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Cited by 467Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMindfulness and Compassion InterventionsChild and Adolescent Psychosocial and Emotional Development

How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal

Open access
Hofmann, Stefan G., Heering, Sanna, Sawyer, Alice T., Asnaani, Anu·2009·Behaviour Research and Therapy
DOI 10.1016/j.brat.2009.02.010PMC PMC2674518
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Abstract

It has been suggested that reappraisal strategies are more effective than suppression strategies for regulating emotions. Recently, proponents of the acceptance-based behavior therapy movement have further emphasized the importance of acceptance-based emotion regulation techniques. In order to directly compare these different emotion regulation strategies, 202 volunteers were asked to give an impromptu speech in front of a video camera. Participants were randomly assigned to one of three groups. The Reappraisal group was instructed to regulate their anxious arousal by reappraising the situation; the Suppression group was asked to suppress their anxious behaviors; and the Acceptance group was instructed to accept their anxiety. As expected, the Suppression group showed a greater increase in heart rate from baseline than the Reappraisal and Acceptance groups. Moreover, the Suppression group reported more anxiety than the Reappraisal group. However, the Acceptance and Suppression groups did not differ in their subjective anxiety response. These results suggest that both reappraising and accepting anxiety is more effective for moderating the physiological arousal than suppressing anxiety. However, reappraising is more effective for moderating the subjective feeling of anxiety than attempts to suppress or accept it. © 2009 Elsevier Ltd. All rights reserved.

Integrity signals

Registry

Crossref · 10.1016/j.brat.2009.02.010

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

1 of 24 cited sources checked · 1 supported · 0 flagged

  • Study design and conductcitation

    Replication of earlier results suggests the suppression manipulation was effective.

    “We used similar instructions as Gross and colleagues to induce suppression (e.g., Gross & Levenson, 1997), and we replicated their earlier findings, suggesting that our experimental manipulation worked (Gross, 1998, 2002; Gross & Levenson, 1997).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Gross & Levenson, 1997 source
    • cites Gross, 1998 source
    • cites Gross, 2002 source
  • Findingown data

    Heart rate changes from baseline did not differ between the Acceptance and Reappraisal conditions.

    “The Acceptance and Reappraisal groups did not differ from one another in heart rate changes from baseline (p > .81).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants complied with the emotion regulation instructions they received.
    • Rests on an assumption: The speech task produced enough anticipatory anxiety to reveal group differences.
  • Findingown data

    The proportion of participants who ended the speech early did not differ among the three conditions.

    “Approximately half of the participants in all three groups (48.52% of the Reappraisal group, 47.76% of the Suppression group, and 58.20% of the Acceptance group) terminated the speech before the 10 minutes elapsed, χ2 (2) = 1.82, p > .4.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Participants complied with the emotion regulation instructions they received.
    • Rests on an assumption: The speech task produced enough anticipatory anxiety to reveal group differences.
  • Findingown data

    Speech length did not differ among the three conditions.

    “The three groups did not differ in the length of speeches, F (2, 199) = 1.88, p > .15.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Participants complied with the emotion regulation instructions they received.
    • Rests on an assumption: The speech task produced enough anticipatory anxiety to reveal group differences.
  • Findingreasoning

    The between-group differences in absolute terms were modest.

    “It should be noted, however, that the absolute differences between the groups were not very large.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 12
  • May combine two claims. 16
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Baseline STAI scores were a little higher in Acceptance than in Reappraisal and Suppression; Reappraisal and Suppression were similar.

    “However, the three groups showed a small, but statistically significant difference in the STAI scores at baseline, F (2, 193) = 3.06, p = .049, partial η2 = 0.03. Pairwise post-hoc group comparisons (Least Square Difference) showed that the Acceptance group had slightly higher STAI scores at baseline than the Reappraisal group (mean difference: −1.39, SE = .65, p = .034) and the Suppression group”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Reappraisal can be viewed as antecedent-focused, while suppression and possibly acceptance can be viewed as response-focused.

    “Based on Gross’ model of emotional processing (Gross, 1998), reappraisal may be considered an antecedent-focused strategy, whereas suppression and possibly acceptance (Hofmann & Asmundson, 2008) may be seen as response-focused strategies.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Gross, 1998 source
    • cites Hofmann & Asmundson, 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Because they regulate emotion before it peaks, antecedent-focused strategies are thought to be more effective and less effortful than response-focused ones.

