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Cover Designer Anne Masters Design Washington DC Emotion and Cultt Cover Illustrator James Yang Emotion Disclosur TechnicaUProduction Editor Edward B Meidenbauer Examining Lives in

Library of Congress Cataloging-in-Publication Data Development Emotion disclosure and health I edited by James W Pennebaker Hostility Coping

p cm Organ Donation al Includes bibliographical references and indexo Factors ISBN 1-55798-308-9 (alk paper) The Perception of ~ 1 Emotions--Health aspects 2 Mental health 3 Self

Perspectives on Soc-disclosure l Pennebaker James W

Psychological TestitRC4554E46E46 1995

61689-dc20 95-16989 Psychology ofWom CIP and Applicatio

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Contributors

Nekane Basabe Basque Country University Spain

Roger J Booth University of Auckland New Zealand

Thomas D Borkovec Pennsylvania State University

Wtlma Bucci Adelphi University

Kathryn P Davison Southern Methodist University

Benjamiacuten Domiacutenguez National Autonomous University of Mexico

Eugenia Georges Rice University

Susan Lee Goldman Yale University

Ioseba Iraurgi Basque Country University Spain

John Kinyon Pennsylvania State University

John P Kline University of Arizona

Julie D Lane Uniacuteversity of Virginia

Michael J Mahoney University of North Texas

Gloria Martiacutenez National Autonomous University of Mexico

Jobn D Mayer University of New Hampshire

Viacutector Manuel Meacutendez National Autonomous University of Mexico

Mariacutea de los Angeles Meza National Autonomous University of Mexico

Yolanda Olvera National Polyteehnic Institute Mexico City

Dario Paez Basque Country University Spain

Tibor P Palfai Yale University

James W Pennebaker Southern Methodist University

Sara Lidia Peacuterez National Autonomous University of Mexieo

Keith J Petrie University of Auckland New Zealand

Bernard Rimeacute University of Louvaiacuten Belgium

Lizabeth Roemer Pennsylvania State University

Peter Salovey Yale University

Gary E Schwartz University of Arizona

Xt

I

Amparo Silva National Autonomous University of Mexieo

Williarn B Stiles Miarni University Ohio

Harald C Traue University of Ulrn Germany

Carolyn Turvey Yale University

Pablo Valderrarna National Autonomous University of Mexieo

Maite Valdoseda Basque Country University Spain

Carmen Velasco Basque Country University Spain

Daniel M Wegner University of Virginia

Jane Wellenkarnp University of California Los Angeles Emotional upheavals ean

ness rates levels of rumi

following traumatic experiel

eerns how people overeOme t

past deeade psyehologists n4

writing about emotions or Pi

vous system activity immun~

links between disdosure and

sueh links exist is still unkn01

dress SOrne of the most basic i to emotional upheavals in d

event into language affect phl

understanding of disdosure

eost -effeetive ways

The guiding idea of this

of thinkers and researehers t

enees into words ean promot

problem that is not the exdw

ehology Rather if researeher

sure emotion and health wo

personality and health psyeh

anthropology must be eonsid

In order to establish a ee

searehers met at Fort Burgwi

pus in Taos New Mexieo in

induded approximately 40 f~

seleeted on the basis oftheir r4

Preface

Emotional upheavals can disrupt virtually all aspects of our lives Illshy

ness rates levels of rumination and social conflict typically increase

followiacuteng traumatic experiences A central psychological question conshy

cerns how people overcome these events On the basis of research over the

past decade psychologists now have a strong sense that taIking or even

writing about emotions or personal upheavals can boost autonomic nershy

vous system activity immune function and physical health Although the

links between disclosure and health have now been firmly established why

such links exist is still unknown The purpose of this book then is to adshy

dress some of the most basic issues of psychology How do people respond

to emotional upheavals in their Uves and why Why does translating an

event into language affect physical and psychological health How can our

understanding of disclosure and health be applied in clinically useful and

cost-effective ways

The guiding idea of this book was to bring together a diverse group

of thinkers and researchers to address why translating upsetting experishy

ences into words can promote physical and mental health Thiacutes is a broad

problem that is not the exclusive domain of any subdiscipline within psyshy

chology Rather if researchers are to understand the links among discloshy

sure emotion and health work in cognitive physiological cliacutenical social

personality and health psychology as well as allied areas in mediacutecine and

anthropology must be considered

In order to establish a common focus an international group of reshy

searchers met at Fort Burgwin the Southern Methodiacutest University camshy

pus in Taos New Mexico in the summer of 1994 The three-day meeting

included approximately 40 faculty and graduate students who had been

selected on the basis of their research and clinical work related to the broad

xm

PREFACE

p

Intr topic of emotion disdosure and health Following this meeting particishy

pants wrote chapters drawing on their own and others research The fishy

nal product is a series of intriguing perspectives that should be of intershy

est to students researchers dinicians and a generallay audience

This book and the Taos conference could not have been accomplished

without the generous help of Southern Methodist University (SMU) and

the Science Directorate of the American Psychological Association (APA)

From the beginning SMU Deans James Jones and Michael Best have ofshy

fered financial and moral support Within APA 1am indebted to Virginia

Holt and Mary Lynn Skutley for their help The conference itself would

not have been possible without the generous efforts of Nadiacutene Pearce in

the SMU-in-Taos office and the help of the following graduate students

at SMU Michael Crow Kathy Davison Sun-Mee Kang Roberta Mancuso

and Anne Vano Finally the conference coordinator Jane Richards deshy

serves more praise than anyone Since this is not an academy award thankshy

you speech suffice it to say that dozens of others have been invaluable and

have not gone unnoticed

JAMES W PENNEBAKER

DALLAS TEXAS

xiv

Emotion Disclosure and Health An Overview James w Pennebaker

I n the psychological and medicalliteratures there is overwhelming evshy

idence that traumatic experiences provoke mental and physical health problems A central tenet of most psychotherapies is that talking about these experiences is beneficial Indeed meta-analyses of therapy outcomes

indicate that virtually all therapies-irrespective of their theoretical orientation-bring about improvements in both psychological and physshyical health An important nonspecific feature of therapy is that it allows

individuals to translate their experiences into words The disclosure process itself then may be as important as any feedback the client receives from the therapist

Until the mid-1980s the scant psychological research on disclosure focused on interpersonal relationships (Jourard 1971) the role of conshyfession in healing (Frank 1961) the broad value of social support (Cobb

1976) and disclosure within the therapeutic relationship especially as it related to transference (Freud 19201966 Rogers 1951) Occasional studshy

The preparation oC this chapter was made possible in part by a grant from the National Science Founshydation SBR9411674

3

JAMES W PENNEBAKER

ies in anthropology reported that medical healing ceremonies in Native

American African and andent Asian sodeties typically involved sorne

form of confession or diselosure of secrets by the person who was to be

healed (see Georges chapter 2)

For the past S to 8 years a growing nurnber of researchers frorn sevshy

eral disciplines have begun investigating why talking or writing about emoshy

tional upheavals can influence mental and physical health For example

investigators have now found that writing about traumatic experiences

produces improvements in immune function drops in physician visits for

illness and better performance at school and work (eg Esterling Antoni

Fletcher Margulies amp Schneiderman 1994 Pennebaker 1993a Spera

Buhrfeind amp Pennebaker 1994) Similarly other studies indicate that the

failure to talk or acknowledge significant experiences is associated with inshy

creased health problems autonomic activity and ruminations (eg Rimeacute

Mesquita Philippot amp Boca 1991 Wegner 1994) Yet other investigations

frorn the cognitive and eliacutenical realms are now finding that traumatic exshy

periences affect basic cognitive and memory processes (Freyd 1993) and

the abilities to construct coherent narratives (Mahoney 1991)

