Emotional Inhibition

Abstract

Emotional inhibition constitutes a dysfunctional verbal and nonverbal interaction between individuals. Emotional inhibition may be classified into genetic, repressive, suppressive, and deceptive inhibition, and the extreme form, emotional implosion. Overt emotional inhibition is characterized by reduced expressiveness, unemotional language, and shyness, all of which are related to dysfunctional bodily reactions and may be adaptive in a short-term social stress situation. In the long run, emotional inhibition is likely to have a harmful effect on the individual along any of three pathways: neurobiological, social-behavioral, and cognitive. There is implicit knowledge in most societies that emotional inhibition has negative health implications. Most psychotherapeutic techniques are directed at emotional behavior and experience and focus largely on changes in intra- and interindividual emotional regulation and the construction of meaning from emotional experience.

Full text

in emergency ambulance personnel: a review of the
literature. Emergency Medicine Journal 20, 75–78.
Ursano, R. J., Bell, C., Eth, S., et al. (2004). Practice
guideline for the treatment of patients with acute stress
disorder and posttraumatic stress disorder. American
Journal of Psychiatry 161(supplement), 3–31.
Wagner, S. L. (2005). Emergency response service person-
nel and the critical incident stress debriefing debate.
International Journal of Emergency Mental Health 7,
33–41.
Emotional Inhibition
H C Traue
The University of Ulm, Ulm, Germany
R M Deighton
The Cairnmillar Institute, Melbourne, Australia
ã2007 Elsevier Inc. All rights reserved.
This article is a revision of the previous edition article
by H C Traue and R M Deighton, Volume 2, pp 32–38,
ã2000, Elsevier Inc.
Emotion and Inhibition
Domains of Emotional Inhibition
Pathways from Emotional Inhibition to Health Disorders
and Illness Behaviors
Rituals and Therapeutic Interventions
Glossary
Alexithymia A constellation of cognitive and affective
characteristics including difficulty iden-
tifying and communicating subjective
feelings, a restricted imaginative life,
and a concrete and reality-oriented style
of thinking.
Behavioral
inhibition
A concept encompassing several beha-
viors in about 15% of otherwise healthy
children in response to unfamiliar social
events, including reduced spontaneity,
subdued emotional expressiveness, shy-
ness, social avoidance and several pe-
ripheral physiological hyperactivities. It
is thought to be related to limbic-hypo-
thalamic arousal, in response to socially
stressful events.
Emotional
intelligence
The ability of an individual to adaptively
and effectively regulate his or her emo-
tional behavior in a social context. This
encompasses the ability to recognize sub-
jective feelings, to manage emotions, to
transform emotions into expressiveness
and action, to react empathetically, and
to shape relationships.
Myogenic pain Pain stemming from dysfunctional mus-
cular activity as part of motor behavior
in relation to stress, posture, movement,
and emotion (e.g., low back pain, ten-
sion type headache, repetitive strain
injury, and myofascial pain disorder).
Socialization The process by which an individual grad-
ually becomes integrated into the norm
and value system of a social group or a
society. It is based on the assumption
of interaction between the biological
organism and the social environment
during psychological development.
Torture One of the most severe stressors moti-
vated mainly by political ideologies and
perpetrated in about 60 states world-
wide. The adverse effects of torture
stem from the man made nature of these
stressors and induce specific and nonspe-
cific physical and mental disorders of
long duration because they shatter vic-
tims’ basic assumptions about human
benevolence.
Emotion and Inhibition
Emotions are essentially transactions between indivi-
duals and their social environment. They give personal
meaning to external and internal stimuli and com-
municate meaning from the individual to others.
Emotions are composed of interpretations of intero-
and exteroceptive stimuli, intentions, physiological
patterns of arousal, and motor behavior including
overt emotional expressiveness. The interaction of
these different components in the individual and
the social and physical environment are mediated
by the central nervous system. From a system regu-
lation point of view, emotional expressiveness has
two important functions: first, it serves a communi-
cative function in that it facilitates the regulation of
person–environment transactions and, second, the
feedback function of behavioral expressions controls
908 Emotional Inhibition

the intraindividual regulation of emotion. This means
that active responding toward the environmental trig-
ger may influence an experience indirectly through the
attenuation of a negative emotional stimulus or directly
through self-regulation. Thus, expressive behavior can
serve simultaneously as a component of emotional
processes and as a coping response. Three prominent
scientists of the turn of the century, all of whom were
active at a time of major discoveries in neurophysiolo-
gy, contributed to important developments in the
concept of inhibition. The neurophysiology of C. S.
