Affect labeling explained

Affect labeling is an implicit emotional regulation strategy that can be simply described as "putting feelings into words". Specifically, it refers to the idea that explicitly labeling one's, typically negative, emotional state results in a reduction of the conscious experience, physiological response, and/or behavior resulting from that emotional state.[1] For example, writing about a negative experience in one's journal may improve one's mood.[2] Some other examples of affect labeling include discussing one's feelings with a therapist, complaining to friends about a negative experience, posting one's feelings on social media[3] or acknowledging the scary aspects of a situation.

Affect labeling is an extension of the simple concept that talking about one's feelings can make oneself feel better. Although this idea has been used in talk therapy for over a century, formal research into affect labeling has only begun in recent years.[4] Already, researchers have quantified some of the emotion-regulatory effects of affect labeling, such as decreases in subjective emotional affect, reduced activity in the amygdala, and a lower skin conductance response to frightening stimuli. As a consequence of being a relatively new technique in the area of emotion regulation, affect labeling tends to be compared to, and is often confused with, emotional reappraisal, another emotion-regulatory technique. A key difference between the two is that while reappraisal intuitively feels like a strategy to control one's emotions, affect labeling often does not. Even when someone does not intend to regulate their emotions, the act of labeling one's emotions still has positive effects.[5]

Affect labeling is still in the early stages of research and thus, there is much about it that remains unknown. While there are several theories for the mechanism by which affect labeling acts, more research is needed to provide empirical support for these hypotheses. Additionally, some work has been done on the applications of affect labeling to real-world issues, such as research that suggests affect labeling may be commonplace on social media sites. Affect labeling also sees some use in clinical settings as a tentative treatment for fear and anxiety disorders. Nonetheless, research on affect labeling has largely focused on laboratory studies, and further research is needed to understand its effects in the real world.

History

The notion that talking about or writing down one's feelings can be beneficial is not a recent one. People have kept diaries for centuries,[6] and the use of talk therapy dates back to the beginnings of psychotherapy. Over the past few decades, the idea that putting one's feelings into words can be beneficial has been shown experimentally.[7] [8] More recently, the concept of affect labeling has grown out of this literature, honing in on the emotion regulation aspect of the benefits of vocalizing feelings.

In recent years, research on affect labeling has mostly focused on proving its applicability as an emotion regulation strategy. Although some research exists on the behavioral and neural mechanisms behind its effectiveness,[9] [10] this area of study is still in its early, speculative stages.

Regulatory effects

Emotional experience

When engaging in affect labeling, subjects subjectively report lower levels of emotional affect than they do in identical conditions without the affect labeling. This effect is not only found when subjects rate their own emotional state,[11] but also when they label the emotion displayed or evoked by stimuli such as images.[12] [13]

Autonomic response

Autonomic responses characteristic of various emotions may decrease after performing affect labeling. For instance, upon quantifying their level of anger on a rating scale, subjects subsequently experienced decreases in heart rate and cardiac output. Research also indicates that giving labels to aversive stimuli results in a lower skin conductance response when similar aversive stimuli are presented in the future, implying affect labeling can have long-term effects on autonomic responses.

Neuroscientific basis

Research has found that engaging in affect labeling results in higher brain activity within the ventrolateral prefrontal cortex (vlPFC), and reduced activity in the amygdala when compared to other tasks involving emotional stimuli.[14] In addition, evidence from brain lesion studies also point to the vlPFC's involvement in the affect labeling process. Subjects with lesions to the right vlPFC were less able to identify the emotional state of a character throughout a film. This implies that the region is required in order for affect-labeling to take place.[15] Additionally, it has been shown through meta-analysis that while the amygdala is found to be active in tasks involving emotional stimuli, activity is lower when subjects had to identify the emotions rather than simply passively viewing the stimuli.[16]

One theory that integrates these findings proposes that the ventrolateral prefrontal cortex works to down-regulate activity in the amygdala during affect labeling.[17] This theory is supported by evidence from several studies that found negative connectivity between the two brain regions during an affect-labeling task.[18] [19] [20] [21] Furthermore, researchers have used dynamic causal modeling to show specifically that increased activity in the vlPFC is the cause of lower amygdala activity.

Comparison to emotional reappraisal

Emotional reappraisal is an emotion regulation technique where an emotional stimulus is reinterpreted in a new, usually less negative, fashion in order to reduce its effect. As an example, someone might reinterpret a bad test score as being a learning experience, rather than dwelling on the negative aspects of the situation. As it is a related emotion regulation strategy, affect labeling research often draws insight from the existing literature on reappraisal.