The increasingly elear links among traumatic experiences emotional

expression cognitive processes and language have been difficult to study

beca use they cross several areas of expertise within psychology The purshy

pose of this book is to briacuteng together a diverse group of thinkers to

address sorne of the central features of the disclosure--health relationship

As suggested by the organization of the book three of these features inshy

elude the cognitive emotional and social dimensions of disc1osure

COGNITIVE PROCESSING IN INHIBITING

AND DISCLOSING

When upheavals occur in our lives we think differently Cornrnon sympshy

torns of thought disruptions incIude rurninating and worrying Why do

these cognitive changes occUr One argurnent that has roots in Freuds

drearn analyses as well as in the Gestalt views of perception is that indishy

viduals are psychologically atternpting to reach elosure or in sorne way

4

resolve the upheaval

1993) Recent worko

The reason that we I

to ruminate about ti mere act of thought

titillating secrets-m

dislodge from our

examining technique~

minating Borkovec

citing evidence to sug

of the same coin Wh closure about the pas

If taIking about tl work One idea is tlJa of structure 10 the exp able to organize strucl

periences and the ever

ses of client disc10sure

urne) proposes that tal First taIking both ref]

over time gradually p1

estingly Bucci (chapte

Coming frorn a psych(

chotherapeutic discou

to the creation of a m

When individuals WI

logical changes OCCUI

talking about trauma

rnuscle tension and s

elosure These biolog

I

~s in Native

olved sorne

o was to be

s from sevshy

aboutemoshy

or example

experiences

an visits for

iacuteng Antoni

193a Spera

ate that the

tedwithinshy

(eg Rimeacute

vestigations

aumatic exshy

11993) and

)

~ emotional

ult to study

iexcly The purshy

kers to

elationship

features inshy

losure

ING

mon sympshy

ng Why do in Freuds

is that indishy

l sorne way

AN OVERVIEW

~

resolve the upheaval (cf Horowitz 1976 Martin Tesser amp McIntosh

1993) Recent work on thought suppression provides another perspective

The reason that we ruminate about events is because we are trying not

to ruminate about them (Wegner amp Lane chapter 3 this volume) The

mere act of thought suppression- whether about distressing traumas or

titillating secrets-makes the thoughts more accessible and difficult to

dislodge from our minds Several ongoing cliacutenical investigations are

examining techniques that may reduce peoples levels of worrying and rushy

minating Borkovec and colleagues (chapter 4 this volume) provide exshy

citing evidence to suggest that disclosure and worry may be opposite sides

of the same coin Whereas future-oriented worry may disrupt health disshy

closure about the past may reduce worrying and improve health

If talking about the past reduces ruminations and worries how does it

work One idea is that translating experiences into words forces sorne kind

of structure to the experiences themselves Through language individuals are

able to organize structure and ultimately assimilate both their emotional exshy

periences and the events that may have provoked the emotions In his analyshy

ses ofcliacuteent disclosure within a therapeutic setting Stiles (chapter 5 this volshy

ume) proposes that talking about an event accomplishes two important goals

First talking both retlects and reduces anxiety Second repeated disclosure

over time gradually promotes the assimilation of the upsetting event Intershy

estingly Bucci (chapter 6 this volume) offers a complementary explanation

Coming from a psychoanalytic perspective she suggests that an effective psyshy

chotherapeutic discourse progresses from a concrete description of an event

to the creation of a more abstract narrative of it

EMOTIONS EXPRESSIVENESS AND

PSYCHOSOMATICS

When individuals write or talk about emotional events important bioshy

logical changes occur During confession in the laboratory for example

taIking about traumas brings about striking reductions in blood pressure

muscle tension and skin conductance during or immediately after the disshy

closure These biological effects are most apparent among participants who

5

JAMES W PENNEBAKER

express emotion Indeed other laboratory studies indicate that long-term

health benefits of disdosure are only apparent if individuals are enshy

couraged to write about or express theIacuter emotions as opposed to providshy

ing factual accounts of their upheavals (Pennebaker 1989) The

disdosure-health link then is c10sely tied into our understanding of emoshy

tions and their biological concomitants

A traditional debate within psychology and psychosomatics has surshy

rounded the definition of emotion Is it more important for example to

consider emotion as a subjective experience or as its expressive or biologshy

ical manifestations As the contributors to this volume indicate this overshy

looks the fact that all components of an emotional experience may have

important hea1th correlates Salovey and his colleagues (in chapter 7 of

this volume) make a compelling case that the subjective ways by which we

perceive and cope with our emotions can influence health and social beshy

haviors Traue (chapter 8 this volume) drawing on the rich and someshy

times controversial assumptions of Harold G Wolff (eg Wolf amp Goodshy

ell 1968) and Wilhelm Reich (1949) provides impressive data that link

inhibited emotional expressiveness in various parts of the body to

headache and back pain In short both subjective experienced emotion

and the bases of emotional expressiveness are tied to health and illness

One reason that researchers in psychology have shied away from studyshy

ing emotion and its links to illness is that they have not known how to

deal with the concept of repression Clinical signs of emotional repression

and denial are observed quite frequently When a friend assures one that

he is happy and relaxed in the midst of an emotional upheaval and at the

same time his facial muscles are rigid and his speech is clipped and hosshy

tile one knows something is amiss A discipline that relies too heavily on

straightforward self-reports cannot by definition see or measure represshy

sion (d Shedler Mayman amp Manis 1993)

The repression or inhibition of emotion is central to an understandshy

ing of disclosure In theory individuals who attempt to confront traumatic

experiences without acknowledging emotions should not benefit and could

perhaps suffer from disclosure The work by Schwartz and Kline (chapter

9 this volume) indicates that individuals who are classified as repressive

6

copers are indeed h

brain wave and even ir ter 10 this volume) ex

but intuitively appeal

repression In their W4

that alexithymics maJ

logical problems Fina

ume) offer an import

function Their chapt4

psychologically relevru

CLINICA

Disclosure of ones dec

nomenon whether in

intimate topics with al

trust between the part

closes personal experie

on the relationship doser Ceel better it ca

1993b)

Within a dinical

emotions can provok(

apist Drawing on a ce volume) suggests that

therapist and dient al

To accomplish this th

emotions as well as to

joint emotional worlc

leagues (chapter 13 ti with clients emotions

help people learn to r

to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy

ata that link he body to

ed emotion md illness

from studyshy

own how to

al repression

res one tbat

uand at the ed and hosshy

o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW

copers are indeed hyperresponsive to emotional stimuli as measured by

brain wave and even immune system activity Paez and his colleagues (chapshy

ter 10 this volume) extend this thinking by focusing on the often-maligned

but intuitively appealing concept of alexithymia-a conceptual cousin of

repression In their work with cancer patients the authors are discovering

that alexithymics may be at greater risk for both psychological and bioshy

logical problems Finally Petrie Booth and Davison (chapter ll this volshy

ume) offer an important overview of repression disclosure and immune

function Their chapter describes how and why the immune system taps

psychologically relevant dimensions associated with emotions

CLINICAL AND SOCIAL DIMENSIONS

OF DISCLOSURE

Disclosure of ones deepest thoughts and feelings is a powerful social pheshy

nomenon whether in a therapeutic setting or in daily life Talking about

intimate topics with another person typically assumes a particular level of

trust between the participants Furthermore the degree to which one disshy

closes personal experiences may have profound positive or negative effects

on the relationship Whereas talkjng about a trauma may make the disshy

closer feel better it can make the listener feel worse (Pennebaker 1990

1993b)

Within a clinical setting the clients disclosure of powerful negative

emotions can provoke meaningful thoughts and images within the thershy

apist Drawing on a constructivist perspective Mahoney (chapter 12 this

volume) suggests that the most effective therapy occurs when both the

therapist and client are able to build on their shared emotions together

To accomplish this the therapist must be attuned to both his or her own

emotions as well as to those of the client Whereas Mahoney examines the

joint emotional world of the therapist and client Domiacutenguez and colshy

leagues (chapter 13 this volume) take a very different strategy in dealing

with clients emotions They believe that the ultimate goal of therapy is to

help people learn to reverse their emotions quickly going from negative

to positive states

7

JAMES W PENNEBAKER

Moving beyond the laboratory and clinic Rimeacute and Wellenkamp

(chapters 14 amp 15 of this volume respectively) address the nature of the

social sharing and disclosure of emotions among people in the real world

on a daily basis In an intriguing series of studies Rimeacute demonstrates that

an overwhelming majority of people share most of their emotional expeshy

riences with others This natural tendency however is most likely to be

blocked for the emotions of shame In addition he finds that social sharshy

ing is powerful in reducing anxiety and psychological distress with a varishy

ety of populations Wellenkamp an anthropologist supports many of these

observations on the basis of her field work with the Toraja culture from

the remote regions of Indonesia Wellenkamp like Georges (chapter 2)

