11

22

The Adaptive Potential of Coping through Emotional ApproachAnnette L. Stanton, Ph.D., UCLAAnnette L. Stanton, Ph.D., UCLA

Sponsored by U.S. Army Medical Sponsored by U.S. Army Medical Research and Materiel CommandResearch and Materiel Command

National Cancer InstituteNational Cancer Institute

California Breast Cancer Research California Breast Cancer Research ProgramProgram

33

CollaboratorsCollaborators

Carissa LowCarissa Low Qian LuQian Lu Patricia GanzPatricia Ganz David CreswellDavid Creswell Sharon Danoff-BurgSharon Danoff-Burg Sarah KirkSarah Kirk Christine CameronChristine Cameron Andrew EllisAndrew Ellis Charlotte CollinsCharlotte Collins Jennifer AustenfeldJennifer Austenfeld Melissa HugginsMelissa Huggins

James BerghuisJames Berghuis Lisa SworowskiLisa Sworowski Michelle BishopMichelle Bishop Robert TwillmanRobert Twillman Ann BranstetterAnn Branstetter Alicia Rodriguez-Alicia Rodriguez-

HanleyHanley David AmodioDavid Amodio Sarah MasterSarah Master Shelley TaylorShelley Taylor

44

PlanPlan

Emotional processing and Emotional processing and expression in the context of stress expression in the context of stress and coping researchand coping research

Coping through emotional Coping through emotional approach: development of the approach: development of the constructconstruct

Adaptive value of coping through Adaptive value of coping through emotional approachemotional approach

Mechanisms for effectsMechanisms for effects

55

Coping ProcessesCoping Processes

Cognitive, emotional, and Cognitive, emotional, and behavioral efforts to manage behavioral efforts to manage demands that tax or exceed demands that tax or exceed individual’s resourcesindividual’s resources

Traditional distinction = problem-Traditional distinction = problem-focused and emotion-focusedfocused and emotion-focused

Oriented toward approaching or Oriented toward approaching or avoiding the stressoravoiding the stressor

66

The Bad Reputation of The Bad Reputation of Emotion-Focused Emotion-Focused CopingCoping ““Emotion-focused coping has Emotion-focused coping has

consistently proven to be consistently proven to be associated with negative associated with negative adaptation” (Kohn, 1996, p. 186)adaptation” (Kohn, 1996, p. 186)

Relation of emotion-focused Relation of emotion-focused coping and poor adjustment in 26 coping and poor adjustment in 26 of 27 studies reviewed (Stanton, of 27 studies reviewed (Stanton, Parsa, & Austenfeld, 2002)Parsa, & Austenfeld, 2002)

77

Problems in Conceptualization Problems in Conceptualization and Operationalization of and Operationalization of Emotion-Focused CopingEmotion-Focused Coping Aggregation of distinct strategies into Aggregation of distinct strategies into

umbrella construct umbrella construct – Tell myself that it is really not happening to me. Tell myself that it is really not happening to me. – Get angry. Get angry.

Self-report assessment contaminated with Self-report assessment contaminated with distress and self-deprecationdistress and self-deprecation– I get upset and let my emotions outI get upset and let my emotions out– I become very tenseI become very tense– I focus on my general inadequaciesI focus on my general inadequacies

No existing unconfounded measuresNo existing unconfounded measures

88

Are Published Emotion-Focused Are Published Emotion-Focused Coping Scales Confounded with Coping Scales Confounded with Distress? (Stanton et al., 1994, Distress? (Stanton et al., 1994, JPSP)JPSP) Clinical psychologists (Clinical psychologists (nn = 194) judged = 194) judged

majority of published emotion-focused majority of published emotion-focused coping items as reflecting symptoms of coping items as reflecting symptoms of psychological disorderpsychological disorder

Longitudinal study of young adults (Longitudinal study of young adults (nn = = 171) coping with self-nominated 171) coping with self-nominated stressorstressor– Published emotion-focused scales weak Published emotion-focused scales weak

predictors of adjustment when Time 1 DV predictors of adjustment when Time 1 DV controlledcontrolled

– Unconfounded items predicted adjustment Unconfounded items predicted adjustment