The most salient difference between affect labeling and reappraisal lies in people's perception of the efficacy of affect labeling. Unlike reappraisal, affect labeling's effectiveness in regulating emotion is fairly unintuitive. Research has shown that while subjects expect reappraisal to reduce emotional distress, they predict the opposite for affect labeling, expecting the vocalization of feelings to actually increase their emotional distress. In reality, while the magnitude of the reduction in emotional response is found to be stronger for reappraisal than for affect labeling, both strategies produce a noticeable decrease.

Individuals who respond more to reappraisal after the presentation of emotional stimuli tend to also benefit more from affect labeling, indicating they may act through the same mechanism.

Reappraisal and affect labeling share similarities in their neural signatures. As in affect labeling, reappraisal produces activity in the vlPFC while inhibiting response in the amygdala. However, in contrast to affect labeling, reappraisal has also been found to generate activity in the anterior cingulate cortex, supplementary motor area, and dorsolateral prefrontal cortex.[22] [23] [24] [25] [26]

Possible mechanisms

Distraction

One possible explanation for affect labeling's effectiveness is that it is simply preventing the labeler from fully experiencing the emotional response by drawing their attention away. Distraction techniques have been shown to elicit similar neural activity as affect labeling, with increased activity in the vlPFC and decreased in the amygdala.[27] Additionally, some explicit distraction paradigms have been shown to result in similar reductions of negative emotions.

However, evidence is mixed on this front, as other tasks that involve turning attention away, such as a gender labeling task, do not produce the same reduction. Applications of affect labeling seem to suggest that the mechanism of action is not simply distraction. When applied with exposure therapy, affect labeling was found to be much more effective in reducing skin conductance response than distraction.[28] Affect labeling is also known to result in long-term benefits in clinical settings, whereas distraction is generally considered to negatively affect progress.[29] [30]

Self-reflection

Another proposed mechanism for affect labeling is through self-reflection. Emotional introspection differs from affect labeling in that it does not require explicit labeling of emotion; however, engaging in introspection has similar effects to affect labeling. As such, rather than being the entire process, affect labeling could act as a first-step in an emotional introspective process. Evidence supporting this mechanism uses a measure of dispositional mindfulness[31] to quantify people's ability to self-reflect. Researchers were able to link dispositional mindfulness to affect labeling by showing that people with higher levels of dispositional mindfulness showed stronger brain activation in regions associated with affect labeling, such as the vlPFC. Additionally, they showed greater reductions in activity in the amygdala, suggesting that mindfulness modulates the effectiveness of affect labeling, and lending support to the idea that introspection is the mechanism of action.[32]

Unfortunately, this theory of affect labeling struggles to explain affect labeling's benefits on stimuli that do not apply to the self. For instance, the regulatory effects of labeling external stimuli, such as faces or aversive images presented during an experiment, are unlikely to be explained by a self-reflective process.

Reduction of uncertainty

People are known to be ambiguity averse, and the complexity of emotion can often create uncertainty in feelings that is unpleasant. Some researchers believe that affect labeling acts by reducing uncertainty in emotion.[33] [34] This is supported by neural evidence connecting uncertainty to activity in the amygdala.[35] Affect labeling has been shown to down-regulate activity in the amygdala, and this may be a result of the reduction of uncertainty of feelings.

Evidence against this theory is the fact that while some emotions are characteristically uncertain, such as fear or anxiety, others tend to be more straightforward, e.g. sadness and anger. Since affect labeling is known to work across all these types of emotions, it is unlikely that uncertainty reduction is the only mechanism by which it acts.[36] [37]

Symbolic conversion

Another theory of affect labeling posits that the act of labeling is a sort of symbolic encoding of information, changing the stimulus into language. It has been proposed that this symbolic conversion may act as a type of psychological distancing from the stimulus, leading to overall lower levels of affect.[38] While affect labeling specifically refers to giving labels to emotions, assigning abstract content labels, such as identifying objects as "human", "landscape", etc., has been found to yield many of the same benefits.[39] [40] There is neural evidence to support this as well. Several studies have found that when subjects classify stimuli based on non-emotional categories, they exhibit greater vlPFC activity and less activity in the amygdala, just like in affect labeling.[41] The fact that labeling non-emotional stimuli has similar effects to that of emotional stimuli suggests that the simple act of converting a stimulus into language may be driving the effect.[42]

