Citation
Bottling it up

Material Information

Title:
Bottling it up suppression versus acceptance of negative emotion in the development of anxiety
Creator:
Boland Matthew
Publication Date:
Language:
English
Physical Description:
vii, 32 leaves : ; 28 cm.

Thesis/Dissertation Information

Degree:
Master's ( Master of Arts)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
Department of Psychology, CU Denver
Degree Disciplines:
Psychology

Subjects

Subjects / Keywords:
Anxiety ( lcsh )
Emotions ( lcsh )
Negativism ( lcsh )
Anxiety ( fast )
Emotions ( fast )
Negativism ( fast )
Genre:
bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis (M.A.)--University of Colorado Denver, 2009.
Bibliography:
Includes bibliographical references (leaves 29-32).
General Note:
Department of Psychology
Statement of Responsibility:
by Matthew Boland.

Record Information

Source Institution:
|University of Colorado Denver
Holding Location:
Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
465019954 ( OCLC )
ocn465019954

Full Text
/
BOTTLING IT UP: SUPPRESSION VERSUS ACCEPTANCE OF NEGATIVE
EMOTION IN THE DEVELOPMENT OF ANXIETY
by
Matthew Boland
Bachelor of Arts, Santa Clara University, 2002
A thesis submitted to the
University of Colorado Denver
in partial fulfillment
of the requirements for the degree of
Master of Arts
Department of Psychology
2009


This thesis for the Master of Arts
degree by
Matthew Boland
has been approved
Elizabeth Allen
Iris Mauss
Date


Boland, Matthew, E. (Master of Arts, Clinical Psychology)
Bottling It Up: Suppression versus Acceptance of Negative Emotional Experience in the
Development of Anxiety
Thesis directed by Assistant Professor Elizabeth Allen, Ph D.
ABSTRACT
Recent studies have found correlations between suppressing negative emotions and
anxiety. In order to test the effects of suppression and see if it causes anxiety compared to
emotional acceptance or to a control, participants were randomly assigned to one of three
groups: those instructed to suppress their emotions, those instructed to accept their
emotions, and those given emotion-neutral instructions (control). They were then asked to
view a sad film clip and give an impromptu speech in front of a camera. Contrary to what
was expected, those suppressing negative emotions did not become more anxious than
those in other groups. Results suggest that suppressing may not cause anxiety, but that
other factors may characterize this relationship.
This abstract accurately represents the content of the candidates thesis. I recommend its
publication.
Signe _
Elizabeth Allen


DEDICATION
For my father; a great man and a mad scientist in his own right. He helped ignite in me a
passion for inquiry.


ACKNOWLEDGMENTS
I would like to sincerely thank Dr. Iris Mauss. Her guidance and support has been
invaluable, and conducting this study would absolutely not have been possible without her.
I would also like to thank Dr. Amanda Shallcross, Dr. Elizabeth Allen, Dr. Allison Bashe,
the entire University of Denver Emotion Regulation Lab, and all others who gave their time,
knowledge, and support to help me in this endeavor.


CONTENTS
Figures ..........................................................page iii
CHAPTER
1. INTRODUCTION........................................................1
Limitations of Previous Research and the Present Study..........7
Hypotheses......................................................8
2. METHODS............................................................10
Participants...................................................10
Measures.......................................................10
Procedures.....................................................11
3. RESULTS............................................................16
Outlier and Randomization Checks...............................16
Manipulation Checks............................................16
Hypothesis Testing: Effect of Emotion Regulation
Instruction on Anxiety after Sadness Induction.................18
Hypothesis Testing: Effect of Emotion Regulation
Instruction on Anxiety after Anxiety Induction.................20
4. DISCUSSION.........................................................22
Conclusions....................................................23
Limitations of the Present Approach ...........................24
Strengths of the Present Approach..............................26
Implications and Future Directions.............................27
REFERENCES ................................................................29
VI


FIGURES
Figure
2.1 STUDY PROCEDURES........................................15
3.1 STATE ANXIETY SCORES AFTER THE SAD FLIM CLIP AND
AFTER THE SUBSEQUENT RECOVERY PERIOD....................19
3.2 STATE ANXIETY SCORES AFTER THE SPEECH AND AFTER
AFTER THE SUBSEQUENT RECOVERY PERIOD....................21
vii


1. INTRODUCTION
A number of studies have found that suppression of negative emotion is
associated with maladaptive outcomes, including anxiety, depression, increased negative
emotion, social difficulties, decreased well-being, and other symptoms of psychopathology
(Campbell-Sills et al., 2006a; Egloff et al., 2006; Feldner et al., 2006; Gross, 2002; Gross,
1998; Gross & John, 2003; Gross & Levenson, 1997; Hayes et al., 2004; Hofmann et al., in
press; Kashdan etal., 2006, Levitt etal., 2004; Liverantetal., 2008; Roemeretal., 2005).
Increasing evidence of the existence of these relationships has made emotion suppression
an important topic for study in order to determine its role in the development and
maintenance of emotional difficulties.
A number of these studies are characterized by two different approaches to their
models of suppression. Gross model of emotion regulation (1998) proposes that emotion
suppression is the conscious or subconscious inhibition of ongoing emotional responses
(Gross, 1998), which enables individuals to consciously avoid emotional responses that
may be difficult or socially undesirable in public contexts (Gross & John, 2003). For
example, if having found ourselves in the face of potential disciplinary action in high school,
suppression helped us not to break out in laughter while being interrogated by the Vice
Principal. This model focuses on how individuals suppress the behavioral expression of
their emotions. A number of negative outcomes have been associated with active
behavioral suppression, including sympathetic activation (e.g. increased blood pressure,
heart rate, skin temperature, skin conductance; Gross, 1998; Butler et al., 2002), a key
feature of anxiety and anxiety related disorders (Sadock & Sadock, 2004), as well as
decreased interpersonal functioning compared to cognitive reappraisal, which was related
1


