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TO THINK OR NOT TO THINK: THE EFFECTS OF EMOTIONALLY CHARGED INTROSPECTION BEFORE WRITTEN EMOTIONAL EXPRESSION OF A TRAUMATIC EXPERIENCE BY ZOE POSNER A Thesis Submitted to the Division of Social Sciences New College of Florida in partial fulf illment of the requirements for the degree Bachelor of the Arts Under the sponsorship of Steven Graham Sarasota, Florida March, 2013
ii Acknowledgements Thank you to my thesis sponsor, Dr. Steven Graham for your continued support and advice throughout my four years here and for making the thesis process as smooth and who have encouraged me to think analytically (but not too much) and to question research. Thank you Pro fessor Hirshfield for inspiring me to pursue a career in Social Work and to view the world in a sociological and psychological lens. I want to thank my good friends Kaly and Erin for always being there for me. Your friendship means the world to me. I also want to thank Colt for helping me get through my last semester. Thank you Julia, Jessa, Em, and Nina for being great friends throughout my time here and for the study parties. Thanks to my roommates Marc and Zoe and the gang for the laughs and the good ti mes that made this year so much more fun. Lastly, I want to thank my family. Thank you mom for being my cheerleader and for offering me words of wisdom and a shoulder to lean on. Your unconditional love and support have helped me get to where I am today. Y role model to me. Xander, you always know how to make me laugh.
iii Table of Contents ACKNOW LEDGMENTS ii TABLE OF CONTENTS iii LIST OF TABLES iv ABSTRACT v INTRODUCTION 1 THE CURRENT STUDY 27 METHOD 31 RESULTS 38 DISCUSSION 42 REFERENCES 52 TABLES 57 FIGURES 60 APPENDIX A: BASELINE MEASURES 64 APPENDIX B: POST TASK M EASURES 65 APPENDIX C: FOLLOW UP MEASURES 69
iv LIST OF TABLES TABLE 1: Means (standard deviations) of dependent measures for Emotional Introspection and Neutral Introspection as an effect of writing across condition 57 TABLE 2: Mean (standard deviation) Positive Affect across Time as a function of Condition 58 TABLE 3: Mean (standard deviation) Negative Affect across Time as a Function of Condition 59
v TO THINK OR NOT TO THINK: THE EFFECTS OF EMOTIONALLY CHARGED INTROSPECTION BEFORE WRITTEN EMOTIONAL EXPRESSION OF A TRAUMATIC EXPERIENCE Zoe Posner New College of Florida, 2013 ABSTRACT The effects of two types of introspection, one emotional and relevant t o writing and one neutral and unrelated to writing, were compared in combination with a ten minute period of written emotional expression about a traumatic life experience. Forty five undergraduate participants were randomly assigned to one of three condit ions: 1) emotional introspection, 2) neutral introspection, or 3) control. Participants in the emotional introspection condition experienced significantly fewer intrusive and avoidant thoughts as compared to participants in the neutral introspection condit ion. Affective scores significantly differed after writing for both introspection conditions but did not surpass that of the control condition at follow up two days later. Writing did not produce significant short term mental health benefits; however, intr ospection seemed to mediate the effect of writing and thus should be included in future studies for additional benefits. Steven Graham Division of Social Sciences
1 out we hold in some feelings and not others? The metaphors of human language are blow off some and to release other emotions. The study of emotional expression traces its origins Studies on Hysteria Over time, psycho logists have made connections between experienced trauma and the development of physical or mental illness. It has been suggested that inhibiting feelings or emotions is detrimental to health in many ways. Thus, whereas inhibition can have negative effects on overall health, emotional expression presumably can counteract these negative effects and promote well being. Inhibition Theory and the Cathartic Method The main premise of inhibition theory posits that inhibition, or the restraint of thoughts and fee lings, requires work. Inhibition forces an individual to consciously exert effort to not think about something, and certainly not to express it in the form of spoken or written language. Over time, this manifests itself in the body or mind in the form of i llness. Inhibition, therefore, is a cumulative stressor and, like other stressors, can break the nervous system. James W. Pennebaker (1990) shed light on the importanc e of disclosing traumatic memories to others and the connection between mind and body. He found that those who had experienced a traumatic event during childhood were more
2 likely to experience health problems as an adult. Notably, the type of trauma exper ienced did not matter. The death of a parent was no worse than a sexual trauma, and vice versa. What mattered most, however, was that those who experienced trauma and also held in their feelings were at the highest risk for negative impacts to long term he alth (Pennebaker, 1990). Essentially, living with the repercussions of an experienced trauma leads to ruminations which continue to stress the individual over time and, consequently, negatively affects health. work of Sigmund Freud. Pennebaker viewed the psychological stress accompanying an experienced trauma in the trauma. According to Freud, emotional inhibition is a determinant in the development of psychological illness. With this presumption, Freud developed abreaction theory which is the belief that a particular affect towards a traumatic event can be abreacted, or released, by way of language. Language takes the place of action and allows us to express reactions. Freud had found evidence for diminishing symptoms following an individual recalling a trauma as well as bringing to the forefront their feelings and emotions, describing them in detail, and expressing them in language. I n other words, the re experience of potentially painful phenomena actually led to the cessation of such negatively felt symptoms. Taken together, it is the persistent reminiscences that cause suffering to an individual who has experienced a traumatic or di stressing event, especially when that event or experience produced memorable feelings of which the individual can still vividly replay (Breuer & Freud, 1957).
3 wn as psychoanalysis came to be known as the cathartic method. This method involved emotional release, or abreaction, of a traumatic memory. By talking about a traumatic event, the individual releases previously repressed, herein referred to as inhibited, thoughts and emotions and subsequently overcomes her trauma. Yet, F future understanding of why individuals suffer from holding in emotions. Emotional Inhibition E motional Inhibition is the purposeful restraint of emotions coupled with the withholding of thoughts related to an emotional experience (Smyth & Pennebaker, 2001). These emotions are felt in response to a traumatic or distressing life event, generally inte rnalized, cumulative, and chronic. Emotional Inhibition occurs when an individual is conscious of his or her emotions but feels unable to express them and, therefore, intentionally restrains these emotions to his or her own mind. In the early work of Penne baker, he noticed immediate physiological changes in those who inhibited emotions including increased perspiration evidenced on hands and feet. He speculated that this increased perspiration was unique to increased stress. Thus, he used the measure of skin conductance, or electrodermal activity, evident in perspiration on hands and feet. This paved the way for measuring physiological responses to stress. Because of the limited research on emotional inhibition, Gross and Levenson (1997) looked at the effect s of inhibition of positive, negative, and neutral emotions. Four short films were shown to participants: first a baseline clip to help familiarize participants with the lab, then a comedic film meant to arouse amusement; a neutral film showing a
4 geometric display, and a sad film showing an upset mother at a funeral. Films were chosen to arouse a single specific emotion and little to no other emotion. Before each film, participants completed a self report measure indicating how they currently felt. Particip ants in the suppression group were instructed to not let their feelings show and those in the no suppression group were given no instructions to suppress or to express. After a one minute period following the film, participants filled out a self report de scribing their emotional responses. A hidden video camera was used to record facial expressions and upper body movement. Emotional response was measured via heartbeat, skin conductance levels, finger temperature and pulse, and respiration. Participants in the suppression condition inhibited the specific emotions evoked by each of the films and exhibited increased overall physiological arousal compared to the no suppression condition. However, those in the suppression condition suppressed their emotions onl y to an extent and some participants could better suppress than others. Nonetheless, suppression of both positive and negative emotions had a clear and immediate physiological effect on the participants, evidenced in increases in body movements, breath, he art rate, and skin perspiration. Furthermore, those in the suppression group reported lower levels of amusement when watching the amusing film in comparison to the no suppression group. Similarly, inhibiting negative emotions is unlikely to help someone fe el better. By inhibiting a negative emotion such as sadness, one is not relieved of that sadness and may even prolong or exacerbate it. In a similar study, Labott, Ahleman, Wolever, & Martin (2010) devised an experiment in which female participants either inhibited or expressed laughter or crying.