Sherrington (born 1857), the theory of the higher ner-
vous system of I. P. Pavlov (born 1849), and the psy-
choanalysis of S. Freud (born 1856) transformed the
principle of inhibition into a key concept in neurophys-
iology (in the case of Sherrington) and higher mental
functioning (in the cases of Pavlov and Freud).
For many years, an inverse relationship between
expressive behavior and autonomic responsivity has
been documented, such that the inhibition of overt
emotional expressiveness can lead to an autonomic
overreaction. This has been considered to be a signif-
icant factor in the etiology and maintenance of psy-
chosomatic disorders. A number of early researchers
in the first two decades of the century reported mea-
surements of high physiological activity in subjects
suppressing emotional expression. These studies led
toward the concept of internalization and external-
ization, wherein two behavioral coping styles for
dealing with psychological tension were discerned:
behaviorally, outwardly directed, or physiologically,
within the individual. Following this concept, the
term internalizer has been used to describe a person
exhibiting a low level of overt expressiveness under
stress yet a high level of physiological excitation,
whereas an externalizer is characterized by high ex-
pressiveness and a low level of physiological expres-
siveness in social situations. Temoshok proposed
a model of internalizing and externalizing coping
styles integrating the severity of stressors which in-
tended to predict the occurrence of mental disorders
(dependent on degree of externalizing coping) and
somatic disorders (dependent on degree of internaliz-
ing coping). Another inhibition theory, put forward
by Pennebaker, summarizes the process by which fail-
ure to confront traumatic events results in poorer
health. The principal assumption of this theory is
that inhibiting ongoing behavior, thoughts, and feel-
ings requires physiological work. It has been sug-
gested that the increased autonomic responses of
internalizers may reflect the work of behavioral inhi-
bition. Over time, the work of inhibition acts as a
low-level cumulative stressor. As with all cumulative
stressors, sustained inhibition is linked to increases
in stress-related diseases and various other disorders
such as cardiovascular and skin disorders, asthma,
cancer, and also pain.
Domains of Emotional Inhibition
A model (see Figure 1) of how emotional stress, under
a given social situation, can trigger or modulate
health disorders is described later. Health disorders
and illness behavior are considered as different,
but related, processes, and distinct mechanisms may
contribute dependently and independently to differ-
ent aspects of a given disorder and its behavioral
consequences.
On a phenomenological level, emotional stress
can occur on a severity dimension ranging from
daily stressors, through more traumatic life events,
to more chronic or severe psychotrauma. A common
underlying factor among such situations is that each
needs to be coped with by the individual. Emotional
stress can be seen as being processed by way of an
inhibition-implosion dimension (to implode means
to collapse or cause to collapse inward in a violent
manner as a result of external pressure), modulated
by dispositional factors (innate, personality, and
socialization).
Innate and socialization factors are of particular
importance. Possible individual differences in limbic
mechanisms for opioidergic pathways corresponding
with increased vulnerability to stress induction have
been suggested. Emotional processing relating to
the inhibition–implosion idea has been discussed in
relation to several topics like control, suppression,
type C personality, repression, alexithymia, or ambiv-
alence. Each of these concepts covers different aspects
of overt emotional expressiveness from a personality
or coping perspective.
Inhibition is the most general term for the incomplete
processing of emotional stress when these stressors
induce bodily changes (physiological, endocrinologi-
cal, or immunological) and the cognitive, emotional,
and behavioral processing are dysfunctional such that
subjective experience and spontaneous expression
of emotions and action tendencies are separately
or simultaneously attenuated and intra- and interper-
sonal regulation is disturbed. This process may be a
product of innate and/or acquired behavior.
A classification of involved mechanisms differenti-
ates among the following: genetic inhibition, repres-
sive inhibition, suppressive inhibition, and deceptive
inhibition. All four classes of inhibition occur in every
state of psychophysiological arousal produced by
emotional stimulation.
