Ambivalence Over Emotional Expression Research Articles

Pathways Linking Parental Care and Control to Loneliness in Breast Cancer Patients with A History of Childhood Maltreatment: Exploring the Mediating Roles of Ambivalence Over Emotional Expression and Self-Discrepancy.

Childhood maltreatment is a risk factor for loneliness and is linked to breast cancer. Parental bonding experienced during one's childhood also plays a significant role in increasing or decreasing the risk of loneliness later in life. Previous research has highlighted the significance of ambivalence over emotional expression (AEE) and self-discrepancy in the psychological adaptation of breast cancer patients, particularly concerning the impact of parental care and control experienced by patients in their relationship with their parents during childhood. Nevertheless, previous studies have not examined the mediating effects of AEE and self-discrepancy on parental care and control, as well as loneliness, in breast cancer patients. This study aimed to investigate whether AEE and self-discrepancy mediate the association of childhood parental care and control with loneliness in breast cancer patients with a history of childhood maltreatment. One hundred and thirty-three breast cancer patients who were receiving chemotherapy within the first 3 months post-diagnosis were recruited from one private and three public hospitals in Tabriz, Iran, to complete questionnaires. Parental bonding, loneliness, AEE, and self-discrepancy were assessed using the Parental Bonding Instrument (PBI), University of California Los Angeles (UCLA) Loneliness Scale, Ambivalence over the Expression of Emotion Questionnaire (AEQ), and Self-Discrepancies Scale (S-DS). Mediation models were tested using structural equation modeling. Effects of parental care (β = -.17, p < .05) and control (β = .21, p < .001) on loneliness were significant. Furthermore, both AEE (β = .19, p < .05) and self-discrepancy (β = .23, p < .01) significantly predicted loneliness. The pathway between parental care and AEE was significant (β = -.21, p < .001), as was the direct effect of parental control on self-discrepancy (β = .19, p < .05). Bootstrapping results showed that AEE significantly mediated the relationship between parental care and loneliness (95% confidence interval [CI] [-0.09, -0.01]). In addition, there was a significant indirect effect from parental control to loneliness via self-discrepancy (95% CI [0.11, 0.01]). These findings suggest that AEE and self-discrepancy could potentially be utilized in preventing or addressing loneliness in breast cancer patients who have a history of childhood maltreatment. Future research could, for example, assess whether integrating psychosocial interventions focusing on these variables as part of medical care can improve the mental health status of this subgroup of breast cancer patients who have experienced childhood maltreatment.

College students’ ambivalence over emotional expression and counselor’s directiveness: an analogue experiment on perceived therapeutic bond

ABSTRACT This experimental analogue study estimated how clients’ ambivalence over emotional expression (AEE) is linked to their perception of the therapeutic relationship and satisfaction with counseling, depending on the counselor’s communication style (i.e., directive versus non-directive). One hundred and seventy three college students were recruited using a research participation pool. Participants viewed videos of mock counseling sessions that demonstrated a counselor with a directive or non-directive communication style and were instructed to imagine they were the client in the video. Participants then rated their perceived therapeutic bond and satisfaction with the counseling in the video. Results from a moderated mediation effect analysis indicated that the counselor’s directiveness moderated the relationship between AEE and perceived therapeutic bond, which in turn mediated the relationship between AEE and counseling satisfaction. Specifically, participants with higher levels of AEE reported lower levels of satisfaction when they watched a non-directive style of therapy session, and this relationship was mediated by lower levels of perceived therapeutic bond. However, this association was not found for the directive style video. Implications and future directions for research and practice are discussed.

Caregiving burden and self-efficacy mediate the association between individual characteristics and depressive symptoms among husbands of Chinese breast cancer patients.

Perceptions of caregiving burden and self-efficacy are found to be associated with well-being among husbands of breast cancer patients (BCP). However, little is known about how individual characteristics associate with such caregiving-related perceptions and cancer caregivers' well-being. This study examined the associations between two individual characteristics (male gender role norms and ambivalence over emotional expression (AEE)) and depressive symptoms among husbands of Chinese BCP, and the potential mediating roles of caregiving burden and self-efficacy in such associations. Participants (n = 176) were recruited in two hospitals in Weifang, China. Their endorsement of male gender role norms (e.g., "men should not ask for help"), AEE, caregiving burden, and depressive symptoms were measured in a cross-sectional survey. Path analysis results supported the proposed mediation model with satisfactory fit indices (χ2(2) = 2.73, p = .26, CFI = 1.00; IFI = 1.00; RMSEA = 0.05). Specifically, male gender role norms and AEE were associated with higher caregiving burden and lower caregiving self-efficacy, which in turn were associated with more depressive symptoms. Bootstrapping results supported that both male gender role norms (β = 0.16; 95%CI = 0.09, 0.25) and AEE had significant indirect effects on depressive symptoms (β = 0.11; 95%CI = 0.04, 0.18) via caregiving burden and self-efficacy, indicating that caregiving-related perceptions could mediate between individual characteristics and depressive symptoms. Male gender role norms and AEE might affect depressive symptoms among husbands of Chinese BCP through caregiving-related perceptions. Future interventions that reduce those husbands' barriers to express emotions, appreciate their commitment to take good care of their spouses, enhance caregiving skills, and reduce caregiving burden may decrease their depressive symptoms.

