negative emotional expression

A recent study published in the British Journal of Health Psychology suggests that positive and negative emotional expression predicts physical health indices, including self-reports of interference from physical health symptoms and objective measures of heart rate variability.


Emotion regulation is broadly defined as the ability to enhance or suppress emotional expression based on the situation or circumstance at hand. Studies have shown that positive and negative emotional expression is associated with better physical health, while emotional suppression may have negative health consequences. Many of these studies have focused on indices of cardiovascular health; however, they are not without limitations and results depend on how emotion is defined and measured, and how studies are structured.

The majority of studies have assessed self-reported emotion or emotion regulation at the trait-level, which suggests that individuals have the tendency to express or suppress emotions in a characteristic fashion dictated by personality traits that are considered fixed. These studies do not allow for a flexible conceptualization of emotion regulation as a skill that can be learned, one that is adaptive, and malleable in response to situational opportunities and constraints. In many studies, it is also difficult to determine whether emotion or emotion regulation strategies like suppression are responsible for health outcomes. Emotional suppression has been associated with poor health, but individuals who suppress emotion may have more negative emotions to suppress, and when researchers account for high levels of negative emotion, associations between emotional suppression and poor health are reduced. Further, researchers often tend to “lump” positive and negative emotions and emotion regulation strategies together, assuming that all positive and all negative emotions are the same, rather than exploring emotion regulation strategies particular to specific emotions.

A group of researchers in New Zealand conducted a cross-sectional study to address these limitations. Instead of using self-reported trait assessments of emotional expression, they used an objective skill-based test to examine the relationship between the ability to enhance and suppress emotion and physical health. They examined the ability to regulate joy, sadness, and anger separately, rather than aggregating positive and negative emotional expression. In addition to self-reported physical health symptoms, they used an objective measure of heart rate variability (HRV), or beat-to beat variability in heart beat; this measure has been previously studied in relation to emotional expression, and it has been described as a proxy for physical health. Low HRV has been associated with negative health outcomes including heart failure, metabolic syndrome, and inflammation.

The researchers used secondary data from a previously conducted experimental study to investigate the relationship between regulatory strategies and physical health. Their sample consisted of 117 participants ages 18 to 88 who were recruited in Auckland, New Zealand through university and hospital mailing lists and posted advertisements. Participants provided data on physical health, emotion, and sociodemographic characteristics. Physical health data included data on the presence or absence of various health conditions and a physical health symptoms inventory that assessed the degree to which health symptoms interfered with participants’ lives over the past three months. The researchers calculated HRV for each participant using electrocardiogram readings and software.

Trait and state emotion were assessed. Trait emotion was assessed using an emotion inventory, which asked participants about the degree that they typically experienced a variety of emotions in daily life. Participants rated state emotion, temporary emotion felt in response to stimuli, before and after viewing film clips designed to elicit anger, sadness, and amusement. After watching brief clips, they were instructed to enhance or suppress any felt emotion, and their reactions were video recorded. Researchers used the video recordings to score participants’ abilities to enhance or suppress emotion. They also assigned expressive flexibility scores that indicated the degree to which participants could engage equally in both expression and suppression.

After accounting for sociodemographic variables and trait-level emotion, the researchers found that the ability to enhance expressions of joy was associated with lower physical health symptom interference. The ability to enhance sad expressions was associated with higher HRV, indicative of better health. The ability to flexibly enhance and suppress expressions of joy and sadness was also linked to lower physical health symptom interference. There were no significant findings with regard to anger, although the ability to flexibly regulate anger was marginally associated with decreased HRV.

In general, studies have shown that expressing emotion, especially positive emotion, is associated with better health, while suppressing emotion has negative health consequences. This study suggests that positive and negative emotional expression predicts physical health indices based on both self-reported (physical health symptoms interference) and objective measures (HRV). In particular, the ability to engage equally in enhancing and suppressing emotional expressions of joy and sadness may improve health. These findings persisted after accounting for trait-level emotion, suggesting that emotion regulation is not a fixed trait dictated by personality, but an adaptive skill, or set of skills, that can be applied and practiced in response to environmental situations and circumstances. Further, differential relationships between regulation of specific emotions and physical health indices suggest that associations are complex and vary based on the emotion studied.

This study was limited by a cross-sectional design and a largely white sample. Additional research is needed to assess the effects of emotion regulation on physical heath over time among more diverse populations. Different indices of physical health should also be tested. Further research is needed to better understand differential relationships between the ability to regulate specific emotions and health, and to elucidate the mechanisms through which regulatory skills improve health.


Written By: Suzanne M. Robertson, Ph.D

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