to more adaptive and successful interpersonal functioning (Gross & John, 2003). It was
also found that participant use of behavioral suppression related to a negative sense of
well being, whereas cognitive reappraisal was related to a positive sense of well being
(Gross & John, 2003).
Other studies have focused on the suppression of individuals internal experiences,
as opposed to suppression of their behavioral expression, and have found it to be
associated with a number of maladaptive behaviors and mental difficulties. This study will
focus on how individuals attempt to suppress negative emotional experiences, which I will
refer to as experiential suppression. For example, an individual may try to suppress the
sadness they feel while grieving for a lost loved one because that emotion is difficult to
experience or because is it evaluated as negative or unreasonable to experience. Hayes
and colleagues (1996) proposed the theory of experiential avoidance to conceptualize the
process that individuals initiate to avoid negative internal experiences. Experiential
avoidance is the phenomenon that occurs when an individual is unwilling to remain in
contact with particular private experiences... and takes steps to alter the form and
frequency of these events and contexts that occasion them (Hayes et al., 1996). In
addition to avoiding emotional experience, experiential avoidance includes avoiding
thoughts, memories, or bodily sensations. As experiential suppression is thought to be a
process initiated in order to avoid negative internal experiences, it is considered to be inline
with experiential avoidance.
Experiential suppression contrasts with acceptance, which is simply accepting
emotions for what they are, while allowing one-self to experience them as they are in
conscious experience. Acceptance means not trying to alter the form or frequency of
emotions experienced. This has become a popular strategy for the treatment of
psychopathology, as in Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, &
2


Wilson, 1999), Dialectical Behavior Therapy (DBT; Linehan, 1993), and general humanistic
treatment methods (Hayes et al., 2004).
Experiential suppression is quite similar to the socially understood terms bottling
up emotions or burying emotions. An entertaining example from popular media would be
the classic Seinfeld episode in which the characters Kramer and Frank Costanza
(Georges father) use the Serenity Now! technique; they continually try to avoid or push
from conscious experience their responses to any stressful situation they encounter.
Subsequently, they experience more emotional and physiological distress.
Such counter-intuitive responses have been recorded in individuals cognitive
experiences in research on thought suppression. In his pioneering work, Wegner (1990)
found that instructing students not to imagine a white bear caused them to have more
intrusive and pervasive thoughts of a white bear. For suppression of emotional experiences
there may be a similar response. As suppressing emotion does allow for short-term
avoidance of that emotion in conscious experience (Hayes et al., 1996), it is assumed here
that suppressed emotions rebound after this short term relief, manifesting as negative
emotional states. In particular, suppressing negative emotions may cause individuals to
experience anxiety, as a number of studies have linked suppression of negative emotion to
anxiety and anxiety symptoms when comparing it to acceptance of emotional experiences.
Hayes and colleagues (2004) found that experiential avoidance correlated with
self-reported levels of anxiety, as well as depression, a variety of specific fears, trauma,
lower quality of life, and psychopathology in general. A study by Roemer and colleagues
(2005) found strong associations in relation to anxiety symptoms when examining anxiety
specifically. The authors found that high emotional avoidance, as opposed to accepting
ones experiences, was associated with chronic worry and generalized anxiety disorder
(GAD) symptomatology in both a clinical and nonclinical sample.
3


Suppression of emotional experiences has been shown to be a common strategy
among individuals with anxiety and mood disorders. Campbell-Sills, Barlow, Brown, &
Hofmann (2006a) showed an emotion-provoking film to 60 participants with anxiety or
mood disorders and to 30 control participants without clinical diagnoses, and then gave self
report measures to all participants. Participants in the clinical group rated their emotional
experiences as less acceptable and suppressed them to a greater extent than controls did
(but they did not use other emotion regulation strategies, like cognitive reappraisal or
acceptance). The authors effectively showed that maladaptive efforts to control undesired
emotions are part of the phenomenology of emotional disorders. Indeed, the present
findings suggest that if individuals engage in suppression, they may unintentionally
increase and prolong negative emotion (p. # 594). However, the authors recognize that
the design of their study does not allow conclusions to be made about the role of
suppressing emotional experiences in the etiology of anxiety or mood disorders and
negative emotional states (Campbell-Sills et al., 2006a).
Levitt and colleagues (2004) found that patients with panic disorder (PD) rated
suppression techniques as a common part of their attempts to cope with anxiety. In a study
examining 60 patients with PD, they also found that a 10 minute audiotape intervention
employing emotional acceptance techniques significantly alleviated anxiety given after an
air reduction challenge (a technique in which a certain level of carbon dioxide is inserted
into the air and participant response is observed) compared to a similarly formatted
intervention employing experiential suppression techniques. First, their study supports the
idea that laboratory manipulations can be use to effectively examine the consequences of
experiential suppression. Second, their results show that greater use of experiential
suppression strategies was related to greater subjective anxiety, and that experiential
suppression is a key process contributing to the maintenance of anxiety responses in panic
4