helps to put disclosure iexclnto the broader cultural perspective That is many

but not all cultures look favorably on the sharing of emotions In addition

the types of emotions and the modes of expression vary considerably

SUMMARY

The links among emotion disdosure and health exist at multiple levels

of analysis Within Western culture the disdosure of traumatic and emoshy

tional experiences can promote physical and psychological health The unshyderlying mechanisms for this phenomenon are cognitive emotional bioshy

logical and social Each of these systems of understanding are intimately

interrelated Shakespeares King Lear Rostands Cyrano de Bergerac the

Truly Guilty person in any of Erle Stanley Gardners Perry Mason books

or even the wolf in Litde Red Riding Hood all change once they reveal

their true identities Their thoughts behaviors probable physiology and

relationships to others are immediately transformed-usually but not alshyways for the best Once the disclosure is made however the person (or

wolf) becomes an internally consistent creature wherein all features of

mind and body become synchronous

REFERENCES

Cobb S (1976) Social support as a moderator of Jife stress Psychosomatic Medishy

cine 38 300-313

8

Esterling B A Anto

Emotiacuteonal discl

Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New

Martiacuten 1 L Tesser J

fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti

Reich W (1949) eh Rimeacute B Mesquita E

Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman

iexclcan Psychologist

id Wellenkamp le nature of the n the real world monstrates that IDotional expeshy10st likely to be that social sharshyress with a varishy15 many of these aja culture from ges (chapter 2) re That is many ons In addition onsiderably

t multiple levels unatic and emoshy1health The unshy emotional bioshy19 are intimately de Bergerac the ry Mason books once they reveal physiology and uaUy but not alshyr the person (or in aU features of

sychosomatic Medi-

AN OVERV1EW

Esterling B A Antoni M Fletcher M Margulies S amp Schneiderman N (1994)

Emotional disclosure through writing or speaking modulates latent Epsteinshy

Barr virus reactivation lournal of Consulting and Cliacutenical Psychology 62

130-140

Frank J D (1961) Persuasion and healing Baltimore Johns Hopkins Press

Freud S (1966) Introductory lectures in psychoanalysis (J Strachey Trans) New

York W W Norton amp Co (Original work published 1920)

Freyd J J (1993) Theoretical and personal perspectives on the delayed memory deshy

bate Center for Mental Health at Foote Hospitals Continuing Educatiacuteon Conshy

ference Ann Arbor MI

Horowitz M (1976) Stress response syndromes Northvale NJ Jason Aronson

Jourard S M (1971) Self-disclosure An experimental analysis of the transparent self

New York Wiley-Intersciacuteence

Mahoney M J (1991) Human change processes The scientific foundations of psyshy

chotherapy New York Basic Books

Martiacuten L L Tesser A amp McIntosh W D (1993) Wanting but not having The efshy

fects of unattained goals on thoughts and feelings In D M Wegner and J W

Pennebaker (Eds) Handbook ofmental control (pp 552-572) Englewood Cliffs

NJ Prentice Hall

Pennebaker J W (1989) Confession inhibition and disease In L Berkowitz (Ed)

Advances in experimental social psychology Vol 22 (pp 211-244) New York

Academic Press

Pennebaker J W (1990) Opening up The healiacuteng power ofconfiding in others New

York William Morrow

Pennebaker J W (I993a) Putting stress into words Health linguistic and therashy

peutic implicatiacuteons Behaviour Research and Therapy 31 539-548

Pennebaker J W (1993b) Mechanisms of social constraint In D M Wegner amp

J W Pennebaker (Eds) Handbook ofmental control (pp 200-219) Englewood

Cliffs NJ Prentice Hall

Reich W (1949) Character analysis (3rd ed) New York Orgone Institute Press

Rimeacute B Mesquita B Philippot P amp Boca S (1991) Beyond the emotional event

Six studies on the social sharing of emotion Cognition amp Emotion 5 435-465

Rogers C R (1951) Client-centered therapy Its current practice implications and

theory Boston Houghton Mifflin

Shedler J Mayman M amp Manis M (1993) The illusion of mental health Amershy

ican Psychologist 48 1117-1131

9

I

JAMES W PENNEBAKER

SperaS P Buhrfeind E Dbull amp Pennebaker J W (1994) Expressivewritingand copshy

ing with job 10ss Academy ofManagement Journal 37 722-733

Wegner D M (1994) Ironie processes of mental control Psychological Review 101

34-52

Wolf S amp Goodell H (1968) Harold G Wolffs stress and disease (2nd ed) Springshy

field IL Charles C Thomas

A Cul Persp(

T he disdosure of an entrenched al

culturally as weU COI

ray ofsocieties Howe actively discouragedshythoughts and feelings

In a number of e strated the health ben eg Pennebaker 1993 efits such as reduced function Pennebaker practice of disdosure as highly meaningful ~

meanings attached to fect healing as weU as tain health In additio as-therapy in the West in a brief and prograrn

10

bull The Roles of Disclosure and Emotional Reversal

in Clinical Practice Benjamiacuten Domiacutenguez Pablo Valderrama

Mariacutea de los Angeles Meza Sara Lidia Peacuterez Amparo Silva Gloria Martiacutenez Victor Manuel Meacutendez

and Yolanda Olvera

L ove pleasure and pain play central roles in human experience Deshy

spite the importance of emotions in everyday life scientific efforts to

try to understand them and their links to the mind and brain have proved

troublesome Particularly problematic from a clinical perspective are creshy

atiacuteng and instituting ways of controlling emotions (especially negative

ones) in clients and even in psychologists The present chapter examines

two overlapping cliacutenical issues in helping iacutendividuals to manage stress and

emotions among adults in Mexico City The first focuses on therole of

written disclosure on the control ofbiological and subjective stress A secshy

ond strategy considers the role of disclosure as a technique to bring about

emotional reversaL As we discuss processes related to disclosure and emoshy

tional reversal may not conform to traditional notions of stress and linshy

ear causal relations

If we are to understand the effects of emotional stress on human beshy

havior we need to be able to distinguish between an emotional and a nonshy

emotional state Unfortunately apure physiological defrnition of emotion

of stress is limited Selye (1983) defines stress as the result of any demand

255

DOMiacuteNGUEZ ET AL

on the body using objective indicators such as bodily and chemical

changes that appear after any demando The perception and interaction of

such arousal iacutes an important psychological issue It is the perceived expeshy

rience of an emotional change that determines its effect on other mental

processes such as attention and short-term memory (Horgan 1994)1t iacutes

the perception of arousal as well as the preoccupation with probable stresshy

sors that interferes with continuous conscious processing (Mandler 1993)

Current theories view emotions as consisting of an interaction of a

cognitive evaluative schema with visceral arousal In this context evaluashy

tive cognitions provide the qualitative component of an emotional expeshy

rience and visceral activity provides its intensity and peculiar emotional

characteristics Sorne strokes for example may cause peculiar conditions

known as prosopagnosia in which the patient is unable to recognize faces

even those as familiar as a spouses or childs Even though the patient is

unable to recognize them looking at the face of someone emotionally close

will increase the heartbeat rateo Thus the visual stimulus can evoke an

emotional response even if the verbal association is lost (Klivington 1989)

Observations such as these have led to the idea that visceral arousal is necshy

essary for emotional experience but that the nature of emotional experishy

ence will depend on an individuals thoughts memories and current

circumstances Accordiacuteng to this view individuals will evaluate any expeshy

rience as a positive or negative emotion depending on what they expect

of it their social context and whether they feel in control of a situation

Most relevant to the present discussion is the emotional state of stress

Historically people have believed that stress-relevant psychological factors

affect disease susceptibility and course (see Georges chapter 2 this volshy

ume) A number of recent studies have shown that various stressors can

adversely affect immune function and that sorne psychological intervenshy

tions may reduce stress thereby improving immune function (eg Kiecoltshy

Glaser amp Glaser 1992) An important current task is the development of

effective psychological interventions for immune-related illness that iacutes

linked to out of control emotional states The controlled intervention

design in which potentiaUy valuable applications of psychoimmunologic

research are tested represents a scientifically superior method for revealshy

256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r

emotional of causal v

single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th

THE ROLE OF DISCLOSURE AND EMOTIONAL REVERSAL

and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is

10tionally close can evoke an

vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy

ing causal or perhaps nonlinear relationships between psychosodal and

physiological processes

MOVING BEYOND SIMPLE CAUSAL MODELS

Lazarus (1993) argued that stress is an inevitably undean variable that

depends on a dynamic and changing interaction between person and enshy

vironment He also noted that it is possible to break down a complex stressshy

fuI situation into interdependent variables-in other words within linear

cause-effect approaches-especially when it comes to studying people in

natural clinical and everyday situations From our view however reducshy

ing complex relationships into simple causal components is probably not

possible

Cliacutenical interventions often try to modify the presumed causes of a

clients behavior or emotional problems For example responses to psyshy

chosodal stressors are often the focus of treatment programs for different

chronic pain populations (Domiacutenguez Valderrama Peacuterez amp Meza 1994)