5 Pre experiment, participants filled out questionnaires included the Depression Adjective Checklist (DACL), the Profile of Mood States (POMS) and measures of crying and humor coping. Saliva was collected for four minutes to measure the antibody immunoglobulin A (S IgA) in order to calculate physiological immunity. Then, participants were randomly assigned to either an expression condition, an inhibition condition, or a control condition. Using counterbalancing, hal f of the participants in each condition viewed a 28 minute video intended to evoke sadness first and the other half viewed a 28 minute humorous video first. Those in the expression condition were instructed to openly express as much emotion as possible; th ose in the inhibition condition were instructed to inhibit all expression. As participants watched the videos an experimenter observed behaviors through a one way mirror. After each video, participants completed the DACL and POMS, self rated their amount o f laughter and crying, and provided a sample of saliva. Those in the control condition were not instructed to express or inhibit and viewed two 28 minute PBS documentaries. This method exhibited design flaws because of the stimuli used to evoke emotion. N ot all participants in the expression condition cried when watching the sad video. In addition, some participants in the inhibition condition could not entirely inhibit their laughter or crying. Hence, the sample size was small at only 16 participants tota l in the experimental conditions. Salivary antibodies were lowest in the expression condition after crying and highest after laughter. For the sad video, expressive crying produced a significant decline in immunity compared to participants who inhibited c rying. Exposure to the humorous video enhanced immunity in both experimental conditions, especially the expression
6 condition. More negative moods were evident in the expression condition than the inhibition condition. These results indicate suppressed immu nity following crying, suggesting that crying may be detrimental to health, especially if prolonged and repeated. However, these results cannot be said to be conclusive or generalizable because the crying exhibited in this study is different than crying ex hibited in therapy and in a non experimental setting. Crying in therapy is evoked by personal matters and is more intense and timely. Thus, while manipulating and arousing emotions is common in experiments, they may not be representative of true emotions that occur naturally to individuals. For this reason, research has examined naturally occurring emotions regarding a traumatic or distressing life event. In fact, this is the crux of Pennebaker's inhibition theory. In real life, thoughts and emotions norm al to individuals are not manipulated as they are in the laboratory. Thus, individuals must choose whether to express or inhibit a strong emotion. Many of Pennebaker's experiments allowed participants to choose the topic of expression, as opposed to being assigned to write about one specific topic, though this method has also been employed. Yet, Pennebaker was primarily interested in topics that were personally meaningful to an individual and more likely to be inhibited due to their personal and traumatic n ature. He was also interested in the effect of inhibition on health, measured in a variety of ways. To explore whether emotional inhibition is associated with short term immunological effects Petrie, Booth, and Pennebaker (1998) had participants write for 15 minutes for three consecutive days about a traumatic and primarily undisclosed experience without instructions to suppress, and another condition in which participants
7 received the same initial instructions, but then were prompted to suppress what they had just expressed. When the participant thought about what they had just written, they pressed the spacebar on a keyboard. Two control conditions were included in which participants wrote about what they did the day before and then either suppressed thei r thoughts about what they had just written, or did not. At the start of the study, participants filled out a demographic and health behavior questionnaire which asked about sleep habits, alcohol consumption, and exercise. Before each session, all particip ants completed the POMS. Blood samples were taken before and after each writing session to assess levels of circulating lymphocytes (T lymphocytes, T helper lymphocytes, natural killer lymphocytes) which respond to stressors in the body and help regulate i mmunity. Eight weeks later, participants completed the same health behavior questionnaire and rated the degree to which they had thought about what they wrote and how much they talked to others regarding what they wrote. Participants also reported the pos itive and negative effects of the study as well as how happy or sad they felt in the weeks following the study. Writing samples were analyzed for content using the Linguistic Inquiry and Word Count program which categorized words used as negative emotion, positive emotion, overall cognitive processes, insight, and causal. bloodstream. In contrast, writing about an emotional topic increased the total number of lymphocytes. Those who had written about an emotional topic, compared to the control, had more difficulty suppressing their thoughts. Further, those who emoted reported thinking and talking about what they had written more. They also found more meaning in
8 the study and reported tha t the study had more positive effects than did participants in the control condition. They also used more cognitive and positive words than those in the other conditions. These results suggest that suppression, or inhibition, may cause changes to the immun e system that could subsequently affect health. These findings are important determinants of the negative impact of emotional inhibition on health, especially the immune system. Inhibiting emotions, presumably because an individual does not want or does n ot feel able to express such emotions, actually causes these emotions to become more prominent. Because the individual is working to ignore an emotion, that emotion is given precedence and is sustained (Purdon, 1999). Pennebaker bolsters this theory. He cl aims that many of us are prisoners to our own thoughts; when we try to inhibit a thought or feeling that is bothering us, that thought or feeling is more likely to resurface in the mind (Pennebaker, 1990). The work of inhibiting unwanted thoughts or feeli ngs is not an easy task. To explore what occurs when an individual attempts to avoid a certain thought Wegner, Schneider, Carter, and White (1987) instructed one group of participants to describe any current thoughts that came to mind into a tape recorder. Next, participants were instructed to not think about a white bear and to ring a bell if they did. This period was followed by the free expression of thoughts about a white bear. Another group received the same instructions but in the opposite order; thus they initially expressed thoughts and followed this with the suppression of thoughts. Thoughts were expressed more frequently after suppression but not when suppression followed expression. Wegner referred to this the inhibition of thoughts actually led to the
9 recurrence of these intentionally suppressed thoughts, even when the thought was not disturbing or traumatic. These results can be explained by inhibition theory. By actively inhibiting thoughts, the individ uals increased the occurrence and persistence of these thoughts. The same is true when applied to emotions and the inhibition of emotions. Because ruminations or obsessive thoughts generally ignite over a distressing topic, rather than a friendly white be ar, a study by Muris, Mercelbach, Hout, and Jong (1992) examined the effects of inhibition on emotions. Each participant read either an emotional story, in which the main character was responsible for the death of a baby, or a non emotional story in which emotional words had been replaced with neutral words, twice. In all conditions, participants were instructed to try to identify with the main character of the story. Following this, the participants rated the emotionality of the story they had just read. N ext, participants in the suppression conditions were instructed to not think about the story they just read and to press a button every time they did. Participants in the expression conditions were instructed to think about anything they wanted and to pres s a button when they had thoughts of the story. Five minutes later, all participants rated how much they thought they suppressed thoughts regarding the story. This was followed with a five minute expression period, in which participants were free to think or not to think about the story. Next, all participants engaged in a distraction task wherein they viewed neutral slides not related to the story they had just read. This was followed by another five minute expression period. Skin conductance and respirati on were measured at baseline and after the experiment. No differences were found between suppression and expression participants. As would be expected, the emotional story was rated as more emotional than
10 the neutral story. Also, those in the suppression c onditions reported avoiding thoughts regarding the story more than those in the expression conditions. There was a rebound effect only for th e neutral suppression condition. T hose who tried to not have thoughts about the neutral story reported more thought s regarding it in comparison to those who read the same story but could express their thoughts. Thus, the enhanced frequency of thoughts pertaining to the neutral story was evident, but this was not found for the emotional story. Consequently, the suppres sion of emotional material did not have more of a rebound effect than the suppression of neutral the participants had in identifying with the main character of the stories. It may just be that the emotionality of the stories was not enough to produce intrusive or disruptive thoughts. Perhaps if participants had been instructed to suppress or express a personally emotional experience, a stronger rebound effect would h ave been evident. Krause, Mendelson, and Lynch (2003) examined how emotional inhibition of a childhood traumatic event results in and predicts long term psychological distress. Kraus et al. proposed childhood emotional invalidation, or the rejection or di smissal of an emotion by a caregiver, is mediated by emotional inhibition, which predicts psychological distress later in life. To test the plausibility of this mediational model, Kraus et al. used a structural equation modeling (SEM) analysis SEM evaluat es the likelihood of a model regarding the relationships between several variables and evaluates measures related to the constructs used to measure these variables. Measures of emotional invalidation included the Socialization of Emotion Scale and Psycholo gical Abuse Scale. Measures of emotional inhibition included the Ambivalence over Emotional
11 Expressiveness Questionnaire, the White Bear Suppression Inventory, a Coping Styles Questionnaire and the Impact of Event Scale. Finally, to measure p sychological d istress, the Beck Depression and Anxiety Inventories were used. The results supported the proposed model in which childhood emotional inhibition mediates the relationship between childhood emotional invalidation and psychological distress in adulthood. Th e recollection of emotionally invalidating experiences and abuse in childhood was shown to be associated with inhibiting emotions and unwanted thoughts, and with current and long term avoidant responses to stressful situations. It is suggested that emotion al inhibition as a child and as an adult may function as a way of coping with the experience and expression of unwanted emotion. Notably, parental distress was highly correlated with thought suppression, depression and anxiety, and emotional inhibition. Mo reover, emotional inhibition was associated with depressive and anxious symptoms. Males reported more negative emotion socialization experiences than females indicating different reactions from parents in response to a daughter versus a son. This may be a a female more than the same expressions from a male. Thus, while emotional inhibition may be functional as a child in reducing parental distress and rejection, long term emotional inhi bition has negative consequences for the inhibitor. Emotional inhibition is a prominent characteristic of many mental illnesses and may be particularly present in the case of depression, anxiety, and suicidal thoughts. Based on the work of Pennebaker and Freud, inhibition is a health threat and can be cured, per se, by expressing emotions that arise following a traumatic or distressing event. Unfortunately, there is relatively little research on the effects of emotional
12 inhibition on mental health in clini cal samples. Nonetheless there is research suggesting negative effects of emotional inhibition and positive effects of emotional expression. Overall, the inhibition of emotions leads to undesirable health effects if the inhibition is long term. If emotiona l inhibition is detrimental psychologically and physically to the inhibitor, then the opposite, the expression of emotions, may work towards reversing these negative effects. Emotional Expression Contrary to emotional inhibition, emotional expression is t he process whereby an individual discloses their deepest thoughts and feelings in some form of language, whether written or verbal. Emotional expression is not bound to any one medium. Many pay a trained therapist to talk about their issues; whereas, a mul titude of research has been conducted on the benefits of written emotional expression. There are limits to what individuals choose to disclose, however. Pennebaker (1990) has suggested that some traumas or distressing experiences are more likely to be shar ed than others. People are more likely to share experiences regarding the death of a parent than they are regarding the divorce of their parents, sexual trauma, and violence. Furthermore, many feel unable to express emotions that may be perceived by socie ty as socially unacceptable. Lesbian, gay, bisexual, and transgender (LGBT) communities often are forced to inhibit their thoughts and emotions due to social constraints, discrimination, victimization, and stigmatization and thus experience more distress a nd a high occurrence of mental illnesses. In a study by Pachankis and Goldfried (2010), participants were randomly assigned to one of three groups: writing over three days about their most traumatic gay related event; writing over three days about the even t