The detrimental effects of ambivalence over emotional expression on well‐being among Mainland Chinese breast cancer patients: Mediating role of perceived social support

Recent research has documented the harmful effects of ambivalence over emotional expression (AEE) on psychological well-being, but few studies to date have examined AEE among Mainland Chinese breast cancer patients, an ethnic group that prioritizes emotion restraint to preserve social harmony. The present study examined the relationship between AEE and well-being (viz, anxious and depressive symptoms and quality of life) and evaluated perceived social support as a potential mediator of this relationship in a sample of Mainland Chinese breast cancer patients. Three hundred twenty-seven Chinese breast cancer patients recruited from Weifang, China, completed a self-reported questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Medical Outcomes Study Social Support Scale (MOS-SSS), the Self-rating Anxiety Scale (SAS), the Self-rating Depression Scale (SDS), and the Functional Assessment of Cancer Therapy-Breast (FACT-B). Overall, Mainland Chinese breast cancer patients endorsed high levels of AEE. A series of mediation analyses revealed perceived social support served as a partial mediator of the relationship between AEE and well-being. Specifically, AEE was associated with lower perceived social support (βs=-.13, P<.001), which in turn, was associated with greater anxious symptoms (β=.23, P<.001), depressive symptoms (β=.20, P<.001) and lower quality of life (β=-.30, P<.001). The harmful relationship between AEE and well-being is partially explained by reduced social support. Psychosocial interventions that facilitate emotional disclosure without harming social harmony may be culturally effective for mainland Chinese breast cancer patients.

Ambivalence over emotional expression and physical functioning and limitations: mediating and moderating effects of PTSD symptoms and acculturation among Chinese breast cancer survivors

The psychosocial correlates of physical functioning and limitations are not well-known among Chinese breast cancer survivors. Previous research suggests a link between ambivalence over emotional expression (AEE) and physical functioning. The current study built upon this research by examining post-traumatic stress symptoms (PTSS) as a mechanism. Further, we also examined the moderating effects of mainstream cultural orientation. To this end, we tested study hypotheses using moderated mediation models. Participants were 96 Chinese-speaking breast cancer survivors in the USA. Participants were diagnosed within the past five years with stages 0-III breast cancer. Participants completed questionnaires related to AEE, PTSS, SF-36 physical functioning, and role limitations due to physical health subscales, and acculturation. Results from moderated mediation models provided support for study hypotheses. AEE was positively related to overall PTSS and its three subscales (i.e., re-experiencing symptoms, avoidance, and arousal). Further, PTSS and the three subscales were negatively related to physical functioning and positively related to role limitations due to physical health. The indirect effects of AEE on physical functioning and role limitations due to physical health through PTSS and the three subscales were significant. Moderated mediation models showed that the indirect effects of AEE on physical functioning through PTSS and the re-experiencing subscale were stronger for those high, compared to low, in mainstream culture orientation. Those with high AEE experience had worse physical functioning and greater role limitations due to increased PTSS. However, the indirect effects were stronger for those who endorse greater mainstream culture. Implications for results suggest that interventions aimed at addressing AEE and PTSS may help alleviate physical health problems especially those high in mainstream culture orientation.

Relation of social constraints on disclosure to adjustment among Chinese American cancer survivors: A multiprocesses approach.

The present study examines the association between social constraints and depressive symptoms among Chinese American breast cancer survivors, and the mechanism underling this association. A multiprocesses model is tested to examine the mediating roles of ambivalence over emotional expression (AEE), avoidance, intrusive thoughts, and social support in the association between social constraints and depressive symptoms among Chinese American breast cancer survivors. Ninety-six Chinese American breast cancer survivors were recruited from Chinese community organizations. They were asked to complete a questionnaire package that assessed social constraints, AEE, avoidance, intrusive thoughts, social support, depressive symptoms, and demographic information. Path analysis was conducted to test the hypothesized model. The overall and specific indirect effects of social constraints on depressive symptoms through AEE, avoidance, intrusive thoughts, and social support are significant. When the mediators are controlled for, the direct effect of social constraints on depressive symptoms is no longer significant. A multiprocesses model of social constraints and depressive symptoms is tested in a sample of Chinese American breast cancer survivors. The findings suggest that the existence of multiple pathways through which social constraints may associate with depressive symptoms among Chinese American breast cancer survivors.

