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Anxiety, Stress & Coping
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The importance of the repressive coping style: findings from 30 years of
research
Lynn B. Myers a
a Department of Psychology, School of Social Sciences, Brunel University, Uxbridge, Middlesex, UK
First published on: 26 October 2009
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The importance of the repressive coping style: findings from
30 years of research
Lynn B. Myers*
Department of Psychology, School of Social Sciences, Brunel University, Uxbridge,
Middlesex UB8 3PH, UK
(Received 13 July 2009; final version received 26 September 2009)
During the last three decades there has been substantial research exploring the
repressive coping style as defined by Weinberger, Schwartz, and Davidson. As
‘‘repressors,’’ who score low on trait anxiety and high on defensiveness, account
for up to 50% of certain populations, they are an essential group for psychologists
to study. However, there are methodological issues in identifying repressors as
well as considerable evidence that repressors avoid negative self-relevant
information. Possible methods of addressing these difficulties are discussed in
this review. Importantly, there is a body of evidence linking repressive coping and
poor physical health, including heart disease and cancer. However, some
preliminary findings suggest that repressors compared to non-repressors may
be better at health behaviors that they perceive as under their personal control.
This needs more extensive investigation as such behaviors are only one aspect of
health and other factors may contribute to repressors’ poor physical health.
Possible future directions of research are discussed including: the need for
systematic empirical research of a new theory of repressive coping the
VigilanceAvoidance Theory more longitudinal health studies, and an in-depth
exploration of the physiological mechanisms which may underlie repressive
coping.
Keywords: repressive coping style; avoidance of negative affect; physical health;
self-care behavior; vigilanceavoidance theory; cross-cultural differences
It is over 30 years since Weinberger, Schwartz, and Davidson (1979) commenced a
new era in research on repression, by renewing interest in repression as an individual
difference variable. They operationalized this concept by identifying individuals who
possess a repressive coping style by their pattern of scores on two self-report
variables: trait anxiety and defensiveness. Repressors score low on trait anxiety scales
(measured by various trait anxiety scales, e.g., the Bendig version of the Manifest
Anxiety Scale (MAS); Bendig, 1956) and high scores on defensiveness (often
measured with the MarloweCrowne Social Desirability Scale (MC); Crowne &
Marlowe, 1964). Apart from the ‘‘repressor’’ group, three control groups are
typically identified using the same typology: a further low trait anxiety group that
This article was invited by the editors following Professor Myers’ keynote address at the 29th
meeting of the Stress and Anxiety Research Society (STAR) in July 2008 in London, United
Kingdom.
*Email: lynn.myers@brunel.ac.uk
ISSN 1061-5806 print/1477-2205 online
#2009 Taylor & Francis
DOI: 10.1080/10615800903366945
http://www.informaworld.com
Anxiety, Stress, & Coping
Vol. 23, No. 1, January 2010, 317
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are low on defensiveness (low-anxious) and two high trait anxiety group, one of
which is low on defensiveness (high-anxious) and the other one is high on
defensiveness (defensive high-anxious).
The seminal Weinberger et al. (1979) study and numerous later studies found that
repressors dissociate their somatic reactions from their perceptions of distress, with
repressors, in potentially stressful situations, reporting low levels of distress and
anxiety but exhibiting high levels of physiological activity (Asendorpf & Scherer,
1983; Barger, Kircher, & Croyle, 1997; Benjamins, Schuurs, & Hoogtraten, 1994;
Derakshan & Eysenck, 1997, 2001a, 2001b; Gudjonsson, 1981; Jamner & Schwartz,
1986; Lambie & Baker, 2003; Newton & Contrada, 1992; Pauls & Stemmler, 2003).
Control groups typically exhibit different patterns of responses, with high-anxious
participants exhibiting the opposite pattern of response to repressors and low-
anxious participants reporting similar low levels of distress to repressors but without
high levels of physiological arousal. Studies which have included a defensive high-
anxious group have found that this group do not show the repressors’style of
dissociation (e.g., Asendorpf & Scherer, 1983; Derakshan & Eysenck, 1997).