Genetic inhibition reflects the genetically deter-
mined basis of behavioral inhibition. Studies working
with young children have classified those children
Emotional Inhibition 909

who were least able to initiate interaction in a social
situation with other children and adults as behavior-
ally inhibited. Most children’s degree of behavioral
inhibition has been shown to be stable over a period
of 5 years. In inhibited children, increased levels of
arousal, norepinephrine and salivary cortisol have
been found.
Repressive inhibition is defined as emotional pro-
cessing with attenuated subjective experience of
emotional arousal. Emotional expressive responses
in repressive inhibition can be based solely on cogni-
tive interpretation of the situation and are nonspon-
taneously organized. Because the individual is unable
to feel his or her own arousal, insufficient response
information is experienced, which in turn decreases
the need to express emotions or cope with an emotional
stressor. In addition, the cognitive interpretation of
the situation without the emotional component may
be wrong or misleading. Prolonged bodily arousal and
impaired coping could result. Repressive coping style
is the best known model for repressive inhibition.
Suppressive inhibition is best circumscribed by sup-
pression of emotional arousal. The emotional arousal
is recognized by the individual but spontaneous
expressive and cognitive behaviors are involuntarily
suppressed. Suppressive inhibition of emotions could
result from interactions between innate factors and
socialization. For exampleif individuals show increased
responses under stressful encounters, they are prone to
socialization conditions of punishment and negative
reinforcement, initiating a learning history with de-
creases in spontaneous expressiveness and increases in
bodily reactivity.
Finally, individuals under emotional stress, aware
of their bodily reactions and their urge for expressive-
ness, can voluntarily suppress this need or try to
Social context
− historical, political,
cultural factors
Emotional stress
− traumatic experience
− critical event
− social and daily stressors
Innate:
genetic
inhibition
Neurobiological pathways
− hypothalamic-limbic overactivation
− autonomic response specificity
− interhemispheric communication
− behavioral inhibition systems
Social-behavioral pathways
− disturbed communication
− impaired coping
− reduced social support
− operant conditioning
Cognitive pathways
− thought control
− alexithymic thinking
− activation of fear networks
− symptom misinterpretation
IIIness behaviors
− symptom report
− secondary gain
− impairment/disability
− seeking medical care
− social isolation
Health disorder
− onset of disease/episode
− progression
− chronification
− severity/complexity
− delayed healing
Learned:
repressive, suppressive,
and deceptive inhibition
Sudden onset:
emotional
implosion
Inhibition and emotional implosion
Disposition
− innate factors
− personality
− socialization
Figure 1 Psychological pathway model of emotional inhibition with neurobiological, social-behavioral, and cognitive pathways between
stress/disposition, emotional processing, and subsequent health disorders or illness behaviors (adapted from Traue, 1998).
910 Emotional Inhibition

present a false response to a receiver, called deceptive
inhibition. Whether an individual is poker faced or
displays a false emotional response, such inhibition
consumes cognitive capacity, reducing the individual’s
coping capacity and providing additional stress.
In reviewing the psychophysiological and psy-
chosomatic data, one is led to the conclusion that
emotional inhibition is potentially harmful. However,
it should be noted that although the correlations
between bodily processes and the above four forms
of inhibition support such a notion, in certain cir-
cumstances inhibition can be beneficial for the indi-
vidual and his/her relationship with the social
environment. Inhibition becomes toxic when it is
related first to physiological, endocrinological hyper-
arousal or immunological dysfunction, second to long-
standing disregulation of emotions within the individ-
ual on a cognitive and behavioral basis, and third if
inhibition disturbs the individual’s social relations.
Inhibition constitutes a risk factor for health
under normal stressors. If the severity of stressors is
dramatically high, the mental and physical health
consequences are inevitable. In traumatic stress situa-
tions like rape, criminal bodily attacks, or torture, the
individual may well lose control over strong emo-
tional responses. The emotional responses of horror,
panic, and loss of control, could literally cause a
violent breakdown in the mental and bodily sys-
tems. Such an emotional implosion is visible in the
symptom pattern of posttraumatic stress disorder
(PTSD): cognitive and behavioral avoidance of trau-
ma stimuli, numbing of general and emotional respon-
siveness (emotional anasthesia), detachment from
other people, and persistent symptoms of arousal
such as disturbed sleep, exaggerated startle response,
and somatic complaints. In addition, persons with
PTSD suffer an increased risk of social phobia and
major depressive and somatizing disorders.