Applications

Social media

The act of posting about one's feelings on social media sites such as Twitter is a type of affect labeling.[43] One research study analyzed 74,487 Twitter users' tweets for emotional contact, classifying tweets as either before or after instances of affect labeling, which were identified as tweets stating "I feel...". The researchers found that emotions tended to increase in valence over time in tweets preceding the affect labeling tweet, with the greatest positive or negative emotion being experienced closest to the act of labeling. After the affect labeling tweet, the emotional intensity of the following tweets was found to fall off quickly, going back to baseline levels of valence. The results of this study support the application of affect labeling as an emotion regulation strategy in real-world settings, and show that social media users engage, potentially unknowingly, in affect labeling all the time.

Mental health

A small body of work has begun to look at affect labeling's potential as a clinical treatment in conjunction with exposure therapy for phobias, anxiety disorders, and other stress disorders.[44]

One study found that subjects with high public speaking anxiety who chose from a set of predetermined emotion words to describe their feelings before giving a speech in front of an audience showed greater reductions in anxiety, quantified by physiological responses such as heart rate, than subjects who performed a control, shape-matching, task before giving their speeches. These results suggest that combining affect labeling with an exposure treatment is more effective than exposure alone. Notably, the affect labeling and control conditions found no difference in self-reported anxiety; however, physiological responses characteristic of anxiety were reduced for the subjects who performed the affect labeling.[45]

Another study found similar results in spider-fearful individuals, exposing them to a tarantula over two days while simultaneously verbalizing their feelings. Compared to subjects in reappraisal, distraction, and control conditions, subjects who engaged in affect labeling showed lower skin conductance response than the other conditions, although there was no difference between conditions in self-reported fear.

Although there is tentative evidence for the value of affect labeling in clinical settings, researchers acknowledge that there is still a need for many more studies drawing from clinical populations in order to deduce the value of using affect labeling in conjunction with other treatments before it can be safely adopted into practice.

Limitations and concerns

The use of self-report measures of emotion in psychological research may invoke affect labeling, even in studies unrelated to the topic. Whether or not this poses a problem for emotion researchers is still largely unknown.

Although affect labeling appears be effective in laboratory studies with many participants, as with all psychological phenomena, individuals will vary in their experience. The reasons for individual differences in the effectiveness of affect labeling are in need of further research. Furthermore, paradigms used to study affect labeling differ widely, with some providing subjects with pre-prepared labels to select, while others require subjects to self-generate their own labels. These paradigms produce noticeable differences in results, with self-generative paradigms finding more long-term delayed effects of regulation,[46] [47] and pre-prepared paradigms finding immediate effects. The explanation for the differences in these results is still relatively unexplored, though some suspect it may be due to pre-prepared labels implying a kind of interpersonal emotion regulation, since it may be interpreted as a kind of support from the experimenter.[48]

Whether or not the laboratory findings about affect labeling are applicable to affect labeling in the real world is another question researchers must ask. The situations in which people use affect labeling in real life are rich with context, and it is difficult to say whether the particular operationalizations of affect labeling used in a study allow the results to generalize.

