Expressive Regulation and Health: Does the ability to regulate the expression of emotion predict physical health outcomes?

Abstract

The relationship between emotion regulation and physical health has been of considerable scientific and public interest since at least the time of Freud. In general, openly expressing emotions is framed as a hallmark of adaptive behaviour, whereas suppressing emotions and ‘bottling them up’ is widely thought to have a detrimental impact on mental and physical health. However, closer examination of the evidence base supporting these claims reveals an over reliance on self-reported measures and a near exclusive focus on trait regulation. Traits represent only one part of the broader emotion regulatory construct, and re-directing attention towards the assessment of expressive skills or abilities is more consistent with both evolutionary and functionalist accounts of emotion. Furthermore, recent advances in emotions theory suggest that the ability to regulate the expression of emotion in a manner that fits with personal goals and motivations should be associated with better outcomes. In support of this possibility, accruing empirical work indicates that greater regulatory skill predicts better psychological wellbeing. However, whether ability-based assessments of expressive regulatory skill are also associated with physical health has not yet been systematically examined. In addressing this gap in the literature, three studies tested whether expressive regulatory skills were associated with physical health indices. A first study based on 117 men and women found that the ability to both enhance and suppress expressivity predicted better self-reported health and had mixed links with heart rate variability (HRV). A second study (N=80 women) demonstrated that skill in rapidly expressing discrete emotions also predicted outcomes, with findings detailed across two reports. The first showed that higher HRV predicted greater skill in expressing some emotions, and the second showed that greater skill predicted better self-reported outcomes and had mixed links with immune parameters. Finally, a third study (N=82 men and women) found that greater skill in expressing positive emotion predicted lower cardiovascular disease (CVD) risk among men. In moving beyond the limitations of trait assessments, findings from across this programme of doctoral research offer initial evidence that greater expressive regulatory skill predicts better subjective and objective health outcomes. These findings suggest that rather than any single regulatory strategy (such as suppression) predicting better or worse outcomes, the ability to flexibly regulate the expression of emotion in accordance with situational demands represents a useful way of thinking about adaptive emotion regulation.