The psychological, physical, and social symptoms
in PTSD are a form of emotional processing that
describes an extreme form of inhibition. While
inhibition generally develops over a long time span
through interaction between innate and socialization
factors, implosion can occur in a very short time as a
result of a single event.
Pathways from Emotional Inhibition to
Health Disorders and Illness Behaviors
Emotional stress modulated through innate, person-
ality, and socialization factors can trigger, maintain,
or worsen health disorders and related illness behav-
ior through neurobiological, social-behavioral, and
cognitive pathways. With respect to illness behaviors,
the pathways include biases in symptom reporting,
secondary gain by presented symptoms, subjective
feeling of being impaired, pressure to seek medical
help, and social isolation.
Neurobiological Pathways
It can be assumed that emotional inhibition is strong-
ly neurobiologically based. The behavioral inhibition
system and the behavioral activation system have
been discussed as possible neurobiological structures.
Empirical evidence from between-subject studies
shows that inhibited, repressed, or suppressed emo-
tional expressiveness is linked to greater autonomic
arousal, both under conditions of emotion induction
and voluntary deception. There is rich empirical evi-
dence for neurobiological correlates of inhibition in
respiratory, cardiovascular, muscular, digestive, endo-
crine, and immune functions. Immune functioning is
of particular interest because it is the immune system
that may be relevant in all sorts of infectious, allergic,
and neoplastic illness processes. Inhibited style of
processing upsetting events can compromise immune
functions, resulting in higher serum antibody titers,
decreased monocyte counts, and poorer natural killer
cell activity. Other areas of research relevant to the
neurobiological pathways of inhibition include hypo-
thalamic-limbic overactivation, prolonged activation
of physiological response specificity, hemispheric
brain lateralization of emotion processing and faulty
interhemispheric communication, the neuroregula-
tion of action, and the behavioral activation and
behavioral inhibition systems.
Social-Behavioral Pathways
A variety of social-behavioral pathways connect
inhibition–implosion to health disorders and illness
behaviors. First, neurobiologically innate factors
(shyness, behavioral inhibition, hypersensitivity, in-
troversion) are superimposed by classical and operant
conditioning in the socialization of an individual.
Since individuals with these characteristics in early
childhood are more easily conditioned, the process
of socialization involves greater vulnerability to
them than it does for others. Under critical develop-
mental conditions, the gap between emotional ex-
pressiveness and physiological hyperactivity may
increase. A lack or deficit in emotional expressiveness
will hinder interpersonal communication. It is im-
plied that deficits in interpersonal communication
disturb the development of emotional competence
which is important for sharing experiences, maintain-
ing psychological and physical contact, and adapting
to the social environment. These are the deficiencies
in healthy coping competencies that Salovey and
Emotional Inhibition 911

Mayer termed emotional intelligence. Other conse-
quences of inhibited emotional expressiveness are
disturbed social relations resulting in social isolation
and a disrupted social support network.
Normally, persons respond to emotion-evoking
stimuli with emotional expression, and such reactive
expression is realized through facial muscle activity
and movements with reafferent neuronal signals in
the central nervous system, which contribute to the
individual’s emotional experience. However, subjec-
tive emotional experience does not depend mainly on
this nervous input as argued in the facial feedback
hypotheses, but feedback does contribute positively
to sensitivity toward the physiological aspects of
emotion. If this sensitivity is disrupted, an individual
will not perceive adequately increased muscle tension
or other autonomic nervous system reactions caused
by stress and consequently will not initiate healthy
relaxing behavior. Bischoff et al. demonstrated that
the hypothesis of deficient perception of muscle ten-
sion holds for myogenic pain. Patients with this kind
of pain were reliably less able to judge the extent of
their muscle tension than were controls.