See also

References

  1. Torre JB, Lieberman MD . 46664580. 2018-03-20. Putting Feelings Into Words: Affect Labeling as Implicit Emotion Regulation. Emotion Review. en-US. 10. 2. 116–124. 10.1177/1754073917742706. 1754-0739. free.
  2. Thomassin K, Morelen D, Suveg C . 2012-12-01. Emotion Reporting Using Electronic Diaries Reduces Anxiety Symptoms in Girls With Emotion Dysregulation. Journal of Contemporary Psychotherapy. en. 42. 4. 207–213. 10.1007/s10879-012-9205-9. 24944792 . 1573-3564.
  3. Fan R, Varol O, Varamesh A, Barron A, van de Leemput IA, Scheffer M, Bollen J . The minute-scale dynamics of online emotions reveal the effects of affect labeling . Nature Human Behaviour . 3 . 1 . 92–100 . January 2019 . 30932057 . 10.1038/s41562-018-0490-5 . 56399577 .
  4. Lieberman MD, Eisenberger NI, Crockett MJ, Tom SM, Pfeifer JH, Way BM . 1445321 . Putting feelings into words: affect labeling disrupts amygdala activity in response to affective stimuli . Psychological Science . 18 . 5 . 421–8 . May 2007 . 17576282 . 10.1111/j.1467-9280.2007.01916.x .
  5. Lieberman MD, Inagaki TK, Tabibnia G, Crockett MJ . Subjective responses to emotional stimuli during labeling, reappraisal, and distraction . Emotion . 11 . 3 . 468–80 . June 2011 . 21534661 . 3444304 . 10.1037/a0023503 .
  6. Makdisi. George. 1986. The Diary in Islamic Historiography: Some Notes. History and Theory. 25. 2. 173–185. 10.2307/2505304. 0018-2656. 2505304.
  7. Frattaroli J . 19481201 . Experimental disclosure and its moderators: a meta-analysis . Psychological Bulletin . 132 . 6 . 823–65 . November 2006 . 17073523 . 10.1037/0033-2909.132.6.823 .
  8. Pennebaker JW, Beall SK . Confronting a traumatic event: toward an understanding of inhibition and disease . Journal of Abnormal Psychology . 95 . 3 . 274–81 . August 1986 . 3745650 . 10.1037/0021-843x.95.3.274 .
  9. Torrisi SJ, Lieberman MD, Bookheimer SY, Altshuler LL . Advancing understanding of affect labeling with dynamic causal modeling . NeuroImage . 82 . 481–8 . November 2013 . 23774393 . 3759566 . 10.1016/j.neuroimage.2013.06.025 .
  10. Burklund LJ, Craske MG, Taylor SE, Lieberman MD . Altered emotion regulation capacity in social phobia as a function of comorbidity . Social Cognitive and Affective Neuroscience . 10 . 2 . 199–208 . February 2015 . 24813437 . 4321630 . 10.1093/scan/nsu058 .
  11. Burklund LJ, Creswell JD, Irwin MR, Lieberman MD . The common and distinct neural bases of affect labeling and reappraisal in healthy adults . Frontiers in Psychology . 5 . 221 . 2014-03-24 . 24715880 . 3970015 . 10.3389/fpsyg.2014.00221 . free .
  12. Constantinou E, Bogaerts K, Van Diest I, Van den Bergh O . Inducing symptoms in high symptom reporters via emotional pictures: the interactive effects of valence and arousal . Journal of Psychosomatic Research . 74 . 3 . 191–6 . March 2013 . 23438708 . 10.1016/j.jpsychores.2012.12.015 .
  13. Taylor SF, Phan KL, Decker LR, Liberzon I . Subjective rating of emotionally salient stimuli modulates neural activity . NeuroImage . 18 . 3 . 650–9 . March 2003 . 12667842 . 10.1016/s1053-8119(02)00051-4 . 39472883 .
  14. Taylor SE, Eisenberger NI, Saxbe D, Lehman BJ, Lieberman MD . Neural responses to emotional stimuli are associated with childhood family stress . Biological Psychiatry . 60 . 3 . 296–301 . August 2006 . 16460697 . 10.1016/j.biopsych.2005.09.027 . 14988867 .
  15. Goodkind MS, Sollberger M, Gyurak A, Rosen HJ, Rankin KP, Miller B, Levenson R . Tracking emotional valence: the role of the orbitofrontal cortex . Human Brain Mapping . 33 . 4 . 753–62 . April 2012 . 21425397 . 3217132 . 10.1002/hbm.21251 .
  16. Costafreda SG, Brammer MJ, David AS, Fu CH . Predictors of amygdala activation during the processing of emotional stimuli: a meta-analysis of 385 PET and fMRI studies . Brain Research Reviews . 58 . 1 . 57–70 . June 2008 . 18076995 . 10.1016/j.brainresrev.2007.10.012 . 18848087 .