99

Coping through Coping through Emotional ApproachEmotional Approach Efforts to manage perceived demands via:Efforts to manage perceived demands via: Emotional processing = active attempts to Emotional processing = active attempts to

acknowledge, explore meanings of, and acknowledge, explore meanings of, and come to an understanding of one’s emotionscome to an understanding of one’s emotions– I delve into my feelings to get a thorough I delve into my feelings to get a thorough

understanding of themunderstanding of them Emotional expression = observable verbal Emotional expression = observable verbal

and nonverbal behaviors that communicate and nonverbal behaviors that communicate or symbolize emotional experienceor symbolize emotional experience– I take time to express my emotionsI take time to express my emotions

1010

Development of Instruments to Development of Instruments to Assess Coping through Emotional Assess Coping through Emotional Approach (Stanton et al., 2000, Approach (Stanton et al., 2000, JPSPJPSP))

Confirmatory factor analysisConfirmatory factor analysis Uncorrelated with social Uncorrelated with social

desirabilitydesirability Related to parents’ assessment of Related to parents’ assessment of

copingcoping Related to behavioral indicators of Related to behavioral indicators of

sadness in sadness inductionsadness in sadness induction Not just social supportNot just social support

Emotional Expression and Frontal EEG Asymmetry

r = .51

-2

-1.5

-1

-0.5

0

0.5

1

1.5

2

1 1.5 2 2.5 3 3.5 4

Emotional Expression

Fron

tal E

EG A

sym

met

ry

(con

trol

ling

for

asym

met

ry

at o

ther

sca

lp r

egio

ns)

1212

The Adaptive Utility of The Adaptive Utility of Coping through Emotional Coping through Emotional ApproachApproach Longitudinal research with young Longitudinal research with young

adults, infertile couples, breast adults, infertile couples, breast cancer patientscancer patients

Experimental research on Experimental research on expressive disclosureexpressive disclosure

Reveals context-dependent Reveals context-dependent effects effects

1313

Gender x Emotional Approach Gender x Emotional Approach Interaction on Adjustment (Stanton Interaction on Adjustment (Stanton et al., 1994, et al., 1994, JPSPJPSP))

Men Women Depression .15* -.17* Life Satisfaction -.19* .18*

n = 171 undergraduates coping with current most stressful situation across one month 1) Relations hold controlling for social support. 2) Sex x EAC interaction for depressive sx specific to interpersonal (not achievement) and low-control (not high-control) situations.

1414

The Question of The Question of GenderGender Women use more emotional Women use more emotional

approach coping, but < 7% approach coping, but < 7% variance accounted for by gendervariance accounted for by gender

Greater adaptiveness of Greater adaptiveness of emotional approach for young emotional approach for young womenwomen

BUT gender effects not consistent BUT gender effects not consistent across studiesacross studies

1515

Predictive Utility for a Predictive Utility for a Dyadic StressorDyadic Stressor Berghuis & Stanton (2002, JCCP) Berghuis & Stanton (2002, JCCP) 43 infertile couples across an 43 infertile couples across an

alternate insemination attemptalternate insemination attempt

1616

Time 2 Depressive Symptoms Time 2 Depressive Symptoms Regressed on Emotionally Regressed on Emotionally Expressive CopingExpressive Coping

R2 Change

Men

T1 Initial Value .29 .08

Own Expressive Coping -.41 .16*

Women

T1 Initial Value .62 .39*

Own Expressive Coping -.45 .20*

Partner Expressive Coping -.22 .03

Self x Partner Interaction 1.94 .10*

1818

Emotional Approach in Emotional Approach in Breast Cancer Patients Breast Cancer Patients (Stanton et al., 2000; (Stanton et al., 2000; Stanton et al., 2002)Stanton et al., 2002) Control for Initial Values on Dependent Control for Initial Values on Dependent

VariablesVariables > 80% Participation > 80% Participation Stage I and II Breast CancerStage I and II Breast Cancer AgeAge 50s (Range 21 – 76)50s (Range 21 – 76) EducationEducation > high school> high school WhiteWhite > 87%> 87% EmployedEmployed > 65%> 65% MarriedMarried 78%78%

