Cited by 191Cancer, Stress, Anesthesia, and Immune ResponsePsychosomatic Disorders and Their TreatmentsCancer survivorship and care

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Emotional expression in cancer onset and progression

Gross, James·1989·Social Science & Medicine

DOI 10.1016/0277-9536(89)90342-0

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Abstract

Despite the intensive biomedical research in oncology since World War II, recent studies show a steady increase in age-adjusted mortality for all kinds of cancer. This findings gives impetus to the efforts of researchers who have adopted the biopsychosocial model. Systematic research using such a model has shown several psychosocial factors to be associated with cancer onset and progression, and Temoshok has recently suggested a theoretical model which unifies these findings. In this paper, I consider the evidence that one of these psychosocial factors, emotional expression, may be directly involved in cancer onset and progression. I review 18 relevant studies, discuss how one might operationalize the term 'emotional expression', and make 12 suggestions for future research.

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Background
Repressive coping before and after diagnosis of breast cancer
Zachariae, R. H., Jensen, A. B., Pedersen, C. B., Jørgensen, M. M., Christensen, S., Lassesen, B., & Lehbrink, M. (2003) · Psycho-Oncology · doi:10.1002/pon.772 · Cited by 38
“A number of systematic reviews of the literature on personality and psychological coping factors and cancer onset have been conducted over the years (Gross, 1989; Levenson et al., 1994; Fox, 1998; Butow et al., 2000; Petticrew et al., 2002).”
BackgroundResultInfluential
Emotion and Health: An overview
Pandey, R., & Choubey, A. K. (2010) · Cited by 37
A repressive coping style and affective, facial and physiological responses to looking at emotional pictures
Houtveen, J. H., Rietveld, S., Schoutrop, M., Spiering, M., & BROSSCHOT, J. F. (2001) · International Journal of Psychophysiology · doi:10.1016/s0167-8760(01)00150-7 · Cited by 37
Clarification of the conceptualization and measurement of denial in psychosocial oncology research
Moyer, A. E., & Levine, E. G. (1998) · Annals of Behavioral Medicine · doi:10.1007/bf02884955 · Cited by 38
Personality and physical health: toward an ecological approach to health-related personality research
Heck, G. L. V. (1997) · European Journal of Personality · doi:10.1002/(sici)1099-0984(199712)11:5 · Cited by 79
Emotion regulation, disgust sensitivity, and psychophysiological responses to a disgust-inducing film
Rohrmann, S., Hopp, H., Schienle, A., & Hodapp, V. (2009) · Anxiety Stress & Coping · doi:10.1080/10615800802016591 · Cited by 36
“Following the investigation by Gross (1998) the subjects viewed three validated silent films (see Gross & Levenson, 1995). The neutral film showed geometric figures and took 60 s. The two other films showed medical procedures (see Ekman, Friesen, & O’Sullivan, 1988). The first one dealt with the treatment of burn vict…”
BackgroundMethodInfluential
Socially Inhibited Individuals Show Heightened DTH Response during Intense Social Engagement
Cole, S. W., Kemeny, M. E., Birnbaum‐Weitzman, O., Schoen, M., & Anton, P. A. (1999) · Brain Behavior and Immunity · doi:10.1006/brbi.1998.0543 · Cited by 35
Communication Behaviors and Patient and Caregiver Emotional Concerns: A Description of Home Hospice Communication
Clayton, M. F., Reblin, M., Carlisle, M., & Ellington, L. (2014) · Oncology nursing forum · doi:10.1188/14.onf.311-321 · Cited by 32
“Although emotional expression can be beneficial (Berry & Pennebaker, 1993; Gross, 1989; Hoyt et al., 2013; Langer, Rudd, & Syrjala, 2007; Pennebaker, Mayne, & Francis, 1997; Petrie, Booth, & Pennebaker, 1998; Stanton et al., 2000; Suls, Green, Rose, Lounsbury, & Gordon, 1997), it also can be taken…”
Emotional acceptance, inflammation, and sickness symptoms across the first two years following breast cancer diagnosis
Reed, R. G., Weihs, K. L., Sbarra, D. A., Breen, E. C., Irwin, M. R., & Butler, E. A. (2016) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2016.02.018 · Cited by 35
“…cycle, whereas less effective emotion regulation strategies (e.g., suppression, repression, avoidance, cognitive perseveration) may exacerbate it (Chapman et al., 2013; Classen et al., 1996; Schlatter and Cameron, 2010; Gross, 1989; Tamagawa et al., 2013; Giese-Davis et al., 2008).”
Who benefits from emotional expression? An examination of personality differences among gynaecological cancer patients participating in a randomized controlled emotional disclosure intervention trial