13 after having read their writing from the previous day; and writing about a neutral topic over three days. Measures of affect, psychological well being, physical health, self concealment, and perceived social support were recorded. Those who wrote about a gay related event were more open about their sexual orientation three months after the study. Those who wrote about more distressing events and reported having a low level of social support benefited the most from the writing exercise. In this way, writi ng can serve as a way to eliminate the social stigma that may be present in face to face interactions when dealing with topics that others may not be comfortable with. Through writing an individual may become more comfortable with issues they are strugglin g with and be more open to sharing them with others in the future. To see if openness of sexual orientation moderates the effect of writing Lewis, Derlega, Clarke, Kuang, Jacobs, and McElligott (2005) had women write about their most stressful lesbian rela ted experience or a control topic. Those who were less open about their sexual orientation reported less confusion and self reported stress two weeks later. Yet, those who were more open reported more distress at follow up. Neither writing condition had an y significant effect toward physical health, contrary to what has been found in numerous other studies, though this study used women of all ages rather than one specific age group. These results support the idea that writing about undisclosed, inhibited to pics is more beneficial than writing about topics that are openly shared with others. Thus, writing may be beneficial in a number of ways and may or may not include direct benefits to physical health. Benefits of Written Emotional Expression
14 Emotional Exp ression is not constrained only to the expression of negative affect. Positive health effects have been found for those who write about an array of negative life experiences with differing degrees of severity. Even writing about an imagined trauma produced the same health benefits as writing about a real trauma and even writing one time for only two minutes produced beneficial health effects (Burton & King, 2008; Greenbu rg, Wortman, & Stone, 1996). Wh e reas Freud is cited as the origin for psychotherapy, or talk therapy, Pennebaker is cited as the father of therapeutic writing. Pennebaker created an expressive writing paradigm consisting of several 15 30 minute writing sessions wherein participants write about their thoughts and feelings towards a stressful l ife event over several days. Pennebaker and colleagues have discovered that this type of writing generally produces positive outcomes including long term decreases in health problems, increased immunity, and better adjustment to college. The reasons for wh y writing produced beneficial health effects are unclear, but many aim to identify moderating factors. A meta analysis by Smyth (1998) confirmed the beneficial health effects of written emotional expression and identified several moderating factors that m ay offer some explanation for why writing is beneficial to health. The meta analysis included 13 the outcome types of physical health, psychological well being, physio logical processes ( heart rate, blood pressure), general functioning (employment, G.P.A) and health behaviors (exercise, drug use). Writing about a trauma resulted in health benefits for the following outcome types: reporte d health, psychological well bein g, physiological func tioning, and general functioning
15 Moderating variables for the overall effect size included a higher percentage of males in the studies and longer periods of time spent writing. Thus, males benefitted more from this writing exercise, a nd longer writing times produced more benefits for the outcome types measured. Overall, the results provide evidence that a written emotional expression task produces significant beneficial health effects for the outcome types measured here, though it incr eased short term distress. The negative short term effects as well as the beneficial long term health effects of writing about negative life experiences are well evidenced, especially in student populations. In another study by Smyth, Hockemeyer, Heron, W onderlich, and Pennebaker (2008), the prevalence, severity, and level of disclosure of negative life experiences among college students was assessed. The majority of college students reported experiencing at least one traumatic event, and even more student s reported experiencing an upsetting academic experience. When the researchers asked students from a different geographic location about their negative life experiences, students from the upper mid west U.S. reported a lower rate of negative life events th an students from the Southwest. These results are revealing and indicate that the prompt used to assess to negative life experiences can make a difference in what students write about and that geographic location may play a role in the number of reported a dverse life experiences. Given that the prevalence of negative life experiences in college students is similar to adult populations, college students are an important population to study and can provide results that can be generalized to public, non clinic al samples. The transition to college is an emotional experience and many students are affected negatively. Those who become depressed during this time generally ruminate on
16 their lives before college; thus, putting those thoughts into words should help an individual overcome them, or at least give meaning to them and possibly accelerate the coping process. To test this Pennebaker, Colder, and Sharp (1990) had college students write about either their transition to college or a control topic. Participants were tested in four waves throughout the fall semester to assess the stage approach of coping (denial, anger, bargaining, depression, and acceptance). This had no effect on measures of health; those who wrote in the beginning of the year showed no signifi cant differences compared to those who wrote towards the end of the year. Those who wrote about the transition to college reported fewer health center visits relative to those who wrote about their day, the control condition. In this case it is likely that assimilation, rather than reduced inhibition, promoted better health effects of writing but writing did not speed up the coping process. Instead, writing seemed to have helped students to reevaluate their thoughts regarding the transition to college. A re evaluation of thoughts regarding a variety of stressful, emotional life experiences can be achieved by writing, but the type of experience may influence the outcome. In a more recent experiment, Lepore and Greenberg (2002) looked at the mental and physic al benefits of expressive writing in response to a breakup with a focus on how this writing affects cognitive processing. Participants were randomly assigned to either write about a relationship break up or to write about non emotional relationship issues. Upper respiratory symptoms were measured as well as mood, cognitive processing, and relationship status and feelings and attitudes towards the ex partner. Those in the experimental condition showed improvements in mood, physical health and social function ing and, notably, were more likely to get back together with their ex than those in
17 the control group. They also did not report an increase in upper respiratory symptoms, did not affect their likelihood of starting a new relationship, the levels of intrusive or avoidance related thoughts, or their feelings and attitudes towards their ex partner As predicted, those in the control group with incomplete cognitive processing, represented by higher occurrences of intrusive and avoidance thought patterns, had short term increases in upper respiratory symptoms. Thus, it is suggested that those in the expressive writing condition who had written about a break up were less suscepti ble, or better able to cope with stress, fatigue, and symptoms of a common cold but this writing have an effect on health and mood it may unpredictably influence actua l behavior they are affected by the writing experience. and Beall (1986) speculated that emotional release via writing about a traumatic personal event would be helpful in decreasing stress and stress related diseases. Moreover, confronting the event should help an individual categorize and start to process the event. Previous research has su ggested that linking thoughts and feelings to a traumatic event may help an individual begin, at least, to come to terms with the event. Over four nights, participants wrote about a personal traumatic event or a trivial topic. The trauma conditions had thr ee levels: trauma emotion in which participants wrote about their feelings, trauma fact in which participants did not write about feelings and only what happened during the event, and trauma combination in which both facts and feelings
18 were recalled. The r esearchers measured heart rate, blood pressure and administered self reports collecting information about mood and physical health. Four months after the experiment, participants again reported on their health; six months after the experiment records were collected from the health center. The short term, immediate effects for the trauma emotion and trauma combination included higher blood pressure and more negative moods, however both groups showed long term benefits such as improved health. Those in the tr auma fact condition did not report being upset by writing while those in the other conditions did. These results suggest that those who wrote about feelings and facts about the experience benefited the most, at least long term, compared to the other condit ions. These results suggest that emotional expression alone, while it may be emotionally arousing, may not be enough to produce beneficial effects of an expression task. Perhaps the combination of emotional expression with cognitive processing may result i n even better outcomes. Many previous studies have hinted at this causal significance, but few have tested it. In a similar study Ullrich and Lutgendorf (2002) predicted that a writing task that combined emotional expression with cognitive processing sho uld produce the most beneficial effects. Participants were randomly assigned to an emotional expression group, a cognitions and emotions group, or a control group. The control group wrote about factually distressing events in the media. Straying from the t radition writing paradigm, the researchers had each group write in a journal over a one month period. Positive growth significantly increased only in the cognitions and emotions group. Those in the emotional expression group reported an increase in illness symptoms while those in the cognitions and emotions group and the control group did not. Notably, neither the
19 cognitions and emotions group nor the control group experienced benefits to physical health. This suggests that journaling about a stressful even t focusing on cognitions and emotions, rather than just emotions, can raise awareness towards that event and lead to a better understanding of it. By explaining and thinking purposefully about a traumatic event, individuals may be better able to organize t heir feelings and thoughts towards it and may develop better coping strategies. If this is true then cognitive processing, or introspection, may also decrease the immediate but short term negative effects of writing about negative experiences. Introspectio n thoughts and feelings; it can take the form of thought for other people, objects, and experiences. Introspection is used in many realms of psychological research, namely attitude research. Simply asking people to think about and explain their attitudes has been found to sway their attitudes (Wilson & Hodges, 1992; Wilson, Kraft, and Lis le, 1990). Introspection has been shown to alter attitudes in a number of studies. In a study of undergraduates in dating relationships Wilson and Kraft (1993) recorded initial s thereafter, participants either listed reasons for liking their romantic partner or listed reasons for choosing their college major, the control condition. In the first week those who introspected about reasons began listing reasons that were inconsisten t with their initial reasons listed and changed their attitudes accordingly. This attitude change persisted and, strikingly, the control group also changed their attitudes at an increasing rate throughout
20 the four weeks. What this study suggests is that th thoughts to better fit the attitude implied by their reasons. However, because the study took place over four weeks, it could be the passage of time that led to attitude c hange rather than introspection; Thus, studies that do not take place over time but still implement introspection are common. Wilson and Schooler decisions. In one study, undergraduate participants were asked to think ab out and list their reasons for why they liked or disliked jams that they had just tasted that were also rated by trained taste experts. A control condition also tasted the jams but completed a filler questionnaire which asked participants to list the reaso ns for choosing his or her college major with no reasons analysis. All participants rated how much they liked the thought about why they liked the jams changed how th ey evaluated the jams and adopted the attitude consistent with their reasons, even though they were different from the In a second study, participants listed reasons for choosing to take a course while also considering alternative factors such as the time the course meets. Participants received descriptions of nine Psychology courses and were randomly assigned to one of three conditions. In the rate all condition participants were asked to think about each piece of information given for th e course and then rate how it influenced their decision to take each of the course s Those in the reasons condition analyzed and listed reasons for wanting or not wanting to take a course. Those in the control condition read the course information and rec eived a filler questionnaire asking about issues relating to the
21 university. All participants rated how likely they were to take each course and then filled out a recall questionnaire, which instructed participants to write as much information about the co urses as they could remember. Participants gave permission for the researchers to contact the registrar in order to determine the courses for which each participant had registered. Faculty members rated how important each piece of course information was to the student. Participants in the rate all condition differed significantly from the control condition in recall and how important they rated the course information. Further, participants in the rate all condition were less likely than the control conditi on to produce ratings that were consistent with the ratings of the faculty members and less likely to register for the courses that students who had previously taken the course said were the best courses. A similar effect was found for participants in the reasons analysis condition. These results suggest that analyzing reasons may lead to an individual focusing on aspects that are not as important as others and subsequently using these aspects to form preferences and decisions that may not be optimal. Take n together, these similar results of studies examining the effects of listing and analyzing reasons may suggest that the more we think about a topic we already have mixed feelings about or a topic we are certain in our feelings about, the easier it is to o ffer ourselves alternative explanations for why we feel a certain way towards an individual, towards a personal choice, or towards food and objects. With regard to a personally experienced traumatic event, the reasons for feeling a certain way may be more difficult to understand.
