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234 Biobehavioral Resilience to Stress

has also been associated with increased vulnerability to stress-related diseases
as well as adverse outcome in cancer and cardiovascular disease (Cooper
& Faragher, 1992, 1993; Ornish, Brown, Scherwitz, Billings & Armstrong,
1990; Pennebaker, Kiecolt-Glaser & Glaser, 1988; Sapolsky, 1998, 1999; Stein
& Spiegel, 2000).
By focusing primarily on the expressive regulation of negative emo-
tion, the clinical literature has contributed to a polarized portrayal of emo-
tion expression as healthy and of emotion suppression as unhealthy (e.g.,
Consedine, Magai & Bonanno, 2002; Salovey, 2001). The construct of expres-

sive flexibility encapsulates the idea that the expression and the suppression

of emotion each have both costs and benefits. For example, although ver-
bal disclosure of emotionally charged information is necessary at times to
elicit practical and emotional support, it may also incur signifi cant social
and psychological costs depending on what is expressed, to whom, and how
(Kelly & McKillop, 1996; Kennedy-Moore & Watson, 2001). Th e listener may
misinterpret the speaker’s intent or minimize or dismiss the importance of
the information being shared, leaving the communicator to feel rejected and
humiliated (e.g., Lehman, Ellard & Wortman, 1986; Major et al., 1990; Silver,
Boon & Stones, 1983; Silver & Wortman, 1980; Silver, Wortman & Croft on,
1990). In close relationships, the expression of emotional distress can insti-
gate or intensify negative escalation cycles, particularly if the listener per-
ceives that he or she is being blamed (e.g., Gottman & Levenson, 1986; Julien,
Markman, Leveille, Chartrand & Begin, 1994). The duration and intensity

of negative emotional expression tends to increase when negative emotion is
expressed as anger (Ebbesen, Duncan & Konecni, 1975).
The psychological and social implications of negative emotion expression

may differ depending upon personal and cultural standards (e.g., Kitayama
& Markus, 1996; Mesquita & Frijda, 1992; Porter & Samovar, 1998; Surgenor
& Joseph, 2000). For example, in Japan or China, it is considered socially
desirable to inhibit the expression of negative emotion (Markus & Kitayama,
1991; Mesquita, 2001). Thus, while some individuals may feel quite comfort-

able about the expression of negative emotion, others may view it as a shame-
ful lapse in self-control (Kennedy-Moore & Watson, 1999).
There is evidence to suggest that the ability to modify negative emo-

tional expression may support recovery of normal functioning in adverse
circumstances. Bonanno and Keltner (1997) studied reactions to bereave-
ment in a normal population and found that facial expressions of negative
emotion, and anger in particular, predicted a more protracted course of grief
even when initial levels of grief and self-reported emotional experience were
statistically controlled. By contrast, the expression of positive emotion while
relating distressing information about the loss of one’s spouse predicted
reduced levels of grief at subsequent assessments. Recently, researchers have
drawn attention to the adaptive value of positive emotional expression as a

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