This robust ‘‘repressive dissociation’’ has been found: (a) in male (e.g., Asendorpf
& Scherer, 1983) and female participants (e.g., Newton & Contrada, 1992); (b) in
student samples (e.g., Derakshan & Eysenck, 1997), general population samples
(e.g., Jamner & Schwartz, 1986), and patient samples (e.g., Benjamins et al., 1994);
(c) using various measures of anxiety such as the MAS (Bendig, 1956; e.g.,
Weinberger et al., 1979), the Four Systems Anxiety Questionnaire (Derakshan &
Eysenck, 1997; Koksal & Power, 1990), and the Spielberger State-Trait Anxiety
Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983; e.g., Derakshan &
Eysenck, 2001b); and (d) using different measures of defensiveness such as the MC
(Crowne & Marlowe, 1964; e.g., Weinberger et al., 1979) and the Lie Scale of the
Eysenck Personality Inventory (Eysenck & Eysenck, 1964; Gudjonsson, 1981).
Repressors make up a significant percentage of various populations, accounting
for between 10 and 20% of non-clinical populations (e.g., Codd & Myers, 2009;
Myers & Reynolds, 2000; Myers & Vetere, 1997; Phipps & Srivastava, 1997), between
30 and 50% of patients with various chronic illnesses (e.g., Cooke, Myers, &
Derakshan, 2003; Myers, Davies, Evans, & Stygall, 2005a), and up to 50% of elderly
groups (Brown et al., reported in O’Leary, 1990; Erskine, Kvavilashvili, Conway, &
Myers, 2007). Weinberger et al.’s (1979) article has been very influential: a recent
Web of Knowledge search (July 2009) indicated nearly 650 citations for this article. It
should be noted that the current review focuses on certain areas of repressive coping
research and is not meant to be a review of the entire literature.
How have the different coping styles been described? Myers (2000) reported that
people who fall into one of the four different groups tend to behave in a
characteristic style and gave brief descriptions of four participants whose style is
typical of their group, taken from notes after meeting participants in various studies.
Repressor: ‘‘Early for appointment. Talks in definite, clipped style. Is polite and
follows my instructions to the letter without question.’’ Low-anxious: ‘‘Late with no
excuse or apology. Calm and chatty. Appears very eager to receive payment of
incidental expenses for taking part in study, and not really interested in knowing
what the study is about at debrief.’’ [Non-defensive] high-anxious: ‘‘Tells me during
the study how anxious she is feeling and the reasons in her life for this, discloses
personal details not required for study. Treats me more like a therapist than a
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researcher.’’ Defensive high-anxious: ‘‘Appears to be uncomfortable in disclosing
information required by the study. Embarrassed and worried about my tape-
recording the interview, but allows me to continue’’ (pp. 400401). In their original
study, Weinberger et al. (1979) reported ‘‘repressors’preoccupation with mastering
negative emotion and rigorously controlling their behavior was particularly striking.
They clearly value a rational, non-emotional approach to life ...In contrast ... the
low-anxious ...displayed a lack of defensiveness and an openness to experience and
interpersonal relationships ...The [non-defensive] high-anxious ...reported being
shy, unassertive, and generally threatened by interpersonal contact’’ (pp. 378379).
Similarly, in a later review, Weinberger (1990) described repressors as ‘‘people
who fail to recognize their own affective responses ... who consider maintaining low
levels of negative affect central to their self-concept [and] are likely to employ a
variety of strategies to avoid conscious knowledge of their ‘genuine reactions’...
repressors as a group, seem actively engaged in keeping themselves (rather than just
other people) convinced that they are not prone to negative affect’’ (p. 338).