disorder patients. However, as the authors point out, their study does not fully describe the
nature of this relationship. It is possible that greater anxiety during the challenge led to
greater use of suppression, rather than vice versa (Levitt et al., 2004, p. 762). From this
study, it is not shown that one response evidently causes the other, especially given that
the sample was confined to patients with panic disorder.
Much of the literature on experiential avoidance supports a correlational
relationship between experiential suppression and anxiety or anxiety disorders.
Suppression of negative emotional experiences is mostly viewed as a mechanism that is
related to, and in many cases a feature or outcome of anxiety and mood disorders or
associated symptoms. However, recent speculation based on existing evidence has
pointed to avoidance of negative emotions being a psychological vulnerability for anxiety
pathology (Kashdan et al.2006). It may be that those who are engaging in the emotion
suppression process are likely to develop anxiety symptoms. Although a few other authors
have discussed the causal effect of suppression for anxiety in light of correlational findings
(Gross & John, 2003; Levitt et al., 2004), further research is clearly needed to investigate
the causal nature of suppression as it relates to anxiety.
Campbell-Sills and colleagues (2006b) did conduct a causal study to examine the
effects of experiential suppression. Using the clinical portion of their sample (2006a; those
participants with anxiety and mood disorders), they instructed participants to either
suppress or accept their emotional experience in response to a distressing film clip
(designed to induce stress). They found that those in the suppression group showed a
greater persistence of negative affect (as measured by a composite of different types of
negative affect) after the film had ended compared to those instructed to accept their
emotions. However, in addition to confining their sample to only clinical populations, the
authors focused on the effects of experiential suppression on negative affect more
5


generally, and did not report on effects on any specific negative emotions, like anxiety or
sadness.
Another of the few studies to use experimental manipulation to directly examine
the effects of suppression compared to acceptance is a recent study by Hofmann and
colleagues (in press). The authors found that participants instructed to behaviorally
suppress their emotions in response to an impromptu speech task (designed to induce
anxiety) reported experiencing higher levels of anxiety compared to participants instructed
to use cognitive reappraisal but not participants instructed to accept their emotions. This
study is impressive, as it is among the first of its kind to compare suppression, cognitive
reappraisal, and acceptance all in the same study. However, it did have some key
limitations. First, those instructed to suppress were instructed to suppress the expression
of their emotions, while participants instructed to accept were instructed to accept the
experience of their emotions. It might be more telling to have a study that instructed all
participants to respond emotionally in the same way or at the same level of the emotional
response. That is, this type of study may have greater theoretical validity if participants
were either instructed to suppress their emotional experience or to accept their emotional
experience. Telling participants to suppress the experience of their emotions could yield
very different results compared to acceptance than instructing them to suppress the
expression of their emotions.
Second, baseline anxiety scores in the group instructed to accept their emotions
were already significantly higher than for those instructed to suppress their emotions,
making it difficult to determine whether or not the lack of difference in anxiety scores after
experimental manipulation between suppression and acceptance groups might be
accounted for by a large increase in anxiety scores for the suppression group. Furthermore,
this study did not include a control group. A group of participants given no instructions for
6


emotion regulation (control) would be more informative, in that each strategy could be
compared with a normative condition.
Limitations of Prior Research and the Present Study
More research is clearly needed to investigate the causal nature of suppression as
it relates to anxiety. That is, not enough is understood about direction of this relationship;
suppression could cause symptoms of anxiety, but it could also be possible that those who
are anxious tend to suppress their negative emotional experiences.
The current study will focus on the effects of experiential suppression compared to
the effects of accepting negative emotional experiences or to a control. The purpose of this
study is to determine if experiential suppression in response to aversive emotion-inducing
stimuli causes state anxiety. As mentioned above, many studies have found a relationship
between suppression and anxiety or anxiety-related states (e.g., anxiety disorders, panic,
negative affect, depression, sympathetic activation; Campbell-Sills et al., 2006; Egloff et al.,
2006; Feldner et al., 2006; Gross, 2002; Gross, 1998; Gross & John, 2003; Gross &
Levenson, 1997; Hayes et al., 2004; Levitt et al., 2004). However, few studies have been
conducted that examine the causal role of experiential suppression (as distinguished from
suppression of behavioral suppression) in the development of state anxiety in a nonclinical
sample. Those few that have attempted to examine the effects of suppression have not
done so with a nonclinical population and a control group in the same study, while also
comparing experiential suppression and acceptance.
Participants in this study were instructed to either suppress their emotional
experience, accept their emotional experience, or to simply pay attention to the stimuli they
were going to be exposed to (control). After seeing an emotion-neutral film clip, participants
were then shown a film clip designed to induce sadness. This was followed be a brief
recovery period intended to help participants recover from high emotional reactivity.
7