1919

Dependent VariablesDependent Variables

Profile of Mood States (POMS)Profile of Mood States (POMS) Self-reported physical Self-reported physical

health/symptomshealth/symptoms Medical care utilizationMedical care utilization

– Cancer-related morbiditiesCancer-related morbidities 88% - 92% concordance with medical 88% - 92% concordance with medical

recordsrecords

2020

Longitudinal Design - Longitudinal Design - Stanton et al. (2000)Stanton et al. (2000) 92 Breast Cancer Patients after 92 Breast Cancer Patients after

Treatment Completion (Treatment Completion (MM = 6 = 6 months post-diagnosis)months post-diagnosis)

Assessment at Treatment Assessment at Treatment Completion and Three MonthsCompletion and Three Months

2121

HypothesesHypotheses

Coping through actively processing and Coping through actively processing and expressing emotion will predict expressing emotion will predict enhanced physical and psychological enhanced physical and psychological adjustment over timeadjustment over time

Dispositional hope (Snyder et al., 1991) Dispositional hope (Snyder et al., 1991) will moderate the relations of emotional will moderate the relations of emotional approach coping with adaptive approach coping with adaptive outcomesoutcomes– I meet the goals I set for myself.I meet the goals I set for myself.– I can think of many ways to get the things in I can think of many ways to get the things in

life that are most important to me.life that are most important to me.

2222

Regressions and Partial Regressions and Partial Correlations for 3-Month Correlations for 3-Month OutcomesOutcomes

Poor Health

Medical Visits

POMS Distress

POMS Vigor

FACT QOL

T1 DV .62*** --- .50*** .53*** .78*** Age -.07 -.29* .05 .09 .11 Emo Proc .14 -.04 .31* -.13 -.22 Emo Exp -.24* -.25* -.27* .26* .16 Avoidance .15 .18 .25* -.32* -.14 Spiritual .15 .29* -.30* .17 .15 Accept -.07 .27* .04 -.16 .26* R2 .53*** .25** .57*** .56*** .78*** Note. Social support, Prb-focused, Pos. reappraisal not shown. *p < .05. **p < .01. ***p < .0001.

2323

Medical Visits for Medical Visits for Cancer-Related Cancer-Related MorbiditiesMorbidities

00.20.40.60.8

11.21.41.61.8

Low High

Emotional Expression

Medical Visits

2424

Expressive Coping x Hope Interaction on Expressive Coping x Hope Interaction on Medical Visits for Cancer-Related Medical Visits for Cancer-Related Morbidities at 3 MonthsMorbidities at 3 Months

0

0.5

1

1.5

2

2.5

3

3.5

4

Low Hope High Hope

Low ExpressiveCopingHigh ExpressiveCoping

2525

Emotional Disclosure Emotional Disclosure Interventions (Pennebaker)Interventions (Pennebaker)

Participants randomly assigned to write Participants randomly assigned to write about “deepest thoughts and feelings” about “deepest thoughts and feelings” for 20 minutes on 3-4 occasionsfor 20 minutes on 3-4 occasions

Demonstrates enhanced physical health Demonstrates enhanced physical health and psychological well-being relative to and psychological well-being relative to control conditions (Smyth, 1998; Frisina, control conditions (Smyth, 1998; Frisina, Borod, & Lepore, 2004)Borod, & Lepore, 2004)– Physical health benefits especially Physical health benefits especially robust in clinical populationsrobust in clinical populations

2626

Randomized, Controlled Trial of Randomized, Controlled Trial of Written Emotional Expression and Written Emotional Expression and Benefit Finding (Stanton et al., JCO, Benefit Finding (Stanton et al., JCO, 2002)2002) HypothesesHypotheses Experimentally induced emotional Experimentally induced emotional

disclosure and benefit finding will disclosure and benefit finding will produce enhanced physical and produce enhanced physical and psychological adjustment relative to a psychological adjustment relative to a fact-control conditionfact-control condition

Condition x cancer-related avoidance Condition x cancer-related avoidance interactioninteraction– I try not to think about it. I try not to think about it. – I turn to work or other activities to take my I turn to work or other activities to take my

mind off things.mind off things.