Repressive coping and the avoidance of negative affect
There are many studies that have indicated repressors avoid negative affect (see
Myers, 2000; Myers & Derakshan, 2004a, for reviews). Briefly, repressors compared
to non-repressors: (a) have poorer recall of negative autobiographical memory from
childhood and adulthood (e.g., Davis, 1987; Myers & Brewin, 1994; Myers &
Derakshan, 2004b, 2009); (b) have worse recall of negative material in both
intentional and incidental learning paradigms (Myers & Brewin, 1995; Myers,
Brewin, & Power, 1998; Myers & Derakshan, 2004a,c); and (c) use an avoidant style
of information processing (Derakshan, Myers, Hansen, & O’Leary, 2004; Fox, 1993;
Geraerts, Merckelbach, Jelicic, & Smeets, 2006). However, Geraerts et al. (2006)
found that repressors were better than all non-repressor groups in suppressing/
avoiding anxious autobiographical memories immediately after the task, seven days
later they had the highest number of intrusive autobiographical memories. This is an
important finding as it strongly suggests that possessing a repressive coping style is
not adaptive in the longer term.
Numerous studies indicate that repressors answer self-report measures in such a
way to conclude that they avoid negative information regarding the self rather than
being overly positive (see Myers, 2000; Myers & Derakshan, 2004b, for reviews).
Repressors compared to non-repressors: (a) reported higher comparative optimism
for negative events (Eysenck & Derakshan, 1997; Myers & Brewin, 1996; Myers &
Reynolds, 2000); (b) rated negative words as less self-descriptive (Codd & Myers,
2009; Myers & Brewin, 1996); (c) gave the reasons for negative hypothetical events
happening to them as a composite of external, unstable, and specific attributions
which is opposite to the depressive attributional style (Creswell & Myers, 2002;
Gomez & Weinberger, 1986, reported in Myers, 1996; Weinberger, 1990); (d) self-
reported lower levels of psychological symptomatology (Myers & Vetere, 1997); (e)
self-reported lower levels physical symptomatology (Jurbergs, Long, Hudson, &
Phipps, 2007; Myers & Vetere, 1997); (f) scored lower on self-report measures of
alexithymia (Myers, 1995; Myers, Derakshan, & Edmunds, 2009; Newton &
Contrada, 1994); (g) scored lower on dispositional optimism (negative items only;
Myers & Steed, 1999); and (h) reported fewer intrusions following an experimentally
Anxiety, Stress, & Coping 5
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induced stressor (Overwijk, Wessel, & de Jong, 2009). In a recent study of falling in
an elderly population with a history of serious falls, repressors self-reported fewer
numbers of falls, even though there were no group differences for an objective
independent measure of motor function (Hauer et al., 2009).
In summary, the studies discussed demonstrate that repressors avoid negative
affect.This suggests that standard self-report measures are a poor way of collecting
data from this group who may account for up to 50% of certain populations.
However, research has shown that some types of self-report measures are more
suitable for repressors (Myers, 2000).
Can repressors’avoidance of negative affect be bypassed?
Firstly, evidence suggests that repressors tend to downplay the negative rather than
overstating the positive. For example, repressors did not differ from non-repressors
on their comparative optimism for positive events and they did not describe
themselves more positively when using positive descriptors (Codd & Myers, 2009;
Myers & Brewin, 1996). Similarly, on a measure of dispositional optimism,
repressors did not differ from non-repressors on positive items of an optimism
scale (Myers & Steed, 1999).
If repressors are allowed to express themselves positively on some items of a self-
report measure, they may rate themselves negatively on other items. For example,
repressors compared to non-repressors are more likely to rate themselves as having
an avoidant style of romantic attachment (a negative response), as long as they can
also rate themselves as having a secure style (a positive response), but if they have to
exclusively choose one style, they rate themselves as securely attached (a positive
response) (Myers & Derakshan, 2009; Vetere & Myers, 2002).
Repressors may rate themselves negatively on some items but not on others. This
is demonstrated by a study on the use of different strategies to suppress negative
thoughts which found that repressors compared to non-repressors reported using
more distraction strategies and fewer punishment strategies (Myers, 1998). Distrac-
tion may be seen as less negative than punishment.