Given the central role played in this clinical context of causal variables in

the treatment programs many authors (Haynes Huland amp Oliveira 1993)

have emphasized that an empirically based causal analysis is important to

the development of effective treatment programs for clients Errors in

causal analysis of any given problem are also likely to lead to poor treatshy

ments

With most clients and patients the identification and diagnosis of

emotional problems is necessary but not suffident for the identification

of causal variables That is beca use there can be many possible causes for

single psychological stress problems as well as differences across clients in

the impact of various causes of the same emotional state problem Conshy

sequently it is usually not possible to select among social skills cognitive

biofeedback or pharmacological interventions just on the basis of the

dients diagnosis of for example posttraumatic stress disorder

Most of the current methods for detecting causal relationships preshy

sume that the relationships are linear (Le the strength of the relationship

between the variables is equal across their values) An accumulating body

257

DOMIacuteNGUEZ ET AL

of research suggests however that the causal relationship often demonshy

strates functional plateaus criticallevels varying causallatencies durashy

tion of effects and more complex nonlinear functional relationships

(Haynes et al 1993)

Causal relationships can change across time They are unstable and

dynamic There is strong empirical support for the hypothesis that the

causes of many distress-associated disorders such as chronic pain subshy

stance abuse or depression may change across time and developmental

periods (Haynes et al 1993) Consequently the relative strength of causal

variables can change across the course of effective treatments According

to Barton (1994) the general characteristics of self-organizations (a conshy

cept that denotes a process by which a structure or pattern emerges in an

open system without specifications from the outside environment) are

shared by chemical biological and psychological systems and include

among others (a) readiness to exhibit multiple stable states that change

suddenly from one to another if a parameter value crosses a critical threshshy

old (eg chronic pain patients who go from a suffering to a relaxation

state) (b) cyclical state changes (as the ones that happen within a

Monday-Friday cyele linked to work stress) (c) the structural coupling of

component processes (d) temporal spatial and behavioral organization

(eg patients relaxation skills that progress from muscular-response to

language mediated change) (e) localized instabilities that can lead to one

part of the system to organize itself differently from another part of the

system (eg the clinical finding of patients with relaxed peripheral temshy

perature index and stressed verbal reports) (f) the ability of one unit to

cause other units to oscillate at a harmonically related frequency (enshy

trainment) and (g) behaviors that could be modeled by a system of nonshy

linear equations (eg inverted-U functions as in the Yerkes-Dodson Law)

There are dinically relevant implications in considering transitions

from one to another emotional state as a causal variable First the degree

of change of a variable (or the degree of contrast between current and

previous magnitudes of the causal variable) is an important target of asshy

sessment (psychophysiological stress profile) Second the effects of intershy

258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A

In 1985 Me earthquake i1 becoroe psych

sors This soc

ogists profess

tive level appr

managers in g

nition of the i nance ofboth

mand for effe

dinical psych(

approaches s

symptom synlt

pression or in There Ola

shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a


lemonshy vention may dissipate with time rendering this causal phenomenon difshy

durashy ficult to detecto Third patients and clients with equal values on psyshy

mships chophysiological measurements are not necessarily equal on that state

(stress impact or subjective pain)

)le and

hat the IDENTIFYING AND TREATING STRESS WITHIN n subshy

A CLINICAL CONTEXT RELAXATION Imental

AND DISCLOSUREf causal

ording In 1985 Mexico City experienced a devastating earthquake After the

(a conshy earthquake it soon became widely accepted that virtuaUy anyone could

S in an beco me psychologicaUy or physically affected by current or recaUed stresshy

nt) are sors This social reaction created the appropriate conditions for psycholshy

indude ogists professional intervention Within this context a primary prevenshy

change tive level approach to stress management was soon adopted by many top

threshshy managers in goverment In recent years there has beena growing recogshy

axation nition of the important role that stress plays in the etiology and mainteshy

ithin a nance of both psychological and somatic disorders Consequently the deshy

pling of mand for effective stress management programs has been increasing in

lization clinical psychology as well as in medicine Unlike many other treatment

onse to approaches stress management is not targeted toward any particular

110 one symptom syndrome or diagnostic category Stress or negative emotion exshy

t of the pression or inhibition may playa role in any disorder or illness

~al temshy There may be instances in which a subject reports feeling stressed but

unit to shows no obvious physiological sign of sympathetic arousal (the de facto

cy (enshy sign of stress) In such cases psychophysiological analyses offer little conshy

ofnonshy structive contribution to the understanding of the phenomenology of

n Law) stress Conversely there may be instances where a person shows dear patshy

lsitions terns of physiological reactivity to an eliciting stimulus but reports no

degree emotional signs of distress How should psychologists interpret such disshy

~nt and junction among behavior subjective experience and physiological reshy

t of asshy sponse Is it reasonable to assume that psychophysiological responses

f inter- alone define a stress response Or is the proper definition of stress in the

259


final analysis a phenomenological one Psychophysiological measureshy

ment as a subdiscipline of the broader interdisciplinary field of behavshy

ioral neuroscience is distinguished by its use of surface recordings of bioshy

electric activity rather than invasive procedures for the study of emotional

activity linked to biological changes

Among the many biological measures of stress we have tended to rely

on hand temperature Circulation in the hands and fingers is controlled

by the autonomic nervous system through sympathetic vasoconstricting

nerves as well as by circulating vaso active hormones 1t is generally asshy

sumed that feedback-iacutenduced vasodilation results from lowered sympashy

thetic activation (SuOOt Pilon amp Fenton 1978) Temperature feedback

studies employing brief training sessions (Keefe 1978) generally have

demonstrated significant vasodilation whereas those employing longer

sessiacuteons have failed to do so (Surwit 1977)

Disclosllre Within a Stress Management Setting

In 1992 we began a large scale stress management program llsing peshy

ripheral temperature as a biologiacutecal indicator of the effectiacuteveness of each

of several interventions The stress management program involved 174

male (468) and 198 female (532) adults ranging in age from 23 to

63 The sample was selected by management based on administrative crishy

teria outlined by the the Director of Training within a large governmenshy

tal office Workshops of 15 hours consisting of small groups of approxishy

mately 14 people were run for three to five consecutive sessions The

project had two main goals First we attempted to provide relaxation reshy

sponse training in order to help participants decrease or restructure their

dysfunctional coping style to job stressors Second we offered partiacutecipants

a ready to use technique based on self-disclosure through writing to modshy

erate or decrease active inhibition effects on cognitive and somatic meashy

sures of stress (Pennebaker 1993)

General results linked to the first goal were achiacuteeved with autogenic

relaxation training techniques Using skin temperature as the dependent

measure the autogenic training data were ultimately compared with a secshy

ond training technique which we caH Pennebakers exercises wherein

260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I

secrets for four seiexcl perspectives were b

indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt

ural writing style (

pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the

autogeniacutec relaxati

temperature from

the two Trauma VI

over twice as mu(

l measureshy of behavshy

ngsofbioshyemotional

lded to reIy

controlled onstricting

nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174

from 23 to iexcltrative crishy

overnmenshy

)f approxishy

osions The

axation reshy

lcture their larticipants

Ilgtomodshy

natic mea-

I autogenic

dependent with asecshys wherein


participants wrote about their stressors The physiological data were then

compared in terms of temporal shifts in temperature and correlation beshy

tween subjective emotional change and physiological changes

In the writing phase of the project participants wrote about their painful

secrets for four separate days different perspectives each day The different

perspectives were based on correlational findings by Pennebaker (1993) that

indicated that people who consistently use negative emotions in their writshy

ing secrets sessions subsequently evidence greater health improvements

than those who overuse positive emotions In addition those who move

from conveying very little to a high degree of insight and causal thinking

over the 3-5 days of writing also demonstrate health improvements

On the 1st day of writing subjects received the standard trauma writshy

ing instructions (Trauma Writing-I condition) Do not pay attention to

grammatical rules while writing use first person anonyrnity guaranteed

write nonstop about painful secrets On the 2nd day participants were

told to write about traumas using specific language rules induding the

use of a high number of negative emotion and low number of positive

emotion words and encouragement to use causal words within their natshy

ural writing style (Language Guided condition) On the 3rd day particishy

pants repeated the standard trauma writing that had been employed on the 1st day (Trauma Writing-I1 condition) Finally on day 4 participants

were encouraged to avoid using first person in their writing in ordeacuter to

pro mote psychological distancing from the original emotional state (Third

Person condition)