  17. Young . Katherine S. . LeBeau . Richard T. . Niles . Andrea N. . Hsu . Kean J. . Burklund . Lisa J. . Mesri . Bita . Saxbe . Darby . Lieberman . Matthew D. . Craske . Michelle G. . 2019 . Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder . Journal of Affective Disorders . en . 242 . 105–110 . 10.1016/j.jad.2018.08.016 . 6816743 . 30173058.
  18. Foland LC, Altshuler LL, Bookheimer SY, Eisenberger N, Townsend J, Thompson PM . Evidence for deficient modulation of amygdala response by prefrontal cortex in bipolar mania . Psychiatry Research . 162 . 1 . 27–37 . January 2008 . 18063349 . 2410029 . 10.1016/j.pscychresns.2007.04.007 .
  19. Hariri AR, Bookheimer SY, Mazziotta JC . Modulating emotional responses: effects of a neocortical network on the limbic system . NeuroReport . 11 . 1 . 43–8 . January 2000 . 10683827 . 10.1097/00001756-200001170-00009 . 45615807 .
  20. Payer DE, Baicy K, Lieberman MD, London ED . Overlapping neural substrates between intentional and incidental down-regulation of negative emotions . Emotion . 12 . 2 . 229–35 . April 2012 . 22468617 . 4111128 . 10.1037/a0027421 .
  21. Payer DE, Lieberman MD, London ED . Neural correlates of affect processing and aggression in methamphetamine dependence . Archives of General Psychiatry . 68 . 3 . 271–82 . March 2011 . 21041607 . 3447632 . 10.1001/archgenpsychiatry.2010.154 .
  22. Buhle JT, Silvers JA, Wager TD, Lopez R, Onyemekwu C, Kober H, Weber J, Ochsner KN . 6 . Cognitive reappraisal of emotion: a meta-analysis of human neuroimaging studies . Cerebral Cortex . 24 . 11 . 2981–90 . November 2014 . 23765157 . 4193464 . 10.1093/cercor/bht154 .
  23. Diekhof EK, Geier K, Falkai P, Gruber O . Fear is only as deep as the mind allows: a coordinate-based meta-analysis of neuroimaging studies on the regulation of negative affect . NeuroImage . 58 . 1 . 275–85 . September 2011 . 21669291 . 10.1016/j.neuroimage.2011.05.073 . 20211635 .
  24. Frank DW, Dewitt M, Hudgens-Haney M, Schaeffer DJ, Ball BH, Schwarz NF, Hussein AA, Smart LM, Sabatinelli D . 6 . Emotion regulation: quantitative meta-analysis of functional activation and deactivation . Neuroscience and Biobehavioral Reviews . 45 . 202–11 . September 2014 . 24984244 . 10.1016/j.neubiorev.2014.06.010 . 22933500 .
  25. Kalisch R . The functional neuroanatomy of reappraisal: time matters . Neuroscience and Biobehavioral Reviews . 33 . 8 . 1215–26 . September 2009 . 19539645 . 10.1016/j.neubiorev.2009.06.003 . 207088442 .
  26. Kohn N, Eickhoff SB, Scheller M, Laird AR, Fox PT, Habel U . Neural network of cognitive emotion regulation--an ALE meta-analysis and MACM analysis . NeuroImage . 87 . 345–55 . February 2014 . 24220041 . 4801480 . 10.1016/j.neuroimage.2013.11.001 .
  27. McRae K, Hughes B, Chopra S, Gabrieli JD, Gross JJ, Ochsner KN . The neural bases of distraction and reappraisal . Journal of Cognitive Neuroscience . 22 . 2 . 248–62 . February 2010 . 19400679 . 4136451 . 10.1162/jocn.2009.21243 .
  28. Kircanski K, Lieberman MD, Craske MG . Feelings into words: contributions of language to exposure therapy . Psychological Science . 23 . 10 . 1086–91 . October 2012 . 22902568 . 4721564 . 10.1177/0956797612443830 .
  29. Craske MG, Street L, Barlow DH . Instructions to focus upon or distract from internal cues during exposure treatment of agoraphobic avoidance . Behaviour Research and Therapy . 27 . 6 . 663–72 . 1989-01-01 . 2575376 . 10.1016/0005-7967(89)90150-2 .
  30. Grayson JB, Foa EB, Steketee G . Habituation during exposure treatment: distraction vs attention-focusing . Behaviour Research and Therapy . 20 . 4 . 323–8 . 1982-01-01 . 7126114 . 10.1016/0005-7967(82)90091-2 .
  31. Baer RA, Smith GT, Allen KB . Assessment of mindfulness by self-report: the Kentucky inventory of mindfulness skills . Assessment . 11 . 3 . 191–206 . September 2004 . 15358875 . 10.1177/1073191104268029 . 34718343 .
