Emotional approach coping (EAC) comprises two interconnected facets: emotional processing (EP) and emotional expression (EE).
EP entails actively acknowledging and making sense of emotions stemming from a stressor. It involves introspection to gain insights into one’s emotional experiences.
For example, following a job loss, exploring the emotions of anxiety, frustration, and self-doubt to gain insight into the situation.
Conversely, EE encompasses active attempts to communicate or outwardly express emotions related to the stressor, either verbally by talking about one’s feelings or nonverbally through methods like journal writing or art.
While distinct, EP and EE are closely linked, as processing emotions often facilitates their expression, and expressing emotions can further aid in processing them.
Hoyt, M. A., Llave, K., Wang, A. W.-T., Darabos, K., Diaz, K. G., Hoch, M., MacDonald, J. J., & Stanton, A. L. (2024). The utility of coping through emotional approach: A meta-analysis. Health Psychology, 43(6), 397–417. https://doi.org/10.1037/hea0001364
Key Points
- Emotional approach coping (EAC), which involves intentionally processing and expressing emotions related to stressors, was associated with better overall mental and physical health outcomes across 86 studies.
- Both facets of EAC – emotional expression (EE) and emotional processing (EP) – were positively associated with better health, though the relationships did not reach statistical significance when examined separately.
- In analyses of specific health domains, EAC was linked to better health in biological/physiological, physical, and resilience-related psychological adjustment domains. However, it was associated with worse outcomes in the risk-related psychological adjustment and mental/emotional distress domains.
- Results for EE and EP separately mirrored the overall EAC pattern, with the exception that only EP was associated with more engagement in health-promoting behaviors.
- The EAC literature is marked by heterogeneity across study methodologies, measures, and types of stressor contexts examined, limiting definitive conclusions. More longitudinal studies are needed.
Rationale
Over the past three decades, research has investigated the utility of coping through emotional approach (i.e., processing and expressing stressor-related emotions) in predicting physical and psychological health (Stanton et al., 1994; Austenfeld & Stanton, 2004).
Some studies suggest EAC exerts a salutary impact across a wide range of stressors and health outcomes (e.g., Cho et al., 2013; Juth et al., 2015; Stanton, 2011), while others have found null relationships (e.g., Moreno et al., 2016; Pakenham et al., 2007).
Additionally, the two facets of EAC – emotional expression (EE) and emotional processing (EP) – do not always show the same effects (Hoyt, 2009).
This meta-analysis aimed to synthesize the current literature to:
- Determine the overall strength of association between EAC and mental and physical health;
- Examine whether effects differ for EE and EP; and
- Explore potential moderators of these relationships. By capturing the complexity and variability of this literature, this review can inform the development of interventions to enhance effective use of EAC.
Method
A systematic literature search was conducted in EBSCO databases (MEDLINE, PsycINFO, Cochrane) from inception to November 2022.
The meta-analysis included 86 studies that measured unconfounded EAC (free of distress content) and a physical or mental health outcome. A three-level random effects model examined overall effects.
Moderation by study (e.g., design, EAC measure) and sample (e.g., gender, cancer) characteristics was tested.
Sample
The 86 included studies had sample sizes ranging from 15 to 1,453 (mean=220). 76% of samples were more than half female.
Mean ages ranged from 17 to 94 years. 46 studies (53%) involved clinical samples, mostly cancer survivors.
Measures
- Emotional Approach Coping Scale (Stanton et al., 2000) assessing dispositional or situational EE and EP
- Various physical and mental health measures categorized into 8 domains: behavioral, biological/physiological, mental/emotional distress, physical, positive psychological, social, resilience-related, and risk-related
Results
- Emotional approach coping (EAC) associated with better overall health (r = .05, p = .04)
- In specific domains, positive associations found for biological/physiological, physical and resilience outcomes
- Negative associations found for risk-related adjustment and mental/emotional distress
- Patterns similar for EE and EP separately, but only EP linked to health behaviors
- No significant moderation effects emerged
Insight
This meta-analysis provides the most comprehensive evidence to date that coping through intentional processing and expression of emotions predicts better physical and mental health on average, especially for biological, physical and psychological resilience outcomes.
However, it may exacerbate distress and certain emotional risk factors in the short term.
The lack of difference between EE and EP effects was unexpected, given some previous research (e.g., Hoyt, 2009). However, they may operate through distinct mechanisms not captured here.
This unexpected finding suggests that EE and EP may influence health through separate, unmeasured pathways.
For instance, EE might impact health by reducing emotional inhibition and promoting social support, while EP could operate through increased self-awareness and meaning-making.
Future studies should explore these potential unique mechanisms to better understand how EE and EP differently contribute to physical and mental well-being.