As can be seen in Figure 1 hand temperature increased markedly in

the two Trauma Writing conditions and decreased in the Third Person

condition Interestingly only the Language Guided condition failed to evshy

idence a significant increase in peripheral temperature from before to afshy

ter writing Particularly striking is the comparison ofchanges in hand temshy

perature for the various writing conditions with the results from the

autogenic relaxation training Overall the within -session increase of hand

temperature from before to after reIaxation was 070 C Averaging across the two Trauma Writing conditions hand temperature increased 15deg Cshyover twice as mucho

261


ID Before After

33

335

325

32

315

31

305

30

Trauma1 Language TraumamiddotU 3rd Person

Figure 1

Changes in sItin temperature (in centigrade) from before to after writing as a function of condition TraumamiddotI and Trauma-U refer to indiviacuteduals writing about traumas Language refers to the language-guided condition 3rd Person rcfers to people writing about traumas from the third person perspective From Domiacutenguez et al (1994) based on data from 372 workers between 1992 and 1993

Analyzing the data on a ease-by-ease basis iacutet was possible to find a

general pattern of temperature temporal patterning as early as during the first trauma writing that served as a predictor of which subjeets would evshy

idenee emotional improvements and who would not Beginning the first

writing session dominant hand temperature started to inerease then at

the middle of session (when people report disclosure of negative emoshy

tions) temperature deereased signifieantly from the initial temperature

Although preliminary these observations suggest that we ean gaiacuten tremenshy

dous insight by looking at specifie fluetuations in temperature on a

minute-by-minute basis 4

In summary autogenic training and disclosure through writing are

both effeetive in redueing stress as measured by inereased hand tempershy

ature Whereas the writing produeed more striking inereases the degree to which the relaxation training may have aetually augmented the writshy

ings effeets is not known To explore these issues in greater detail we atshy

tempted to adapt these teehniques to a ehronic pain sample

262

THE ROLE OF

Potel

Aeeording to an ev

tions play functiofl

in helping organisr Chronic pain has o

sponse to a trauma serves the biologic

present and that a

healiacuteng to oeeur

Chronic pain I

6 months often in

bulk of the researe

teristies ofspecifie 1 developiacuteng psychOl

various psyehologi

and affeetive respo

medical and psych

iacutemprovements in 1

Although reseiexcl

eontinues to be a

traek (Wall amp Jone

eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal

cliacutenical proeedure pend more on hist

a number of empi

sive management

should determine

fective for a partiacutee Alvarez Cortes amp

Srd Persao

-15 a function of Imas Language about traumas 1 data from 372

ble to find a lS during the

ts would evshy

ling the first ease then at

~gative emoshy

temperature gain tremenshy~rature on a

1 writing are

and tempershy

gt the degree

ed the writshyletail we at-


Potential Value of Disclosure Among Chronic Pain Patients

According to an evolutionary approach negative as well as positive emoshy

tions play functional roles in human behavior Pain too has survival value

in helping organisms avoid further injuries to tissues (Domiacutenguez 1994) Chronic pain has often been distinguished from acute pain which is a reshy

sponse to a trauma and dissipates once healing has taken place Acute pain

serves the biological function of warning the body that tissue damage is present and that a change in behavior may be necessary for repair and

healing to occur

Chronic pain on the other hand is pain that persists for at least 3 to 6 months often in the absence of specific evidence of tissue damage The

bulk of the research on chronic pain has focused on identifying characshyteristics ofspecific pain syndromes (eg headache and chronic back pain)

developing psychometric instruments for assessing pain and delineating various psychological parameters associated with pain such as cognitive

and affective responses Research has also addressed the efficacy of both

medical and psychological treatments on the relief of chronic pain and improvements in behavior despite the subjective reports of pain

Although research in this field has yielded encouraging results pain continues to be a complex phenomenon for clinicians to diagnose and track (Wall amp Iones 1991) One important area where confusion prevails

concerns basic definition For example researchers disagree on how to deshyfine pain in general and how to describe specific syndromes (Flor amp Turk

1989)

The position that the clinician adopts in defining pain has both asshysessment and treatment implications The decision to employ a specific clinical procedure with a particular pain syndrome often appears to deshy

I pend more on history and intuition than on empirical findings Although a number of empirically sound procedures are available for the noninvashy

sive management of chronic pain it remains unclear how the dinician should determine which of these procedures is likely to be the most efshy

fective for a particular patient with a specific pain problem (Domiacutenguez Alvarez Cortes amp Olvera 1993)

263


The fastest growing area of research on the assessment of chronie pain

deals with cognitive variables One topie of current interest is patient beshy

liefs about pain One reason for assessing pain beliefs is that they may preshy

diet response to treatment Williams and Thorn (1989) found that patients

who believed that their pain was likely to be a chronie condition failed to

comply with physieal therapy or behavioral therapy assignments

Another cognitive process that is relevant to the understanding of pain

responses-self-efficacy-is based on peoples judgments of their abilities

to execute given levels of performance and to exercise control over events

(Bandura OLeary Taylor Gauthier amp Gossard 1987) Chronie pain pashy

tients differ in the degree to which they view themselves as having conshy

trol over pain (internal or proprioceptive control) versus other external

factors having control over pain (eg inhibition or social sharing of

painful emotional experience)

Coping style reflects another aspect of cognitive processing In a reshy

cent review of coping among chronie pain patients Turner (1991) emshy

phasized the roles of attentional control and other psychologieal factors related to the ability of people to cope with pain First chronie pain pashy

tients who remain passive or who use catastrophizing ignoring and reinshy

terpreting attention diversion and praying and hoping as coping strateshy

giacutees typieally have high levels of physical and psychological disability

Second patients who rate their perceived control as high or who rely on

active or attentional coping function much more effectively Researchers

need to iacutedentify whieh of these constructs is more useful in understandshy

ing pain disability and if there are other basie processes such as active inshy

hibition that support observed variability and outcomes

It has been clear from the beginning that the kind of questions and

answers raised about pain reflect different sets of needs that are not alshy

ways convergent Whereas the scientist seeks to explain data and predict

future emotional and disability states the healthcare expert searches for tools to promote effective treatment optiacuteons The patient of course seeks

pain relief and improved quality of life These divergent needs help exshy

plain the persistence of unresolved issues in the field both in the research

enterprise and in the cliacutenical setting For example the recognition that

THE ROLE

emotion and 1

the important

decades tend 1

the mind (Me published reS4

causes when p ica) interventic

Supported

the disclosure

10gieal variabll

problem Earl tional and psy entation of a

pain resolves ~

Although

chronic pain (]