Repressors may rate themselves differently on indirect measures compared with
direct measures. Whereas, repressors compared to non-repressors rated hypothetical
negative events as less likely to be due to internal causes on a direct measure of
attributional style (avoiding negative affect), the opposite pattern was found on an
indirect measure, with repressors rating hypothetical negative events to by more
likely to be due to internal causes (Creswell & Myers, 2002).
It is possible to bypass the problem of repressors’avoidance in reporting negative
affect by using measures which allow an independent rater to judge participants
responses, for example, semi-structured interviews (see Figure 1). Using a semi-
structured interview for assessing early experiences, female repressors reported a
more negative view of their fathers than non-repressors, whereas using questionnaire
measures of childhood experiences, female repressors reported a more positive view
of their fathers than non-repressors (Myers, 1999; Myers & Brewin, 1994; Myers,
Brewin, & Winter, 1999). Similarly, in a study in which participants were rated on
alexithymia by both a questionnaire measure and an independently rated interview
(Myers et al., 2009), repressors scored significantly lower than the truly low-anxious
group (low-anxious) on the questionnaire measure of alexithymia but scored
6L.B. Myers
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significantly higher than the low-anxious group on the interview measure, indicating
a dissociation between self-report and independently rated measures of alexithymia.
In conclusion, care must be taken when collecting information from repressors. A
standard questionnaire may not be the best way of collecting data and other means
should be investigated. For example, using a carefully designed self-report measure
dealing with the concerns already discussed or using an independently rated
interview measure.
Other issues
Identifying repressors
As discussed in Myers and Derakshan (2004b), one of the major difficulties with
repressor research is a lack of consensus when identifying groups. Traditionally, the
trait anxiety/defensiveness method depends on categorizing people into groups based
on their location along two dimensions. Various studies identify their participants at
the beginning of the study by screening a large number of potential participants and
choosing extreme scorers on trait anxiety/defensiveness to define repressors, low-
anxious, high-anxious, and (possibly) defensive high-anxious groups, using quartile
splits, tertiary splits or set cut-off points; omitting non-extreme scorers (e.g.,
Asendorpf & Scherer, 1983; Derakshan & Eysenck, 1997; Myers & Brewin, 1994,
1996; Myers & Derakshan, 2004b; Myers & Steed, 1999; Myers et al., 1998,
Experiment 2). Other studies have used the entire available pool of participants and
hence do not use such stringent measures in defining different groups, usually using
median splits on trait anxiety/defensiveness to identify repressors and control groups,
thereby not losing any potential participants (e.g., Denollet, Martens, Nyklicek,
Conraads, & de Gelder, 2008; Jensen, 1987; Shaw et al., 1986). Others may use preset
cut-offs on anxiety/defensiveness to identify repressors and compare them with all
non-repressors (e.g., Cooke et al., 2003) or compare them with non-repressors omitting
borderline repressors (Myers & Brewin, 1995; Myers et al., 1998, Experiment 1).
Some studies have compared different methods. For example, a major problem
with using median splits is that potentially borderline repressors may be included in
the repressor group and only by using extreme scoring participants can we be more
confident that those identified as repressors are truly repressors. However, Myers
Repressors
Independently
rated
interviews
Self-report
measures (e.g.,
questionnaires)
Negative childhood
experiences
High alexithymia
Positive childhood
experiences
Low alexithymia
Figure 1. Repressors’differences between interviews and questionnaires.
Anxiety, Stress, & Coping 7
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and Derakshan (2004c) in an incidental recall memory task (the directed forgetting
task) found similar results using both quartile splits and median splits. In two slightly
earlier directed forgetting experiments, similar results were found when comparing
repressors against a composite group of non-repressors (omitting borderline
repressors; Experiment 1) and when comparing repressors to the three extreme-
scoring control group (Experiment 2; Myers et al., 1998). These findings indicate
that median splits and comparing repressors to a mixed non-repressor control group
should be considered for incidental recall tasks.
Some studies have used a whole sample and initially compared repressors to three
extreme-scoring control groups, omitting non-extreme scoring participants, and
subsequently comparing repressors to all non-repressors (Myers & Reynolds, 2000;
Myers & Vetere, 1997). Although both of these studies indicated similar findings
with either method, the four-group typology yielded more information.
