The Pain of Ambivalence over Emotional Expression
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Ambivalence over emotional expression (AEE) is defined as the desire to express emotion but failing to do so. Recent studies have revealed that AEE is associated with more pain. Pain is common among cancer survivors. This cross-sectional study investigated the association between AEE and pain, its underlying mechanism, and cultural relevance among cancer survivors.
Ninety-six Chinese American breast cancer survivors completed a questionnaire package assessing AEE and pain.
AEE was positively associated with pain severity and pain interference. The association between AEE and pain interference was mediated by intrusive thoughts.
Cancer survivors who are ambivalent over emotional expression may experience high levels of intrusive thoughts, which results in high levels of symptom reports in their pain. The study confirmed the association between AEE and pain and its underlying mechanism among a group whose culture generally encourages emotional suppression. Findings suggest interventions focusing on reducing intrusive thoughts may be effective at reducing pain.
KeywordsAmbivalence over emotional expression Pain Breast cancer Intrusive thoughts Asian-American
This study was funded in part by the American Cancer Society (MRSGT-10-011-01-CPPB, Principal Investigator: Qian Lu).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the University of Houston Institutional Review Board.
Informed consent was obtained from all individual participants included in the study.
- 4.Norman SA, Lumley MA, Dooley JA, Diamond MP. For whom does it work? Moderators of the effects of written emotional disclosure in women with chronic pelvic pain. Psychosom Med. 2004;66:174–83. https://doi.org/10.1097/01.psy.0000116979.77753.74.CrossRefPubMedGoogle Scholar
- 7.Tucker JS, Winkelman DK, Katz JN, Bermas BL. Ambivalence over emotional expression and psychological well-being among rheumatoid arthritis patients and their spouses. J Appl Soc Psychol. 1999;29(2):271–90. https://doi.org/10.1111/j.1559-1816.1999.tb01386.x.CrossRefGoogle Scholar
- 8.West SG, Aiken LS. Toward understanding individual effects in multicomponent prevention programs: design and analysis strategies. In: Bryant KJ, Window M, West SG, editors. The science of prevention: methodological advances from alcohol and substance abuse research. Washington, DC: American Psychological Association; 1997. p. 167–209.CrossRefGoogle Scholar
- 10.Stanton AL, Danoff-Burg S, Sworowski LA, Collins CA, Branstetter AD, Rodriguez-Hanley A, et al. Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. J Clin Oncol. 2002;20:4160–8. https://doi.org/10.1200/JCO.2002.08.521.CrossRefPubMedGoogle Scholar
- 12.Horowitz MJ. Stress-response syndromes: a review of posttraumatic and adjustment disorders. Hosp Community Psychiatry. 1986;47(3):241–9.Google Scholar
- 13.Lu Q, Man J, You J, LeRoy AS. The link between ambivalence over-emotional expression and depressive symptoms among Chinese breast cancer survivors. J Psychosom Res. 2015; https://doi.org/10.1016/j.jpsychores.2015.01.007.
- 16.Sue DW, Sue D. Counselling the culturally diverse: theory and practice. 5th ed. New York: Wiley; 2008.Google Scholar
- 27.McEwen BS, Seeman T. Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load. Ann N Y Acad Sci. 1999;896(1):30–47. https://doi.org/10.1111/j.1749-6632.1999.tb08103.x.CrossRefPubMedGoogle Scholar
- 33.Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: The Guilford Press; 2013.Google Scholar
- 44.Feldman G, Greeson J, Senville J. Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts. Behav Res Ther. 2010;48(10):1002–11. https://doi.org/10.1016/j.brat.2010.06.006.CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Lu Q, Wong C, Gallagher M, Tou R, Young L, Loh A. Expressive writing among Chinese American breast cancer survivors: a randomized controlled trial. J Health Psychol. 2016; https://doi.org/10.1037/hea0000449.