La gestion des émotions et ses déficits,chez les personnes atteintes de douleur chronique : une revue systématisée des études relatives à l’alexithymie, à l’intelligence émotionnelle, à la régulation émotionnelle et au coping

The goal of this review is to synthesize the data of scientific literature on emotional management and its deficits in chronic pain. We used terms referenced in databases and MesH terms (of the United States National Library of Medicine) to perform a literature search in a powerful online search engine (EBSCOhost research databases). Four hundred and forty-nine papers, taken from international reviews and published of 1994 (because it is in the middle of the 1990s that this theme begins to be handle) to the end of January, 2015, are identified by a total 5 electronic databases with predefined keywords about emotions and chronic pain. Forty-six of which met the inclusion criteria, according to their title, their summary and their complete text. The findings suggest that some emotional management strategies and its deficits can maintain a vicious circle of negative emotional states with physiological and psychopathological consequences. Several studies show that alexithymia, emotional ambivalence and emotional suppression have a deleterious impact on pain, emotional distress (depression, anxiety) and disability. In spite of some contradictions concerning the nature of this effect (sensory or affective pain intensity or even duration of pain), it seems that alexithymia is a major variable implied in chronic pain. Inversely, experiential acceptance has a beneficial effect on psychological distress (depression, anxiety and stress). Emotional disclosure (of stressful or traumatic events) can decrease pain intensity but not disability and mental health. Likewise, emotional expression in daily life seems beneficial, but when the expression of the positive and negative feelings are distinguished, emotional expression of negative feelings increases pain, disability and distress. The whole of these findings emphasize the need to further research about emotional management in chronic non-cancer pain. It is necessary to identify and control the source of potential bias. Some hypotheses have been proposed to explain these findings. In the future, it would be interesting to use a multifactorial approach to investigate the interactions between various processes of emotional management in chronic pain patients.     

Alexithymia, emotion, and somatic complaints

Alexithymia, by definition, involves difficulties in identifying and describing emotions and has been assumed to be associated with somatization (i.e., a tendency to express psychological distress in somatic rather than emotional form). Empirical research so far, however, has produced no convincing evidence that alexithymia is more associated with somatic complaints than with emotional complaints or that alexithymia correlates with somatic complaints when negative affect is controlled for. In the present study, alexithymia, as measured by the TAS-20, showed no association with somatic complaints in a community sample of 137 individuals when trait anxiety and depression were controlled. Alexithymia did correlate negatively with positive affect, and positively with negative affect. The former association, however, was much more robust, whereas the latter association was found mainly on subjective trait measures of negative affect (as distinct from state measures and more objective trait measures derived from daily recordings during an 8-week period). It is suggested that the association between alexithymia and lack of positive affect deserves more attention in future research.     

Psychosocial Perspectives on Pregnancy: Prenatal Maternal Stress and Coping

Pregnancy is a momentous life event experienced by most women that involves biomedical and psychosocial changes that are potentially stressful. High levels of maternal stress in pregnancy contribute to adverse fetal, infant, child, and adult outcomes, including cognitive, emotional, neurodevelopmental, and physical health effects. This article discusses definition, measurement, and effects of stress in pregnancy and describes current research questions such as whether the timing or pattern of prenatal stress accentuates its effects and whether prenatal stress accounts for ethnic disparities in adverse birth outcomes in the United States. We review research on the ways that women cope with prenatal stress and research examining associations of coping with maternal emotional state, health, and birth outcomes. Additionally, we describe important factors that improve women's psychosocial adaptation to pregnancy, their health, and their birth outcomes, specifically trait optimism, social support, and physical activity, and we emphasize interventions that utilize these factors.     

Understanding and Improving the Effectiveness of After-School Practice

The question driving research on after‐school programs is shifting from “do programs make a difference,” to “why are some programs effective while others are not?” This article draws on the work in this volume and related studies to suggest that there is an emerging consensus on the importance of staff‐youth interactions as a determinant of program effectiveness. The commentary recommends that future research should continue to focus on understanding and improving program practices at the point‐of‐service. In doing so, two lines of inquiry seem promising. The first involves linking measures of changes in staff‐youth interactions to changes in developmental outcomes. The second is to examine how policies or other interventions intended to improve program effectiveness affect the practices of line staff.     