Perceived Social Support Mediates the Longitudinal Relations between Ambivalence over Emotional Expression and Quality of Life among Chinese American Breast Cancer Survivors.

The present study examined perceived social support as a mediator of the longitudinal link between ambivalence over emotional expression (AEE) and quality of life among a sample of Chinese breast cancer survivors. Ninety-six Chinese breast cancer survivors recruited from Southern California completed four surveys in total: (1) a baseline survey (T1), 1-month follow-up (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), and the Medical Outcomes Study Social Support Scale (MOS-SSS). Higher T1 AEE was associated with lower T1 social support (B = -0.01, SE = 0.004, p < 0.01) which in turn was associated with lower quality of life at T2 (B = 2.98, SE = 0.64, p < 0.01), T3 (B = 2.14, SE = 0.54, p < 0.01), and T4 (B = 2.08, SE = 0.68, p < 0.01). These results suggest that the harmful effect of AEE on quality of life is explained by reduced social support. Given the detrimental effects of AEE on social support and quality of life, future research on interventions that facilitate emotional disclosure is needed. Implications for the effects of Chinese culture on AEE are discussed.

The Pain of Ambivalence over Emotional Expression.

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.

Acculturation matters in the relation between ambivalence over emotional expressions and well-being among Chinese American breast cancer survivors.

Ambivalence over emotional expression (AEE) is the inner conflict of desiring emotion expression and fearing consequence of emotion expression. Few studies to date have examined the effects of AEE within an ethnic group that prioritizes emotional self-control. The present study examined the associations between AEE and well-being (viz., quality of life and depressive symptoms) as a function of acculturation among a sample of Chinese American breast cancer survivors. Ninety-six Chinese breast cancer survivors (M age=54.64years old, SD=7.98) were recruited from Southern California. Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-Breast (FACT-B), and the Center for Epidemiologic Studies Depression Scale-Short Form (CESD-10). Acculturation was a statistically significant moderator of the relations between AEE and depressive symptoms, and a statistically marginally significant moderator of the relations between AEE and quality of life. Simple slopes revealed that AEE was negatively associated with quality of life (B=-.45, p<.001) and depressive symptoms (B=.20, p<.001) for women with high acculturation, but not associated for women with low acculturation (Bs=-.15 and .04, ps>.05, for quality of life and depressive symptoms, respectively). These results suggest that less acculturated Chinese breast cancer survivors are protected by Chinese cultural values of emotional self-control and restraint, and thus do not experience the detrimental effects of AEE on their depressive symptoms and quality of life. Implications are discussed.

Should I say thank you? Gratitude encourages cognitive reappraisal and buffers the negative impact of ambivalence over emotional expression on depression

The present study assessed relationships among gratitude, ambivalence over emotional expression (AEE), cognitive reappraisal, and depressive symptoms. Three-hundred and fifty-two undergraduates (M age=23.51years, SD=6.80) completed study materials. Findings revealed that higher levels of gratitude mitigated the positive relationship between AEE and depression. Those who were high in AEE and gratitude reported higher levels of cognitive reappraisal. Moreover, moderated mediation models showed that cognitive reappraisal mediated the relationship between AEE and depressive symptoms for those who reported high levels of gratitude. These results indicate that gratitude may be particularly useful for ameliorating depressive symptoms for those who are high in AEE through the use of cognitive reappraisal. These results can inform future interventions for those high in AEE and experiencing depressive symptoms.

God, Can I Tell You Something? The Effect of Religious Coping on the Relationship between Anxiety Over Emotional Expression, Anxiety, and Depressive Symptoms.

The current study investigated whether religious coping would moderate the association between ambivalence over emotional expression (AEE) and depressive symptoms and anxiety symptoms such that the positive relationship between AEE and depressive symptoms and anxiety symptoms would be weaker among those higher in religious coping. Three-hundred and fifty-two undergraduates (M age=23.51 years, SD=6.80; 84.4% female) completed study materials. Contrary to expectations, results revealed a significant interaction between religious coping and AEE such that religious coping exacerbated the relationship between higher AEE and distress symptoms. The implications of this study suggest that religious coping may not be an ideal coping mechanism for individuals with high levels of AEE. These results indicate the need to further examine the role of AEE in religious coping, and have potential implications for clinicians, healthcare professionals, and religious mentors who may promote the use of religious coping in treatment.