2727

Randomized, Controlled Trial of Randomized, Controlled Trial of Expressive Writing in Breast Cancer Expressive Writing in Breast Cancer PatientsPatients

60 breast cancer patients within 20 wks after 60 breast cancer patients within 20 wks after completion of primary medical tx (M = 28 completion of primary medical tx (M = 28 weeks post-diagnosis)weeks post-diagnosis)

Random Assignment to:Random Assignment to:– Deepest Thoughts and Feelings (EMO)Deepest Thoughts and Feelings (EMO)– Benefit Finding (BEN)Benefit Finding (BEN)– Fact Control (CTL)Fact Control (CTL)

Four, 20-minute writing sessions over 3 weeks Four, 20-minute writing sessions over 3 weeks conducted in home, labconducted in home, lab

Three-Month Follow-UpThree-Month Follow-Up DV – Distress, Somatic Symptoms, Medical DV – Distress, Somatic Symptoms, Medical

Appointments for Cancer-Related MorbiditiesAppointments for Cancer-Related Morbidities

“The past year has been a roller coaster ride….It’s hard to express these feelings of frustration, sadness, anger, bitterness, and disappointment. I worry about finances. I’m never feeling just right, with so many changes going on in my body… There is anger and real fear. I must return to the real world. I have to function, but I don’t know how. I need to move on, trust. I’m realizing I don’t have control, and am experiencing real anger now. Every twinge or pain brings fear. How fragile life is. Why does it take this, to see that? How do I move on?”

“I feel so grateful each morning to wake up in my bed and feel so good and alive and eager to face another day. The inherent goodness of my family and friends has been a really positive aspect. They are all so supportive and make me feel like such a loved and special person…I feel like I make more time for my friends and family. I also do more things for myself and don’t feel guilty about it. I feel like this makes me a calmer, happier woman. I talk to God on a much more personal level now…I’ve learned to let go of anger I had in the past. I feel more forgiving and a lot less judgmental of other people and their lives. When I think of the future, I realize that it may not be as long as I had thought, but having cancer makes me appreciate this moment in my life.”

 

3030

Somatic Symptoms at Somatic Symptoms at Three-Month Follow-upThree-Month Follow-up

0

5

10

15

20

25

30

35

EMO BEN CTL

Symptoms

FF(2, 50) = 4.70, (2, 50) = 4.70, pp = .014 = .014

3131

Medical Appointments at Medical Appointments at Three-Month Follow-upThree-Month Follow-up

0

0.5

1

1.5

2

2.5

3

EMO BEN CTL

Appts.

FF(2,51) = 6.04, (2,51) = 6.04, pp = .004 = .004

3232

Condition x Avoidance Interaction on Condition x Avoidance Interaction on POMS Distress at Three-Month Follow-upPOMS Distress at Three-Month Follow-up

0

5

10

15

20

25

30

35

40

45

Low Avoidance High Avoidance

ExpressiveDisclosureBenefit Finding

Fact Control

3333

Medical Student Expressive Medical Student Expressive Writing Trial (Austenfeld & Writing Trial (Austenfeld & Stanton, in press)Stanton, in press) 64 medical students in third-year 64 medical students in third-year

clinical clerkshipsclinical clerkships Random assignment to:Random assignment to:

– Deepest Thoughts and Feelings (EMO)Deepest Thoughts and Feelings (EMO)– Best Possible Self (BPS)Best Possible Self (BPS)– Fact Control (CTL)Fact Control (CTL)

Three, 25-minute writing sessions Three, 25-minute writing sessions conducted in labconducted in lab

Three-month follow-upThree-month follow-up

Emotional processing x condition Emotional processing x condition interaction on prediction of interaction on prediction of depressive symptoms at 3-month depressive symptoms at 3-month follow-upfollow-up

0

2

4

6

8

10

12

14

16

18

20

Pre

dic

ted

Po

std

epre

ssiv

e sy

mp

tom

s

Expressive Disclosure

Best Possible Self

Fact Control

Low Emotional Processing

High Emotional Processing

Emotional processing x condition Emotional processing x condition interaction on prediction of health care interaction on prediction of health care visits at 3-month follow-upvisits at 3-month follow-up