Other studies have treated trait anxiety/defensiveness as continuous variables and
analyzed using hierarchical multiple regression (e.g., Mendolia, 2002). However, the
author concluded that either categorical or continuous methods are comparable as
long as there is sufficient power and sample size (Mendolia, 2002).
A worrying trend is that a substantial number of studies that identify the
repressor group and control groups do not include a defensive high-anxious group,
just the high-anxious, and low-anxious groups as controls (e.g., Dawkins &
Furnham, 1989; Frasure-Smith et al., 2002; Millar, 2006; Newton & Contrada,
1994). The problem with this is that any group differences between repressors and the
two control groups, low-anxious and high-anxious could just be due to repressors
high defensiveness scores alone and not due to their unique combination of low
anxiety and high defensiveness. This complicates findings as there is a parallel
literature indicating that high defensive and low defensive individuals differ on many
dimensions. However, this literature is out of the scope of the current review.
As discussed earlier, different measures of anxiety and defensiveness are used to
define repressive copers and control groups. So with all of these different measures
and different ways of identifying repressors and non-repressors, as well as the issue
of including a defensive high-anxious group it is not surprising that there are
inconsistencies within the repressive coping literature. For example, although the
finding of dissociations between self-report measures and physiological measures of
distress are well replicated (see above), there have been some studies which have not
been able to replicate this finding (e.g., Jørgensen & Zachariae, 2006). These authors
suggest that future studies should use a more consistent operationalization of
repressive coping and compare alternative methods in the same study. This is an
important issue for all repressive coping researchers to consider.
Cultural differences
In a study of children in the USA, there were more Mexican (20.8%) versus
Caucasian (7.8%) repressors (Varela, Steele, & Benson, 2007). In another sample of
children from the USA, there were more repressors in African-American children
(39%) versus Caucasian children (15.8%) (Steele, Elliot, & Phipps, 2003). In a study
of 231 students from the UK, repressors and control groups were identified using the
same cut-off points as Myers and Brewin (1996). Similar numbers of White and
Chinese participants were classified as repressors (27.8 and 27.3%, respectively), a
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slightly lower number of Asian students were classified as repressors (21.5%) and
fewer Black students were classified as repressors (15.4%) (Codd & Myers, 2009).
Therefore, some limited data suggest cultural differences which need to be more
thoroughly investigated.
How do repressors repress?
Derakshan et al. have proposed an exciting theory on the repressive coping style, the
VigilanceAvoidance Theory (see Figure 2), which takes into account several key
findings (Derakshan, Eysenck, & Myers, 2007). According to the theory, repressors
have an initial rapid vigilant response triggering behavioral and physiological
responses and involving attentional and interpretive biases to self-relevant threat
stimuli. The initial vigilance stage is followed by an avoidance stage involving
avoidant cognitive biases that inhibit the conscious experience of anxiety. Systematic
empirical research needs to be undertaken on all aspects of the VigilanceAvoidance
Theory.
Repressive coping and physical health
There is a large body of evidence linking repressive coping with poor physical health.
There is also an increased prevalence of repressive coping in chronic illness
populations (e.g., Cooke et al., 2003; Phipps, Steele, Hall, & Leigh, 2001). As
literature on repressive coping and illness has been comprehensively reviewed
elsewhere (Myers et al., 2007), the present review focuses on two illnesses: heart
disease and cancer.
Figure 2. The essential features of the VigilanceAvoidance Theory. [Figure 1 from
Derakshan, Eysenck, and Myers (2007).]
Anxiety, Stress, & Coping 9
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Heart disease
The most exciting, longitudinal, findings have been in the area of cardiovascular
disease, with two longitudinal studies on coronary heart disease (CHD) indicating
that repressive coping is a risk for mortality in CHD. Denollet et al. (2008) followed-
up 731 patients with CHD from two prospective studies at five and 10 years (mean
follow-up time 6.6 years). Over 20% of patients were classified as repressors. Results
indicated that repressors were at increased risk for death and myocardial infarction
(MI). Specifically, after controlling for various psychological and physiological
variables, repressive coping was shown to be an independent predictor associated
with a two-fold increased risk of death, MI, and other cardiac events.