22 Alternatively, introspection towards the self rather than others or objects may increase self insight. Hixon and Swann (1993) hypothesized that introspection towards the self should be beneficial because the information is self rel evant and accessible, and therefore, thought sh ould promote rather than hinder self insight. In one experiment, participants were pretested on how sociable they perceived themselves with favorable and unfavorable feedback. Favorable feedback was described as rating oneself highly in terms of s ociability, likability, and interestingness on the Texas Social Behavior Inventory (TSBI). Unfavorable feedback was described as rating oneself low on the TSBI. Participants had either a negative or positive self conc ept and either a high or low level of self reflection. In a low reflective condition, participants judged the accuracy of the feedback for 10 seconds, and those in the high reflective condition did so for 45 seconds. Female participants were asked to revie w two evaluations (favorable or unfavorable) containing ratings of how sociable, likable, and interesting they perceived themselves to be and then rated the accuracy of their evaluations. Participants with negative self concepts in the high reflective cond ition were less likely to differentiate between the two evaluations than participants in any of the other conditions. Thus, those with negative self concepts in the high reflective condition accepted unfavorable feedback as accurate. In a second experiment assessments on five personality reflected or did not. Those who did not reflect rated themselves as more sociable and artistic but not
23 more intelligent, attractive, or athletic. Participants in the high reflective condition agreed Finally, in a third experiment, the type of reflection was investigated for participants wit h low self reflection did not affect one's tendency to judge the favorable evaluation more accurately than the unfavorable one. However reflection affected how accurately participants favorable evaluation was more accurate than the unfavorable one. As with the first two exp eriments, these results suggest that self reflection may increase self knowledge when the type of reflection is focused rather than analytical. In accordance with previous research on introspection, thinking about why one is the way they are may disrupt in sight awareness, especially when the thinker has a negative self conception. Thus, certain types of introspection are more beneficial than others. Because thinking about reasons for liking something or someone has shown to be disruptive t examined how knowledge of the attitude object may moderate this effect. In a reasons condition, participants listed reasons for liking or disliking a presidential candidate of the time, Walter Mondale. Those in the control condition completed a filler questionnaire to political topics have changed over time. Attitudes and behaviors were measured as well as knowledge of the candidates. Attitude behavior consistency was determined by the attitude one held towards Mondale and the number of Mondale fliers participants took at the end of the study. Analyzing
24 reasons reduced attitude behavior consistency for unknowledgeable participants but n ot for knowledgeable participants. Those who were more knowledgeable had more extreme attitudes and listed more consistent reasons for liking Mondale than those who were less knowledgeable. These results suggest that knowledge of the topic at hand moderate s the effects of thinking about reasons in regards to attitude behavior consistency. If one is knowledgeable about a topic, especially if it is self relevant, they should be less likely to change how they feel about said topic, even after introspection. I ntrospection about negative life experiences Post traumatic stress disorder (PTSD) can be considered a type of overactive introspection in which thoughts or images of a traumatic event occur persistently. This dysfunctional thinking style, evident in rumin ations, is characteristic of individuals who have experienced a traumatic or distressing life event. However, there may be functional and dysfunctional forms of ruminative thinking that may account for why some people do not develop PTSD and why others con tinue to struggle with ruminative thoughts. In a recent study, Santa Maria, Reichert, Hummel, and Ehring (2012) examined the effects of abstract evaluative thinking compared to concrete experiential thinking on ruminative memories for undergraduate partic ipants who had experienced a negative life event within the past five years. Abstract evaluative thinking was defined as ruminative the event and the gap between the cu rrent and the desired outcome. Concrete experiential awareness of the feelings and thoughts associated with the experience of the event.
25 Participants were first given a sympt om provocation task and asked to remember allowing the imagery and emotio ns to come to mind. This task was repeated after the experiment. Next, participants were randomly assigned to write in either an abstract evaluative or in a concrete experiential way, which was prompted by questions that induced the participant to think a bout their negative experience in either an abstract or concrete way. Participants wrote on a computer for 15 minutes each and text was analyzed using the Linguistic Inquiry Word Count (LIWC) program. Using an adapted version of the Intrusions Questionnair e, intrusive memories were assessed. Intrusive memories were also assessed 12 and 36 hours after the writing session using three que stions from the Impact of Event Scale. Negative mood was measured with the Positive and Negative Affect Schedule (PANAS) and ruminative negative thoughts were measured with the Ruminative Responses Subscale of the Response Style Questionnaire and with the Perseverative Thinking Questionnaire (PTQ). Resting heart rate was measured throughout the experiment. Abstract evaluative processing led to more persistent intrusive memories than did concrete experiential processing. Participants in both groups experienced a decrease in intrusive memories from the 12 to 36 hours after the experiment, but those in the concrete experiential g roup had significantly fewer intrusive memories. These results support the idea that the way one thinks about a negative life event is critical to whether this way of thinking is functional or dysfunctional. Thinking about a negative life event
26 in an abstr act, non experiential way may prolong post traumatic stress symptoms whereas thinking about the event in a sensory, experiential way may decrease these symptoms. It is notable that the two conditions did not differ in mood after the writing task; thus, the effects of different types of thinking on the maintenance of intrusive memories cannot be said to be affected by mood. While writing about a personally experienced event may be beneficial by itself it is the type of thinking that goes into the writing tha t ultimately determines the outcome of the writing. Writing about traumatic experiences has been shown to reduce distress, negative affect, and depression over time. But, what about simply thinking about a traumatic event? Lyubomirsky, Sousa, and Dickerho of (2006) proposed that thinking about a traumatic event would not be as beneficial as writing or talking about the event. Lyubomirsky et al. randomly assigned participants to either a written, verbal, or thought condition in which participants wrote, spok e into a tape recorder, or thought for 15 minutes about a traumatic experience over three consecutive days. A comparison group that did not engage in any manipulation was also included as a control. All groups filled out questionnaires measuring life satis faction, affect, and physical health. The three experimental groups also completed questionnaires assessing their worst life experience. After the experimental conditions, as a manipulation check, participants indicated how many of the last 15 minutes they spent focusing on the task given. Four weeks after the experiment, participants completed the same outcome measures. Participants in the thought condition spent the most time thinking about a tr aumatic experience compared to those who wrote or talked abou t a traumatic experience. Participants rated their worst life experiences as extremely upsetting and very
27 significant to them. Those in the thinking condition reported decreased life satisfaction in comparison to the other conditions. Interestingly, no sig nificant group differences were found regarding affect, contrary to predictions, though it should be noted that affect was measured four weeks after the experiment as opposed to immediately afterwards. As indicated by Health Survey scores, those in the thi nking condition reported decreased overall health and mental health compared to the writing and speaking groups, but not to the comparison group. In contrast, those who wrote or talked about their worst life experience reported improved well being and heal th relative to the thought participants. These results support previous research findings showing written emotional expression is beneficial to overall health. However, this method of thought alone without expression seems particularly contrived. It seems obvious, based on previous research, that thinking about a bad experience and not expressing it (i.e. emotional inhibition) will arouse negative emotions, which may then result in decreased health, mood, and so on. Thus, it should be interesting to assess the effects of thinking in combination with different means of emotional expression on psychological measures. The Current Study Constraining strong emotions and feelings has been shown to negatively impact physical and mental health due to the increased stress placed on an individual. Emotional inhibition predicts long term psychological distress (Krause et al., 2003) and reduces immune system function resulting in increased susceptibility to illness (Petrie et al., 1998). In contrast, written emotional expression offers numerous benefits including reduced health center visits, improved immune system functioning (Pennebaker & Beall,
28 1986), fewer intrusive and avoidance symptoms, and better mood (Baikie & Wilhem, 2005). When an individual attempts to inhi bit or suppress negative thoughts or feelings, a rebound effect occurs and these thoughts and feelings intensify and become even more difficult to suppress (Wegner et al., 1987). Moreover, the way a person thinks about a distressing experience influences how they are affected by it. Ruminative thinking about negative experiences or feelings has been shown to increase symptoms of stress while thinking aimed at recalling the facts and feelings associated with the experience has been shown to decrease symptom s of stress (Santa Maria et al., 2012). Finally, thinking negatively about the event, without expressing such thoughts, results in decreased life satisfaction (Lyubomirsky et al., 2006). Similar results have been found for those who attempt to analyze thei r reasons for liking others, food items, or posters (Wilson, Kraft, & Dunn, 1989; Wilson, Lisle, Schooler, Hodges, Klaaren & LaFleur, 1993; Wilson & Schooler, 1991). Thus, thoughts and feelings about a negative life event need to be controlled by a specifi c processing mode before being expressed in writing in order to avoid ruminative thinking Hence, the current study combines different emotional tones of introspection with written emotional expression. In this way the effects of emotional introspection ca n be compared to neutral, unemotional introspection when combined with an emotional or neutral writing task on measures of affect, mood, and intrusive and avoidance symptoms. Because emotional expression independent of thought and thought independent of em otional expression produce different effects, emotional expression combined with a period of emotional introspection should result in increased positive affect two days after the written expression task. The current study aims to explore the short term