Inhibition and reappraisal within emotional disclosure: the embodying of narration

The emotional disclosure paradigm (EDP) associates better health with repeated disclosure of emotional experiences. However, disclosure does not bring health benefits for all, and neither does the EDP adequately specify embodied mechanisms or neural pathways whereby benefits might be produced. This paper addresses these issues by offering more sophisticated notions of emotional inhibition and cognitive reappraisal. It then outlines aspects of the somatic marker hypothesis which supports a more comprehensive conceptualization of the processes that may enable both the positive and negative health effects of disclosure.     

When the social self is threatened: shame, physiology, and health

Our program of research focuses on shame as a key emotional response to "social self" threats (i.e., social evaluation or rejection). We propose that shame may orchestrate specific patterns of psychobiological changes under these conditions. A series of studies demonstrates that acute threats to the social self increase proinflammatory cytokine activity and cortisol and that these changes occur in concert with shame. Chronic social self threats and persistent experience of shame-related cognitive and affective states predict disease-relevant immunological and health outcomes in HIV. Across our laboratory and longitudinal studies, general or composite affective states (e.g., distress) are unrelated to these physiological and health outcomes. These findings support a stressor- and emotional response-specificity model for psychobiological and health research.     

Alexithymia and individual differences in emotional expression

Two studies examined verbal and nonverbal expression in relation to facets of alexithymia. Participants were videotaped while they talked about negative and positive events that had happened to them. Persons high in difficulty identifying feelings were less emotionally expressive, nonverbally, of positive emotion during a positive talk, and of negative emotion during a negative talk. Other facets of alexithymia were not independently related to expressiveness. Verbal expressiveness was not independently related to any facet of alexithymia. Study 2 showed that these relationships were independent of whether the participant was alone or with another. The implications for the understanding of the nature of the deficit in alexithymia, and of the effects of disclosure are discussed.     

Alexithymia, Irrational Beliefs, and the Rational-Emotive Explanation of Emotional Disturbance

In recent discussions of Rational-Emotive Behavior Therapy (REBT), Ellis has argued that unconscious processes supplement irrational beliefs in explaining psychopathology. The hypothesis of this investigation was that these unconscious processes reflect alexithymia. University students responded to the three factors from the Toronto Alexithymia Scale, the Malouff and Schutte Belief Scale (MSBS), 5 subscales from the Survey of Personal Beliefs, and instruments recording depression, anxiety, and neuroticism. As hypothesized, alexithymia and irrational beliefs predicted greater emotional disturbance while also displaying some small positive correlations with each other. In multiple regressions, both types of variables combined to predict emotional disturbance, with alexithymia explaining the greater amount of variance. Alexithymic difficulties in identifying emotions had uniquely negative mental health implications. The MSBS and the Low Frustration Tolerance subscale were the most noteworthy measures of a pathogenic irrationality. These data supported the claim that the unconscious processes of REBT could be conceptualized in terms of alexithymia.     

Gender Differences in Experimental Disclosure: Evidence, Theoretical Explanations, and Avenues for Future Research

Interest in emotional expression is long-standing. Given well-established gender differences in expressivity, it is surprising that researchers have not consistently examined gender as a potential moderator of outcome in the context of experimental disclosure studies. This article comments on Range and Jenkins’ (2010) research recommendations in light of the suggestion that males evidence greater benefit of disclosure than females and three gender theories: gender schema theory, social role theory, and gender socialization theory. Further avenues for research are also presented, including the examination of gender differences in subjective, expressive and physiologic indicators of emotion during disclosure. Such data could elucidate mechanisms by which persons of different genders or persons with different schemata/ social roles/ socialization histories differ on pre/ post disclosure outcomes.     