Zakowski, S. G., Herzer, M., Barrett, S., Milligan, J. G., & Beckman, N. J. (2010) · British Journal of Psychology · doi:10.1348/000712610x524949 · Cited by 30
“…need for the kind of support that allows emotional expression (Rime, 1995) and that such expression is associated with psychological and somatic benefits (e.g., Gross, 1989; Stanton et al., 2000; van der Ploeg et al., 1989; Watson et al., 1991; Zakowski et al., 2004; Zakowski et al., 2001).”
Background
Subtypes of Psychosocial Adjustment to breast cancer
Nelson, D. V., Friedman, L. C., Baer, P. E., Lane, M., & Smith, F. E. (1994) · Journal of Behavioral Medicine · doi:10.1007/bf01858101 · Cited by 30
How Psychological Therapy may Prolong Survival in Cancer Patients: New Evidence and a Simple Theory
Cunningham, A. J., & Watson, K. L. (2004) · Integrative Cancer Therapies · doi:10.1177/1534735404267553 · Cited by 28
“The clinical evidence is supported by studies showing that repression may be a risk factor.(13,67-70,84,85) The convergence of observations here is persuasive.”
Background
Association between emotional intelligence and effective brain connectome: A large-scale spectral DCM study
Bajaj, S., & Killgore, W. D. S. (2021) · NeuroImage · doi:10.1016/j.neuroimage.2021.117750 · Cited by 27
“…emotions such as anger and ostility are more susceptible to heart related diseases ( Vlachaki and aridaki Kassotaki, 2013 ; Vlachakis et al., 2018 ), abnormal blood presure ( Brownley et al., 1996 ; Zysberg and Raz, 2019 ) and even cancer Gross, 1989 ; Mirzaei et al., 2019 ; Rey et al., 2013 ).”
Relationship of Emotional Intelligence and Adherence to Combination Antiretroviral Medications by Individuals Living With HIV Disease
Willard, S. S. (2006) · Journal of the Association of Nurses in AIDS Care · doi:10.1016/j.jana.2006.01.001 · Cited by 27
“disgust, happiness and sadness) that are related to increased immune function and enhanced mental and physical health (Cole, Kemeny & Taylor, 1997; Gross 1989).”
Background
Repressive Coping and Blood Measures of Disease Risk: Lipids and Endocrine and Immunological Responses to a Laboratory Stressor1
Barger, S. D., Bachen, E. A., Marsland, A. L., & Manuck, S. B. (2000) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.2000.tb02458.x · Cited by 26
Emotional Suppression and Breast Cancer: Validation Research on the Spanish Adaptation of the Courtauld Emotional Control Scale (CECS)
Ferrandis, E. D., Andreu, Y., Garrido, M. J. G., Ibáñez, E., Pérez, S., Ferrando, M., Murgui, S., & Martínez, P. (2010) · The Spanish Journal of Psychology · doi:10.1017/s1138741600003966 · Cited by 24
“In the past three decades, a great deal of research on psychosocial risk factors in cancer has focussed on the hypothesis of a Type C behavior pattern involved in cancer onset and prognosis (Contrada, Leventhal & O’Leary, 1990; Greer & Watson, 1985; Gross, 1989; McKenna, Zevon, Corn & Rounds, 1999; Temoshok, 1987).”
Influential
A Nationwide Population-Based Cohort Study: Will Anxiety Disorders Increase Subsequent Cancer Risk?
Liang, J., Sun, L.-M., Su, K., Chang, S., Sung, F.-C., Muo, C., & Kao, C. (2012) · PLoS ONE · doi:10.1371/journal.pone.0036370 · Cited by 23
“Following a review of the literature, we found that only a limited number of papers discussed or even addressed this issue, and the association between AD and cancer remains unclear [11–15].”
Background
Emotion in humanistic psychotherapy.
Greenberg, L. S., Korman, L. M., & Paivio, S. C. (2002) · American Psychological Association eBooks · doi:10.1037/10439-016 · Cited by 23
Role of resilience and emotional control in relation to mental health in people with cancer
Macía, P., Gorbeña, S., Barranco, M., de Erentzun, E. A. R., & Castillo, I. I. (2020) · Journal of Health Psychology · doi:10.1177/1359105320946358 · Cited by 26
“, 2015) has also been related to the cancer onset and prognosis (Greer and Watson, 1985; Gross, 1989).”
Background
Attachment and Cancer: A Conceptual Integration
Tacón, A. M. (2002) · Integrative Cancer Therapies · doi:10.1177/1534735402238188 · Cited by 22
“This fact has implications for well-being; research indicates that the nonexpression of negative emotions is linked to health.(25,26)”
Background
Early quality-of-life and psychological predictors of disease-free time and survival in localized prostate cancer
Lehto, U., Ojanen, M., Väkevä, A., Dyba, T., Aromaa, A., & Kellokumpu-Lehtinen, P. (2018) · Quality of Life Research · doi:10.1007/s11136-018-2069-z · Cited by 18