29 psy chological effects, as opposed to the well studied physical health effects, of written emotional expression. The preponderance of previous research on the health benefits of emotional expression has relied on concrete physical health measures such as the n umber of health center visits, self reports of physical symptoms, and mildly intrusive measures of immune functioning such as blood samples, perspiration, and heart rate. A limited number of studies have looked specifically at how emotional expression infl uences mental health and even fewer have considered the link between introspection and emotional expression. Can a one time emotional expression task that involves thinking beforehand produce short term psychological benefits to an individual who has expe rienced a distressing event? Moreover, what are the effects of different types of introspection on a written emotional expression task? Research by Pennebaker has concluded that emotional expression produces short term increases in negative affect but lon g term decreases in health problems (Pennebaker & Beall, 1986; Pennebaker & Susman, 1988). However, the effects of emotional expression on short term measures of affect are lacking evidence. Based on these previous findings, emotional expression should pr oduce an increase in negative affect immediately following the expression task, but negative affect should decrease over time. Emotional expression of a distressing event should be most beneficial when an individual processes these memories into more meani ngful thoughts by way of introspection. Putting troubling thoughts and feelings into language, especially those that one may not
30 the negative affect of the writing t ask has subsided, and especially for participants who engage in a brief period of emotional introspection. No previous research has included introspection as a moderator of the effects of written emotional expression. For this reason, the current study e mploys a method similar to Pennebaker's (1990) original expression paradigm in which participants are instructed to write for a total of 10 minutes about a traumatic or distressing event that has impacted the individual. However, the main difference here is that participants in an emotional introspection condition will partake in a brief period of purposive, emotional introspection before the writing task. A non emotional introspection condition will write about the same emotional topic but engage in a bri ef period of introspection about a neutral, unemotional topic that is unrelated to the writing prompt. A control group will engage in the same period of neutral introspection, and then write about their time management on the weekdays as compared to the we ekends, a non emotional topic. Participants will complete measures of affect before, immediately after, and two days after writing. Experimental participants will complete a measure of subjective distress in relation to the event they have just expressed. The current study hypothesizes that written emotional expression alone is not enough to produce short term psychological health benefits, rather, written emotional expression combined with purposive, emotional introspection should allow an individual to h ave more time to process and organize their thoughts about the traumatic, upsetting experience they choose to write about. Further, participants who engage in emotional introspection may experience an increase in positive affect two days after writing once negative affect has subsided. In this way introspection related to the writing topic should
31 aid in this progressive increase in positive affect. Initially negative affect should increase for both experimental conditions immediately after writing but shoul d decrease two days later. Method Participants Forty five participants were recruited from a small liberal arts college in southwestern Florida. The sample consisted of 11 males, 33 females, and one person who o 22 with a mean age of 20.13. Participants were recruited through an advertisement posted on campus and on an online forum. The advertisement asked participants to be 18 or older and current students in order to participate. The advertisement also stated that students would receive five dollar gift cards to an on campus caf for their participation. Contact information of the experimenter was provided in order to set up times to participate in the experiment. All participants returned for the second part o f the experiment. Materials Measures. Positive and Negative Affect Schedule The Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) measures the current mood of participants. Ten positive and ten negative emotion items are in cluded. Participants indicate on a scale of 1 ( very slightly or not at all ) to 5 ( extremely ) the degree to which they have experienced each emotion. The PANAS has been used to measure affect in the current moment, on one day, in the past few days, in the p ast week, in the past few weeks, in the past year, and on average. Watson et al.
32 .86 to .90 for the Positive Affect scale and .84 to .87 for the Negative Affect scale. F or the general period, alpha was .88 for Positive Affect and .87 for Negative Affect. Positive Affect assesses the degree to which a person feels active and enthusiastic. Low positive affect is characterized by sadness and low energy. In contrast, negativ e affect assesses subjective distress. Low negative affect indicates the individual is calm. Whereas sadness can be derived from this scale, happiness is not strictly measured. Thus, in the current study, three items ( happy, cheerful, joyful) from a specif ic positive affect scale, Joviality, were included. Watson et al. (1994) have demonstrated high reliability of this scale with a Cronbach's alpha ranging from .88 to .94. Further, to ensure consistency, three items measuring basic negative emotions ( sad, b lue, lonely) were included, as verified by Watson et al. (1994). Thus, the final scale consisted of 26 items. For the current study, the PANAS was administered three times: before writing, immediately after writing, and two days after the experiment. Thu s, the directions were s of measurement, respectively. Participants indicated on a scale of 1 ( not at all ) to 7 ( very much ) how often he or she had experien ced each emotion. See Appendi ces A C for full measure. Ratings. After the written expression task, all participants comple ted a one question scale measuring current mood on a scale of 10 ( very negative mood) to +10 ( very positive
33 mood) A similar scale has been used as part of the Brief Mood Introspection Scale (Mayer & Gaschke, 1988). This was included in the current study along with the PANAS in order to get the most accurate mood of the participant immediately after the writing task. See Appendix B for full measure. Additionally, following the writing task, all participants rated on a scale from 10 ( Not at all emotional ) to +10 ( very emotional) how emotional they perceived their writing to be. This was included to examine group differences in the emotionality of ea ch writing topic. See Appendix B for full measure. Impact of Event Scale Revised The Impact of Event Scale measures subjective distress in regards to a stressful life event. Horowitz, Wilner, and Alvarez (1979) conducted in depth interviews of psychotherapy patients to assess common responses a person has after experiencing a stressful life event. The most com monly experienced responses include intrusive and avoidant thoughts. Thus, the scale includes seven intrusive statements ( I thought about it and eight avoidant statements ( I tried not to think about it) which combine to form a total subjective stress score. Horowitz et al. (1979) determined each subscale as highly reliable in a clinical population. The scale has also been used in non clinical populations with a high test retest reliability of .87 on scores of total stress. In the cu rrent study, experimental participants indicated the frequency with which they experienced each of the difficulties listed on a scale from 1 ( not at all) to 7 ( often) in relation to the emotional event about which they had just written. To ensure
34 confident iality of personal information, participants were not asked to list the difficult event. See Appendix B for full measure. Manipulation Check A manipulation check asked participants in each condition to indicate how much time each participant spent thinkin g about his or her assigned topic. Since five minutes were allotted for introspection, participants circled one number from 1 to 5, or indicated that they had not spent any time thinking about the event. See Appendix B for full measure. Demographics. Demo graphics were collected at the end of the experiment. A short questionnaire asked participants to indicate their gender and age. Writing task. For the writing task, all participants were given a pen and five sheets of lined paper to write on. The writing prompt was provided to participants in a sealed envelope to assure the experimenter was blind to condition. All instructions were provided in print. Procedure Upon arrival, each participant was greeted by the experimenter and seated at a study carrel in a quiet study room. The experimenter tested each participant individually. Participants were informed that the study may involve writing about an emotional experience, and that they may choose not to participate, and may stop at any time. Written informed consent was attained before beginning the experiment. Each participant
35 was handed a large envelope containing the contents of the experiment and instructed to open it and to only focus on the top page until instructed to proceed. First, to assess baseline mood, all participants were given the Positive and Negative Affect Schedule (PANAS). Next, participants engaged in a brief period of introspection. Introspection Manipulation. Participants were randomly assigned to one of three conditions: emotional intro spection, neutral introspection, or a control. The experimenter instructed each participant to read their assigned prompt and think about the prompt for the next five minutes. The experimenter set a timer for five minutes and sat out of view of the partici pant. This ensured that the experimenter was blind to the condition assigned to the introspection condition were given a prompt with the following instructions: For the next 5 min utes please think about the most traumatic, upsetting, or intrapersonal (a conflict with yourself, for example) or interpersonal (a conflict/experience with friends, family, or si gnificant others, for example). It can be related to academics or your college career. It can be something that has not directly happened to you but it must in some way have impacted you (death of a something you have had to deal with and that you feel has impacted you. Ideally, this topic should be topic should be one that still bothers you at some level and that you still think
