Emotions – Keep them in or Let them Out?


By: Kenneth Nowack, Ph.D.

Any emotion, if it is sincere, is involuntary.  Mark Twain
Have you ever experienced leaders who seem to lose it during meetings or tense interactions with others–emotions spewing out of them like hot lava leaving an active Mount St. Helens? Or, dealing with those analytical, controlled and “closed” leaders who always appear to be emotionally constipated?

Feelings expressed or feelings repressed.  Which one is most damaging to your health?

Those Who Feel and Express….
Two types of studies tend to illustrate how expression of some emotions in leaders might have serious long term consequences for health.

First, Ed Suarez, Ph.D. at Duke University illustrated an association between anger, hostility and a very important inflammatory marker of cardiovascular disease called C-reactive protein (others have found the same outcome with homocysteine). In his study of 123 healthy non-smoking men and women he found that anger and hostility were significantly associated with higher levels of C-reactive protein while controlling for other factors1.

This study adds to the growing recognition that practicing “sign language” when being cut off on the freeway may not exactly be the best way to react to social and interpersonal challenges if you want to live long. Indeed, expressing anger seems to increase the inflammatory stress response which can have some negative long term health consequences.

Type D Personality
Second, Johan Denollet, Ph.D. has studied a very interesting personality type he calls “Type D” for many years. “Type D” personality types are identified based on high scores of ratings of negative emotions (e.g., worry and anxiety) and low scores on social inhibition, or being insecure socially and lacking assertiveness.

In just one of his many studies, Denollet followed 319 individuals for five years and tracked cardiovascular events that developed. Individuals high in “Type D” were four times more likely to suffer a second heart attack than “non-D Types”2.

However, recent research using different statistical analyses that were not utilized in the initial studies do not tend to support the earlier claims that Type D personality is an independent risk factor at least equivalent in importance to the other “conventional” coronary heart disease predictor factors3.  Recent findings using different statistical techniques still suggest that expressed social anxiety and depression may indeed play an important role in the development of cardiovascular disease.

Emotional Expressive Writing
The interest in the relationship between emotionally expressive writing and health has grown in the last few years. The first study was published in 1986. By 1996, approximately 20 studies had been published. By 2009, over 200 have been published in English language journals.

Although many studies have examined psychological and physical health outcomes, an increasing number have explored writing’s effects on a wide variety of outcomes including:

  • Attitude change
  • Creativity
  • Working memory
  • Motivation
  • Life satisfaction
  • School performance
  • Health‐related behaviors

Current research suggests that writing sessions greater than 15 minutes were more potent than writing sessions less than 15 minutes4.

Although several variations on the expressive writing method have been tested, none have been found to be consistently superior to the original trauma writing or other methods that encourage the participants’ freely choosing their writing topic.  Just getting your feelings out in writing seem to be equally powerful whether you accentuate the positive or negative aspects of them.

Those Who Keep Emotions In….
What about those of us who don’t express feelings such as anxiety and anger? These individuals also appear to be at risk to get sick and equally vulnerable to cardiovascular disease and even cancer5.

My friend and true “data shaman” Gary Schwartz, Ph.D. at the University of Arizona School of Medicine was one of the first to explore the relationship between those who work so hard to present themselves (and others) in an overly positive light and health. These “repressive copers” don’t report being anxious at all–in fact, they report just the opposite. Individuals who utilize repressive coping tend to work hard to create very favorable and positive impressions to others (high impression management) and report little or no worry, anger and anxiety (low negative affect).
In fact, those of us who tend to “repress” emotions appear to be at risk for high blood pressure, heart disease and even breast cancer6.

Apparently, the energy to repress emotions is physiological taxing to ourselves but seems to give most others in our lives a break! Some preliminary research using 360 degree feedback also suggests these leaders might actually be prone to “over estimating” their strengths and working endlessly to self-promote themselves to others. These self-enhancing leaders might not only be at high risk to derail because of inaccuracy about their skills, knowledge and abilities but they might also be prone to getting sick.

A meta-analysis of 22 studies revealed significant associations between repressive coping, cancer and cardiovascular diseases, especially hypertension7. For repressors, the risk of a cancer diagnosis is increased by 51% in 10 published studies included in this review but it is important to note that this association was evident only following the diagnosis (i.e., this type of coping might be a consequence and not a cause of cancer).

Emotional Expression–What Do We Know?
We can make at least three conclusions about expressing or holding in emotions:

  1. Expressing negative emotions seems to be pretty strongly associated with negative long term health consequences.
  2. It’s not the negativity of the emotions, per se that is the problem, but how leaders cope with these emotions.
  3. It seems more important to feel good, than having a goal of merely feeling good.

How are you feeling at this point?

At least expressing how you feel might actually make you better physically and psychologically.

  1. Suarez, E. (2004). C – reactive protein Is Associated with Psychological Risk Factors of Cardiovascular Disease in Apparently Healthy Adults. Psychosomatic Medicine, 66, 684-691.
  2. Denollet J, Vaes J, Brutsaert D.L. (2000). Inadequate response to treatment in coronary heart disease: adverse effects of Type D personality and younger age on 5-year prognosis and quality of life. Circulation, 102, 630–6355.
  3. Coyne, J. et al., (2011). Lack of Prognostic Value of Type D Personality for Mortality in a Large Sample of Heart Failure Patients, Psychosomatic Medicine, 73, 557-562.
  4. Chung, C. K., & Pennebaker, J. W. (2008). Variations in the spacing of expressive writing sessions. British Journal of Health Psychology, 13, 15-21.
  5. Schwartz, G. (1990). The psychobiology of repression and health. In J. Singer (Ed.), Repression and dissociation (pp. 405-434). Chicago: University of Chicago Press
  6. McKenna, C., Zevon, M., Corn, B., & Rounds, J. (1999). Psychosocial factors and the development of breast cancer: A meta-analysis. Health Psychology, 18, 520-531.
  7. Mund, M. & Mitte, K. (2012).  The cost of repression: A meta-analysis on the relation between repressive coping and somatic diseases.  Health Psychology, 31, 640-649.


Kenneth Nowack, Ph.D. is a licensed psychologist (PSY13758) and President/Chief Research Officer/Co-Founder of Envisia Learning, Inc., is a member of the Consortium for Research on Emotional Intelligence in Organizations. Ken also serves as the Associate Editor of Consulting Psychology Journal: Practice and Research.

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