Existing research indicates that across different emotions (e g. sadness, disgust,
embarrassment), suppression yields surprisingly similar experiential, behavioral, and
physiological consequences (Gross, 2002). Sadness induction, in addition to having not
often been used in previous studies on suppression, could be a very practical way to
examine the effects of suppressing negative emotional experience because sadness is a
general yet very common human emotion that is viewed as negative. Furthermore, using
sadness induction will help examine the idea that experiential suppression as a process
causes anxiety no matter what negative emotion is induced, as opposed to testing the idea
that it causes higher levels of the same emotion that is induced.
After the sad film clip I showed participants another neutral film clip and then
induced anxiety using an impromptu speech task. Inducing anxiety with this type of speech
has been shown to be effective in previous studies (Hofmann et al, in press; Egloff et al,
2006). The speech task was also followed by a brief recovery period. To determine if
experiential suppression causes participants to feel more anxious compared to accepting
negative emotions or to controls, participants were asked to rate the level of anxiety they
experienced after the sad film clip and after the recovery period that followed, as well as
after the speech and recovery period that followed.
Hypotheses
Hypothesis 1. Based on previous research and theory, I hypothesize that
individuals instructed to suppress their emotional experience when viewing a sad film clip
will report feeling more anxiety over time (from after the film clip to after a subsequent
recovery period) after the clip compared to those instructed to accept their emotions or
those given emotion-neutral instructions (control). I make no predictions about the
differences between acceptance and control groups after the recovery period.
8


Hypothesis 2. I also hypothesize that those instructed to suppress their emotional
experience during an impromptu speech task will report feeling more anxiety over time
(from after the speech to after a subsequent recovery period) after the speech compared to
those instructed to accept their emotions or those given emotion-neutral instructions.
Although Hofmann and colleagues (in press) found that groups instructed to behaviorally
suppress their emotions did not report feeling higher levels of anxiety over time (from
neutral baseline to after an impromptu speech to after a recovery period) in response to an
impromptu speech than those instructed to accept their emotions, the participants in the
current study were instructed to suppress their emotional experience, and I believe that will
result in significantly higher levels of anxiety over time for that group. I make no predictions
about the differences between acceptance and control groups after the second recovery
period.
9


2. METHODS
Participants
This study is part of a larger study taking place at the University of Denver.
Participants were recruited from the undergraduate student population at the University of
Denver and from the community in and around the city of Denver. Due to conditions set by
the larger study for which this study is apart, only female participants were recruited for the
study. The sample for this study consisted of 58 females, aged 18-25.
The majority of participants identified as being of European descent (55.9%). Other
participants identified themselves as Latino (11.9%), African-American (6.8%), East Asian
(6.8%), Pacific Islander (3.4%), and Other (8.5%). The mean age of the sample was 21.1
years (range=18-25; SD=2.34)
Measures
Emotional experience. To assess emotional experience, participants were asked to
rate their level of thirteen state emotions on a 1-9 Likert scale (1=low, 9=high). State
emotion ratings were taken at ten different time points throughout the study. Current level
of anxiety was assessed with the first question, which reads, Please rate the amount of
anxiety you feel now. This is the primary dependent variable. Also assessed in this
measure are the emotions experienced during the procedure; however, these will not be
included in the main analyses. Participant ratings of sadness and anxiety experienced
during the sad film clip and the speech (respectively) were used to check on whether or not
the inductions actually induced the intended emotions. These items read, Please rate the
maximum amount of sadness you felt while watching the film clip and Please rate the
maximum amount of anxiety you felt while giving the speech. Similar measures of state
10


emotion have been used in a number of recent studies on emotion and emotion regulation
(Mauss et al., 2007; Mauss, Wilhelm, & Gross, 2004).
Emotional process. Participants were also asked eleven questions assessing the
extent to which they regulated, monitored, or tried to control their emotions in certain ways
during the film clips or speech. These items are also rated on a 1-9 Likert Scale (1= not at
all, 9= extremely). Gross and John (2003) successfully used these types of questions to
measure the extent to which participants regulated their emotions during an emotion
induction film clip. Two target questions from this measure are, I tried to alter my
emotional reactions to the film clip (or speech)", and I made an effort to feel less negative
during the film clip (or speech). These questions correlated highly with each other in
response to the inductions of the study (first baseline induction: a=.84; sadness induction:
a=.84; anxiety induction; a=. 78), so a composite was made from their responses (emotion
regulation composite) to assess the degree to which participants attempted to regulate
their emotional experience during the inductions. This measure was used as a
manipulation check to see if participants followed their given emotion regulation
instructions (suppression, acceptance, or control).
Procedures
After arriving at their individual laboratory session, participants were told that they
were taking part in a study on television programming (of which they are informed
otherwise when debriefed at the end of the study) in order to limit the effects of social
desirability bias on their responding. Figure 1 shows a visual representation of the
procedures of the study. At the beginning of the laboratory session, all participants viewed
the same emotion-neutral film clip (designed to bring them to a relatively neutral emotional
state) and then were asked to rate their levels of various state emotions (including current
anxiety) as well as the degree to which they regulated their emotions during the film clip.
11