A slightly earlier study, the Montreal Heart Attack Readjustment Trial (Frasure-
Smith et al., 2002), was a randomized control trial of psychosocial interventions for
post-MI patients (N1376). The intervention involved screening and treating non-
specific psychological distress and was based on evidence that increases in stress may
lead to poor prognosis after a MI. It was a 12-month intervention in which the
treatment group received monthly telephone monitoring of psychological distress
and home nursing visits. After one year, there were no differences in either survival or
psychological outcomes between the two groups, even though the intervention group
received five or six nursing visits of one hour. Participants were followed up for five
years after hospital discharge. At five years follow-up, repressors and two control
groups (low-anxious and high-anxious) were identified. The program was associated
with significantly reduced survival in both male and female repressors. Other results
suggested that the program caused distress in repressors, as they were more likely to
be prescribed benzodiazepines and to have visited emergency rooms without being
readmitted than those in the control groups. A note of caution: Frasure-Smith et al.
(2002) did not identify the other high defensive group, defensive high-anxious.
Consequently, their findings could possibly be due to repressors’high defensiveness
and not repressors unique combination of low trait anxiety and high defensiveness
(see above).
Frasure-Smith et al.’s (2002) findings suggest that repressors do not do well when
they have to take on board high-risk information about themselves, which replicates
findings from two earlier studies of CHD. Shaw, Cohen, Doyle, and Palasky (1985)
studied the impact of repressive coping and cardiac knowledge on hospitalized
patients who were recovering from MI. They found that repressors gained less
information about cardiac risk factors. Six months later it was found that repressors,
who had gained high-risk information, reported more complications (e.g., arrhyth-
mias, fluid retention) and poorer functioning (e.g., sleep disturbance, depression,
tension). In a slightly later study, Shaw et al. (1986) examined the relationship
between repressive coping, cardiac information, and medical complications in
patients undergoing treatment for narrowed coronary arteries. Six months after
treatment, repressors with high knowledge levels about cardiac disease and no
history of MI had a significantly higher risk of medical complications (e.g.,
hospitalization for chest pain, MI).
Overall, findings from these four studies strongly suggest a poor prognosis in
repressors with CHD especially those who have to face psychological aspects of their
illness and/or gain knowledge about their condition. This is a critical issue that must
be taken into account when designing psychological interventions for cardiac
10 L.B. Myers
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patients and further studies are needed to ascertain what type of interventions would
be beneficial for repressors.
Cancer
An early study reported that skin cancer (melanoma) patients were significantly
more repressed than cardiovascular patients and controls (Kneier & Temoshok,
1984). In fact, a higher percentage of repressors have been identified in children,
adolescents, and adults with cancer (e.g., Canning, Canning, & Boyce, 1992; Kreitler,
Chaitchik, & Kreitler, 1993; Phipps & Srivastava, 1997). Many studies have found
that children with cancer tend to report relatively low levels of disturbance on any
self-report measures of experienced distress such as depression and anxiety (e.g.,
Elkin, Phipps, Mulhern, & Fairclough, 1997; Phipps et al., 1995; Worchel et al.,
1988) and they rate themselves as less depressed than do their parents, nurses, or
physicians (Phipps & Srivastava, 1997; Worchel et al., 1988). In several studies,
Phipps and co-workers have documented high levels of repressors, and relatively low
levels of high-anxious children in the paediatric cancer population. Phipps and
Srivastava (1997) reported the percentage of repressors in the cancer group was
double that of a control group (3618%). This finding has been replicated several
times (Phipps & Steele, 2002; Phipps et al., 2001).