    “It has been suggested that antecedent-focused strategies are more effective and less effortful than response-focused strategies because the emotional response can be regulated before it has risen to an overwhelming peak (John & Gross, 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites John & Gross, 2004 source

  • May combine two claims.

    Premisecitation

    Eifert and Heffner (2003) reported that acceptance led to lower fear intensity and fewer catastrophic thoughts than control or no-instruction conditions.

    “Eifert and Heffner (2003) compared the effects of acceptance versus control strategies on the avoidance of panic-relevant interceptive stimulation, elicited by carbon dioxide enriched air. The authors reported that participants assigned to the acceptance condition reported less intense fear and fewer catastrophic thoughts as compared to participants in the control or non-instruction condition.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Eifert and Heffner (2003) source

  • May combine two claims.

    Interpretationreasoning

    This study cannot fairly test acceptance-based treatment, cognitive reappraisal, ACT, or CBT.

    “Although the present study expands the emerging research on emotion regulation, the study is by no means a fair test of acceptance-based treatment strategies, cognitive reappraisal techniques, or of Acceptance and Commitment Therapy or Cognitive-Behavioral Therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The SIAS has good psychometric properties.

    “The SIAS is a measure of general level of social anxiety with good psychometric properties (Heimberg, Mueller, Holt, Hope, & Liebowitz, 1992).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Heimberg, Mueller, Holt, Hope, & Liebowitz, 1992 source

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    Campbell-Sills et al. (2006b) found that acceptance produced less negative affect during post-film recovery, whereas suppression produced greater cardiac arousal and inhibited mood recovery.

    “Campbell-Sills, Barlow, Brown, and Hofmann (2006b) investigated perceived acceptability and suppression of negative emotion in participants with anxiety and mood disorders. Participants were instructed to either suppress or accept their emotional response to an emotion-provoking film. The results showed that participants in the acceptance condition showed less negative affect during the post-film”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Campbell-Sills, Barlow, Brown, and Hofmann (2006b)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The STAI has excellent psychometric properties.

    “The instrument shows excellent psychometric properties (Marteau & Bekker, 1992).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Marteau & Bekker, 1992 source

  • May combine two claims.

    Premisenone given

    Laboratory research on acceptance-based emotion regulation is scarce, and no prior study has directly compared reappraisal with acceptance-based strategies.

    “So far, very few laboratory studies have been conducted examining the effects of acceptance-based emotion regulation strategies, and no study to date has directly compared reappraisal and acceptance-based strategies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The altered reappraisal instructions may have made the speech less threatening for reappraisal participants than for suppression participants.

    “As a result of the deviation from Gross’ reappraisal instructions, the speech task might have been less threatening to participants in the reappraisal condition than in the suppression condition.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    This study is the first to directly compare reappraisal, acceptance, and suppression for regulating anxiety.

    “Our study is the first to directly compare reappraisal, acceptance, and suppression strategies for regulating anxiety.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    ACT includes five other processes besides acceptance, and CBT includes many components besides reappraisal.

    “As noted earlier, acceptance is only one of six processes in ACT, and reappraisal is only one of the many treatment components of CBT.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hayes, Strohsahl, & Wilson, 1999

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Participants were randomly allocated to the three conditions.

    “participants were randomly assigned to one of three groups by receiving one of three instructions orally and in written form.”
    • Also stated in: § Randomization · plain
      “Participants were randomly assigned to one of the three groups (Reappraisal, Acceptance, and Suppression).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Trait social anxiety and general affect probably do not explain the observed group differences in anxiety.

    “The group comparisons in the SIAS and PANAS suggest that these effects are unlikely due to differences in trait levels of social anxiety or general affect.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The PANAS has good reliability and validity.

    “The PANAS consists of two subscales measuring positive affect (PA) and negative affect (NA) and is a widely used instrument with good reliability and validity (Mackinnon et al., 1999; Watson et al., 1988).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Mackinnon et al., 1999 source
    • cites Watson et al., 1988 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Acceptance instructions were short and did not use metaphors or imagery.

