being, we noted thatexpressing different types of feelings is likely toaffect relationships in different ways by elicit-ing different corresponding responses fromother people. We also described clinical theo-

ries concerning the importance of expressingprimary emotions rather than well-rehearsedsecondary emotions, and we pointed out thatexpression involving moderate levels of inten-sity is most likely to lead to acceptance, insight,and positive responses from others.Our focus in this article has been expressionof distress, but recent research and theory pointto the importance of expression of positive emo-tions (e.g., Bonanno & Keltner, 1997; Fredrick-son, 1998; Keltner & Bonanno, 1997). Ideally,expression of distress is accompanied by ex-pression of positive emotions. Positive emo-tions can counterbalance negative ones: Empa-thy can diffuse anger; love and humor can di-minish sadness; hope and acceptance can maketrauma-related feelings more bearable.

Pennebaker and Francis (1996) found thatexpression of both negative and positive emo-tions was linked to health outcomes. In fact, inthis study, use of positive emotion words was astronger predictor of improved health than useof negative words. Pennebaker et al. (1997,study 1) found that optimum results from writ-ing about traumatic experiences occurred whenparticipants used a moderate number of nega-tive emotion words and a relatively large num-ber of positive emotion words. Pennebaker andSeagal (1999) speculate that this combinationentails "acknowledgment of problems with aconcomitant sense of optimism" (p. 1249).Other investigators have found that the pro-cess of shifting from negative mood to positivemood over the course of written or verbal dis-closure is linked to improvements in self-esteem, cognition, and behavior (Donnelly &Murray, 1991 ; Murray, Lamnin, & C arver,1989). In psychotherapy, a shift from negativeto positive emotions is often an indication ofsignificant emotional processing (L. S. Green-berg & Safran, 1987).Expression of positive feelings along withnegative feelings can also make distress expres-sion more palatable to recipients. For instance,Keltner and Bonanno (1997) found that be-reaved people who laughed or smiled genuinely(i.e., with their eyes as well as their lips) whiletalking about their deceased spouses evokedmore positive reactions from strangers and re-ported getting along better in their current rela-tionships. Expression of positive emotion canalso be a way of halting negative escalation


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EMOTIONAL EXPRESSION 205cycles when couples argue (Gaelick, Boden-hausen, & Wyer, 1985).Individual Differences in Comfort WithExpression

Research on individual and cultural differ-ences suggests that expression can carry verydifferent 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 expressivegoals and values.) Sometimes people refrainfrom expressing because of deeply held per-sonal or cultural values. Such people are un-likely to seek out opportunities to express andmay view involuntary expression as a shamefullapse in self-control. They are unlikely to ben-efit from expression unless they can find a wayof expressing that is consistent with their val-ues. As Lazarus and Folkman (1984) point out,coping strategies, such as expression, that areinconsistent with one's values "are likely to beused reluctantly or without conviction and arelikely to fail" (p. 189).

In general, people who want to express then-feelings and feel comfortable doing so are morelikely to benefit from it than people who arereluctant to express. For instance, Labott andTeleha (1996) had women who w ere either highor low in self-reported crying frequency watch asad movie with instructions either to try to ex-press their feelings fully or to inhibit completelyany overt signs of their feelings. They observeda significant interaction between weeping pro-pensity and expression instructions: Womenwho typically cried frequently felt most com-fortable crying and least comfortable inhibitingtheir tears, whereas women who rarely criedpreferred to inhibit their tears and felt stressedwhen asked to openly express their emotions. Inother words, participants reported feeling leaststressed when the experimental instructionsmatched their usual crying propensity, and theyfelt most stressed when instructions were con-trary to their usual behavior. Similarly, Enge-bretson, Matthews, and Scheier (1989) foundthat people's preferred anger expressive strat-egy tends to be their most adaptive strategy.Stanton, Kirk, et al. (2000, Study 4) also foundevidence that students who generally copethrough emotional expression showed the best

outcomes (i.e., the least arousal and negativeaffect) following an emotional expression inter-vention. Taken together, these findings suggestthat the answer to what sort of expression is"best" varies for different people.Sometimes the issue is not whether peopleexpress but how they express. Donnelly andMurray (1991) noted individual differences incomfort with different forms of expression.Women and individuals who typically pay agreat deal of attention to their inner experience(i.e., those high in a trait called private self-consciousness) reported better mood followingan expressive writing intervention. In contrast,men and individuals who typically do not attendto their inner experience reported better moodafter ex pressing their feelings in the presen ce ofa warm psychotherapist. Perhaps people whoare less "in touch" with their feelings have agreater need for support from an empathic otheras they struggle to express their feelings.

ConclusionThe paradox of distress expression is thatexpression of negative feelings is both a sign ofdistress and a possible means of coping with

that distress. Throughout this article, we haveargued that expression of negative feelings isadaptive to the extent that it leads to some kindof resolution involving the source or signifi-cance of distress. Our review suggests that res-olution of distress does not follow directly orautomatically from expression. Instead, the ben-efits of distress expression stem from cognitiveor interpersonal processes. Expression of dis-tress is not an adaptive goal in and of itself, bu tit can serve as a means of enhancing self-accep-tance, fostering self-understanding, or improv-ing social relationships.Emotions are a source of information aboutthe relationship between the self and the envi-ronment. Expression is a means of processingand communicating this infor

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How When Does Express Help 2001