36 about from time to time. The most important aspect is that the topic is personally meaningful for you. Take this time to really think about and organize your thoughts on this issue. In other words, identify what experience really impacted you and t he feelings and thoughts associated with it. Participants in both the neutral introspection and control conditions engaged in a five minute period of introspection but were instructed to spend that time thinking about the foods they had eaten recently. Af ter five minutes, the experimenter alerted the participant that time was up and gave the participant a one item manipulation check. This was given to all participants to determine how many of the past five minutes each participant had spent thinking about their assigned topic. Emotional Expression task. Then, the next instructions included the writing prompt: Now that you have thought about an upsetting experience, please take the next 10 minutes to write down your thoughts. Please write about the most ups etting experience you have just thought about. Your response will not be read. Do not worry about spelling or grammar. It is critical that you explore and write about your deepest thoughts and feelings related to this stressor and really let go of the th oughts you have just brought to mind. You can start off listing thoughts and feelings, but please try to tell a story with your time. Experimental participants were asked to try to tell a story in order to help organize their writing about a complex emotional experience, which may help to integrate thoughts and
37 feelings about the event (Pennebaker & Seagal, 1999). The writing prompt for the neutral introspection condition was ide ntical, with the exclusion of any reference to thought. At that point, the experimenter left the room for 10 minutes in order to enable the participant to write freely and comfortably. The experimenter returned after 10 minutes and the participant stopped writing. Finally, each participant completed the remainder of the packet which included the PANAS, Impact of Event Scale, a current mood rating, and a measure of the emotionality of their writing. Before leaving, the participant discarded their writing. The control condition followed a similar procedure. Participants in the control condition received the following instructions: Please take the next 10 minutes to write about how you manage your time on the weekdays compared to the weekends. Write about th e facts only. Please try to answer as factually as you can without thinking too much about your response. Your response will remain anonymous. Do not worry about spelling or grammar and write until 10 minutes is up. This writing prompt was intended to be non emotional, so that only the experimental conditions were engaging in emotional expression. Control participants completed the PANAS, a current mood rating, and a measure of the emotionality of their writing. Finally, two days after the writing task, a ll participants returned to the same room at a scheduled time and completed the PANAS and a short demographics questionnaire. Participants were thanked, debriefed and told of the nature of the study. The experimenter made sure participants felt comfortabl e and at ease with the experiment
38 before leaving. Contact information for the on campus Counseling and Wellness center was provided and participants were given their gift card. The total procedure took around 25 minutes. Results All 45 participants compl eted the entirety of the experiment. Descriptive statistics show that all participants spent approximately the same amount of time thinking about their assigned introspection prompt, but participants in the emotional introspection condition spent the most time ( M = 3.60, SD = 1.45). This difference, however, was not significant ( F (2, 42) = .52, p =.601 ). In order to determine how emotionality differed across condition as a result of writing, a one way ANOVA was conducted. See Table 1 for all means and sta ndard deviations of the dependent variables across condition. There was a significant difference between emotionality and condition ( F (2, 42) = 11.66, p < .001 ) such that mean emotionality significantly differed as a function of condition. A post hoc anal emotional introspection ( M = 2.87, SD = 5.08 ) and neutral introspection ( M = 4.80, SD = 4.41 ) conditions rated their writing as significantly more emotional than did participants in control condition ( M = 3.33, SD = 4.94 ). However, while mean emotionality was higher for participants in the neutral introspection condition ( M = 4.80, SD = 4.41 ) than it was for participants in the emotional introspection condition ( M = 2.87, SD = 5.0 8 ) this difference was not statistically significant. See Figure 1 for a graph of the mean mood, emotionality, and time scores across condition. This indicates that participants who wrote about their most upsetting experience, regardless of the type of i ntrospection performed beforehand, rated their writing as significantly more emotional than the control condition.
39 To assess how mood was affected immediately after writing, all participants rated their current mood on a scale of 10 to 10 with 10 being the best mood. A one way ANOVA comparing mood across condition indicated significantly different mean mood scores for emotional introspection participants ( M = 1.40, SD = 4.12 ) compared to participants in the neutral introspection condition ( M = .60, SD = 4.34 ) and control condition ( M = 2.40, SD = 3.35 ); ( F (2, 42) = 3.84, p = .029). A post hoc analysis using condition were significantly lower than mean mood scores for the con trol condition, but neither condition significantly differed from the neutral introspection condition. This indicates that participants who engaged in a period of emotional introspection before writing had the worst mood immediately after writing, relevan t to the control condition. Positive and Negative Affect The second set of analyses run investigated whether or not there was a significant shift in positive and negative affect scores over time across condition. The GLM repeated measures procedure was us ed for positive and negative affect, respectively. See Table 2 for all means and standard deviations of positive affect across time. See Table 3 for all means and standard deviations for negative affect across time. In order to determine if there was a si gnificant shift in affect, positive and negative affect for the emotional introspection, neutral introspection, and control conditions were compared across Time 1 (baseline), Time 2 (post writing) and Time 3 (2 days post writing). There was a non signific ant interaction between condition and time (Time 1) on positive affect ( F (2, 42) =1.49 p = 2.36) such that baseline positive affect was comparable for participants in the
40 neutral introspection condition ( M =4.7, SD = .801) to participants in both the emot ional introspection ( M =4.5, SD = .623) and control conditions ( M =4.05, SD = 1.38). There was a significant interaction between condition and time (Time 2) on positive affect ( F (2, 42) = 4.109, p = .023) such that mean positive affect scores for each cond ition significantly differed. A post hoc comparison using the Tukey HSD test determined a significant difference in mean positive affect scores immediately after writing between the neutral introspection ( M = 2.62 SD = 1.10 ) and control condition ( M = 3.6 5 SD = 1.177 ). While mean positive affect did decrease at Time 2 for the emotional introspection ( M = 2.87 SD = .73 ) condition, this was not significantly different from the control condition. There was no significant interaction between condition and t ime (Time 3) on positive affect ( F (2, 42) = .040, p = .96 ) such that positive affect as measured two days after the writing task did not significantly differ for participants in the emotional introspection condition ( M = 4.21 SD = .61 ) the neutral intros pection co ndition ( M = 4.12 SD = .94 ) and the control condition ( M = 4.19, SD = 1.43). See Table 2 for a graph of mean positive affect scores across time for each condition. This indicates that, regardless of condition, all participants had similar increa ses in positive affect between Time 2 and Time 3. Similarly, there was no significant interaction between condition and time (Time 1) on negative affect ( F (2, 42) = 2.12, p = .13) such that negative affect, as measured at baseline, did not significantly differ across the emotional introspection ( M = 2.94, SD =
41 .92) neutral introspection ( M = 3.34, SD = .94) and control ( M = 3.62, SD = .84) conditions. There was a significant interaction between condition and time (Time 2) for negative affect ( F (2, 42) =1 3.39, p <.001 ) such that the mean negative affect scores for each condition significantly differed from each other after writing. Post hoc comparisons using the Tukey HSD test indicate that the mean negative affect score at Time 2 significantly increased for both the emotional introspection ( M = 3.23, SD = .92 ) and neutral introspection ( M= 3.68, SD = 1.17) conditions as compared to the control condition ( M= 2.02, SD = .52 ) scores which, in contrast, significantly decreased. This indicates that both experi mental conditions significantly increased in negative affect immediately after writing, but the opposite was true for the control condition. There was no significant interaction between condition and time (Time 3) for negative affect ( F (2,42) = .012, p = .99) such that negative affect as measured two days after writing was similar across condition. The means that the emotional introspection ( M = 2.62, SD = .71), neutral introspection ( M = 2.67, SD = 1.09) and the control ( M = 2.65, SD = .90) condition were nearly equal. See Table 3 for mean negative affect scores across time for each condition. This indicates that the final negative affect scores for all conditions did not differ from each other, regardless of the type of writing. Impact of Event Scale Re vised An independent samples T test was run in order to determine the difference in intrusive and avoidant symptoms in the two experimental conditions: emotional introspection and neutral introspection. There was a significant difference in mean
42 intrusive scores across condition ( t (28) = 2.30, p = .029) such that participants in the emotional introspection condition had significantly lower mean intrusive scores ( M = 2.53, SD = 1.51) than did participants in the neutral introspection condition ( M =3.70, S D = 1.27). See Table 4 for a graph of mean intrusive and avoidant scores for each experiment condition. Similarly, there was a significant difference across condition for mean avoidance scores ( t (28) = 2.61, p =.014) indicating that participants in the emotional introspection condition had significantly lower mean avoidance scores ( M =2.51, SD = 1.46) than did participants in the neutral introspection condition ( M =3.98, SD = 1.61). These results suggest that participants who engaged in emotional intro spection about an upsetting event before writing about it rated their upsetting life event as inflicting significantly fewer intrusive and avoidance symptoms than did participants who engaged in unemotional introspection. Discussion The findings of the cu rrent study partially support the hypotheses. Participants in the emotional introspection and neutral introspection conditions both experienced a significant increase in negative affect after writing about an upsetting life experience, as compared to parti cipants in the control condition. However, this increase in negative affect did, as predicted, dissipate over a short period of time. Contrary to prediction, regardless of the type of introspection, participants who wrote about an ups etting life experience had similar positive and negative affect scores as participants in the control condition as measured two days after writing.