Participants were then randomly selected for one of three groups: suppression, acceptance,
or control.
Participants were then instructed on how to regulate their emotional experience in
response to the film clips and tasks of the study depending on the experimental group they
are selected for. One group was instructed to suppress their emotional experience when
watching the film clips and completing tasks (N=20), one was instructed to fully accept and
allow themselves to experience their emotions (N=20), and one was told simply to pay
attention to the film clips and tasks in order to be to be able to make accurate judgments
about them later (a script designed to be emotionally neutral; control group; N=18).
Specific instructions for each group were then read aloud while also presented visually to
ensure that participants paid attention to them. They read as follows:
Suppression group
Television companies are interested in researching ways that viewers
respond emotionally to their programming. Many research findings show
that individuals who suppress, or try not to feel the emotions they
experience, are more able to pay attention to the content of television
programs. Actively pushing feelings away can also help you to more easily
accomplish tasks you perform. Additionally, pushing away the feelings you
are experiencing will enable you to not have to put up with unnecessary
emotional discomfort or distress. Research shows that it is possible for
people to weaken their emotions if they really concentrate on trying not to
feel them.
During the following film clips and tasks of the study, do everything
possible to not experience any emotions that may arise. Whatever you
may feel during the film clips and tasks, try to keep those feelings down so
that you dont have to feel them.
Acceptance group
Television companies are interested in researching ways that viewers
respond emotionally to their programming. Many research findings show
that struggling against relatively natural emotions can actually intensify
and prolong an individuals distress. It has also been found that people
who tend to accept their emotions tend to make good judgments, have
healthy relationships, and have a positive well-being. Being willing to
experience feelings, good.and bad, can free people up to focus on what
12


really matters in their lives. If you are willing to feel any emotions that
come up for you, you can choose the activities that you want to participate
in, so that you ultimately choose your directions in life.
Whatever you may feel during the film clips and tasks of today's study, try
to actively notice your emotions, observe them and simply let them happen.
Just let them be. Allow yourself to accept your emotions without trying to
get rid of them.
Control Group
As is well-known, people who make accurate judgments experience
benefits in their social relationships, professional success, and overall
health and well-being. Therefore, being able to
make accurate judgments about television programming may be indicative
of important benefits:
those who make the most accurate judgments tend to be successful,
healthy, and popular. Conversely, people who make inaccurate judgments
tend to be less successful, healthy, and popular. In fact, recent research
shows that people who make accurate judgments in all kinds of
circumstances, can experience long-term beneficial outcomes. In other
words, people who can make accurate judgments about film clips such as
the ones you are about to see are people who are generally more
successful in their lives. Our goal, therefore, is to examine people's
judgments of film clips.
With the above in mind, watch the following film clips as carefully as
possible. Try to, as much as you can, watch all the details of the clips.
Each participant then viewed a sadness-inducing film clip. This clip is a 3.5 minute
excerpt from the movie Return to Me, in which the main characters wife dies in a car
accident. They then were given questions about current anxiety and sadness experienced
during the film clip. This was followed by a resting period for which they were instructed to
take a few minutes to just sit and look straight ahead. This sitting time was intended to
give participants an opportunity to recover from the emotional reactivity induced by the clip.
After that resting period they rated their current anxiety and levels of emotion regulation
during the film clip.
13


Participants were then shown another emotion-neutral film clip intended to help them
return to a neutral emotional state. Following this, participants rated their current level of
anxiety and were then given reminder instructions on how to regulate their emotions.
Reminder instructions were composed of a small paragraph summarizing the main
instructions for emotion regulation that are given after the first neutral film clip. This
paragraph was read aloud as well as presented visually to ensure that participants paid
attention to the directions. Participants were then instructed to prepare to give an
impromptu speech for two minutes and then give the speech in front of a camera for three
minutes. All were told that their speech will later be reviewed by judges (during debriefing
participants are told that the film will not actually be reviewed later by judges). This was
designed to mimic a public speaking task and so induce anxiety (see Hofmann et al., in
press; Egloff et al, 2006). Participant ratings of current anxiety and anxiety during the
speech were then taken, followed by a two-minute resting period. After the resting period
participants rated their current anxiety and levels of emotion regulation during the speech.
Analytical approach. The independent variable is the type of emotion regulation
strategy that each group was instructed to employ while viewing the sad film clip and while
preparing for and giving the speech. The dependent variables are the level of state anxiety
taken immediately after each neutral film clip, after the sadness induction, after the anxiety
induction, and after each subsequent two-minute resting period.
14


Procedures
First Induction
- Sadness
- Return to Me clip
Control condition | Neutral | SadClp | 0

0 Suppression manipulation | Neutral | Sad Clip | 0

0 Acceptance manipulation | Neutral | SadClp | 0

Emo. & Emo. | Emo.
Reg. & Instructions & Reg.
Second Induction
- Anxiety
- Impromptu speech
0 Control condition | NeutrC , Speech 10

0 Suppression manipulation | Neutrl2 Speech 1 0

0 Acceptance manipulation | Neutrt2 Speech 1 0
f
Emo. & Re- Emo. | Emo.
Instruction &
Reg.
Neutral = first neutral film clip
Neuth2 = second neutral film clip
Sad Clip
= sad film clip from Return to Me" (sadness induction)
Speech
= impromptu speech (anxiety induction)
0
= 2-minute resting period (just sit and look straight ahead*)
Emo. state emotion rating; current anxiety, sadness during sad film clip, anxiety duhng speech
Reg
= Emotion Regulation Composite; 2 questions about self-reported emotion regulation during inductions
Figure 2.1. STUDY PROCEDURES. Includes a key for abbreviations.
15