Jensen (1987) conducted a prospective study of women with a history of breast
cancer who were followed up for two years, with results indicating that repressive
breast cancer patients have a poor prognosis. Patients exhibiting a repressive coping
style were at greater risk of death from cancer: of 11 patients who died during follow-
up, eight were repressors, and repressors displayed more rapid progression of the
disease than non-repressors (1755 days remission for non-repressors versus 1204
days for repressors).
Findings from a longitudinal study on women with metastatic breast cancer
suggest poorer survival of repressive copers (e.g., Giese-Davis, DiMiceli, Sephton, &
Spiegel, 2006; Giese-Davis, Sephton, Abercrombie, Duran, & Spiegel, 2004). Poor
survival of women with metastatic breast cancer is probably associated with a
hormonal response, an abnormal diurnal variations of cortisol levels. In an earlier
study of over 100 metastatic breast cancer patients, salivary cortisol was measured at
four time points each day for three days. Cortisol slope predicted survival up to seven
years later, early mortality occurred with a relatively flat diurnal slope (Sephton,
Sapolsky, Kraemer, & Spiegel, 2000). In a later study, repressors with metastatic
breast cancer had a flatter diurnal slope than truly low-anxious participants,
suggesting a hormonal link to their poorer survival (Giese-Davis et al., 2004).
Unlike the studies discussed, many studies on repressive coping and health have
been cross-sectional (see Myers et al., 2007, for a review). There needs to be more
longitudinal studies on repressive coping and health to examine causality.
Physiological mechanisms underlying repressive coping
It is suggested that there is high physiological effort when repressing negative
thoughts, resulting in increased autonomic reactivity. Repressors may not be aware
of their bodily state and symptoms (Schwartz, 1990). A long-term consequence of
Anxiety, Stress, & Coping 11
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this increased autonomic reactivity may be an increased risk of a variety of health
problems.
Another potential clue about the mechanism comes from a study where
participants (N18) undertook a lab-based stressor task and were given either an
opioid antagonist (naltrexone) or a placebo. Opioid antagonism reduced repression.
These results suggest that endogenous opioid dysregulation may underlie repressive
coping (Younger, Lawler-Roe, Moe, Kratz, & Keenan, 2006). However, this should
be seen as a preliminary study due to the low number of participants and more
detailed research is required.
Are all physical health issues concerning repressors negative?
The studies discussed so far have presented evidence linking repressive coping with
poor physical health. However, does this mean that physical health issues concerning
repressors are all negative?
There are preliminary data from three small-scale studies that suggest repressors
may be good at undertaking health behaviors which they perceive as under their
control: these concerned asthma control, diabetes control, and dental care (Myers
et al., 2005a; Myers, Myers, Derakshan, & Fox, 2005b).
A slightly earlier study on asthma patients recruited from hospital outpatient
clinics in London found that repressors scored lower than non-repressors on an
objective measure of well-being (lung function) suggesting worse physiological
control (Cooke et al., 2003). Myers et al. (2005a) also recruited from hospital
outpatient clinics in London. On a similar objective measure of lung function,
repressors had a significantly better lung function than non-repressors, the opposite
finding to Cooke et al.’s (2003). Subjective measures were consistent with the views
of repressors avoiding negative affect. Participants were asked to attribute their
asthma symptoms (e.g., wheezing, lethargy) over the previous four weeks to
medication side effects, the disease, or anxiety. No repressor attributed any symptom
to anxiety, whereas there were 31 ‘‘hits’’ for non-repressors. However, physicians were
asked to rate patients’anxiety and they rated repressors as significantly more
anxious than patients rated themselves, but this was not the case for non-repressors.
How can the different results between lung function be explained between the two
asthma studies? Although published in 2003, Cooke et al.’s data were collected in 2000.
Asthma management in the UK has recently focused much more on self-management
(Gibson & Powell, 2004). Myers et al.’s (2005a) data were collected in 2002, two years
later than Cooke et al.’s, from a clinic which encouraged self-management. It may be
that repressors are better in situations where there is personal control.
