A possible result of suppression, a form of avoidance wherein individuals try to block out or inhibit thoughts or feelings, is the recurrence of intrusive traumatic cognitions (Clark, Ball, & Pape, 1991; Wegner, Shortt, Blake, & Page, 1990), which, as noted earlier in the chapter, may result in a paradoxical effect of amplification. Current research suggests that attempting to avoid or suppress unwanted negative thoughts, emotions, and memories as a means to create psychological health may actually contribute to a magnification of the negative emotional responses and thoughts, and to a longer period of experiencing those events (Wegner & Schneider, 2003; Wenzlaff & Wegner, 2000; Wegner, 1994; Cioffi & Holloway, 1993; Wegner & Zanakos, 1994). This means that suppression presents risks of amplification: Avoidance of thoughts increases their importance (a cognitive fusion process), which then increases their negative impact and induces further efforts to avoid them.
The effects of active suppression of unwanted private experience (e.g., unwanted thoughts or emotions) have been documented in many studies (Cioffi & Holloway, 1993; Clark et al., 1991; Kelly & Kahn, 1994; Muris, Merckelback, van den Hout, & de Jong, 1992; Salkovskis & Campbell, 1994; Walser, 1998; Wegner, 1994; Wegner, et al., 1990). The effects of long-term suppression have also been explored (Trinder & Salkovskis, 1994). These suppression effects, which are generally consistent, are explored briefly below.
Thought suppression studies (Macrae, Bodenhousen, Milne, & Jetten, 1994; Wegner, 1994; Wegner, Schneider, Carter, & White, 1987) indicate that subjects have a difficult time suppressing the unwanted thought and mention the thought frequently during suppression conditions. Subjects also report a conscious, effortful search for anything but the thought; however, these efforts to distract fail. The failure of these efforts may be due to the presence of an unusual sensitivity to the thought throughout periods of attempted suppression (Wegner, 1994). These findings support the notion that we are more likely to think of the very thing we would like to avoid.
Personally relevant intrusive thoughts, or unwanted thoughts that repeatedly come to mind (Edwards & Dickerson, 1987), such as recurring memories, images, evaluations, judgments, and so on, have also been investigated (Rachman & Hodgson, 1980; Salkovskis & Harrison, 1982). For instance, Salkovskis and Campbell (1994) found that suppression causes enhancement of personally relevant, negatively valenced intrusive thoughts. Trinder and Salkovskis (1994) found that subjects who were asked to suppress their negative intrusive thoughts experienced significantly more of those thoughts than subjects who were asked just to monitor their thoughts. In addition, the suppression group recorded significantly more discomfort with the negative intrusions than did subjects in the monitor only group.
Although personally relevant intrusive thoughts are quite common and are thought to occur in about 80% of the population (Rachman & de Silva, 1978), they appear to be particularly problematic for survivors of trauma. The suppression of disclosure about disturbing events, such as past trauma, has been linked to both psychological and physiological problems (Pennebaker, Hughes, & O'Heeron, 1987; Pennebaker & O'Heeron, 1984). Riggs, Dancu, Gershuny, Greenberg, and Foa (1992) have found that female crime victims who "hold in" their anger experience more severe PTSD symptoms. Roemer, Orsillo, Litz, and Wagner (2001) found that strategic withholding of emotions is associated with PTSD. The intrusive experience of emotion seen in PTSD can trigger an opposing process of denial or numbness (Horowitz, 1986), and numbness itself may be used as a way to avoid evocative stimuli (Keane, Fairbank, Caddell, Zimering, & Bender, 1985). This numbing, however, may lead to difficulties in emotional processing and maintenance of PTSD symptomatology (Wagner, Roemer, Orsillo, & Litz, 2003).
It makes sense that a trauma survivor would engage in behaviors to counteract or avoid traumatic thoughts and the emotions that may be associated with them, given the aversiveness of the traumatic event. Furthermore, there is considerable evidence that people attempt to suppress thoughts when they are traumatized (Pennebaker & O'Heeron, 1984; Silver, Boon, & Stones, 1983), obsessed (Rachman & de Silva, 1978), anxious (Wegner et al., 1990), or depressed (Sutherland, Newman, & Rachman, 1982; Wenzlaff & Wegner, 1990). However, as noted earlier, efforts at control of one's mood may paradoxically cause the mood to continue and may also lead to the execution of many maladaptive behaviors, such as alcohol use or binge eating (Herman & Polivy, 1993).
Finally, recycling through a process of suppression, with recurrence of emotion and thought countered by further attempts at suppression, could well produce undesirable internal experience that is fairly robust (Wegner et al., 1990). Suppression of thought and emotion may be a part of the development of such disorders as PTSD, depression, anxiety, and panic. What individuals believe to be the antidote may actually be the venom that produces the very problem, further contributing to their distress. Individuals who use suppression and avoidance may actually be generating an assortment of unwanted consequences and problems because of the strategy.
Research that focuses on self-disclosure of traumatic events—a process of talking openly about the trauma without attempts to suppress—has found that disclosure is associated with lower levels of psychological distress and increased ability to care for oneself (Lepore, Silver, Wortman, & Wayment, 1996; Pennebaker & Harber, 1993). In addition, self-disclosure can elicit the emotions associated with the negative event, thus facilitating a possible decrease in, via exposure to, the negative emotion. In other words, being present to, rather than avoiding, the emotional content of trauma may be the healthier avenue. For example, Bolten, Glenn, Orsillo, Roemer, and Litz (2003) found that self-disclosure is associated with lower levels of PTSD symptom severity. verbal and emotional processing of the traumatic event has also been theorized to be an effective treatment for PTSD. This type of processing includes a full experiencing of the traumatic memory and associated emotions, followed by habituation to the emotions and thoughts (Foa & Rothbaum, 1998). Emotional engagement, rather than emotional avoidance or numbing, appears to be a key ingredient (Jaycox, Foa, & Morral, 1998). Acceptance of previously avoided experiences may have a powerful impact in moving traumatized individuals toward healthy and valued living.
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