Integrating Narrative Family Therapy in an Outdoor Behavioral Healthcare Program: A Case Study

Adolescent mental health is a significant societal concern in the United States. Diagnosable mental health disorders have been reported at rates of 10–20 % among children and adolescents and this does not include adolescents experiencing personal and interpersonal distress not meeting diagnostic criteria. Adolescents who do not respond to traditional mental health services are often placed in residential treatment centers or other out-of-home treatment programs. Outdoor Behavioral Healthcare (OBH) is growing as a viable treatment option for adolescents who struggle with emotional, behavioral or substance related problems; however, questions have been raised about how to integrate the family into an OBH treatment setting. This article describes a case study illustrating how techniques from Narrative Family Therapy can be used to accomplish this integration, and offers a view of using Narrative Family Therapy to further involve families in the treatment and post-treatment process in an OBH program.     

Emotional Disclosure in Day-to-Day Living and Subjective Well Being

There is a large body of empirical research on emotional disclosure and its relationship to health and well being. However, emotional disclosure has been examined largely in the context of illness or trauma. Beneficial outcomes of emotional disclosure in day-to-day living have not been consistently observed in non-experimental studies, although a large proportion of individuals do report perceived benefits. The present study aimed at exploring the association of emotional disclosure with selected intrapersonal and interpersonal variables and their role in prediction of subjective well being in day-to-day living. The sample comprised of 209 adults who did not report presence of any major stressor in the recent past. In hierarchical regression analysis, lower affect intensity, higher emotional clarity, lower trait rumination, higher perceived support and higher emotional disclosure predicted higher subjective well being. In addition, trait rumination emerged as a significant moderator of the relationship between emotional disclosure and subjective well being.     

How benefits of expressive writing vary as a function of writing instructions,ethnicity and ambivalence over emotional expression

Written emotional disclosure has been reported to confer a variety of benefits on physical and psychological well-being. However, variable findings suggest that outcomes may vary systematically as a function of specific parameters of the experimental design. This study aims to investigate the unique and combined effects of disclosure instructions focusing on emotional expression and instructions facilitating cognitive reappraisal and to examine how ambivalence over emotional expression and ethnicity moderate the effects of these writing instructions. Seventy-one Asian and 59 Caucasian undergraduates (N = 130) with at least minimal physical or depressive symptoms were randomly assigned to one of the four writing conditions: emotional disclosure (ED), cognitive reappraisal (COG), the combination of ED and COG, or a control condition. Self-reported physical symptoms, positive affect (PA) and negative affect were assessed at baseline and three follow-ups spanning 4 months. Mixed linear models revealed that COG writing reduced physical symptoms, ED buffered a decrease in PA over time, and the combination of ED and COG (i.e. self-regulation; SR) was most effective. Asians and highly ambivalent participants benefited most from expressive writing. Findings contribute to the development of a SR moderator model and carry implications for designing expressive disclosure studies, particularly for ethnic minorities.     

Gender differences in the role of alexithymia and emotional expressivity in disordered eating

Disordered eating habits such as binge-eating, purging, and extreme diet restriction have been linked to a variety of deficits in emotion regulation. Two such aspects of emotion regulation are alexithymia and emotional expressivity, although much of the research is limited to females. This study examines associations between these aspects of emotion regulation and symptoms of bulimia nervosa (BN) in men and women. Participants were 201 female and male undergraduates who completed self-report measures of emotion regulation and BN symptoms. Consistent with prior research, results indicate that alexithymia predicted BN symptoms in females, but not in the presence of emotional expressivity, which proved to be the only unique predictor of BN symptoms. In the male sample, alexithymia predicted BN symptoms over and above emotional expressivity. These findings suggest that BN symptoms in males may partly be explained by one facet of emotion regulation, but they also highlight important gender differences in disordered eating. Future research should further examine the role of emotion regulation in eating pathology in males.     