-0.4

-0.3

-0.2

-0.1

0.0

0.1

0.2

0.3

0.4

0.5

0.6

Pre

dict

ed M

edic

al V

isits

for

Illne

ss

Expressive Disclosure

Best Possible Self

Fact Control

Low Emotional Processing

High Emotional Processing

3636

Other Emotion Construct Other Emotion Construct ModeratorsModerators

Norman et al. (2004, Psychosomatic Norman et al. (2004, Psychosomatic Med)Med)– High ambivalence over emotional High ambivalence over emotional

expressionexpression less disability at 2 months in less disability at 2 months in chronic pelvic pain patients in EMO vs CTLchronic pelvic pain patients in EMO vs CTL

Alexithymia (Lumley)Alexithymia (Lumley)– High difficulty identifying feelings – no High difficulty identifying feelings – no

benefit of emotional disclosurebenefit of emotional disclosure– High difficulty describing feelings – benefit High difficulty describing feelings – benefit

of emotional disclosureof emotional disclosure

3737

Mechanisms for the Mechanisms for the Effects of Emotional Effects of Emotional ApproachApproach

3838

Mechanisms for the Mechanisms for the Utility of Approach-Utility of Approach-Oriented CopingOriented Coping Signaling FunctionSignaling Function Physiological Physiological

Habituation/RegulationHabituation/Regulation Goal Clarification and PursuitGoal Clarification and Pursuit Cognitive ReappraisalCognitive Reappraisal Regulation of Social EnvironmentRegulation of Social Environment

3939

Stanton et al. (2000) Study Stanton et al. (2000) Study 4 Experimental Disclosure4 Experimental Disclosure

Hypothesized adaptiveness of match between Hypothesized adaptiveness of match between naturally elected and experimentally imposed naturally elected and experimentally imposed emotionally expressive coping emotionally expressive coping

76 undergraduates whose parent had 76 undergraduates whose parent had psychological or physical disorderpsychological or physical disorder

Random assignment to discuss emotions or Random assignment to discuss emotions or facts regarding disorder over two sessionsfacts regarding disorder over two sessions

Dependent variables - PANAS-X negative Dependent variables - PANAS-X negative affect (fear, hostility, guilt, sadness), heart affect (fear, hostility, guilt, sadness), heart rate, skin conductancerate, skin conductance

4040

Study 4 FindingsStudy 4 Findings

High Expression Match

Remaining Cells Combined

HR – Baseline* 68.99 74.11

Interview 72.06 76.78

Recovery* 68.14 73.16

SCL-Baseline* 2.79 3.85

Interview 4.83 6.07

Recovery 3.93 5.26

PANAS-Fear* 1.54 1.61

Hostility* 1.12 1.38

Guilt 1.16 1.41

Sadness 1.40 1.67

HR mediated change in Fear

Breast Cancer Writing Study - Effects of Condition on Heart Rate (HR) Indicators in Multilevel Models (Low, Stanton, & Danoff-Burg, in press)

Potential Mediator EMO(n = 20)

POS(n = 19)

CTL(n = 16)

F (df)

P

Baseline HR 81.68a

2.46

81.46a

2.52

82.58a

2.74

0.05 (2, 52)

.95

HR Activation (writing HR controlling for baseline HR)

 87.43a

1.03

 84.76a

1.02

 85.89a

1.11

 1.70

(2, 48)

 .19

HR Habituation During Writing (Peak – End HR controlling for baseline HR)

 16.78a

1.52

 10.27b

1.54

 6.52b

1.67

 10.74(2, 50)

 

<.001

HR Recovery (post-writing HR controlling for baseline HR)

 77.35a

1.06

 79.90ab

1.08

 81.95b

1.17

 4.29

(2, 51)

 .019

4242

Breast Cancer Patient Breast Cancer Patient Writing Study – Heart Writing Study – Heart RateRate

75

80

85

90

95

100

peak end

Baseline Writing Recovery

Hea

rt R

ate

(BP

M)

EMO

POS

CTL

Expressive intervention Physical symptoms

Within-session heart rate habituation

r = -.41,

F(1,48) = 9.4,

p < .005

F(2,50) = 4.70

p = .01

MEDIATIONAL MODEL

F(2,48) = 1.96, n.s.

