Annals of Behavioral Medicine

, Volume 30, Issue 1, pp 44–53

Styles of emotion regulation and their associations with perceived health in patients with rheumatoid arthritis

  • Henriët van Middendorp
  • Rinie Geenen
  • Marjolijn J. Sorbi
  • Joop J. Hox
  • Ad J. J. M. Vingerhoets
  • Lorenz J. P. van Doornen
  • Johannes W. J. Bijlsma
Article

Abstract

Background: Patients with rheumatoid arthritis face the challenge of adjusting to adverse health consequences and accompanying emotions. Styles of emotion regulation may affect health.Purpose: The objective is to examine associations between styles of emotion regulation and perceived health, consisting of psychological well-being, social functioning, physical functioning, and disease activity.Methods: Principal component analysis was used to summarize styles of emotion regulation of 335 patients with rheumatoid arthritis. Relationships between emotion regulation and perceived health were examined with structural equation modeling.Results: Four styles of emotion regulation were identified: ambiguity, control, orientation, and expression. Ambiguity and control were mutually correlated, as were orientation and expression. Styles of emotion regulation were not uniquely related to perceived physical functioning and disease activity. Emotional ambiguity and orientation were related to poorer, whereas expression and control were related to more favorable psychological well-being and social functioning.Conclusions: Our cross-sectional study suggests that emotion regulation is not of direct importance for perceived somatic health of patients with rheumatoid arthritis, but it may be of importance for psychological well-being and social functioning, and perhaps through this route for somatic health. The more conscious and controlled aspects of control and expression are positively related to psychosocial health, and the more unconscious automatic aspects of ambiguity and orientation are negatively related. Changing emotion regulation will potentially affect psychosocial health. It would be worthwhile to verify this possibility in prospective research.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. (1).
    Bijlsma JWJ, Velthuis PJ: Rheumatoid arthritis. In Kater L, Baart de la Faille H (eds),Multi-systemic Autoimmune Diseases. Amsterdam: Elsevier Science, 1995, 141–172.Google Scholar
  2. (2).
    World Health Organization:International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization, 2001.Google Scholar
  3. (3).
    Gross JJ, John OP: Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being.Journal of Personality and Social Psychology. 2003,85: 348–362.PubMedCrossRefGoogle Scholar
  4. (4).
    Lazarus RS, Folkman S:Stress, Appraisal and Coping. New York: Springer, 1984.Google Scholar
  5. (5).
    Lumley MA, Stettner L, Wehmer F: How are alexithymia and physical illness linked? A review and critique of pathways.Journal of Psychosomatic Research. 1996,41: 505–518.PubMedCrossRefGoogle Scholar
  6. (6).
    Bleiker EM, Van der Ploeg HM, Hendriks JH, Leer JW, Kleijn WC: Rationality, emotional expression and control: Psychometric characteristics of a questionnaire for research in psycho-oncology.Journal of Psychosomatic Research. 1993,37:861–872.PubMedCrossRefGoogle Scholar
  7. (7).
    King LA, Emmons RA: Conflict over emotional expression: Psychological and physical correlates.Journal of Personality and Social Psychology. 1990,58:864–877.PubMedCrossRefGoogle Scholar
  8. (8).
    Gross JJ, John OP: Mapping the domain of expressivity: Multimethod evidence for a hierarchical model.Journal of Personality and Social Psychology. 1998,74:170–191.PubMedCrossRefGoogle Scholar
  9. (9).
    Stanton AL, Kirk SB, Cameron CL, Danoff-Burg S: Coping through emotional approach: Scale construction and validation.Journal of Personality and Social Psychology. 2000,78:1150–1169.PubMedCrossRefGoogle Scholar