Strengths
- Three-level random effects model accounted for dependency among effect sizes within studies
- Examined overall EAC and separate EE/EP effects
- Coded outcomes into meaningful health domains
- Tested relevant study and sample moderators
- Evaluated publication bias and study quality
Limitations
- Inconsistent reporting; many studies only reported EE or EP
- Could not test all possible moderators
- Outcome domains contained variable measures
- Mostly cross-sectional designs
Clinical Implications
The benefits of EAC for health appear robust across contexts, highlighting its utility as a coping resource. Interventions should aim to enhance effective use of EE and EP, tailored to individuals’ unique stressors and health status.
However, distress and certain emotional vulnerabilities may be amplified initially and require additional support. Timing of EAC measurement may also influence results.
Evaluating EAC in relation to other coping processes and testing underlying mechanisms are important next steps to optimize its positive impact. More diverse samples are also needed.
Given that EAC was associated with better overall mental and physical health outcomes, incorporating strategies to enhance emotional processing (EP) and emotional expression (EE) in therapeutic interventions could be beneficial for clients facing various stressors.
Acceptance and Commitment Therapy (ACT), which aligns with the principles of EAC, could be a particularly useful approach. By teaching clients to accept and process their emotions mindfully and express them in adaptive ways, ACT may help individuals cope more effectively with stress and improve their well-being.
However, the meta-analysis also found that EAC was associated with worse outcomes in the risk-related psychological adjustment and mental/emotional distress domains. This suggests that while ACT and other EAC-based interventions can be helpful, they should be applied with caution and tailored to the individual client’s needs.
For example, when working with clients who have a history of emotional trauma or are prone to rumination, therapists may need to provide additional support and guidance to ensure that emotional processing and expression are conducted in a safe and manageable way.
References
Primary reference
Hoyt, M. A., Llave, K., Wang, A. W.-T., Darabos, K., Diaz, K. G., Hoch, M., MacDonald, J. J., & Stanton, A. L. (2024). The utility of coping through emotional approach: A meta-analysis. Health Psychology, 43(6), 397–417. https://doi.org/10.1037/hea0001364
Other references
Austenfeld, J. L., & Stanton, A. L. (2004). Coping through emotional approach: A new look at emotion, coping, and health-related outcomes. Journal of Personality, 72(6), 1335-1364. https://doi.org/10.1111/j.1467-6494.2004.00299.x
Cho, D., Park, C. L., & Blank, T. O. (2013). Emotional approach coping: Gender differences on psychological adjustment in young to middle-aged cancer survivors. Psychology & Health, 28(8), 874-894. https://doi.org/10.1080/08870446.2012.762979
Hoyt, M. A. (2009). Gender role conflict and emotional approach coping in men with cancer. Psychology and Health, 24(8), 981-996. https://doi.org/10.1080/08870440802311330
Juth, V., Dickerson, S. S., Zoccola, P. M., & Lam, S. (2015). Understanding the utility of emotional approach coping: Evidence from a laboratory stressor and daily life. Anxiety, Stress, & Coping, 28(1), 50-70. https://doi.org/10.1080/10615806.2014.921912
Moreno, P. I., Bauer, M. R., Yanez, B., Jorge, A., Maggard-Gibbons, M., & Stanton, A. L. (2016). Dispositional emotional expressivity, cancer-specific coping, and distress in socioeconomically-disadvantaged Latinas. Health Psychology, 35(6), 584-593. https://doi.org/10.1037/hea0000319
Pakenham, K. I., Smith, A., & Rattan, S. L. (2007). Application of a stress and coping model to antenatal depressive symptomatology. Psychology, Health & Medicine, 12(3), 266-277. https://doi.org/10.1080/13548500600871702
Stanton, A. L. (2011). Regulating emotions during stressful experiences: The adaptive utility of coping through emotional approach. In S. Folkman (Ed.), The Oxford handbook of stress, health, and coping (pp. 369–386). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780195375343.013.0018
Stanton, A. L., Kirk, S. B., Cameron, C. L., & Danoff-Burg, S. (2000). Coping through emotional approach: Scale construction and validation. Journal of Personality and Social Psychology, 78(6), 1150-1169. https://doi.org/10.1037/0022-3514.78.6.1150
Stanton, A. L., Danoff-Burg, S., Cameron, C. L., & Ellis, A. P. (1994). Coping through emotional approach: Problems of conceptualization and confounding. Journal of Personality and Social Psychology, 66(2), 350-362. https://doi.org/10.1037/0022-3514.66.2.350
Keep Learning
- What types of stressful situations do you think emotional approach coping might be most beneficial or detrimental for? Why?
- The results suggest EAC is related to worse mental distress and emotional risk factors but better physical and biological health. How can we make sense of this seeming discrepancy?
- If you were designing an intervention to enhance effective use of emotional approach coping strategies, what elements would you include based on these findings? What additional factors would you consider?
- Discuss potential reasons why the separate effects of emotional expression and emotional processing coping did not differ much in this meta-analysis, despite some previous research finding differences. What might be some limitations in examining them separately?