4444

Other FindingsOther Findings

Greater negative emotion word use Greater negative emotion word use predicted reduction of physical symptomspredicted reduction of physical symptoms

Greater use of cognitive mechanism words Greater use of cognitive mechanism words was associated with greater HR was associated with greater HR habituation (habituation (rr = .43, = .43, pp = .001) and more = .001) and more use of negative emotion words (use of negative emotion words (rr = .52, = .52, pp < .001)< .001)

Greater HR habituation predicted fewer Greater HR habituation predicted fewer medical appointments for cancer-related medical appointments for cancer-related morbidities in EMO (morbidities in EMO (rr = -.30), but not a = -.30), but not a significant mediatorsignificant mediator

Possible Neuroendocrine Mechanism?Possible Neuroendocrine Mechanism?Relations of Coping Processes with Adjustment Relations of Coping Processes with Adjustment and Cortisol in Metastatic Breast Cancer Patients and Cortisol in Metastatic Breast Cancer Patients ((nn = 50) = 50)

  CES-DDepressive symptoms

POMSNegative

mood

POMSPositive

mood

Cortisol slope

Mean cortisol

Coping Processes          

Emotional approach -.41* -.40* .56* -.36* -.21

Seek social support -.01 -.15 .22 -.15 .02

Positive reappraisal -.21 -.24 .31* -.32 -.44*

Acceptance -.43* -.45* .32* -.51* .06

Problem-focused coping

-.26 -.42* .54* -.46* -.12

Avoidant coping .72* .76* -.50* .19 -.13

Night time

Waking

4 p.m.

9 p.m.

Day time

1

2

3

4

1.0

.9

.8

.7

.6

.5

.4

.3

.2

.1

0

Saliva

ry C

ortisol (ug

/dl)

45 min after

Cortisol Slopes as a Function of Cortisol Slopes as a Function of Coping through Emotional Coping through Emotional ExpressionExpression

0

0.5

1

1.5

2

2.5

3

3.5

07:00 07:45 16:00 21:00

Time of day

Lo

g t

ran

sfo

rmed

co

rtis

ol

Low Emo Exp

High Emo Exp

4848

ConclusionsConclusions

Adaptive Utility of Coping through Adaptive Utility of Coping through Emotional Approach Depends on ContextEmotional Approach Depends on Context

Intrapersonal ContextIntrapersonal Context– Gender?Gender?– HopeHope

Environmental ContextEnvironmental Context– Stressor Characteristics – controllabilityStressor Characteristics – controllability– Social ReceptivitySocial Receptivity

Importance of Person-Environment FitImportance of Person-Environment Fit– Manne intervention trialManne intervention trial

4949

ConclusionsConclusions

How Does Emotional Approach How Does Emotional Approach Work?Work?– Habituation and Competent Habituation and Competent

Physiological RegulationPhysiological Regulation– Motivates Goal Clarification and Motivates Goal Clarification and

PursuitPursuit– Cognitive ReappraisalCognitive Reappraisal– On-going ResearchOn-going Research

5050

5151

Relations of Confounded Relations of Confounded Emotion-Focused Coping Emotion-Focused Coping with Adjustmentwith Adjustment No Control

for Time 1 Adjustment

Control for Time 1 Adjustment

Depression .54* .11*

Life Satis -.32* .08

Relations of Relations of Unconfounded Coping Unconfounded Coping with Adjustmentwith Adjustment No Control

for T1 Adj. Control for T1 Adj.

Men Depression .37* .15* Life Satis -.27* -.19* Women Depression -.26* -.17* Life Satis .49* .18*

Study 1 Factor Study 1 Factor AnalysisAnalysis

Emotional Processing I take time to figure out what I’m really feeling I delve into my feelings to get a thorough understanding of them I realize that my feelings are valid and important I acknowledge my emotions

.77

.77

.80

.65

.06-.01

.01 .13

Emotional Expression I let my feelings come out freely I take time to express my emotions I allow myself to express my emotions I feel free to express my emotions

-.11 .10 .03 .12

.76

.63

.80

.71

5454

Study 3 Confirmatory Study 3 Confirmatory Factor AnalysesFactor Analyses

ComparativeFit Index

Root MeanSquared Errorof Approx.