Manipulation of Physiological and Emotional Responses to Stress in Repressors and Sensitizers
Rohrmann, S., Hennig, J., & Netter, P. (2002) · Psychology and Health · doi:10.1080/08870440290025795 · Cited by 20
“This has been postulated for essential hypertension and coronary heart disease (e.g., Dembrowski et al., 1985; Manuck and Krantz, 1986; Roter and Ewart, 1992) and for reduced immunological defense with the possible consequence of cancer (e.g., Temoshok, 1987; Gross, 1989; Esterling et al., 1993).”
Background
Employees’ Emotions in Workplace
Gopinath, R. (2009) · Research Journal of Business Management · doi:10.3923/rjbm.2011.1.15 · Cited by 19
Repression, disclosure, and immune function: Recent findings and methodological issues.
Petrie, K. J., Booth, R. J., & Davison, K. P. (1995) · American Psychological Association eBooks · doi:10.1037/10182-010 · Cited by 19
Narratives of Exceptional Survivors Who Work with Aboriginal Healers
Mehl‐Madrona, L. (2008) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2007.0578 · Cited by 18
Achieving frontline communication excellence: the potential cost to health
Mann, S. (1998) · IEEE Transactions on Professional Communication · doi:10.1109/47.735367 · Cited by 18
“In recent years, there have been empirical reports of an association between inhibition of anger and coronary heart disease [22] while others have suggested that emotional inhibition may be linked to cancer onset and progression [ 23 ].”
Background
Psychosocial Factors Related to the Correspondence of Recipient and Provider Perceptions of Social Support among Patients Diagnosed with or at Risk for Malignant Melanoma
Lichtenthal, W. G., Cruess, D. G., Schuchter, L. M., & Ming, M. E. (2003) · Journal of Health Psychology · doi:10.1177/13591053030086005 · Cited by 17
“Gross (1989) explained how the Type C coping style, assumed to be a dispositional characteristic, may become damaging.”
Background
The Cost of Bottling It Up: Emotion Suppression as a Mediator in the Relationship Between Anger and Depression Among Men with Prostate Cancer
Rice, S., Kealy, D., Ogrodniczuk, J. S., Seidler, Z. E., Denehy, L., & Oliffe, J. L. (2020) · Cancer Management and Research · doi:10.2147/cmar.s237770 · Cited by 16
Crying and health
Vingerhoets, A. J. J. M., & Scheirs, J. G. M. (2001) · doi:10.4324/9780203717493-22 · Cited by 15
Colon cancer: Personality factors predictive of onset and stage of presentation
Kavan, M., Engdahl, B. E., & Kay, S. (1995) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(95)00523-4 · Cited by 15
Prospective investigation of emotional control and cancer risk in men (the Zutphen Elderly Study) (The Netherlands)
Tijhuis, M. A. R., Elshout, J. R. A. F., Feskens, E. J. M., Janssen, M., & Kromhout, D. (2000) · Cancer Causes & Control · doi:10.1023/a:1008955818369 · Cited by 13
Emotional suppression: can it predict cancer outcome in women with suspicious screening mammograms?
O׳Donnell, M., Fisher, R., IRVINE, K., Rickard, M., & McConaghy, N. (2000) · Psychological Medicine · doi:10.1017/s0033291799002603 · Cited by 13
“While this finding is inconsistent with earlier evidence in this area (reviewed by Gross, 1989) it lends support to the findings of Bleiker et al. (1996) who, similarly, found no relationship between emotional suppression and a cancer outcome in a large prospective study.”
BackgroundResult

Authors: Gross, J.
Affiliations: University of California, Berkeley (US)
Corresponding author: Gross, James
ORCID: Gross, James
Venue: Social Science & Medicine
Publisher: Elsevier BV
Published: 1989-01
Volume: 28
Issue: 12
Pages: 1239-1248
ISSN: 0277-9536 (ISSN-L)
DOI: 10.1016/0277-9536(89)90342-0
OpenAlex: W2067221825
Cited by: 191
References: 74
Citations by year: 2026: 3 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 9 · 2019: 3 · 2018: 8 · 2017: 1 · 2016: 3 · 2015: 7 · 2014: 6 · 2013: 3 · 2012: 8
FWCI: 1.47
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Social Science & Medicine (publishedVersion)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Stress, Anesthesia, and Immune Response
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: emotional expression, cancer onset, tumor progression, psychosocial factors, biopsychosocial model, cancer mortality, psychosocial stress
MeSH terms: Adaptation, Psychological, Anger, Denial, Psychological, Emotions, Humans, Neoplasms, Personality, Repression, Psychology, Research

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Emotional expression in cancer onset and progression

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