It is conceivable that, under unfavorable circum-
stances, expressive behavior of mainly negative
emotions like anger and aggressiveness is punished
socially and thus justifiably avoided. The suppression
of expressive behavior can be realized by an addi-
tional increase in muscle activity. Such avoidance
behavior or inhibition is very adaptable in the short
term, and it helps to modify a socially stressful situa-
tion. This reduction of emotional expressiveness is
conditioned by the learning mechanism of negative
reinforcement (the avoidance of punishment).
Cognitive Pathways
Memories and thoughts of emotional stressors are
generally unpleasant. Increasing severity of the stress-
ful encounter makes imagining the event painful or
even unbearable in the case of traumatic experience.
Most individuals attempt to suppress or inhibit the
thoughts surrounding the events. As soon as the inhi-
bition work begins, the urge to distract oneself and
the mental energy put into thisprocess fuels the images.
Consequently, triggered intrusions and unwanted
thoughts make life more stressful than before. In addi-
tion, thought control interferes with natural ways of
coping (e.g., sharing the experience with important
others and thinking through the event). Therefore
inhibition may be dangerous because it hampers the
individual who has suffered a critical life event from
resolving the stressful experience cognitively and
behaviorally.
Other facets of problematic cognitive processing
include an alexithymic or low-level thinking style.
As part of the inhibition process, individuals may
tend to exclude the emotional content of the stressful
encounter from their language representation of the
event. Although this may help to avoid negative
emotionality in the short term, it impairs one’s own
complete processing and integration of the stressful
experience. The lack of integration into the self-
concept makes an individual prone to activation of
fear networks. Finally, impaired or unfinished cog-
nitive processing makes an individual prone to a
misinterpretation of bodily symptoms. Instead of
understanding bodily reactions as part of emotional
responses, the individual conceptualizes the bodily
reactions as symptom patterns and seeks medical
help for illnesses. Badly advised medical treatment
procedures result in iatrogenic diseases, trapping
the individual in a vicious cycle. Cognitive appraisal
of a situation depends partly on facial feedback as
a source of emotional information. When the expres-
sive components of emotional reactions are systemat-
ically repressed by inhibition, the individual unlearns
accurate assessment of stressful circumstances. This
learning mechanism occurs since the estimated load
of a stress situation is dependent not only on external
features of the situation, but also on the subjective
experience of stress-conditioned reactions. When,
however, an inhibited person takes bodily reactions
into account in the evaluation of a situation, his or her
judgment will be impaired when the original physio-
logical components of mainly negative emotions are
interpreted as symptoms.
In clinical studies, psychosomatic patients (e.g.,
suffering headache) have been found to report sig-
nificantly lower stress levels than control groups,
but showed nearly twice as much neck muscle tension
as the controls. Although the arousal and muscle
tension data indicated higher levels of stress, patients
were unable or not willing to report those stressors.
It appears that patients tend to interpret their stres-
sors in terms of bodily symptoms rather than as
underlying levels of stress.
Rituals and Therapeutic Interventions
There is at least some implicit knowledge in most
societies that emotional inhibition has negative health
implications. The conflicts resulting from the need
for emotional regulation on the one hand and the
need for disclosure, sharing, and catharsis on the other
lead to a variety of cultural phenomena to overcome
these adverse consequences. These include older
universal cultural rituals (such as rituals of grief or
lament) or religious acts such as confessions. The
Western (Wailing) Wall in Jerusalem, where Jews
have been going for centuries to deliver a written
912 Emotional Inhibition

prayer, is possibly an example of an ancient disclosure
phenomenon. Today people can deliver their prayer
to the Western Wall via the Internet, and similar
services are offered in connection to Christian con-
fession. Contemporary western societies have also
introduced psychotherapy for enhancing emotional
expressiveness. Here, talking or writing about emo-
tions is encouraged as well as acting out emotions, in
role plays. Assertiveness training aims at effective
expression of emotion, and catharsis-based techni-
ques like confrontation are modern remedies for anx-
iety, posttraumatic stress disorders, and the like. All
of these techniques seem to have in common that they
are directed at the construction of meaning from
emotional experience. Different cultures tend to
construe emotional experience (including stress) in
different ways, such that many non-Western cultures
tend to emphasize the somatic components of emo-
tional suffering, whereas Western cultures focus on
the psychological components. Such cultural differ-
ences could influence the pathways between emotion-
al inhibition and illness. Hence, clinicians should
take into account the relevant cultural conceptions
of emotional experience and behavior a client has
been exposed to when choosing interventions for
emotional inhibition. If a client emphasizes the somat-
ic components of his or her reaction to a very stressful
event, it may not be (dysfunctional) emotional inhibi-
tion, but rather a cultural construal of emotional
suffering. Only when culture-sensitive exploration
reveals lack of insight into relevant psychosocial fac-
tors should the possibility of dysfunctional emotion
processing be considered.
