Researchers have documented the consequences of both expressing and suppressing emotion using between-subjects designs. It may be argued, however, that successful adaptation depends not so much on any one regulatory process, but on the ability to flexibly enhance or suppress emotional expression in accord with situational demands. We tested this hypothesis among New York City college students in the aftermath of the September 11th terrorist attacks. Subjects' performance in a laboratory task in which they enhanced emotional expression, suppressed emotional expression, and behaved normally on different trials was examined as a prospective predictor of their adjustment across the first two years of college. Results supported the flexibility hypothesis. A regression analysis controlling for initial distress and motivation and cognitive resources found that subjects who were better able to enhance and suppress the expression of emotion evidenced less distress by the end of the second year. Memory deficits were also observed for both the enhancement and the suppression tasks, suggesting that both processes require cognitive resources.

Self-management cognitive behavior therapy may be a way of delivering effective treatment to large numbers with unmet needs and barriers to care.

Recent research has indicated that many people faced with highly aversive events suffer only minor, transient disruptions in functioning and retain a capacity for positive affect and experiences. This article reports 2 studies that replicate and extend these findings among bereaved parents, spouses, and caregivers of a chronically ill life partner using a range of self-report and objective measures of adjustment. Resilience was evidenced in half of each bereaved sample when compared with matched, nonbereaved counterparts and 36% of the caregiver sample in a more conservative, repeated-measures ipsative comparison. Resilient individuals were not distinguished by the quality of their relationship with spouse/partner or caregiver burden but were rated more positively and as better adjusted by close friends.

This trial assessed the feasibility, acceptability, tolerability, and efficacy of an Internet-based therapist-assisted cognitive-behavioral indicated prevention intervention for prolonged grief disorder (PGD) called Healthy Experiences After Loss (HEAL). Eighty-four bereaved individuals at risk for PGD were randomized to either an immediate treatment group (n = 41) or a waitlist control group (n=43). Assessments were conducted at four time-points: prior to the wait-interval (for the waitlist group), pre-intervention, post-intervention, 6 weeks later, and 3 months later (for the immediate group only). Intent-to-treat analyses indicated that HEAL was associated with large reductions in prolonged grief (d=1.10), depression (d=.71), anxiety (d=.51), and posttraumatic stress (d=.91). Also, significantly fewer participants in the immediate group met PGD criteria post-intervention than in the waitlist group. Pooled data from both groups also yielded significant reductions and large effect sizes in PGD symptom severity at each follow-up assessment. The intervention required minimal professional oversight and ratings of satisfaction with treatment and usability of the Internet interface were high. HEAL has the potential to be an effective, well-tolerated tool to reduce the burden of significant pre-clinical PGD. Further research is needed to refine HEAL and to assess its efficacy and mechanisms of action in a large-scale trial.

In this study, the authors measured grief processing and deliberate grief avoidance and examined their relationship to adjustment at 4 and 18 months of bereavement for 2 types of losses (spouse, child) in 2 cultures (People's Republic of China, United States). Three hypotheses were compared: the traditional grief work assumption, a conditional grief work hypothesis, and a view of grief processing as a form of rumination absent among resilient individuals. Although cultural differences in grief processing and avoidance were observed, the factor structure of these measures proved invariant across cultures. Consistent with the grief work as rumination hypothesis, both grief processing and deliberate grief avoidance predicted poor long-term adjustment for U.S. participants. Furthermore, initial grief processing predicted later grief processing in both cultures. However, among the participants in the People's Republic of China, neither grief processing nor deliberate avoidance evidenced clear psychological consequences.