43 Interestingly, participants in only the neutral introspection condition experienced a significant decrease in positive affect aft er writing, compared to the control participants. Although participants in the emotional introspection condition experienced a decrease in positive affect following written emotional expression, this decrease was not significant. Thus, written emotional e xpression had an immediate negative effect on experimental participants, especially participants who engaged in neutral introspection, evident in significantly more of a decrease in positive affect than participants who engaged in emotional introspection. Participants who engaged in a five minute period of intentional, emotional introspection experienced less of a decrease in positive affect after writing perhaps because introspection allowed them time to process their thoughts and benefit more from the wr iting exercise. While these results confirm the primary hypothesis, the secondary hypothesis that emotional introspection participants should benefit most from the writing exercise, as evidenced by higher positive affect scores at follow up as compared to the other conditions, was not supported. Positive and negative affect scores measured two days after the writing task were nearly equal for all conditions. Thus, while written emotional expression produced initial short term effects consistent with previou s research an increase in negative affect and a decrease in positive affect affective scores two days after writing were no higher for either of the introspection conditions as compared to the control condition. While negative affect decreased and positi ve affect increased from time 2 to time 3 for both experimental conditions, this effect was not more pronounced, as was predicted, for participants who engaged in emotional introspection. Engaging in either emotional or neutral introspection did not influe nce affect scores at follow up.
44 Additionally, as indicated by the manipulation check, all participants spent approximately the same amount of time thinking about their assigned introspection prompt. As measured immediately after writing, participants who engaged in five minutes of emotional introspection had the lowest mood compared to participants who engaged in neutral introspection. While there were no hypotheses regarding emotionality it is notable that participants who engaged in neutral introspection before writing, rated their writing as the most emotional compared to participants in the other conditions. Participants who engaged in emotional introspection rated their writing as more emotional than participants in the control condition, but not signi ficantly so. In terms of the IES, experimental participants as a whole did not rate their upsetting life event as highly distressing. However, in comparison to participants who engaged in neutral introspection before writing, participants who engaged in e motional introspection experienced significantly fewer intrusive and avoidance symptoms in regards to the upsetting event they chose to write about. Written Emotional Expression Research The results of the current study somewhat parallel those found in p revious studies on written emotional expression. An increase in negative affect after writing about an meta analysis that found an increase in distress after writing. Yet, as Smyth noted, this increase in distress was unrelated to health outcomes. Concurrently, this is in line with previous research by Pennebaker and Beall (1986) who found that participants who wrote about the facts and feelings associated with a traum a, and those who wrote strictly about
45 feelings associated with a trauma experienced decreased mood after writing (as was found for emotional introspection participants) and increased anxiety and depression, but long term health benefits. The results of th e current study mimic those of Lyubomirsky et al. (2006) who found no significant group differences in affect at a four week follow up among participants who thought, wrote, or spoke about a traumatic event. However, unlike the current study, Lyubomirsky e t al. (2006) also measured physical health and found positive long term benefits for those who wrote or spoke about a traumatic event. task that spanned four days and the current study involved writing only once, similar patterns occurred. Emotional writing produced an immediate increase in distress, as evidenced by higher negative affect scores, but distress subsided with time. However, it is difficult to suggest that short term mental health improved because affective scores of both conditions who wrote about a traumatic topic did not surpass those of the control condition; on the other hand, emotional introspection participants experienced fewer intrusive and avoidance symptoms after writing, though this is most likely attributable to the type of introspection performed before writing. Furthermore, because participants did not rate their most upsetting life event as extremely distressing they may not have benefited as much from the writing exercise. This is in accordance with the results of Pachankis and Goldfried (2010) who found that those who wrote about more distressing events and who had less social support benefited the most from the writing exercise. Perhaps college partic ipants in this sample did not
46 have a high occurrence of negative events, or they may have already worked through them (as one participant mentioned when providing feedback at the completion of the study). Additionally, participants in this sample came from a supportive and generally accepting community with access to counseling services and, consequently, may have been more open to disclosing their upsetting life events to others rather than inhibiting them. This is in line with the results of Lewis et al. (2005) that suggest that writing about undisclosed, inhibited topics is more beneficial than writing about topics that are openly shared with others. As Smyth et al. (2008) found, the writing prompt used greatly influences results. While the current study original writing instructions the benefits of writing about an emotional topic were not participants to write about thei r most traumatic or upsetting life event; perhaps this language influenced what participants wrote about. Participants may have had several upsetting events, but they may not have considered them to be traumatic. Nonetheless, while writing may not have re sulted in significant health benefits, introspection that was purposive and emotional positively impacted participants. Introspection Research The results of the current study support the research on introspection that suggest that the type of thinking, o r processing mode, can have differential effects. Emotional introspection resulted in significantly fewer intrusive and avoidance symptoms than neutral, unrelated introspection before written emotional expression. Because emotional introspection was focus ed and intended to orient the participants, these results support
47 the type of reflection is focused rather than analytical. Similarly, the results of the current study f ollow those of Santa Maria et al. (2012) in which participants assigned to write about a traumatic experience in a concrete, experiential way experienced significantly fewer intrusive and avoidance symptoms as compared to participants who wrote in an abstr act, evaluative way. In the current experiment, participants in the emotional introspection condition were instructed to think about the traumatic event in more of a concrete, experiential way and were specifically instructed to identify what the experienc e was, rather than think about why or how it happened. about only the emotions associated with a traumatic event reported an increase in illness symptoms while those who wrote about cognitions and emotions (akin to the current neither the cognitions and emotions group nor the control group experienced benefits to physical health which is in li ne with the results of the current study wherein participants in the emotional introspection condition experienced less of a decrease in negative affect and significantly fewer intrusive and avoidance symptoms than participants in the neutral introspection condition, but did not improve significantly in terms of short term mental health compared to participants in the control condition. Thus, emotional introspection decreased the immediate but short term negative effects of writing about a negative experie nce, relative to neutral introspection, but did not produce noticeable benefits relative to the control condition two days after writing. This extends the limited literature on the effects of introspection, or cognitive processing,
48 in combination with writ ten emotional expression. The type of thinking, or processing mode, ultimately affects the immediate and short term outcome of the writing experience, but may or may not show lasting benefits to health. Limitations and Future Research A number of limitati ons that should be considered for future research apply to the current study. The short time period between writing and follow up may have limited results. A ssessment of a longer follow up period than two days might highlight the effects of the experiment. Perhaps participants had not yet benefitted from the experience in the short time that passed. Also, a multitude of external, confounding variables may have occurred during the two days before follow up, thus the final affective scores may not have been a n accurate reflection of the writing task itself, but rather what events transpired during the two days after writing. Of course, as in other studies that recorded health months later, the time after writing until follow up cannot be controlled. Moreover, aside from the PANAS, no additional surveys or measures were administered at follow up. It might have been useful if the same one item mood measure was provided a second time at follow up for comparison. Additionally, it would have been interesting to rec follow up in order to gauge how much participants felt they gained from the experience. were affected by the writing task, in addition to responses on the PANAS. In addition, participants were not prescreened for trauma, mental illness, symptoms of PTSD, or inhibition prior to the experiment, and may not have benefited
49 from writing as much as those inhib iting or struggling with more severe thoughts, feelings, and emotions. Future research should replicate the current study with clinical populations. In this way, these populations may provide results that illuminate the potential effects of emotional think ing before emotional writing. Likewise, long term health was not measured, and furthermore, physical health was not measured. Future research should combine measures of short and long term physical and mental health to see the effects, if any, of introspe ction and written emotional expression on these variables. However, an alternative and more accurate measure of physical health than health center visits should be used such as blood samples as Petrie, Booth, and Pennebaker (1998) used, in order to provide the most control and accuracy. Finally, a more modern version of this experiment should be conducted. Would the results of the experiment been different if writing had instead been typed on a computer? Because so many people today use computers as their primary means of communication (blogs, e mail, social networking), perhaps college samples especially would benefit from a replication of this experiment with typing, rather than writing. This way the writing could be easily analyzed and provide more exte nsive results. However, this could also pose ethical issues because the writing could be stored and accessed digitally, whereas the writing in the current experiment was discarded. Implications The current study demonstrates positive effects of engaging in emotional introspection before writing about an upsetting, emotional life event. This suggests that a
50 brief period of emotional introspection in combination with a ten minute period of written emotional expression positively impacts short term mental health. Mental health here defined in terms of the manifestation of intrusive and avoidance symptoms that are indicative of distress that may be present in individuals with PTSD. Written emotional expression without emotional introspection did not seem to benefit the participant any more than writing about a neutral topic. Along the same lines, emotional introspection did not produce effects that were worse than that of neutral introspection, thus it can be said that emotional introspection was not ruminat ive, but rather focused. In this way, participants who partook in emotional introspection most likely benefitted from the cognitive processing involved in this task. When emotional and cognitive components are combined, the individual may benefit from an improved understanding or worldview (Smyth & Pennebaker, 2001), and improved self awareness (Hixon & Swann, 1993). In other words, some sort of reflection may be necessary in order to reap the benefits of an expressive writing task. However, reflection of an upsetting topic independent of expression is detrimental to mental health (Lyubomirsky et al., 2006). Consequently, the type of introspection clearly matters. Specifically, introspection that is aimed at promoting identification, orientation, and insig ht has abating effects on later ruminative and inhibitory thoughts, evident in the current study. The marked difference in intrusive and avoidant thoughts between emotional and neutral introspection participants is important. This suggests that allowing a thoughts associated with the stressor.