the majority o

group For thi

healthy group Since 198

vasive treatme

tal of Mexico I

munology seI

outpatient vis sample of 800

By wayof con

who were defi

Labor Stress ~

of the Secreta Training for 1

Initially ~ limitations in

These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that


emotion and biology do not function as isolated entities has been one of

the important advances in thought about pain Still beliefs from earlier

decades tend to perpetuate the view that pain is either in the body or in

the mind (Merskey 1985) In clinical practice (and to a lesser degree in

published research) pain continues to be attributed to psychological

causes when physical findings are lacking and pain persists despite medshy

ical intervention

Supported by several clinical case studies we have begun exploring

the disclosure paradigm as a research strategy to help clarify the psychoshy

logieal variables that increase a patients risk for developing a chronie pain

problem Early prospective studies designed to assess verbal negative emoshy

tional and psychological status soon after an injury or earIy in the presshy

entation of a pain complaint permit comparisons between those whose

pain resolves and those whose pain fails to do so

Although it may be possible to identify a group at increased risk for

chronic pain on the basis of psychological features it does not follow that

the majority of patients whose pain becomes chronie are members of tIshy

group For this to be achieved it is still necessary to compare them v

healthy groups within the same paradigm

Since 1988 we have been involved in a wide assessment and nonh

vasive treatment program for chronic pain patients at the General Hospishy

tal of Mexico City Pain Clinie Data collected by Jose Montes chief of imshy

munology serviees indicated that 12 to 22 of the 41000 monthly

outpatient visits were for headache Our initial research was based on a

sample of 800 chronic pain patients who attended the General Hospital

By way of comparison we were able to identify a group of adult workers

who were defined as clinieally healthy who participated in a program of

Labor Stress Management (1992-1994) that was conducted at the request

of the Secretary of Labor of Mexico as part of its National Program of

Training for Total Quality

Initially we identified subjects in both groups who presented notable

limitations in their capacity to express and communieate emotional states

These individuals considered themselves as isolated and with not many

friends and suggested that 1 dont like it that no one knows what is goshy

265


ing on with me Interestingly chronic pain subjects with these charactershy

istics evidenced the highest distress and suffering levels and showed highly

variable physical symptomotology

We started an exploratory clinical study with pain patients that conshy

sisted of biofeedback hypnosis and autogenic relaxation and the stress

disclosure paradigm exercises with the therapeutic target of reducing the

active inhibition mechanism and its psychophysiological consequences

(high systolic pressure and low peripheral temperatures)

Patients were informed that during four sessions they should write

about their painful secrets with the intention of reducing their distress

The instructions for each of the exercises were verbally provided by the

therapist in charge who stayed with the patient during 20 minutes of writ shy

ing Before and after the exercise arterial pressure and pulse were meashy

sured In addition peripheral temperature of the dominant hand was meashy

sured continuously across the sessions At the end of the writing exercise

patients were asked to give a verbal report about their emotions From the

fiacuterst session patients reported different relief levels at the end of writing

which was compared with a relaxation state Overall changes in periphshy

eral temperature from before to after the writing sessions were 2S C

higher than for temperature changes from before to after relaxation

With some patients it was necessary to repeat the writing exercIacutese durshy

ing the days between sessions Preliminary data from 14 chronic pain pashy

tients suggested the temporal patterns of emotional change and periphshy

eral temperature that appeared during the fiacuterst exercise predicted the

ultimate outcomes of the patients Typically patients began writing with

a low temperature (28-30deg C) Within 2 or 3 minutes the temperature inshy

creased (30-33deg C) and then decreased (a mean of 1so C) Finally during

the last 2 or 3 minutes they increased aboye the baseline (3 or more deshy

grees)

When we compare group temperature patterns over time for healthy

subjects with chronic pain patients several differences emerge First psyshy

chophysiological variability is much greater for healthy subjects than for

chronic pain patients Second a smaller proportion of chronic pain pashy

tients could initiate control of skin temperature during biofeedback than

266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with

techniques to 1 from one emo

tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl

able to move i weeks of train

quire a great (

ity to exercIacutese

sary and diffilt In ourop

relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy

e were meashyndwasmeashy

iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy

nie pain pashyand periphshy

redicted the

writing with

tperature inshy

nally during or more de-

e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than


could healthy controls Finally the ways that skin temperatures fluctuated

over time during the disclosure-writiacuteng sessiacuteons tended to predict who

would demonstrate faster cliacutenical improvements

USING DISCLOSURE TO ACHIEVE

EMOTIONAL REVERSAL

Unlike adults young children can move quickly from one emotional state

to another Through maturation however people tend to lose this ability

For adults in distress it is virtually impossible for them to alter their emoshy

tional states Indeed the act of trying to change their emotions can proshy

duce even more stress When this occurs sorne people look for medical

or psychological help At this point the specialist in human behavior must

intervene with at least two goals in mind (a) to choose the most effective

techniques to help clients acquire greater flexibility in making a transition

from one emotional state to another and (b) to make sense of the relashy

tions between a particular emotional state its psychophysiological correshy

lates its linguistic correlates and social consequences

Qur experience in designing psychological treatment programs for

stress-affected persons in Mexico City has led us to consider that stress

shares many characteristics with negative emotions In this context the

most important therapeutic target is to choose and apply techniques that

can create favorable conditions to allow individuals to pass from a negashy

tiacuteve emotional state to a positive one within a relatively brief time An exshy

cellent example of this kind of psychological interven tiacuteo n can be seen with

the application of relaxatIacuteon techniques wherein a stressed individual is

able to move into a state of serenity within a few minutes after only 2-4

weeks of training Acquiring a voluntary relaxation response does not reshy

quire a great deal of effort on the part of the patient However the abilshy

ity to exercise emotional control in other situations is often more necesshy

sary and difficult to do

In our opinion one factor that hinders peoples abilities to master the

relaxation response is the difficulty of maintaining a state of active inhishy

bition Interestiacutengly the writing-disclosure technique may be ideally suited

267

I


to reducing active inhibition in chronic pain patients Writing exercises

then may directly and indirectly decrease the psychophysiological effects

of inhibition and at the same time increase the ability of individuals to

pass from one emotional state to another (Apter Fontana amp Murgatroyd

1985)

According to our cliacutenical research findings the main value of the disshy

dosure-writing paradigm liacutees in the kind of emotional reversal process

that can be attained within a short time This emotion reversal abiliacutety reshy

sults when healthy and chronic pain patients attain insight from expressshy

ing and becoming aware of their deepest emotional secrets or pains and

their related thoughts and psychophysiological patterns of response

Of further interest are the open-ended verbal reports that our subshy

jects have given after writing sessions which illustrate positive long-ter m

effects of the disdosure paradigm Specifically dients report that a writshy

ing intervention produces the fastest transition from one emotional state

(eg distress and suffering) to another (eg relaxation) than any other

psychological techniques we have employed induding autogenic training

and biofeedback Even within-session analyses of the skin temperature

change patterns (micro patterns) appear to have diagnostic and predicshy

tive functions both for healthy and chronic pain samples

The empirical fmding that some chronic pain (low back) patients show

an initial in crease in musde activity (EMG) and a delayed return to baseshy

Hne only in the paraspinal musdes and only when verbally discussing pershy

sonally relevant stress (Flor amp Turk 1989) represents addiacutetional support

for what happens physiologically when people put their feelings about seshycret traumatic events into words Finally it is worth noting that successshy

fuI control of physiological activity associated with nonverbalized negashy

tive emotional activity made evident by biofeedback may serve to enhance

patients perceived control regarding their ability to move from one to anshy

other emotional state

REFERENCES

Apter M J Fontana D amp Murgatroyd S (985) Reversal theory Applications and

developments Cardiff Wales University College Cardiff Press

268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8

Pennebaker J implicatio

cercises 1effects iuals to

5atroyd

the disshyprocess Iility reshyexpressshytins and Ise ur subshyng-term a wrIacutetshy

nal state ly other training Jerature predicshy

ltsshow to baseshyingpershysupport bout seshysuccessshyd negashyenhance le to anshy

tions and


Bandura A OLeary A Taylor c Gauthier J amp Gossard D (1987) Perceived selfshy

efficacy and pain control Opioid and non-opioid mechanisms iexcloumal of Pershy

sonality and Social Psychology 35 563-571

Barton S (1994) Chaos self-organization and psychology American Psychologist

495-14

Domiacutenguez B (1994) La importancia de sentirse mal [The Importance of Feeling

Badly] El Nacional Dominical 23124-27

Domiacutenguez B Alvarez L M Cortes J amp Olvera Y (1993) Multiple-psychophysshy

iological self-report and other measurement in order to obtain cliacutenical signifshy

icance A case study of chronic pain and synthetic opioid addiction Biacuteofeedshy

back and Self-Regulation 18 159-160

Domiacutenguez B Valderrama P Perez S L amp Meza M A (1994) Relaxation health

and chaos theory Paper presented at Annual Meeting of the Society for Chaos

Theory in Psychology and the Life Sciences The John Hopkins University Balshy

timore MD

Flor H amp Turk D (1989) Psychophysiology of chronic pain Do chronic pain pashy

tients exhibit symptom-specific psychophysiological responses Psychological

Bulletin 105215-259

Haynes S N Huland E S amp Oliveira J (1993) Identifying causal relationships in

cliacutenical assessment Psychological Assessment 5 281-291

Horgan J (1994) Can science explain consciousness Scientific American 270

72-78

Keefe F (1978) Biofeedback VS instructional control of skin temperature iexcloumal

of Behavioral Medicine 1 323-335

Kiecolt-Glaser J K amp Glaser R (1992) Psycho-neuroimmunology Can psychoshy

logical interventions modulate irnmunity iexcloumal of Consulting and Clinical

Psychology 60 569-575

Klivington K (1989) The science of mind Boston MIT Press

Lazarus R S (1993) From psychological stress to the emotions A history of changshy

ing outlooks Annual Review of Psychology 44 1-21

Mandler G (1993) Thought memory and learning Effects of emotional stress In

Goldberger amp Bernitz (Eds) Handbook ofstress Theoretical and cliacutenical aspects

