Stressed? It's Best to Repress

Common wisdom says that, after a traumatic incident, it's better to let things out than to keep them bottled up inside, but a recent study has found that people who repress their feelings are healthier.

In other words, it's better to clench after clinches.

"When the avoidance (of emotionally dealing with a traumatic experience) is flexible, is not taken to an extreme, and does not substantially distort the perception of reality, its use may promote well being," Dr. Karni Ginzburg, of the Tel Aviv University School of Social Work, writes. "In these cases, the repressor is able to approach the trauma-induced emotions and cognitions gradually, in small doses, and without being overwhelmed by them and also to maintain his or her hope and courage."

The findings, she said in an e-mail interview, could revolutionize the way people deal with trauma survivors, who are conventionally dealt with by using the "debriefing" method, which encourages them to describe their experience.

"Many times, we tend to ask people to talk about their experience, to share their emotions, to admit their fears and helplessness," she said. "The findings of the study suggest that at least for those who naturally tend to repress, this procedure is unnecessary, and even may be not recommended."

But the study's results stressed out some other stress experts.

"People have to feel the stress or it lodges somewhere and causes physical damage," said Debbie Mandel, who wrote a stress-management guide. "When you repress these memories and block them out, the body manifests it."

Ginzburg and her colleagues, Zahava Solomon and Avi Bleich, who published their study in the September Journal of the American Psychosomatic Society, studied 116 people who suffered heart attacks. First, they categorized the subjects as either having either a repressive coping style or one of three other ways of managing stress. Then they gave the patients examinations both within a week of their heart attack and seven months later. By far, the repressors, people who ignored their anxiety about life-threatening experiences, were less likely to suffer from post-traumatic stress disorder (PTSD) than those who dwelt on their near-death experiences.

People with PTSD often have nightmares or flashbacks about their traumatic experiences, insomnia, a feeling of detachment and irritability. PTSD sufferers also commonly experience immune-system problems, headaches and other physical ailments, and also often also develop associated mental disorders like depression or phobias. According to the National Center for Post-Traumatic Stress Disorder, 7.8 percent of Americans have PTSD, with women twice as likely as men to develop it.

In the study of heart-attack survivors, only 7.1 percent of the people classified as repressors were found to have clinical PTSD, whereas people in the other categories of coping styles experienced PTSD between 17.2 percent and 20 percent of the time.

Ginzburg stresses that the long-term benefits or downsides of repressing stress are unclear, but for the short term, avoidance, denial and suppression are all good things.

She and her fellow researchers found that repressors didn't have a warped sense of reality, as some have suggested. Instead, she theorizes that repressors maintain a more positive self-image, think they have a better ability to cope with stress, or are simply more optimistic in general.

"I think that those who keep on repressing their emotions, and do it naturally, would continue to benefit from the protecting shield that this coping style provides them," she said.

But some stress experts were skeptical of Ginzburg's findings.

Mandel, the Lawrence, Long Island-based author of Turn on Your Inner Light: Fitness for Body, Mind and Soul, recommends not running away or ignoring stress but dealing with it with meditation, fitness workouts and observing one's own thoughts for 45 minutes a day. Not addressing the anxiety leads to physical pain, she said.

"It could be a backache, it could be a neck-ache, you could keep going to the doctor and not know what the problem is, but it comes out in some form or another and it has to be laid to rest" by confronting one's anxieties, she said.

Dr. Bruce Rabin, medical director of the University of Pittsburgh Medical Center's Healthy Lifestyle Program, said the study's results weren't a surprise and that he agreed with them. But he questioned whether repressing is best for a person's long-term health.

"People aren't generally encouraged to repress feelings because that can cause a lot of anxieties later on," he said. "We encourage people to use behavior that will minimize the stress of the disease, talk to friends, engage in social relationships, be optimistic and laugh about things, actively pursue religious activities if religious, do whatever works for you to calm you down."

Pretending a stressful event never happened will only postpone the reckoning, he said.

"At some point, if you haven't dealt with it in positive ways, you realize there's this anxiety you haven't dealt with and you say, 'My God, I had a heart attack! I almost died!' And you don't have any positive behaviors to turn to," he said.