See Also the Following Articles
Anger; Emotions: Structure and Adaptive Functions;
Grieving; Social Support; Cardiovasular Disease, Stress
and; Torture.
Further Reading
American Psychiatric Association (1994). Diagnostic and
statistical manual of mental disorders (4th edn.).
Washington. DC: American Psychiatric Association.
Bischoff, C., Traue, H. C. and Zenz, H. (eds.) (1989).
Clinical perspectives on headache and low back pain.
Hogrefe & Huber. Toronto/Lewiston/Gottingen/Bern.
Deighton, R. M. (2003). Culture, emotional inhibition &
somatization. Ann Harbour, MI: Proquest Digital
Dissertations (www.umi.com).
Deighton, R. and Traue, H. C. (2005) Emotional inhibition
and somatization across cultures, International Revue of
Social Psychology 18(1/2): 109–140.
Kagan, J., Reznick, J. S. and Snidman, N. (1988). Biological
bases of childhood shyness. Science 240(4849), 167–171.
Mauss, I. B. and Gross, J. (2004). Emotional suppression
and cardiovascular disease: is hiding your feelings bad
for your heart? In: Nyklic
ˇek, I., Temoshok, L. &
Vingerhoets, A. (eds.) Emotional Expression and Health.
Advances in theory, assessment, and clinical applications.
Hove/New York: Brunner-Routledge.
Nyklic
ˇek, I., Temoshok, L. and Vingerhoets, A. (2004).
Emotional Expression and Health. Advances in theory,
assessment, and clinical applications. Hove/New York:
Brunner-Routledge.
Pennebaker, J. W. (1995). Emotion, disclosure, and health:
an overview. In: Pennebaker, J. W. (ed.) Emotion, disclo-
sure, and health, pp. 3–10. Washington, DC: American
Psychological Association.
Rime
´, B., Herbette, G. and Corsini, S. (2004). The social
sharing of emotion: Illusory and real benefits of talking
about emotional experiences. In: Nyklic
ˇek, I., Temoshok,
L. & Vingerhoets, A. (eds.) Emotional Expression and
Health. Advances in theory, assessment, and clinical
applications. Hove/New York: Brunner-Routledge.
Salovey, P. and Mayer, J. D. (1990). Emotional intelligence.
Imagination, Cognition, Personality 9, 185–211.
Schwartz, G. E. and Kline, J. P. (1995). Repression, emo-
tional disclosure and health. In: Pennebaker, J. W. (ed.)
Emotion, Disclosure, and Health. Washington, DC:
American Psychological Association.
Smith, C. E., Fernengel, K., Holcroft, C., Gerald, K. and
Marien, L. (1994). Meta-analysis of the association
between social support and health outcomes. Behavior
and Medicine 16, 352–362.
Temoshok, L. (1983). Emotion, adaption, and disease. In:
van Dyke, C. & Zegans, L. S. (eds.) Emotions in Health
and Illness. New York: Grune and Stratton.
Traue, H. C. (1998). Emotion und Gesundheit. Die psycho-
biologische Regulation durch Hemmungen. Heidelberg:
Spektrum.
Traue, H. C. (2001). Emotional Inhibition and Health. In:
Smelser, N. J. & Baltes, P. B. (eds.) The international
encyclopaedia of the social and behavioural sciences,
pp. 4449–4454.
Traue, H. C. and Pennebaker, J. W. (eds.) (1993). Emotion,
Inhibition and Health. Toronto/Lewiston/Gottingen/
Bern: Hogrefe & Huber.
Emotional Inhibition 913