(2nd Ed) New York Free Press

Merskey H (1985) A mentalistic viacuteew of pain and behaviour Behavior and Brain

Sciences 8 65

Pennebaker J (1993) Putting stress into words Health linguistic and therapeutic

implications Behaviour Research and Therapy 31 539-548

269


Selye H (1983) The stress concept Past present and future In C L Cooper (Ed)

Stress research lssues for the eighties New York Wiley

Surwit R (1977) Simple versus complex feedback displays in the training of digishy

tal temperature Journal of Consulting and Clinical Psychology 45 146-147

Surwit R Pilon R amp Fenton C (1978) Behavioral treatment of Raynauds disshy

ease Journal of Behavioral Medicine 1 323-335

Turner J (1991) Coping and chronic pain In M Bond J Charlton amp c Woolf

(Eds) Pain research and clinical management (VoL 4 Proceedings of the 6th

World Congress on Pain) New York Elsevier

Wall P amp Jones M (1991) Defeating pain The war against a silent epidemic New

York Plenum

Williams D amp Thorn B (1989) An empiacuterical assessment of paiacuten beliefs Pain 36

351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

Contributors

Nekane Basabe Basque Country University Spain

Roger J Booth University of Auckland New Zealand

Thomas D Borkovec Pennsylvania State University

Wtlma Bucci Adelphi University

Kathryn P Davison Southern Methodist University

Benjamiacuten Domiacutenguez National Autonomous University of Mexico

Eugenia Georges Rice University

Susan Lee Goldman Yale University

Ioseba Iraurgi Basque Country University Spain

John Kinyon Pennsylvania State University

John P Kline University of Arizona

Julie D Lane Uniacuteversity of Virginia

Michael J Mahoney University of North Texas

Gloria Martiacutenez National Autonomous University of Mexico

Jobn D Mayer University of New Hampshire

Viacutector Manuel Meacutendez National Autonomous University of Mexico

Mariacutea de los Angeles Meza National Autonomous University of Mexico

Yolanda Olvera National Polyteehnic Institute Mexico City

Dario Paez Basque Country University Spain

Tibor P Palfai Yale University

James W Pennebaker Southern Methodist University

Sara Lidia Peacuterez National Autonomous University of Mexieo

Keith J Petrie University of Auckland New Zealand

Bernard Rimeacute University of Louvaiacuten Belgium

Lizabeth Roemer Pennsylvania State University

Peter Salovey Yale University

Gary E Schwartz University of Arizona

Xt

I



































Preface














cost-effective ways














xm

PREFACE

p


















JAMES W PENNEBAKER

DALLAS TEXAS

xiv









3

JAMES W PENNEBAKER



























AND DISCLOSING






4


1993) Recent worko




dislodge from our


minating Borkovec












When individuals WI





I

~s in Native

olved sorne

o was to be

s from sevshy

aboutemoshy

or example

experiences

an visits for

iacuteng Antoni

193a Spera

ate that the

tedwithinshy

(eg Rimeacute

vestigations

aumatic exshy

11993) and

)

~ emotional

ult to study

iexcly The purshy

kers to

elationship

features inshy

losure

ING

mon sympshy

ng Why do in Freuds

is that indishy

l sorne way

AN OVERVIEW

~



























PSYCHOSOMATICS






5

JAMES W PENNEBAKER



































6

copers are indeed h









CLINICA


nomenon whether in





1993b)

Within a dinical









to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

I



































Preface














cost-effective ways














xm

PREFACE

p


















JAMES W PENNEBAKER

DALLAS TEXAS

xiv









3

JAMES W PENNEBAKER



























AND DISCLOSING






4


1993) Recent worko




dislodge from our


minating Borkovec












When individuals WI





I

~s in Native

olved sorne

o was to be

s from sevshy

aboutemoshy

or example

experiences

an visits for

iacuteng Antoni

193a Spera

ate that the

tedwithinshy

(eg Rimeacute

vestigations

aumatic exshy

11993) and

)

~ emotional

ult to study

iexcly The purshy

kers to

elationship

features inshy

losure

ING

mon sympshy

ng Why do in Freuds

is that indishy

l sorne way

AN OVERVIEW

~



























PSYCHOSOMATICS






5

JAMES W PENNEBAKER



































6

copers are indeed h









CLINICA


nomenon whether in





1993b)

Within a dinical









to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

Preface














cost-effective ways














xm

PREFACE

p


















JAMES W PENNEBAKER

DALLAS TEXAS

xiv









3

JAMES W PENNEBAKER



























AND DISCLOSING






4


1993) Recent worko




dislodge from our


minating Borkovec












When individuals WI





I

~s in Native

olved sorne

o was to be

s from sevshy

aboutemoshy

or example

experiences

an visits for

iacuteng Antoni

193a Spera

ate that the

tedwithinshy

(eg Rimeacute

vestigations

aumatic exshy

11993) and

)

~ emotional

ult to study

iexcly The purshy

kers to

elationship

features inshy

losure

ING

mon sympshy

ng Why do in Freuds

is that indishy

l sorne way

AN OVERVIEW

~



























PSYCHOSOMATICS






5

JAMES W PENNEBAKER



































6

copers are indeed h









CLINICA


nomenon whether in





1993b)

Within a dinical









to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

PREFACE

p


















JAMES W PENNEBAKER

DALLAS TEXAS

xiv









3

JAMES W PENNEBAKER



























AND DISCLOSING






4


1993) Recent worko




dislodge from our


minating Borkovec












When individuals WI





I

~s in Native

olved sorne

o was to be

s from sevshy

aboutemoshy

or example

experiences

an visits for

iacuteng Antoni

193a Spera

ate that the

tedwithinshy

(eg Rimeacute

vestigations

aumatic exshy

11993) and

)

~ emotional

ult to study

iexcly The purshy

kers to

elationship

features inshy

losure

ING

mon sympshy

ng Why do in Freuds

is that indishy

l sorne way

AN OVERVIEW

~



























PSYCHOSOMATICS






5

JAMES W PENNEBAKER



































6

copers are indeed h









CLINICA


nomenon whether in





1993b)

Within a dinical









to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (









3

JAMES W PENNEBAKER



























AND DISCLOSING






4


1993) Recent worko




dislodge from our


minating Borkovec












When individuals WI





I

~s in Native

olved sorne

o was to be

s from sevshy

aboutemoshy

or example

experiences

an visits for

iacuteng Antoni

193a Spera

ate that the

tedwithinshy

(eg Rimeacute

vestigations

aumatic exshy

11993) and

)

~ emotional

ult to study

iexcly The purshy

kers to

elationship

features inshy

losure

ING

mon sympshy

ng Why do in Freuds

is that indishy

l sorne way

AN OVERVIEW

~



























PSYCHOSOMATICS






5

JAMES W PENNEBAKER



































6

copers are indeed h









CLINICA


nomenon whether in





1993b)

Within a dinical









to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

JAMES W PENNEBAKER



























AND DISCLOSING






4


1993) Recent worko




dislodge from our


minating Borkovec












When individuals WI





I

~s in Native

olved sorne

o was to be

s from sevshy

aboutemoshy

or example

experiences

an visits for

iacuteng Antoni

193a Spera

ate that the

tedwithinshy

(eg Rimeacute

vestigations

aumatic exshy

11993) and

)

~ emotional

ult to study

iexcly The purshy

kers to

elationship

features inshy

losure

ING

mon sympshy

ng Why do in Freuds

is that indishy

l sorne way

AN OVERVIEW

~



























PSYCHOSOMATICS






5

JAMES W PENNEBAKER



































6

copers are indeed h









CLINICA


nomenon whether in





1993b)