StandardizedRoot MeanSquaredResidual

Recommended(Bentler & Hu,1999)

> .95 < .06 < .08

Dispositional .90 .037 .054

Situational .90 .042 .066

Study 1 Correlations Study 1 Correlations with Relevant with Relevant VariablesVariables

Emotional Emotional ProcessingProcessing

Emotional Emotional ExpressionExpression

Social DesirabilitySocial Desirability .08.08 .06.06

Emotional ExpressivenessEmotional Expressiveness .26*.26* .44*.44*

Family ExpressivenessFamily Expressiveness .17.17 .40*.40*

Problem-Focused CopingProblem-Focused Coping .47*.47* .24*.24*

Seeking Social SupportSeeking Social Support .44*.44* .56*.56*

5656

Stanton et al. (2000) Study Stanton et al. (2000) Study 1 Emotional Processing 1 Emotional Processing Gender DifferencesGender Differences

Men Women

Hope .12 .38**

Anxiety .07 -.25*

Neuroticism -.01 -.25*

Depression -.01 -.26*

Rumination .49** .04

5757

September 11 StudySeptember 11 Study

Undergraduates (Undergraduates (nn = 131) = 131) 36-60 hours after terrorist attacks36-60 hours after terrorist attacks 6-week follow-up6-week follow-up DV = Days of illness-related activity DV = Days of illness-related activity

restrictionrestriction

5858

Neuroticism x Expressive Coping Neuroticism x Expressive Coping Interaction on Days of Illness-Related Interaction on Days of Illness-Related Activity Restriction at 6 Weeks after Activity Restriction at 6 Weeks after September 11September 11

0123456789

10

Low Neo High Neo

Low Emo ExpHigh Emo Exp

Baseline hostility x condition Baseline hostility x condition interaction on prediction of hostility interaction on prediction of hostility at 3-month follow-upat 3-month follow-up

0

2

4

6

8

10

12

14

16

18

20

Pre

dic

ted

Po

sth

os

tility

Expressive Disclosure

Best Possible Self

Fact Control

Low Prehostility

High Prehostility

Effects of Experimental Condition on Essay Word Variables and Self-Reported Mood During Writing Sessions in Multilevel Models (Stanton et al., in press)

Potential Mediator EMO(n = 20)

POS(n = 19)

CTL(n = 16)

F p

Positive Emotion Essay Words 

2.91b

0.244.72a

0.241.41c

0.2641.96

(2, 56)

.0001

Negative Emotion Essay Words 

2.21a

0.121.15b

0.131.03b

0.1426.09

(2, 56)

.0001

Cognitive Mechanism Words

9.44a

0.286.48b

0.286.37b

0.3137.91

(2, 56)

.0001

Self-reported Negative Mood

13.87ab

1.1310.14b

1.1314.48a

1.224.22(2, 58)

.0194

Diurnal Cortisol Rhythm as a Predictor of Breast Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival (Sephton et al., 2000, JNCI)Cancer Survival (Sephton et al., 2000, JNCI)

6262

Emotional Disclosure Emotional Disclosure as a Buffer of Social as a Buffer of Social ConstraintConstraint Zakowski et al. (2004, HP)Zakowski et al. (2004, HP) 104 gyn and prostate cancer 104 gyn and prostate cancer

patientspatients 3 home-based sessions EMO vs CTL3 home-based sessions EMO vs CTL 6 months – no main effects on psych 6 months – no main effects on psych

outcomes, but moderated effectsoutcomes, but moderated effects EMO buffered negative effects of EMO buffered negative effects of

high social constraint in discussing high social constraint in discussing cancer on general distresscancer on general distress

6363

Zakowski et al. (2004)Zakowski et al. (2004)

Emotional-Approach Coping and Peak TNF-alpha

r = -.56

-2

-1.5

-1

-0.5

0

0.5

1

1.5

2

2.5

1 1.5 2 2.5 3 3.5 4

Emotional-Approach Coping

Peak T

NF-a

lph

a

6565