  10. (10).
    Lepore SJ, Smyth JM:The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being. Washington, DC, American Psychological Association, 2002.Google Scholar
  11. (11).
    Gross JJ: Emotion regulation: Affective, cognitive, and social consequences.Psychophysiology. 2002,39:281–291.PubMedCrossRefGoogle Scholar
  12. (12).
    Gohm CL, Clore GL: Four latent traits of emotional experience and their involvement in well-being, coping, and attributional style.Cognition and Emotion. 2002,16:495–518.CrossRefGoogle Scholar
  13. (13).
    Solano L, Costa M, Temoshok L, et al.: An emotionally inexpressive (Type C) coping style influences HIV disease progression at six and twelve month follow-ups.Psychology and Health. 2002,17:641–655.CrossRefGoogle Scholar
  14. (14).
    Tucker JS, Winkelman DK, Katz JN, Bermas BL: Ambivalence over emotional expression and psychological well-being among rheumatoid arthritis patients and their spouses.Journal of Applied Social Psychology. 1999,29:271–290.CrossRefGoogle Scholar
  15. (15).
    Verissimo R, Mota-Cardoso R, Taylor G: Relationships between alexithymia, emotional control, and quality of life in patients with inflammatory bowel disease.Psychotherapy and Psychosomatics. 1998,67:75–80.PubMedCrossRefGoogle Scholar
  16. (16).
    Pennebaker JW, Traue HC: Inhibition and psychosomatic processes. In Traue HC, Pennebaker JW (eds),Emotion, Inhibition, and Health. Seattle, WA: Hogrefe & Huber, 1993, 146–163.Google Scholar
  17. (17).
    Gohm CL, Clore GL: Individual differences in emotional experience: Mapping available scales to processes.Personality and Social Psychology Bulletin. 2000,26:679–697.CrossRefGoogle Scholar
  18. (18).
    Gross JJ, John OP: Revealing feelings: Facets of emotional expressivity in self-reports, peer ratings, and behavior.Journal of Personality and Social Psychology. 1997,72:435–448.PubMedCrossRefGoogle Scholar
  19. (19).
    Smith JA, Lumley MA, Longo DJ: Contrasting emotional approach coping with passive coping for chronic myofascial pain.Annals of Behavioral Medicine. 2002,24:326–335.PubMedCrossRefGoogle Scholar
  20. (20).
    Stanton AL, Danoff-Burg S, Cameron CL, et al.: Emotionally expressive coping predicts psychological and physical adjustment to breast cancer.Journal of Consulting and Clinical Psychology. 2000,68:875–882.PubMedCrossRefGoogle Scholar
  21. (21).
    Smyth JM: Written emotional expression: Effect sizes, outcome types, and moderating variables.Journal of Consulting and Clinical Psychology. 1998,66:174–184.PubMedCrossRefGoogle Scholar
  22. (22).
    Lepore SJ, Greenberg MA, Bruno M, Smyth JM: Expressive writing and health: Self-regulation of emotion-related experience, physiology, and behavior. In Lepore SJ, Smyth JM (eds),The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being. Washington, DC: American Psychological Association, 2002, 99–117.CrossRefGoogle Scholar
  23. (23).
    Lutgendorf SK, Ullrich P: Cognitive processing, disclosure, and health: Psychological and physiological mechanisms. In Lepore SJ, Smyth JM (eds),The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being. Washington, DC: American Psychological Association, 2002, 177–196.CrossRefGoogle Scholar
  24. (24).
    Pennebaker JW, Zech E, Rimé B: Disclosing and sharing emotion: Psychological, social, and health consequences. In Stroebe MS, Hansson RO, Stroebe W, Schut H (eds),Handbook of Bereavement Research: Consequences, Coping, and Care. Washington, DC: American Psychological Association, 2001, 517–543.CrossRefGoogle Scholar
  25. (25).