    “In contrast to previous studies (Campbell-Sills et al., 2006a,b), the acceptance instructions were relatively brief, without the use of any metaphors and imagery.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Campbell-Sills et al., 2006a,b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Cognitive reappraisal lowers stress responses and raises tolerance for emotional stimuli, with no harmful effects.

    “For example, cognitive reappraisal strategies reduce the stress response and increase tolerance for emotional stimuli, without any detrimental effects (Gross, 1998; Richards & Gross, 2000).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Gross, 1998 source
    • cites Richards & Gross, 2000 source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Acceptance might also count as antecedent-focused, since it alters interpretation of the emotion-eliciting stimulus and its meaning.

    “It should be noted, however, that acceptance could also be regarded as an antecedent-focused strategy in the sense that it changes the interpretation of the emotion-eliciting stimulus and its meaning.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    At baseline, the three conditions were comparable on PANAS positive affect, PANAS negative affect, and SIAS scores.

    “The three groups were comparable in the positive affect, F (2, 191) = 2.04, p > .13, and the negative affect, F (2, 191) = .48, p > .6, subscales of the PANAS, and the SIAS, F (2, 193) = .30, p > .7.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    These findings align with earlier work: suppression backfires by increasing unwanted emotion, whereas reappraisal helps regulate both subjective and physiological arousal.

    “These results support earlier research suggesting that suppressing emotions leads to a paradoxical increase in the unwanted emotional experience, whereas reappraisal is an effective method to moderate subjective and physiological arousal (Campbell-Sills et al., 2006a,b; Gross, 1998; Gross & Levenson, 1997).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Campbell-Sills et al., 2006a,b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Gross, 1998 source
    • cites Gross & Levenson, 1997 source
    • Rests on an assumption: Participants complied with the emotion regulation instructions they received.
    • Rests on an assumption: The speech task produced enough anticipatory anxiety to reveal group differences.

  • May combine two claims.

    Interpretationnone given

    Only immediate effects were tested, and the sample was nonclinical.

    “It should be noted, however, that this study only examined the short-term effects of these emotion regulation strategies in a nonclinical sample.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Acceptance was as good as reappraisal for physiological arousal, yet no better than suppression for lowering subjective anxiety.

    “The acceptance strategy was as effective as the reappraisal strategy for regulating physiological arousal, but not more effective than the suppression strategy for reducing the subjective level of anxiety.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants complied with the emotion regulation instructions they received.
    • Rests on an assumption: The brief acceptance instructions were strong enough to engage the intended acceptance process.
    • Rests on an assumption: The speech task produced enough anticipatory anxiety to reveal group differences.
22 of 22

  • The paper relies on this without support.

    Participants complied with the emotion regulation instructions they received.

    “Another weakness was the lack of a manipulation check.”

  • The paper relies on this without support.

    The brief acceptance instructions were strong enough to engage the intended acceptance process.

    “Particularly challenging was the acceptance instructions. In contrast to previous studies (Campbell-Sills et al., 2006a,b), the acceptance instructions were relatively brief, without the use of any metaphors and imagery.”

  • The paper relies on this without support.

    The speech task produced enough anticipatory anxiety to reveal group differences.

    “It is possible that the differences might have been more pronounced if we had induced greater anticipatory anxiety by making the speech task more challenging.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Acceptance led to reduced subjective distress and reduction of the associated psychophysiological response.

    “Previous research could show that acceptance led to reduced subjective distress (e.g., [13,24]) as well as to a reduction of the associated psychophysiological response [24].”

    From Effects of differential strategies of emotion regulation (2019) · cites this paper as [13]

    The Results (Effect of Emotion Regulation on Psychophysiological Arousal; page not provided) show a smaller heart-rate increase with acceptance than with suppression. They do not show a significant difference in subjective anxiety between those groups, so the attributed reduction in subjective distress is not supported by this study. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • The impact of acceptance on affect is comparable to reappraisal, but further effects of accepting emotions seem less extensive compared to reappraisal or suppression.