Good metabolic control was found in a sample of patients with diabetes (Myers
et al., 2005a). Metabolic control is an objective measure of how well a patient’s diabetes
is being controlled over the previous four to six weeks. Results were comparable to the
second asthma study. There were 87 patients with either Type 1 or Type 2 diabetes,
recruited from a hospital outpatient department in London. Repressors, who made up
nearly 50% of the sample, showed significantly better metabolic control than non-
repressors. Again, the explanation could be a matter of personal control. To have good
metabolic control in diabetes, personal control must be high: Individuals with Type 1
diabetes have to balance insulin injections (up to four times a day) with food intake and
exercise. Blood sugars are monitored up to four times a day. Individuals with Type 2
12 L.B. Myers
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diabetes have also to control their food intake and should exercise. They may also be
taking tablets for their diabetes or injecting insulin and also monitor blood sugars.
Whatever the type of diabetes, the better personal control resulting in keeping blood
sugars within normal range, the better the metabolic control. Good metabolic control
is predictive of lower morbidity and mortality (Diabetes UK, 2009).
A further study compared behaviors which vary in personal control: dental care
(Myers et al., 2005b). Dental hygiene is a behavior that requires much personal
control, whereas going to the dentist does not. From the findings of the previous two
studies (Myers et al., 2005a), it was hypothesized that repressors compared to non-
repressors would report better self-care behavior for dental hygiene, but worse
health-care behavior when a dentist was perceived to be in control. Adults were
recruited from the community (N146) and four groups were identified: repressor,
low-anxious, high-anxious, and defensive high-anxious. There were measures of
personal control about brushing teeth: ‘‘How often do you brush your teeth?’’ ‘‘For
how long do you brush your teeth?’’ and ‘‘How often do you forget to brush your
teeth?’’ There were questions about other control: ‘‘When was the last visit to your
dentist?’’ and ‘‘Do you feel you have control of what will happen to you in the dental
chair?’’ The questions were carefully designed not to elicit repressors avoidance of
negative information as there were no obviously right or wrong answers. As
hypothesized, repressors compared to all non-repressor groups reported brushing
their teeth more times per day and for longer, and were less likely to forget to brush
their teeth. However, repressors reported fewer visits to the dentist and wanted more
control in the dental surgery. So, repressors reported significantly better dental self-
care behaviors, that is, behaviors under their control, but were significantly poorer
concerning behaviors which were not under their control. A longitudinal study of
over 1000 healthy men also suggests that repressive coping is associated with good
self-care behavior (Niaura et al., 2003). Repressive coping was negatively associated
with Body Mass Index (BMI), that is, repressors had a significantly lower weight
than non-repressors. In addition, for nonobese men, repressors had a lower weight to
hip ratio (WHR). A low WHR is considered healthy. It should be noted that
repression was measured with the repression subscale of the Minnesota Multiphasic
Personality Inventory (Welsh, 1956).
Preliminary conclusions are that repressors are good at self-care behaviors and
are worse when behaviors are not under their control. These results suggest that
repressive coping and health is more complex than we previously thought. Future
studies should investigate control and health in repressors in a number of ways. For
example, in the rehabilitation phase after a MI, would repressors have better
recovery if rehabilitation was arranged to have a high level of personal control? The
current studies need to be extended to establish whether repressors’health is better
than non-repressors where self-care behavior is important. It may be that such
behavior is only one aspect of repressors’health and that there are other factors
which contribute to the link of repressors coping and poor physical health, such as
hormonal and physiological issues which has been previously discussed.
Concluding remarks
Although we have come a long way since the Weinberger et al.’s (1979) reformulation
of the repressive coping style more than three decades ago, with a host of important
Anxiety, Stress, & Coping 13
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findings, there remains a number of questions to be addressed, many which have
been suggested in this review. We expect the next 30 years will explain the
mechanisms behind many of the current findings, and establish the underlying
reasons (possibly physiological, hormonal, and immunological) for the link between
repressive coping and poor physical health, with the aim of designing successful
health interventions to improve repressors’health.
Acknowledgements
I thank Naz Derakshan for her continual support and enthusiasm for repressive coping
research.
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