    Garssen B, Remie M: Different concepts or different words? Concepts related to non-expression of negative emotions. In Nyklicek I, Temoshok L, Vingerhoets A (eds),Emotional Expression and Health. Advances in Theory, Assessment, and Clinical Applications. Washington, DC: Brunner-Routledge, 2004, 117–136.Google Scholar
  26. (26).
    Gross JJ: The emerging field of emotion regulation: An integrative review.Review of General Psychology. 1998,2:271–299.CrossRefGoogle Scholar
  27. (27).
    Nyklicek I, Vingerhoets A, Denollet J: Emotional(non-)expression and health: Data, questions, and challenges.Psychology and Health. 2002,17:517–528.CrossRefGoogle Scholar
  28. (28).
    Panagopoulou E, Kersbergen B, Maes S: The effects of emotional (non-)expression in (chronic) disease: A meta-analytic review.Psychology and Health. 2002,17:529–545.CrossRefGoogle Scholar
  29. (29).
    Arnett FC, Edworthy SM, Bloch DA, et al.: The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.Arthritis and Rheumatism. 1988,31:315–324.PubMedCrossRefGoogle Scholar
  30. (30).
    Bagby RM, Parker JD, Taylor GJ: The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure.Journal of Psychosomatic Research. 1994,38:23–32.PubMedCrossRefGoogle Scholar
  31. (31).
    Trijsburg W, Passchier J, Duivenvoorden H:De Toronto Alexithymia Schaal (Dutch translation). Rotterdam, The Netherlands: Erasmus Universiteit, afdeling Medische Psychologie & Psychotherapie, 1996.Google Scholar
  32. (32).
    Van der Ploeg HM, Kleijn WC, Mook J, et al.: Rationality and antiemotionality as a risk factor for cancer: Concept differentiation.Journal of Psychosomatic Research. 1989,33:217–225.PubMedCrossRefGoogle Scholar
  33. (33).
    Bijlsma JWJ, OudeHeuvel CHB, Zaalberg A: Development and validation of the Dutch questionnaire capacities of daily life (VDF) for patients with rheumatoid arthritis.Journal of Rehabilitation Sciences. 1990,3:71–74.Google Scholar
  34. (34).
    Stucki G, Liang MH, Stucki S, Bruhlmann P, Michel BA: A self-administered rheumatoid arthritis disease activity index (RADAI) for epidemiologic research. Psychometric properties and correlation with parameters of disease activity.Arthritis and Rheumatism. 1995,38:795–798.PubMedCrossRefGoogle Scholar
  35. (35).
    Huiskes CJAE, Kraaimaat FW, Bijlsma JWJ: Development of a self-report questionnaire to assess the impact of rheumatic diseases on health and lifestyle.Journal of Rehabilitation Sciences. 1990,3:65–70.Google Scholar
  36. (36).
    Wald FD, Mellenbergh GJ: De verkorte versie van de Nederlandse vertaling van de Profile of Mood States (POMS) [The shortened version of the Dutch translation of the Profile of Mood States (POMS)].Nederlands Tijdschrift voor de Psychologie. 1990,45:86–90.Google Scholar
  37. (37).
    Tabachnick BG, Fidell LS:Using Multivariate Statistics (4th ed.). Boston: Allyn and Bacon, 2001.Google Scholar
  38. (38).
    Floyd FJ, Widaman KF: Factor analysis in the development and refinement of clinical assessment instruments.Psychological Assessment. 1995,7:286–299.CrossRefGoogle Scholar
  39. (39).
    Gorsuch RL:Factor Analysis (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc., 1983.Google Scholar
  40. (40).
    Preacher KJ, MacCallum RC: Repairing Tom Swift’s electric factor analysis machine.Understanding Statistics. 2003,2:13–43.CrossRefGoogle Scholar
  41. (41).
    Arbuckle JL, Wothke W:Amos 4.0 User’s Guide. Chicago: SmallWaters, 1999.Google Scholar
  42. (42).
    Hox JJ: A review of current software for handling missing data.Kwantitatieve Methoden. 1999,62:123–138.Google Scholar
  43. (43).
    Chou CP, Bentler PM: Model modification in structural equation modeling by imposing constraints.Computational Statistics & Data Analysis. 2002,41:271–287.CrossRefGoogle Scholar
  44. (44).
    Hox JJ, Bechger TM: An introduction to structural equation modeling.Family Science Review. 1998,11:354–373.Google Scholar
  45. (45).