    “The impact of acceptance on affect is comparable to the impact of reappraisal, but further effects of accepting emotions seem to be less extensive in comparison to strategies of reappraisal or suppression (e.g., [13])”

    From Effects of differential strategies of emotion regulation (2019) · cites this paper as [13]

    The Results (Effect of Emotion Regulation on Psychophysiological Arousal; page unavailable) found no significant difference between acceptance and reappraisal in heart-rate or subjective-anxiety changes. The Discussion says acceptance was as effective as reappraisal for physiological arousal, but reappraisal was more effective overall. The claim's suggestion that acceptance had less extensive effects than suppression is not supported: acceptance moderated physiological arousal better than suppression, while their subjective-anxiety difference was not significant. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Acceptance (vs. control, suppression, or no instruction) has generally been associated with improved anxiety-related outcomes including lower state anxiety, desired avoidance, and physiological arousal in response to stressor tasks.

    “Acceptance (vs.control, suppression, or no instruction) has generally been associated with improved anxiety-related outcomes including lower state anxiety, desired avoidance (Campbell-Sills et al., 2006;Levitt et al., 2004), and physiological arousal (Hofmann et al., 2009) in response to stressor tasks.”

    From Evaluating Mechanisms: Mapping Weekly Dynamics between Experiential Avoidance and SAD Symptoms (2021) · cites this paper as Hofmann et al., 2009

  • Sympathetic activation was found to be reduced by suppression in comparison to non-suppression, but suppression seems less effective in sympathetic downregulation than other ER strategies.

    “Sympathetic activation was found to be reduced by suppression in comparison to non-suppression (but see [11]), but seems to be less effective in sympathetic downregulation than other ER strategies (e.g., [12,13]).”

    From Effects of differential strategies of emotion regulation (2019) · cites this paper as [13]

  • The sample size is quite small compared with other studies.

    “First of all, the sample size is quite small compared to other studies (e.g., [10,11,13]).”

    From Effects of differential strategies of emotion regulation (2019) · cites this paper as [13]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(2, 191) = 2.04reported p > .13 · recomputed p = .133

    “F (2, 191) = 2.04, p > .13”

  • ConsistentF(2, 191) = 0.48reported p > .6 · recomputed p = .620

    “F (2, 191) = .48, p > .6”

  • ConsistentF(2, 193) = 0.3reported p > .7 · recomputed p = .741

    “F (2, 193) = .30, p > .7”

  • ConsistentF(2, 193) = 3.06reported p = .049 · recomputed p = .049

    “F (2, 193) = 3.06, p = .049”

  • ConsistentF(2, 193) = 2.13reported p = .12 · recomputed p = .122

    “F (2, 193) = 2.13, p = .12”

  • ConsistentF(4, 187) = 158.89reported p < .0001 · recomputed p < .001

    “F (4, 187) = 158.89, p < .0001”

  • ConsistentF(2, 190) = 3.46reported p = .033 · recomputed p = .033

    “F (2, 190) = 3.46, p = .033”

  • ConsistentF(2, 190) = 3.56reported p = .03 · recomputed p = .030

    “F (2, 190) = 3.56, p = .03”

  • ConsistentF(2, 199) = 1.88reported p > .15 · recomputed p = .155

    “F (2, 199) = 1.88, p > .15”

  • Consistentχ²(2) = 1.82reported p > .4 · recomputed p = .403

    “χ2 (2) = 1.82, p > .4”

10 of 10

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

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Related

Authors
Hofmann, S. G., Heering, S., Sawyer, A. T., & Asnaani, A.
Affiliations
Boston University (US)
Corresponding author
Hofmann, Stefan G.
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2009-05
Volume
47
Issue
5
Pages
389-394
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2009.02.010
PMC
PMC2674518
OpenAlex
W2030217702
Cited by
464
References
63
Citations by year
2026: 12 · 2025: 19 · 2024: 19 · 2023: 43 · 2022: 29 · 2021: 51 · 2020: 31 · 2019: 31 · 2018: 24 · 2017: 25 · 2016: 34 · 2015: 25 · 2014: 27 · 2013: 34 · 2012: 30
FWCI
25.35
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Funders
National Institute of Mental Health (R01MH078308)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
emotion regulation, anxiety, cognitive reappraisal, acceptance, expressive suppression, anxious arousal, heart rate, subjective anxiety, speaking anxiety, physiological arousal
MeSH terms
Adaptation, Psychological, Adult, Anxiety, Arousal, Female, Heart Rate, Humans, Internal-External Control, Male, Middle Aged, Repression, Psychology, Cognitive Behavioral Therapy, Young Adult

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