Abstract
This is the second special section of Emotion Review that focuses on connections between emotion research and a neighboring academic and applied field. In the January 2016 issue, the first of these special sections examined connections between emotion research and the legal system. In the current issue, a special section comprised of four articles and seven commentaries looks at connections between emotion research and health.
Research on behavioral and emotional aspects of health is often carried out under the rubric of “behavioral medicine” or “health psychology.” The field of behavioral medicine encompasses a wide range of topics integrating medicine with psychology and other disciplines such as anthropology and sociology. In many, but by no means all of these topics, emotion looms large. Nonetheless, many key concepts in theories of emotion seem to crop up rather little in discussions of behavioral medicine. Moreover, the two communities of psychologists have remained fairly separate, with behavioral medicine generally being the province of clinical psychologists and basic emotion research being the focus of experimental psychologists. The effects of emotion on health have been rather rarely discussed in the pages of Emotion Review. The main exception is Williams and Evans (2014), although we have had a number of articles on emotion in mental health and illness (e.g., Kringelbach & Berridge, 2017; Mehu & Scherer, 2015; Stein & Nesse, 2015; see also Armenta, Fritz, & Lyubomirsky, 2017).
I am hopeful, however, that this special section on emotion research and health will be of great interest to emotion researchers and will help to bridge the aforementioned gap. The goal of this special section is to provide a sampling of some of the varied ways that emotions may contribute to health and disease and in so doing to help make a case of just how important it is for basic research on emotion to connect with health research. The contributions summarize some of the ideas and work of scientists who straddle both fields.
The first target article, by Suls (2018), looks at whether predispositions towards different forms of what he terms “toxic affect” (namely, anger, anxiety, and depression) are uniquely associated with coronary heart disease (CHD), a very common cause of mortality. Studies examining each of these emotional dispositions separately have suggested that they are all likely to contribute to CHD. For more than 25 years, the most popular hypothesis on this link is that these are all manifestations of a stress reaction which produces heightened physiological responding that can lead to damage to the cardiovascular system, ultimately leading to disease and death. What behavioral medicine calls “stress” might easily translate into what emotion researchers call general negative affect. Suls points out, however, that these studies generally only examined one type of emotion at a time (or an aggregate measure combining several). Therefore, it has not been clear whether all three forms of affect independently predict CHD or whether each is just an index oa;f more general negative affect. Suls’s article carefully addresses these questions and finds that anxiety and depression play separate roles in this disease, and cannot be reduced to general negative affect. His conclusions are somewhat tentative because of the scarcity of studies that measure multiple emotions.
Where Suls looks at the harmful effect of negative emotions, our second article, by Hernandez et al. (2018), asks whether positive affect broadly construed can provide a protective buffer against disease and death. Hernandez and her colleagues also grapple with the question of whether any effects of positive affect might merely be due to the absence of negative affect. Do you just need to avoid being anxious and down in the dumps or do you actually need to get your groove on to optimize your health? Since the studies in this area include diverse measures of positivity, Hernandez et l.’s review uses the term “psychological well-being” to capture the construct under discussion. However, like Suls, they also try to answer the question of whether different aspects of this general construct make unique contributions to health benefits. They find some intriguing effects, but are limited in how strongly they can draw conclusions because of the diversity of measures and often the failure to use any measures that specifically test between different forms of positive affect. Again, we see the need for studies in the field to employ more specific measures, measures that emotion researchers could help create, test, and validate in the lab. Hernandez et l.’s careful review and summary of the details of existing studies should help point us in the right direction.
The third article in this special section follows up on the theme of increasing health and well-being but does so from an emotion regulation perspective. Jamieson, Hangen, Yeon, and Yeager (2018) review findings that reappraisal of the meaning of the physiological arousal associated with stressful tasks, specifically ones that involve instrumental responding, can alter performance. Their take-home message is that stress reactions need not be bad. For example, telling subjects that their heightened physiological arousal might make them perform better at a task does indeed increase performance. The idea is that by doing so subjects are shifted from a threat mindset (demands exceed resources) to a challenge mindset (resources exceed demands). This connects with a large body of work suggesting that challenge produces a healthier physiological profile (Blascovich, 2013). These are not the terms that traditional emotion researchers typically use, but it is easy to see how these states might be related to the specific emotions of anxiety and anger (although see Jamieson et l., 2018, for nuances). Again, the possibility emerges that anxiety might be more detrimental than anger, a possibility that seems potentially consistent with Suls’s (2018) findings that some emotional predispositions are more strongly linked with impairments to health.
In the final article, Sbarra and Coan (2018) tackle the broad topic of how emotions contribute to the link between relationships and health. They review a considerable number of prominent theoretical models on health and relationships and propose multiple mechanisms by which affect and social interactions influence one another with many potential ramifications for health. It is striking how often theories that use different terms are actually discussing similar processes. Sbarra and Coan also point out that “it is not enough to simply study a physiological outcome; rather, it is critical to demonstrate that physiological effects are practically meaningful and related to clinical or disease endpoints” (p. 49). This neatly ties in with the previous articles and reminds us that simply finding that a manipulation alters some physiological measure does not in and of itself demonstrate the relevance to health. However, the more that we can get traction in the lab on the physiological profiles that may accompany different emotions, appraisals, or high- versus low-intensity states, the more we can offer informed suggestions for intervention research.
The special section concludes with seven commentaries followed by author replies. Given that so many common themes emerge in the different target articles, I asked most commentators to discuss more than one article. I think readers will find that the commentaries draw interesting connections between the articles and, moreover, that they point out many rich connections between points made in the articles and research in the emotion field.
As the present discussion already brings out, many of the themes and questions that emotion theorists grapple with also occur in the applied context of health. For example, one debate that has raged for decades is whether human affective experience is best characterized as a point on several continuous dimensions (e.g., intensity of general arousal and positive–negative valence) versus as distinct emotions that are not reducible to points in the arousal and valence space. A number of the findings reported in this set of articles are more consistent with a specific emotions tradition. For example, Suls (2018) finds that not all negative emotions have the same connection with CHD and Hernandez et al. (2018) raise similar possibilities with positive affect. However, these findings might also arise over other aspects of emotions such as differing appraisals. This emphasizes the need to have more than one type of measure when assessing emotion and health. There is nothing wrong with common measures such as the PANAS, but such global assessments of affect fail to allow us to examine questions such as whether different emotions differentially impact health and disease or whether particular appraisals are useful in predicting effects of emotion on health. Using a general index of positivity and negativity would have obscured many of the interesting findings reported here. Moreover, it could turn out that positivity versus negativity accounts for some physical and behavioral outcomes while distinct emotions or appraisals account for others.
We often lack the basic research needed to shed light on questions that lie near the heart of society and civilization. For example, in the special section on emotion and law, we saw researchers interested in important questions such as “How can we tell if a defendant actually feels remorse?” (Bandes, 2016). The law treats remorse as a real thing, which weighs heavily in sentencing at least in the US. However, we lack firm understanding of what remorse is and how it should be assessed. Studies that are conducted in healthcare and legal settings are often quite costly (people outside of college are not always willing or able to complete large batteries of tests). As basic researchers and theorists, we need to do more to create measures that are reliable and valid and get at answering the questions we care most about.
In closing, the broad domain of health is a perfect place for truly interdisciplinary work. My hope is that this issue will help promote future interactions and possible collaborations between health researchers and emotion researchers from various disciplines. So, share this issue with your colleagues and let’s see what questions can be answered.