98 COGNITIVE THEORY AND RESEARCH ON ANXIETY
sive symptoms to intensify (Gaskell et al., 2001; Koster et al., 2003; Purdon & Clark,
2001; Roemer & Borkovec, 1994; Markowitz & Borton, 2002; Trinder & Salkovskis,
1994). Third, more recent studies have found that suppression of anxious or obsessional
intrusions can sustain or even alter one’s negative appraisal of their reoccurring target
intrusions and in this way contribute to an escalation in anxious mood (Kelly & Kahn,
1994; Purdon, 2001; Purdon et al., 2005; Tolin, Abramowitz, Hamlin, Foa, & Synodi,
2002b). Finally, it is clear that certain parameters can accelerate the negative effects of
suppression and/or reduce its immediate effectiveness such as the imposition of a cogni-
tive load (see Wenzlaff & Wegner, 2000, for review) or presence of a dysphoric mood
state (Conway, Howell, & Giannopoulos, 1991; Howell & Conway, 1992; Wenzlaff,
Wegner, & Roper, 1988). Moreover, some researchers have suggested that individual
difference variables might influence the effects of suppression (Geraerts et al., 2006;
Renaud & McConnell, 2002). For example, highly obsessional individuals may be more
likely to experience persisting negative effects of suppression than individuals low in
obsessionality (Hardy & Brewin, 2005; Smári, Birgisdóttir, & Brynjólfsdóttir, 1995;
for contrary findings, see Rutledge, 1998; Rutledge, Hancock, & Rutledge, 1996).
The nature of intentional thought suppression and its role in psychopathology is cur-
rently the subject of intense empirical investigation. It is obvious that the process is com-
plex and initial views that suppression causes a postsuppression rebound in unwanted
thought frequency that reinforces persistent emotional disturbance is overly simplified.
At the same time, the research is sufficiently clear that suppression of anxious thoughts,
especially worry, trauma- related intrusions, and obsessions, is not a healthy coping
strategy for reducing distressing thoughts and anxiety. For example, in one study indi-
viduals with panic disorder who experienced a 15-minute CO 2 challenge were randomly
assigned to either accept or suppress any emotions or thoughts during the challenge test
(Levitt, Brown, Orsillo, & Barlow, 2004). Analyses revealed that the acceptance group
reported less subjective anxiety and less avoidance in response to the 5.5% CO 2 chal-
lenge than the suppress group, although no differences were evident on subjective panic
symptoms or physiological arousal. At this point it is probably safe to conclude that the
intentional and effortful suppression of anxious thoughts is not a coping strategy that
should be encouraged in the management of anxiety. Rather, the expression and accep-
tance of distressing thoughts and images no doubt has therapeutic benefits that we are
only beginning to understand.
SUPPRESSIoN oF EMoTI oN
There has been increasing interest in the role that emotion regulation or stress reactivity
might play in specific types of psychopathology as well as psychological well-being more
generally (e.g., S. J. Bradley, 2000). One type of emotion regulation that is of particular
relevance to the anxiety disorders is emotion inhibition. Gross and Levenson (1997)
defined emotion inhibition as an active, effortful recruitment of inhibitory processes
that serve to suppress or prevent ongoing positive or negative emotion- expressive behav-
ior. In their study of 180 undergraduate women shown amusing, neutral, and sad film
clips suppression of positive or negative emotion was associated with enhanced sympa-
thetic activation of the cardiovascular system, reduced somatic reactivity, and a modest
decline in self-rated positive emotion.