3. RESULTS
Outlier and Randomization Checks
Participants were randomly assigned to one of three groups (Suppression, Control,
Acceptance). Exploratory analyses revealed that one participant in the suppression group
reported feeling highly anxious during the baseline film clip (R=7, M=2A, SD= 1.6). This
score was more than 2 standard deviations above the mean. Therefore, that participant's
scores were excluded from all analyses, which left 57 participants.
Two analyses of variance (ANOVA), with experimental group (Suppression,
Control, Acceptance) as the group factor and self-reported anxiety after the two baseline
film clips as the dependent variables, revealed that the three groups were comparable in
level of state anxiety at baseline before the sadness induction, F(2, 55)=.91, p=.408, partial
r}*=.033, and at baseline before the anxiety induction, F(2, 55)=.07, p=.931, partial /j^=.003.
To ascertain that participants did not differ in terms of emotion regulation during
the first neutral film clip, an ANOVA with experimental group as the group factor and
emotion regulation attempts measured by the emotion regulation composite as the
dependent variable, revealed that groups did not regulate emotions differently during the
first neutral film clip, F(2, 56)=.44, p=.645, partial /7^=.016.
Manipulation Checks
Effectiveness of the emotion inductions. One pairwise t-test comparing participant
mean sadness during baseline and during the sad film clip revealed that the sad film clip
effectively induced sadness. The mean level of self-reported sadness for all participants
during sadness induction (M= 5.96, SD=2.17) was significantly higher than at baseline
(/I/M.77, SD=1.06; p<001), showing that the sad film clip effectively induced sadness. For
16


the anxiety induction, a pairwise t-test comparing participants mean anxiety at pre-speech
baseline and during the speech task revealed that mean anxiety for all participants was
significantly higher during the speech task (M=6.42, SD=2.3) than at pre-speech baseline
(M= 1.65; SD=1.0; p<001), indicating that the speech task effectively induced anxiety.
Effectiveness of emotion regulation instructions. Responses to items in the
emotion regulation composite were analyzed to check for between-group differences in
emotion regulation during each induction. For emotion regulation in response to the
sadness induction, exploratory analyses revealed that one participant in the acceptance
group did not follow directions for regulating their emotions during the sad film clip, scoring
higher than 2 standard deviations from the mean on the emotion regulation composite
(R=6, M=2.2, SD=1.3). This participant was excluded from analyses for the sadness
induction condition.1
Results showed that instructions for emotion regulation were effective. An ANOVA
comparing between-group emotion regulation composite scores in response to the sad film
clip revealed that there were significant between group differences in emotion regulation
during the clip, F(2, 55)= 47.37, p<001, partial r^=641 Pairwise post hoc group
comparisons (Least Square Difference) showed that the suppression group had
significantly higher scores than the acceptance group on this measure (mean difference:
4.24, SE=.34, p< 001), and had significantly higher scores than the control group, (mean
difference: 3.9, SE=.34, p<001). These results indicate that the suppression group made
greater attempts to regulate their emotions than other groups. There was no significant
difference in composite scores between acceptance and control groups in response to the
sad film clip (mean difference: -.33, SE=.35, p=.498).
1 It should be noted that main analyses held to current levels of significance when this participant
was included.
17


A one-way ANOVA comparing between-group emotion regulation composite
scores in response to the speech revealed that there were significant between-group
differences in emotion regulation during the speech, F(2, 56)= 7.62, p=.001, partial q2^.22.
Pairwise post hoc group comparisons (Least Square Difference) showed that the
suppression group had significantly higher scores than the acceptance group on this
measure (mean difference: 2.33, SE=.61, p<.001), and had significantly higher scores than
the control group (mean difference: 1.6, SE=.63, p=.013). This indicates that the
suppression group again made greater attempts to regulate their emotions than other
groups. There was no significant difference in composite scores between acceptance and
control groups in response to the speech (mean difference: -.73, SE=.62, p=.242).
Hypothesis Testing: Effect of Emotion Regulation Instruction on Anxiety after Sadness
Induction
Hypothesis 1. Figure 2 depicts anxiety after the sadness induction and after the
resting period. To examine differences in the effects of emotion regulation instruction (by
group: suppression v. acceptance v. control) on anxiety scores after sadness induction, I
conducted a repeated-measures analysis of covariance (ANCOVA) with experimental
group (suppression, acceptance, control) as the between-participants factor, time (after the
induction, after recovery period) as the within-participants factor, state anxiety at baseline
as a covariate, and state anxiety ratings after the induction and after the recovery period as
the dependent variables. Results did not show a significant group effect on state anxiety,
F(2, 55)=.32, p=.725, partial rj^=.012, but did show a trending effect of time, F(2, 55)=3.76,
p=.058, partial p^=.067, for which anxiety scores after the speech were greater than those
after recovery The time by group interaction effect was not significant, F(2, 55)=.56,
p=.577, partial p2=.021.
18


Anxiety
4.5
4
3.5
3
2.5
2
1.5
Sad Clip Recovery
Time
Figure 3.1. STATE ANXIETY SCORES AFTER THE SAD FILM CLIP AND AFTER
SUBSEQUENT RECOVERY PERIOD
------- Control
- -a- Suppression


