sclerosis/motor neurone disease. The study used a prospective design with 38 consecu-
tive patients completing measures of mood (anxiety and depression), self-esteem, well-
being and disability at time of diagnosis and after six weeks. Survival and disability were
also measured after six months. Ten patients had died by six months. Controlling for
disease severity, the results showed that those who died reported lower mood at the six
week interview and that low mood at six weeks was also predictive of greater disability in
the survivors.Beliefs
It has also been suggested that beliefs may themselves have a direct effect on the
immune system. Kamen and Seligman (1987) reported that an internal, stable, global
attributional style (i.e. a pessimist approach to life whereby the individual blames them-
selves when things go wrong) predicted poor health in later life. This was supported by
Seligman et al. (1988) who argued that pessimism may be related to health through a
decrease in T-cells and immunosuppression. The authors argued that this was not
mediated through behavioural change but was indicative of a direct effect of
attributional style and beliefs on physiology. In a further study, Greer et al. (1979)
suggested that denial and a fighting spirit, not hopelessness, predicted survival for breast
cancer, suggesting again that beliefs might have a direct effect on illness and recovery.
Similarly, Gidron et al. (2001) measured hopelessness (defined as pessimism and help-
lessness) at baseline and assessed change in a serological marker for breast cancer in
women with breast cancer after four months. The results showed that helplessness
but not pessimism was related to poorer outcome (see Chapter 14 for a discussion
of cancer).Emotional expression
There is evidence that certain coping styles linked to emotional expression may relate
to illness onset and progression. For example, some studies have studied suppression
and denial and have reported associations with poorer health outcomes (e.g. Kune et
al. 1991; Gross and Levenson 1997). Other studies have focused on emotional (non)
expression and an emotionally inexpressive coping style known as ‘type C’ and have
described a link with illness (e.g. Solano et al. 2001, 2002; Nyklicˇek et al. 2002).
Whilst other researchers have highlighted the importance a repressive coping style
(e.g. Myers 2000). This research consistently indicates that non-expression of emo-
tions, particularly negative emotions in stressful situations can be harmful for health.
There is also evidence that encouraging emotional expression through writing or dis-
closure groups may be beneficial. This work has been particularly pioneered by Pen-
nebaker (e.g. Pennebaker 1993, 1997) using his basic writing paradigm. This has
involved randomly allocating participants to either the experimental or control group
with both groups being asked to write for three to five consecutive days for 15 to 30
minutes each day. The experimental group are asked to ‘write about your very deepest
thoughts and feelings about an extremely emotional issue that has affected you and
your life. In your writing I’d really like you to let go and explore your very deepest262 HEALTH PSYCHOLOGY