    Kline RB:Principles and Practice of Structural Equation Modeling. New York: Guilford, 1998.Google Scholar
  46. (46).
    King LA, Emmons RA, Woodley S: The structure of inhibition.Journal of Research in Personality. 1992,26:85–102.CrossRefGoogle Scholar
  47. (47).
    Turvey C, Salovey P: Measures of repression: Converging on the same construct?Imagination, Cognition and Personality. 1993,13:279–289.Google Scholar
  48. (48).
    Stanton AL, Danoff-Burg S, Cameron CL, Ellis AP: Coping through emotional approach: Problems of conceptualization and confounding.Journal of Personality and Social Psychology. 1994,66:350–362.PubMedCrossRefGoogle Scholar
  49. (49).
    Gross JJ, John OP: Facets of emotional expressivity: Three self-report factors and their correlates.Personality and Individual Differences. 1995,19:555–568.CrossRefGoogle Scholar
  50. (50).
    Pennebaker JW: Health effects of the expression (and non-expression) of emotions through writing. In Vingerhoets A, Van Bussel F, Boelhouwer J (eds),The (Non)Expression of Emotions in Health and Disease. Tilburg, The Netherlands: Tilburg University Press, 1997, 267–278.Google Scholar
  51. (51).
    Kelley JE, Lumley MA, Leisen JC: Health effects of emotional disclosure in rheumatoid arthritis patients.Health Psychology. 1997,16:331–340.PubMedCrossRefGoogle Scholar
  52. (52).
    Smyth JM, Stone AA, Hurewitz A, Kaell A: Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial.Journal of the American Medical Association. 1999,281:1304–1309.PubMedCrossRefGoogle Scholar
  53. (53).
    Baerwald CGO, Burmester GR, Krause A: Interactions of autonomic nervous, neuroendocrine, and immune systems in rheumatoid arthritis.Rheumatic Disease Clinics of North America. 2000,26:841–857.PubMedCrossRefGoogle Scholar
  54. (54).
    Bijlsma JW, Cutolo M, Masi AT, Chikanza IC: The neuroendocrine immune basis of rheumatic diseases.Immunology Today. 1999,20:298–301.PubMedCrossRefGoogle Scholar
  55. (55).
    Geenen R, Godaert GL, Jacobs JW, Peters ML, Bijlsma JW: Diminished authonomic nervous system responsiveness in rheumatoid arthritis of recent onset.Journal of Rheumatology. 1996,23:258–264.PubMedGoogle Scholar
  56. (56).
    Lumley MA, Smith JA, Longo DJ: The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: Comparisons with self-efficacy, catastrophizing, and depression.Journal of Psychosomatic Research. 2002,53:823–830.PubMedCrossRefGoogle Scholar
  57. (57).
    Porcelli P, Bagby RM, Taylor GJ, et al.: Alexithymia as predictor of treatment outcome in patients with functional gastrointestinal disorders.Psychosomatic Medicine. 2003,65:911–918.PubMedCrossRefGoogle Scholar
  58. (58).
    Porcelli P, Leoci C, Guerra V, Taylor GJ, Bagby RM: A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease.Journal of Psychosomatic Research. 1996,41:569–573.PubMedCrossRefGoogle Scholar
  59. (59).
    Rimé B, Finkenauer C, Luminet O, Zech E, Philippot P: Social sharing of emotion: New evidence and new questions. In Stroebe W, Hewstone M (eds),European Review of Social Psychology, Vol. 9. New York: Wiley, 1998, 145–189.Google Scholar

Copyright information

© The Society of Behavioral Medicine 2005

Authors and Affiliations

  • Henriët van Middendorp
    • 1
  • Rinie Geenen
    • 1
  • Marjolijn J. Sorbi
    • 1
  • Joop J. Hox
    • 2
  • Ad J. J. M. Vingerhoets
    • 3
  • Lorenz J. P. van Doornen
    • 1
  • Johannes W. J. Bijlsma
    • 4
  1. 1.Department of Health PsychologyUtrecht UniversityUtrechtThe Netherlands
  2. 2.Department of Methodology and StatisticsUtrecht UniversityThe Netherlands
  3. 3.Department of Psychology and Health Tilburg UniversityCenter of Research on Psychology in Somatic disease (CoRPS)The Netherlands
  4. 4.Department of Rheumatology and Clinical ImmunologyUniversity Medical Center UtrechtThe Netherlands

Personalised recommendations