Within a dinical









to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

~s in Native

olved sorne

o was to be

s from sevshy

aboutemoshy

or example

experiences

an visits for

iacuteng Antoni

193a Spera

ate that the

tedwithinshy

(eg Rimeacute

vestigations

aumatic exshy

11993) and

)

~ emotional

ult to study

iexcly The purshy

kers to

elationship

features inshy

losure

ING

mon sympshy

ng Why do in Freuds

is that indishy

l sorne way

AN OVERVIEW

~



























PSYCHOSOMATICS






5

JAMES W PENNEBAKER



































6

copers are indeed h









CLINICA


nomenon whether in





1993b)

Within a dinical









to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

JAMES W PENNEBAKER



































6

copers are indeed h









CLINICA


nomenon whether in





1993b)

Within a dinical









to positive states

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

tlong-term

a1s are enshy

1to providshy

(989) The

ingofemoshy

ics has surshy

example to

e or biologshy

te this overshy

ce maybave

hapter 7 of

bywhich we

id social beshy

1 and someshy

olf amp Goodshy



from studyshy

own how to

al repression

res one tbat


o heavily on

lSure represshy

understandshy

nt traumatic

5t and could

line (chapter

as repressive

AN OVERVIEW












OF DISCLOSURE








1993b)












to positive states

7

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

JAMES W PENNEBAKER















SUMMARY












REFERENCES


cine 38 300-313

8

Esterling B A Anto


Barr virus reac

130-140

Frank J D (1961)1

Freud S (1966) 1m

York W W NO

Freyd J J (1993) T

bate Center fur

ference Ann Arl

Horowitz M (1976)

JourardSM(1971)

New York WUe)

Mahoney M J (199

chotherapy New


fects of unattain

Pennebaker (Eds

NJ Prentice Hal

Pennebaker J W (19

Advances in expl

Academic Press

Pennebaker J W (19

York William M

Pennebaker J W (1~

peutic implicati(

Pennebaker J W (1~

J W PennebakeI

Cliffs NJ Prenti


Six studies on th

Rogers C R (1951)

theory Boston 1

Shedler J Mayman




sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (



sychosomatic Medi-

AN OVERV1EW




130-140















NJ Prentice Hall



Academic Press


York William Morrow













9

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

I

JAMES W PENNEBAKER




34-52



A Cul Persp(






10




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

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understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

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stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

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reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (




and Yolanda Olvera


















255




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (




































256

THE RO

ing causal

physiologi

Lazarus (1

depends 01

vironment

fuI situatio

cause-effe(

natural di

iacuteng comple

possible

Clinica

dients beh

chosocial s1

chronicpai

Given the (

thetreatm~

have emph

the develo]

causal anal

ments

With r


single psycl

the impact

sequently i

biofeedbac

clients dial Most (

sumethat 1

between th


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (


and chemical

interaction of

lerceived expeshy

1 other mental

iexclan 1994) It is

probable stresshy

1andler 1993)

lteraction of a

ontext evaluashy

notional expeshy

lar emotional

~iar conditions

recognize faces

nthe patient is


vington1989)

l arousal is necshy

totional experishy

~S and current

luate any expeshy

lat they expect

of a situation

~ state of stress

ological factors

lter 2 this volshy

18 stressors can

19ical intervenshy

n ( eg Kiecoltshy

levelopment of

illness that is

rl intervention

oimmunologic

hod fur revealshy











possible










ments












257





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (





(Haynes et al 1993)






























258

THE ROL

vention mal

ficult to de

chophysiolo

(stress iropal

IDENTl A


sors This soc

ogists profess

tive level appr

managers in g


mand for effe

dinical psych(

approaches s

symptom synlt


shows no obv

sign of stress)

structive cont

stress Conver

terns of physi

emotional sigJ

junction amo

sponse Is it

alone define a






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (






)le and




























259



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

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understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

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to another Th

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tional states 11

duce even mo

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tions between

lates its lingui

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stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

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reducing the

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iexclhould write

leir distress

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utes ofwritshy


iacuteng exercise

nsFrom the

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s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

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e for healthy

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EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (



































260

THE ROLE OF

participants wrote

compared in term

tween subjective e

In the writing I


indicated that peop

ing secrets sessior

than those who ov

from conveying ve

over the 3-5 days e

On the 1st day

ing instructions (1

grammatical rules

write nonstop abo

told to write abou1

use of a high nuro

emotion words anlt


pants repeated the

the 1st day (Traurr

were encouraged t

promote psycholof

Person condition)

As can be seer

the two Trauma

condition Interest

idence a significan

ter writing Particl

perature for the


temperature from

the two Trauma VI

over twice as mu(



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (



lded to reIy


nerally asshy

ed sympashy

e feedback

erally have

ing longer

ting

I using peshy

ess of each

volved 174


overnmenshy

)f approxishy

osions The

axation reshy


Ilgtomodshy

natic mea-

I autogenic

























Person condition)









261


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (


ID Before After

33

335

325

32

315

31

305

30


Figure 1
















262

THE ROLE OF

Potel

Aeeording to an ev




present and that a


Chronic pain I

6 months often in

bulk of the researe


various psyehologi

and affeetive respo

medical and psych


Although reseiexcl

eontinues to be a


eoneerns basie defi

fine pain in genera

1989)

The position t

sessment and treal


a number of empi

sive management

should determine


Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

Srd Persao



ts would evshy


~gative emoshy


1 writing are

and tempershy

gt the degree









healing to occur








1989)





263


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (


































THE ROLE

emotion and 1

the important

decades tend 1



Supported

the disclosure

10gieal variabll


pain resolves ~

Although

chronic pain (]

the majority o

group For thi


vasive treatme

tal of Mexico I

munology seI


By wayof con

who were defi

Labor Stress ~



These individ

friends and s

264

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

chronic pain

S patient beshy

leymaypreshy

that patients

ion failed to

ents

lding of pain

heir abilities

1 over events

nic pain pashy

having conshy

her external

1 sharing of

ing In a reshy

(1991) emshy

Igical factors

nie pain pashy

ng and reinshy

)ping strateshy

al disability

whorelyon

Researchers

understandshy

as active in-

Jestions and

tare not alshy

and prediet

searches for

ourse seeks

~ds help exshy

the research

gnition that








ical intervention




























265






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (






























grees)






266

THE ROLE

could healthy I

over time dur

would demon

u

Unlike adults

to another Th

For adults in d

tional states 11

duce even mo

or psychologic

intervene with


tions between

lates its lingui

Our expel

stress-affected

shares many e

most importal

can create fav(

tive emotional

cellent exampl

the applicatiOl


quire a great (



relaxation res]

bition Interes

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

ie charactershy

lowed highly

ltS that conshy

Id the stress

reducing the

onsequences

iexclhould write

leir distress

Iided by the

utes ofwritshy


iacuteng exercise

nsFrom the

j of writing

s in periphshy

were 25deg C

axation

~ercise durshy


redicted the

writing with

tperature inshy


e for healthy

e First psyshy

~cts than for

mc pain pashy

edback than






EMOTIONAL REVERSAL




























267

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

I






1985)

























REFERENCES



268

THE ROLE

Bandura A O

efficacy a11

sonality al

Barton S (199

495-14

Domiacutenguez B

Badly] El

Domiacutenguez B

iological

icance A

back and ~

Domiacutenguez B

and chaos

Theoryin

timore M

Flor H amp Tur

tients ero

Bulletin 1

Haynes S N J

clinical as

Horgan J (19

72-78

Keefe F (1978

ofBehavio

Kiecolt-Glaser

logical int

Psychologj

Klivington K

Lazarus R S (

ing outloc

Mandler G (1

Goldberge

(2nd Ed)

Merskey H (1

Sciences 8



5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (


5atroyd




tions and






495-14










timore MD



Bulletin 105215-259




72-78













Sciences 8 65



269












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (












York Plenum


351-358

270

Mel Sharin

1

M ajor nega

known to

ene e traumatie e

ory flashbaeks o

the traumatie si

thoughts and mi

ten persist for lo

an average of 21

71 of investiga

perienee though

repetitive memo

of a major negat

to taIk about th

poorIy doeumer

nebaker 1993) )

reaetions to und

ver amp Wortman

vasive Surveys (

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