Anger Expression, Momentary Anger, and Symptom Severity in Patients with Chronic Disease
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ORIGINAL ARTICLE
Anger Expression, Momentary Anger, and Symptom Severity in Patients with Chronic Disease Michael A. Russell, Ph.D. 1 & Timothy W. Smith, Ph.D. 2 & Joshua M. Smyth, Ph.D. 3
# The Society of Behavioral Medicine 2015
Abstract Background Anger expression styles are associated with physical health, and may affect health by modulating anger experience in daily life. Research examining this process in the daily lives of clinically relevant populations, such as patients with chronic disease, is needed. Method Community adults with asthma (N=97) or rheumatoid arthritis (RA; N=31) completed measures of trait-level anger expression styles (anger-in and anger-out), followed by ecological momentary assessments of anger and physical health five times daily for 7 days. Results High anger-in predicted greater momentary anger, physical limitations, and greater asthma symptoms. High anger-out predicted reduced RA symptoms. Momentary anger was robustly associated with more severe symptoms in daily life. Three-way interactions showed that anger-in moderated these momentary angersymptom associations more consistently in men. Conclusions Anger expression styles, particularly angerin, may affect the day-to-day adjustment of patients with chronic disease in part by altering the dimensions of everyday anger experience, in ways that appear to differ by gender.
* Joshua M. Smyth [email protected] 1
The Pennsylvania State University, University Park, PA, USA
2
The University of Utah, Salt Lake City, UT, USA
3
Department of Biobehavioral Health, The Pennsylvania State University, #231 Biobehavioral Health Building, University Park, PA 16802, USA
Keywords Anger expression and suppression . Asthma . Arthritis . Ecological momentary assessment . Gender differences
Frequent suppression (anger-in) and frequent expression (anger-out) of angry emotion have each been associated with a wide range of health complications, including cardiovascular disease [1, 2], respiratory illness and musculoskeletal problems [3], and pain disorders [4, 5]. Angerin and anger-out represent two broad styles of anger expression describing how people manage or regulate anger arousal [6]. Despite close conceptual links between anger expression styles and anger experiences, few studies have examined their interplay in the daily lives of patients with chronic illness, for whom the dynamic regulation of anger experiences in daily life may play an important role in disease adjustment. The current study uses ecological momentary assessment (EMA) to examine these issues. Anger expression styles characterized by suppression or outward anger expression may affect health insofar as they may represent ineffective emotion regulation strategies [7, 8], with their habitual use potentially leading to anger dysregulation, perhaps evidenced by more frequent and more severe/intense anger episodes. For patients with asthma and arthritis, the experience of frequent and intense anger episodes may lead to greater symptom expression and increased physical limitations (e.g
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