Hypothesis Testing: Effect of Emotion Regulation Instruction on Anxiety after Anxiety
Induction
Hypothesis 2. Figure 3 depicts mean anxiety scores after the speech and after the
resting period. To examine differences in the effects of emotion regulation instruction (by
group: suppression v. acceptance v. control) on anxiety scores after anxiety induction, I
conducted a repeated-measures ANCOVA with experimental group (suppression,
acceptance, control) as the between- participants factor, time (after the induction, after
recovery period) as the within-participants factor, state anxiety at pre-speech baseline as a
covariate, and state anxiety ratings after the induction and after the recovery period as the
dependent variable. Results did not show a significant group effect on state anxiety, F(2,
56)=.08, p=.923, partial p*=.003, but did show a significant time effect, F(2, 56)=24.43,
p<.001, partial rj^.316, for which anxiety scores after the speech were greater than those
after recovery. The time by group interaction effect was not significant, F(2.56)=.93, p=.4,
partial /7*= 034.
20


6.5
6
5.5
5
t
| 4.5
<
4
3.5
3
2.5
Figure 3.2. STATE ANXIETY SCORES AFTER THE SPEECH AND AFTER
SUBSEQUENT RECOVERY PERIOD.
Speech Recovery
Time
21


4. DISCUSSION
Previous research has found correlations between emotion suppression and
anxiety. Along with the increasing popularity of acceptance and mindfulness-based
therapies, these findings have warranted increased examination of the negative effects of
experiential suppression as it compares to emotional acceptance. The few causal studies
previously conducted focus mostly on suppressions effect on negative emotions or affect
generally or within clinical populations that may already experience high levels of anxiety.
Therefore, a causal study with nonclinical participants was necessary to explore the nature
of the correlational relationship between experiential suppression and anxiety specifically.
The goal of this study was to determine if suppressing negative emotional experience
during a sadness induction and an anxiety induction caused individuals to be more anxious
than those accepting negative emotions or than controls.
Similar to previous studies, this study used experimental manipulation to test the
effects of suppression (Campbell-Sills et al., 2006b; Hofmann et al., in press; Feldner et al.,
2006; Levitt et al., 2004; Liverant et al, 2008). In order to see if experiential suppression
caused anxiety compared to accepting negative emotions or compared to a control, I
instructed participants to suppress or accept their emotions during the study, or to simply
pay attention. They were then shown a sad film clip and an impromptu speech task and
asked to rate the level of anxiety they experienced.
Analyses revealed that the inductions themselves worked in inducing both sadness
and anxiety for all participants, and that individuals in the suppression group made efforts
to suppress their emotions more than those in the acceptance or control groups. However,
results did not support the hypotheses that those instructed to suppress their emotions
22


during a sad film clip would report feeling more anxiety after the clip or after a two minute
recovery period compared to those instructed to accept their emotions or to controls.
Results did support the hypothesis that participants instructed to suppress their
emotions would not feel more anxiety after an impromptu speech task than those
instructed to accept their emotions or to controls. However, results were not statistically
significant and so did not support the hypothesis that those given suppression instructions
would report feeling higher levels of anxiety than other groups after recovery.
Conclusions
Together, these results do not support the idea that experiential suppression
causes anxiety. It is not evident from this study that suppression as a cause of anxiety
describes the nature of the correlation between suppression and anxiety that has
frequently been found in previous studies. It may indeed be possible that this relationship is
characterized by a converse effect. That is, anxiety may cause people to suppress their
emotional experience because negative evaluations or attributions of events or emotional
experiences, along with the emotional discomfort that often occur with anxiety, may cause
them engage in the suppression process in order to discontinue contact with those
emotions or experiences (e.g., thoughts, memories of an event). Suppression and anxiety
may also tend to exist in conjunction with each other because of a third-party mediating
factor. For instance, those with low levels of self-efficacy who are suppressing may see
their suppression attempts as a weakness that causes them to be unable to effectively
cope with aversive stimuli. They may then become anxious about their coping abilities
when faced with such stimuli.
It is also possible that the relationship between suppression and anxiety is
characterized by misuse of the timing and degree of initiation of the suppression process in
various situations or in multiple situations collectively. It has previously been posited that
23


what specific emotion regulation strategy used is not as important for resultant affect or
adaptive functioning as is the ability to use those strategies flexibly (Bonnanno, et al.,
2004). Unfortunately, flexibility of emotion regulation strategies was not examined in this
study, and so results could not support or refute that hypothesis. Future studies might do
well to manipulate flexibility of emotion regulation as opposed to instructing constant use
suppression or acceptance.
Limitations of the Present Approach
There are a few possible explanations for why experiential suppression
instructions compared to acceptance or control instructions did not yield significant effects
on anxiety scores. First, participants were only given negative emotion inductions lasting
three to four minutes. It is possible that the short duration of these inductions did not allow
for the suppression process to be initiated for long enough to yield an effect of anxiety. In
the world outside the laboratory, negative emotions usually can last anywhere from a few
hours to a few months. If experiencing a recent breakup of a romantic relationship, an
individual may experience sadness for weeks or months on end, and so suppress that
sadness with a high degree of constancy that may cause anxiety to develop. The same
may apply if the individual experiences anxiety lasting multiple days in anticipation of giving
a speech or presentation and during the speech or presentation itself, which may last up to
one hour. This and related previous studies have relied solely on inductions lasting only a
number of minutes. Future studies may be more externally valid if they use longer
inductions or combine multiple inductions to make a longer laboratory session (e.g., a few
hours long) in which suppression and acceptance could be initiated by participants for a
much longer period.
Second, this study also did not simulate experiential suppression of sadness in
social contexts, a key part of human experience. Social contexts may play a role in
24