General Needs Satisfaction as a Mediator of the Relationship Between Ambivalence Over Emotional Expression and Perceived Social Support

ABSTRACTThe detrimental effect of ambivalence over emotional expression (AEE) on social support has been well documented. However, the underlying mechanism of this effect remains unclear. Research has demonstrated that when general needs are not met, negative psychological outcomes occur. Thus, the current study investigated general needs satisfaction (GNS) as a potential mediator of the association between AEE and social support among 352 undergraduates. Results revealed that AEE was negatively associated with autonomy, relatedness, competence, and social support, whereas social support was positively associated with autonomy, competence, and relatedness. Further, GNS and each of its three subscales were all found to significantly mediate the association between AEE and social support. Thus, findings from the present study contribute to our understanding of AEE by illustrating a potential mechanism through which AEE may lead to a lack of perceived social support, namely GNS.

Canine comfort: Pet affinity buffers the negative impact of ambivalence over emotional expression on perceived social support

This study evaluated pet affinity as a buffer between ambivalence over emotional expression (AEE) and social support. AEE occurs when one desires to express emotions but is reluctant to do so and is related to negative psychological outcomes. Individuals high in AEE may have difficulty receiving social support and thus may not gain accompanying benefits. Social support has been associated with positive health outcomes, and pet support is positively associated with human social support. The present study explores the potential protective effect of pet affinity. One hundred ninety-eight undergraduate dog owners completed measures assessing perceived social support, pet affinity, and AEE. AEE was expected to be negatively associated with social support, and pet affinity was expected to buffer the negative effects of AEE on social support. We found that AEE was negatively associated with perceived social support. An interaction between pet affinity and AEE emerged such that the negative association between AEE and social support was weaker among those higher in pet affinity. Thus, at high levels of AEE, those who felt a close connection with their pets reported more perceived social support than those less connected with their pets. Overall, these findings emphasize the potential benefits of pet affinity.

Expressive disclosure to improve well-being in patients with amyotrophic lateral sclerosis: A randomised, controlled trial

Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (N = 48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression and quality of life) was assessed pre-intervention and also three and six months later. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at three months post-intervention, but not six months. Ambivalence over emotional expression (AEE) moderated three-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE, who disclosed, had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalise to later stages.

Conflict About Expressing Emotions and Chronic Low Back Pain: Associations With Pain and Anger

There has been growing interest among researchers and clinicians in the role of ambivalence over emotional expression (AEE) in adjustment to chronic illness. Because of the salience of anger in chronic low back pain, this condition provides a particularly good model in which to examine the role of AEE. This study examined the relation of AEE to pain and anger in a sample of 61 patients with chronic low back pain. Patients completed standardized measures of AEE, pain, and anger. Correlational analyses showed that patients who had higher AEE scores reported higher levels of evaluative and affective pain as well as higher levels of state and trait anger and the tendency to hold in angry thoughts and feelings. Mediational analyses revealed that most of the associations between AEE and pain, and AEE and anger, were independent of one another. These findings suggest that a potentially important relationship exists between AEE and key aspects of living with persistent pain. This preliminary study suggests that there is a relation between ambivalence over emotional expression and pain and anger in patients with chronic low back pain. Patients who report greater conflict with regard to expressing emotions may be experiencing higher pain and anger.

Ambivalence over emotional expression in patients with gastrointestinal cancer and their caregivers: Associations with patient pain and quality of life

This study examined the role of patient and caregiver ambivalence over emotional expression (AEE) in pain and quality of life (QOL) in a sample of 78 patients with gastrointestinal (GI) cancer. Measures of ambivalence over emotional expression as well as ratings of patient pain and pain behavior were collected from patients and caregivers. Measures of pain catastrophizing, perceptions of social support, and QOL were obtained from patients. Data analyses revealed that patients high in AEE engaged in more catastrophizing and reported higher levels of pain behaviors and poorer QOL. In addition, patients whose caregivers were high in AEE engaged in more catastrophizing, had higher levels of pain and pain behavior, and reported lower emotional well-being. Patient catastrophizing mediated the effects of both patient and caregiver AEE on some patient outcomes. Taken together, these findings suggest that emotional regulation in both patients and their caregivers may be an important factor in understanding cancer patients' experience of and coping with symptoms such as pain.