51 The practical implications of the current study expand research on written emotional expression and promote reflective writing as a form of therapy. Particularly writing that involves thoughtful and intentional introspection beforehand. Because persistent intrusive and avoidant symptoms are evident in individuals who have experienced trauma and such symptoms result in psychologica l dysfunction (Smyth & Pennebaker, 2001), the findings of the current study provide a simple and effective means to diminish these intrusive and avoidant thoughts and, as a result, benefit long term psychological health.
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57 Table 1 Means (stand ard deviations) of dependent measures for Emotional Introspection and Neutral Introspection as an effect of writing across condition Measures EI NI Control Mood 1.40(4.120) .60(4.339) 2.40(3.355) Emotionality 2.87(5.083) 4.80(4.411) 3.33(4.938) Time 3.60(1.454) 3.47(1.457) 3.07(1.580) *EI: Emotional Introspection, NI: Neutral Introspection.
58 Table 2 Mean (standard deviation) Positive Affect across Time as a function of Condition Condition Time 1 Time 2 Time 3 Emotional Introspection 4.502 6(.62348) 2.8671(.73069) 4.2111(.60657) Neutral Introspection 4.6564(.80092) 2.6205(1.10423) 4.1152(.94321) Control 4.0564(1.37649) 3.6462(1.17698) 4.1944(1.43257)
59 Table 3 Mean (standard deviation) Negative Affect across Time as a Function o f Condition Condition Time 1 Time 2 Time 3 Emotional Introspection 2.9436(.91501) 3.2256(.91455) 2.6154(.70681) Neutral Introspection 3.3436(.93665) 3.6812(1.17465) 2.6667(1.09547) Control 3.6154(.83964) 2.0154(.52430) 2.6513(.90124)
60 Fi gure 1. Mood and Emotionality of Writing and Time spent thinking about Introspection Prompt across Condition.
61 Figure 2 Mean Positive Affect Scores Across at Baseline (PA1), Post Task (PA2), and Follow Up (PA3). EI: Emotional Introspection; NI: Neutral Introspection.
62 Figure 3. Mean Negative Affect Scores at Baseline (NA1), Post Task (NA2), and Follow Up (NA3). EI: Emotional Introspection; NI: Neutral Introspection.
63 Figure 4. Intrusive and Avoidant Symptoms among experimental conditions
64 Appendix A Baseline Measures 1 Please indicate the extent to which you have felt each of the following in the past 2 weeks. 1=Not at all 7=Very much _________ 1. Interested _________14. Irritable _________ 2. Distressed _________ 15. Ale rt _________ 3. Excited _________ 16. Ashamed _________ 4. Upset _________ 17. Inspired _________ 5. Strong _________ 18. Nervous _________ 6. Guilty _________ 19. Determined _________ 7. Scared _________20. Attentive _________ 8. Hostile _________21. Jittery _________ 9. Enthusiastic _________22. Active _________10. Proud _________23. Afraid _________ 11. Happy _________ 24. Cheerful _________ 12. Sad _________ 25. Blue _________ 13. Joyful _________ 26. Lonely 1 Positive and Negative Affect Schedule ( W atson, Clark, & Tellegen, 1988 ).
65 Appendix B Post Task Measures 2 How many of the last 5 minutes did you spend thinking about the prompt you just read? Please be honest and write in if you did not spend any time thinking abo ut it. 1 2 3 4 5 other______ ______ ______ ______ ______ ______ 2 Original Introspection Manipulation Check; Original Emotionality Rating; Positive and Negative Affect Schedule ( W atson, Clark, & Telle gen, 1988 ); Original Mood Rating; Impact of Events Scale Revised ( Horowitz, Wilne r, & Alvarez, 1979).
66 Please rate how emotional you perceived your writing to be. 10=Not at all emotional 10=Very emotional 10 9 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8 9 10
67 Please indicate the extent to which you feel each of the following CURRENTLY. 1=Not at all 7=Very much _________ 1. Interested _________14. Irritable _________ 2. Distressed _________ 15. Alert _________ 3. Excited ___ ______ 16. Ashamed _________ 4. Upset _________ 17. Inspired _________ 5. Strong _________ 18. Nervous _________ 6. Guilty _________ 19. Determined _________ 7. Scared _________20. Attentive _________ 8. Hostile _________21. Jittery ________ 9. Enthusiastic _________22. Active _________10. Proud _________23. Afraid _________ 11. Happy _________ 24. Cheerful _________ 12. Sad _________ 25. Blue _________ 13. Joyful _________ 26. Lonely Please rate your current mood. That is, how you feel at this moment in time. 10=Very low mood 10=Very high mood 10 9 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8 9 10
68 Below is a list of difficulties people sometimes have after stressfu l life events. Please read each DURING THE PAST 2 WEEKS with respect to the event or experience you have just written about. 1= Not at all 7= Often 1. I thought abo ut it when I didn't mean to. 1 2 3 4 5 6 7 2. I avoided letting myself get upset when I thought about 1 2 3 4 5 6 7 it or was reminded of it. 3. I tried to re move it from memory. 1 2 3 4 5 6 7 4. I ha d trouble falling asleep or staying asleep, because of pictures o r thoughts about it that came 1 2 3 4 5 6 7 into my mind. 5. I had waves of strong feelings a bout it. 1 2 3 4 5 6 7 6.1 had dreams about i t. 1 2 3 4 5 6 7 7.1 stayed away from reminders of it. 1 2 3 4 5 6 7 8. I felt as if it hadn't happened or it wasn't real. 1 2 3 4 5 6 7 9. I t ried not to talk about it. 1 2 3 4 5 6 7 10. Pictures a bout it popped into my mind. 1 2 3 4 5 6 7 11. Other things k ept making me think about it. 1 2 3 4 5 6 7 12.1 was aware that I still had a lot of fee lings about it, bu t I didn't deal with them. 1 2 3 4 5 6 7 13.1 t ried not to think about it. 1 2 3 4 5 6 7 14. Any reminder br ought back feelings about it. 1 2 3 4 5 6 7 15. My feelings about it were kind of numb. 1 2 3 4 5 6 7
69 Appendix C Follow Up Measures 3 Please indicate the extent to which you have felt each of the following in the past 2 days since the experiment. 1=Not at all 7=Very much _________ 1. Interested _________14. Irritable _________ 2. Distressed _________ 15. Alert _________ 3. Excited _________ 16. Ashamed _________ 4. Upset _________ 17. Inspired _________ 5. Strong _________ 18. Nervous _________ 6. Guilty __ _______ 19. Determined _________ 7. Scared _________20. Attentive _________ 8. Hostile _________21. Jittery _________ 9. Enthusiastic _________22. Active _________10. Proud _________23. Afraid _________ 11. Happy _________ 24. Cheerful ________ 12. Sad _________ 25. Blue _________ 13. Joyful _________ 26. Lonely 3 Positive and Negative Affect Schedule ( W atson, Clark, & Tellegen, 1988 ); Demographics.
70 Age : _________ Gender: _________ If anything from this experiment mad e you uncomfortable please let the experimenter know or contact the Counseling and Wellness Center at (941) 487 4254. Please let the experimenter know if you have any comments or questions.