moderating the degree to which individuals suppress their emotions. Being alone in a lab
room may be a far more acceptable area to experience certain emotions than around other
people, and so suppression instructions may not have as great of an effect on participants
actual levels of suppression. The privacy of the lab environment may not have motivated
participants to suppress their sadness to as high enough a degree as what occurs in the
real world. In a social situation, one might believe that feeling sad is very inappropriate, so
they may make highly concerted attempts to suppress that emotional experience. Even the
speech task may have been more valid for testing the effects of suppression if participants
were actually surrounded by people, as opposed to speaking for people that are not
present but will later view a recording of their speech. Future studies may utilize social
conditions in addition to suppression and acceptance instructions to test whether or not
social contexts moderate the effects of experiential suppression.
It is also possible that the instructions for emotion regulation were not fair
approximations of regulation strategies used by individuals in the real world (Hofmann et
al., in press). Although instructions followed the model of those from previous studies using
similar manipulations (Campbell-Sills et al., 2006b; Feldner et al., 2006; Levitt et al., 2004)
and participants in the suppression group reported that they successfully regulated their
emotions, it is still difficult to know if those instructions fully reflect characteristics of real life
suppression or acceptance. Furthermore, instructions given to participants in the
suppression and acceptance groups are quite brief (lasting about 1 minute) compared to
those given in previous studies. Instructions also and did not include metaphors or imagery.
Longer instructions with examples from everyday life may seem more relevant and be
more easily understood by participants, helping them initiate a more realistic suppression
based on knowledge of past experiences and past suppression attempts.
25


On a similar note, this study may not have asked the right questions or enough of
them to accurately assess participant anxiety levels. Participants were only asked to rate
the level of anxiety [they] feel now. It is possible that more questions aimed at assessing
participant anxiety, like current nervousness or worry, may have found between-groups
effects on anxiety scores if they exist. As in the study by Hofmann and colleagues (in
press), using a more extensive anxiety composite like the State-Trait Anxiety Inventory
(STAI; Spielberger et al., 1970) may be more effective for determining whether or not
participants are experiencing anxiety after suppressing their emotions.
Strengths of the Present Approach
Despite these limitations, this study had a number of strengths. First, instructions
were carefully thought out and followed the model of those used in previous studies
(Campbell-Sills et al., 2006b; Feldner et al., 2006 Levitt et al., 2004,). Furthermore,
suppression and acceptance instructions both targeted emotion regulation at the same
level of the emotional response. That is, they compared suppression and acceptance of
negative emotional experience, whereas some previous studies have compared
suppression of emotional expression with acceptance of emotional experience (Gross,
1998; Gross & John, 2003; Hofmann et al., in press). Instructing participants to suppress
their facial expressions may not necessarily change the impact of their emotional
experience, especially if a given portion of participants are highly skilled at hiding emotions.
Comparing emotion regulation of two different types of emotional responses (i.e. those of
expression versus experience) might make it difficult to see the true effects of suppression
when compared to acceptance.
Second, the design of the study made it possible to compare the effects of
suppression and acceptance to a control group. Even though the majority of primary
analyses did not yield significant results, using a control group provided the opportunity to
26


gain more information about these strategies than simply looking at suppression and
acceptance alone. A control group may also have been a valid representation of emotion
regulation strategies among a normative population. Given no instructions on regulating,
frequency of emotion regulation strategies used within the control group may have
reflected that of the population outside the laboratory.
Lastly, the use of two emotion inductions (sadness and anxiety), as opposed to
one, allowed for more comparisons to be made and opened the possibility for greater
generalizability of the effects of experiential suppression. Additionally, the use of recovery
periods allowed for the examination of possible rebound effects above and beyond the
effects of suppression or acceptance immediately after the inductions. This may also have
acted as a simulation of real life recovery from emotional reactivity experienced in
response to an adverse event.
Implications and Future Directions
The present findings lend to the knowledge of the effects of experiential
suppression. Mainly, that it may not cause anxiety. Experiential suppression and anxiety
may in fact interact in other ways that are not yet known. Future studies are needed to
further investigate the nature of this relationship. These studies should focus on
suppression versus acceptance over longer periods of time, while accounting for individual
differences in flexibility of emotion regulation strategies. Subsequent studies may also do
well to test the converse of this studys hypotheses; mainly, does anxiety cause individuals
to suppress their emotions and if so, what effects does that anxiety based suppression
have on other domains of functioning for clinical and nonclinical participants? In addition to
gaining a deeper understanding of how anxiety might manifest itself in individuals, future
studies could contribute to improved knowledge of how, and at what level of the emotional
27


response, we should target interventions aimed at alleviating anxiety and the negative
effects of experiential suppression.
28


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