School-Based Mental Health Services: A Research Review

This paper provides a synthetic review of research on school-based mental health services. Schools play an increasingly important role in providing mental health services to children, yet most school-based programs being provided have no evidence to support their impact. A computerized search of references published between 1985 and 1999 was used to identify studies of school-based mental health services for children. Study inclusion was determined by (i) use of randomized, quasi-experimental, or multiple baseline research design; (ii) inclusion of a control group; (iii) use of standardized outcome measures; and (iv) baseline and postintervention outcome assessment. The application of these criteria yielded a final sample of 47 studies on which this review is based. Results suggest that there are a strong group of school-based mental health programs that have evidence of impact across a range of emotional and behavioral problems. However, there were no programs that specifically targeted particular clinical syndromes. Important features of the implementation process that increase the probability of service sustainability and maintenance were identified. These include (i) consistent program implementation; (ii) inclusion of parents, teachers, or peers; (iii) use of multiple modalities; (iv) integration of program content into general classroom curriculum; and (v) developmentally appropriate program components. Implications of these findings and directions for future research are discussed.     

Loneliness,Interpersonal Distrust,and Alexithymia in University Students1

Loneliness has been linked to emotional knowledge and interpersonal distrust, but it is unknown whether it is mediated or moderated by these variables. Using self‐report measures, the relationship between loneliness, interpersonal distrust, and alexithymia was investigated in undergraduate students (N = 224). Analyses showed a direct relationship between alexithymia and social, family, and romantic loneliness. We also found that interpersonal distrust partly mediates this relationship, and that alexithymia and interpersonal distrust interacted to predict social and family loneliness. These findings suggest that links between the different facets of alexithymia, interpersonal distrust, and loneliness are complex and multifaceted, and they are discussed with regard to interventions for young adults.     

Blood Pressure and Emotional Responses to Stress: Perspectives on Cardiovascular Reactivity

It has long been thought that increases in blood pressure in response to stress are associated with emotional responses to stress. The health implications of such an association are clear; excessive emotional reactivity leads to excessive cardiovascular reactivity (CVR), which is associated with cardiovascular disease. However, the data do not support a strong association between CVR and emotional responses to acute stress. This lack of support has lead to research that interprets CVR to stress in at least three different ways: (1) as a potential contributor to disease development, (2) as an index of active coping, or (3) as a multidimensional construct that is affected by cognitive appraisals of a situation. In this article, we review these separate perspectives on CVR and suggest that a multidimensional perspective of CVR and emotional responding to stress may help integrate the CVR – health, effort, and appraisal points of view.     

WRITING ABOUT EMOTIONAL EXPERIENCES AS A THERAPEUTIC PROCESS

Abstract— For the past decade, an increasing number of studies have demonstrated that when individuals write about emotional experiences, significant physical and mental health improvements follow. The basic paradigm arid findings are summarized along with some boundary conditions Although a reduction in inhibition may contribute to the disclosure phenomenon changes in basic cognitive and linguistic processes during writing predict better health. Implications for theory and treatment are discussed.     

Memory for emotionally provocative words in alexithymia: A role for stimulus relevance

Alexithymia is associated with emotion processing deficits, particularly for negative emotional information. However, also common are a high prevalence of somatic symptoms and the perception of somatic sensations as distressing. Although little research has yet been conducted on memory in alexithymia, we hypothesized a paradoxical effect of alexithymia on memory. Specifically, recall of negative emotional words was expected to be reduced in alexithymia, while memory for illness words was expected to be enhanced in alexithymia.Eighty-five high or low alexithymia participants viewed and rated arousing illness-related (“pain”), emotionally positive (“thrill”), negative (“hatred”), and neutral words (“horse”). Recall was assessed 45 min later.High alexithymia participants recalled significantly fewer negative emotion words but also more illness-related words than low alexithymia participants. The results suggest that personal relevance can shape cognitive processing of stimuli, even to enhance retention of a subclass of stimuli whose retention is generally impaired in alexithymia.     

Action research is formative: research at Saskatchewan Hospital, 1957-61

The author has examined the five lines of research started at a mental hospital between 1957-61 to determine their immediate effects upon practice and subsequent citations in the literature. Three lines of research combining basic and applied studies affected practice and research as measured by literature citations. One line of basic studies of perception and psychopathology influenced research but not practice. Applied studies of perception and psychopathology influenced research but not practice. Applied studies of staff organization had immediate application but disappeared from the professional literature in a short time.