  32. Creswell JD, Way BM, Eisenberger NI, Lieberman MD . Neural correlates of dispositional mindfulness during affect labeling . en-US . Psychosomatic Medicine . 69 . 6 . 560–5 . 2007 . 17634566 . 10.1097/PSY.0b013e3180f6171f . 17668546 . 10.1.1.432.24 .
  33. Book: Lindquist KA, Gendron M, Satpute AB . 2016 . Language and emotion: Putting words into feelings and feelings into words. . Barrett LF, Lewis M, Haviland-Jones JM . Handbook of emotions . 4th . 579–594 . New York, NY . Guilford Press .
  34. Lindquist KA, Satpute AB, Gendron M . 2015 . Does language do more than communicate emotion? . Current Directions in Psychological Science . 24 . 2 . 99–108 . 10.1177/0963721414553440 . 25983400 . 4428906 .
  35. Whalen PJ . The uncertainty of it all . English . Trends in Cognitive Sciences . 11 . 12 . 499–500 . December 2007 . 18024182 . 10.1016/j.tics.2007.08.016 . 7893002 .
  36. Kassam KS, Mendes WB . The effects of measuring emotion: physiological reactions to emotional situations depend on whether someone is asking . PLOS ONE . 8 . 7 . e64959 . 2013-06-05 . 23785407 . 3680163 . 10.1371/journal.pone.0064959 . 2013PLoSO...864959K . free .
  37. Taylor SF, Liberzon I, Koeppe RA . The effect of graded aversive stimuli on limbic and visual activation . Neuropsychologia . 38 . 10 . 1415–25 . 2000 . 10869585 . 10.1016/s0028-3932(00)00032-4 . 11403922 .
  38. Nook EC, Schleider JL, Somerville LH . 21727159 . A linguistic signature of psychological distancing in emotion regulation . Journal of Experimental Psychology. General . 146 . 3 . 337–346 . March 2017 . 28114772 . 10.1037/xge0000263 . free .
  39. Constantinou E, Bogaerts K, Van Oudenhove L, Tack J, Van Diest I, Van den Bergh O . Healing Words: Using Affect Labeling to Reduce the Effects of Unpleasant Cues on Symptom Reporting in IBS Patients . International Journal of Behavioral Medicine . 22 . 4 . 512–20 . August 2015 . 25367624 . 10.1007/s12529-014-9449-8 . 25871630 .
  40. Constantinou E, Van Den Houte M, Bogaerts K, Van Diest I, Van den Bergh O . Can words heal? Using affect labeling to reduce the effects of unpleasant cues on symptom reporting . Frontiers in Psychology . 5 . 807 . 2014-07-22 . 25101048 . 4106456 . 10.3389/fpsyg.2014.00807 . free .
  41. Hariri AR, Mattay VS, Tessitore A, Fera F, Weinberger DR . Neocortical modulation of the amygdala response to fearful stimuli . Biological Psychiatry . 53 . 6 . 494–501 . March 2003 . 12644354 . 10.1016/s0006-3223(02)01786-9 . 35629401 .
  42. Torre . Jared B. . Lieberman . Matthew D. . Putting Feelings Into Words: Affect Labeling as Implicit Emotion Regulation . Emotion Review . 1 April 2018 . 10 . 2 . 116–124 . 10.1177/1754073917742706. free .
  43. Lieberman MD . Affect labeling in the age of social media . Nature Human Behaviour . 3 . 1 . 20–21 . January 2019 . 30932056 . 10.1038/s41562-018-0487-0 . free .
  44. Marks EH, Walker RS, Ojalehto H, Bedard-Gilligan MA, Zoellner LA . 2019-02-01. Affect Labeling to Facilitate Inhibitory Learning: Clinical Considerations. Cognitive and Behavioral Practice. 26. 1. 201–213. 10.1016/j.cbpra.2018.05.001. 150178051 . 1077-7229.
  45. Niles AN, Craske MG, Lieberman MD, Hur C . Affect labeling enhances exposure effectiveness for public speaking anxiety . Behaviour Research and Therapy . 68 . 27–36 . May 2015 . 25795524 . 10.1016/j.brat.2015.03.004 . 5598201 .
  46. Baikie KA, Wilhelm K . 2005-09-01. Emotional and physical benefits of expressive writing. Advances in Psychiatric Treatment. 11. 338–346. 10.1192/apt.11.5.338. 4695643 . free.
  47. Esterling BA, L'Abate L, Murray EJ, Pennebaker JW . Empirical foundations for writing in prevention and psychotherapy: mental and physical health outcomes . Clinical Psychology Review . 19 . 1 . 79–96 . January 1999 . 9987585 . 10.1016/s0272-7358(98)00015-4 .
  48. Zaki J, Williams WC . 19240003 . Interpersonal emotion regulation . Emotion . 13 . 5 . 803–10 . October 2013 . 24098929 . 10.1037/a0033839 .