Change in Emotion-Regulation Strategy for Women With Metastatic Breast Cancer Following Supportive–Expressive Group Therapy Janine Giese-Davis, Cheryl Koopman, Lisa D. Butler, Catherine Classen, and Matthew Cordova Stanford University School of Medicine Pat Fobair Stanford Hospital and Clinics Jane Benson, Helena C. Kraemer, and David Spiegel Stanford University School of Medicine Four relatively independent emotion-regulation constructs (suppression of negative affect, restraint, repression, and emotional self-efficacy) were tested as outcomes in a randomized trial of supportive– expressive group therapy for women with metastatic breast cancer. Results indicate that report of suppression of negative affect decreased and restraint of aggressive, inconsiderate, impulsive, and irresponsible behavior increased in the treatment group as compared with controls over 1 year in the group. Groups did not differ over time on repression or emotional self-efficacy. This study provides evidence that emotion-focused therapy can help women with advanced breast cancer to become more expressive without becoming more hostile. Even though these aspects of emotion-regulation appear trait-like within the control group, significant change was observed with treatment. A long-standing hypothesis links suppressed, repressed, or dys- regulated emotional expression with greater incidence and faster progression of cancer (see Giese-Davis & Spiegel, in press; Gross, 1989; McKenna, Zevon, Corn, & Rounds, 1999; Spiegel & Kato, 1996, for reviews). Given this controversial literature, our research focus seeks to clarify which emotion-inhibition phenomena may be dangerous to cancer patients (Giese-Davis & Spiegel, 2001) and whether therapy can change emotion-regulation strategy in ways that mediate survival. Spiegel, Bloom, Kraemer, and Gottheil (1989) and several others (Fawzy et al., 1993; Richardson, Shel- ton, Krailo, & Levine, 1990) have found survival effects for cancer patients following participation in group therapy. However, no one has reported the ability to change emotion-regulation strategies and linked that change with survival (Giese-Davis & Spiegel, in press). Emotion-focused group interventions for cancer patients may be particularly effective in facilitating these changes. In a first step toward testing these hypotheses, this study evaluated the impact of supportive– expressive therapy (SET) on four aspects of affect regulation, suppression, restraint, repression, and emotional self-efficacy, in women with metastatic breast cancer. Empirical evidence supports distinctions between the suppres- sion of negative emotions, restraint of aggressive actions, confi- dence in one’s emotional expression skill, and repressive defen- siveness (L. A. King & Emmons, 1991; L. A. King, Emmons, & Woodley, 1992; Kring, Smith, & Neale, 1994; Pettingale, Watson, & Greer, 1985; Roger & Nesshoever, 1987; Watson & Greer, 1983; Weinberger, 1990a; Weinberger & Davidson, 1994; Wein- berger & Schwartz, 1990). In the same sample of women used for the present study, we recently demonstrated that suppression, restraint, and repression were separable in a factor analysis and that—without intervention—these constructs remained relatively stable over 1 year in a multitrait, multioccasion matrix (Giese- Davis & Spiegel, 2001). In this earlier article, we more thoroughly reviewed construct distinctions. Suppression is viewed as a defense mechanism in which a person “intentionally avoids thinking about disturbing problems, desires, feelings, or experiences” (Diagnostic and Statistical Man- ual of Mental Disorders, 4th ed.; DSM–IV; American Psychiatric Association, 1994, pp. 756 –757). Temporary suppression during an inconvenient moment is viewed as a sign of healthy adjustment (Valliant, 2000; Vaillant & Vaillant, 1990). However, this ability may be distinguishable from the chronic suppression of negative Janine Giese-Davis, Cheryl Koopman, Lisa D. Butler, Catherine Clas- sen, Matthew Cordova, Jane Benson, Helena C. Kraemer, and David Spiegel, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine; Pat Fobair, Department of Radiation On- cology, Stanford Hospital and Clinics, Stanford, California. Portions of this study were presented at the annual conference of the Society for Behavioral Medicine, Nashville, Tennessee, April 2000, and at the 5th World Congress of Psycho-Oncology, Melbourne, Victoria, Aus- tralia, September 2000. This study was made possible by National Institute of Mental Health Grants MH47226 and MH47226-11, with additional funding from the National Cancer Institute, the MacArthur Foundation, and California Breast Cancer Research Program Grants 1FB-0383 and 4BB- 2901. We appreciate the contributions of Elaine Miller, project director; Sue Dimiceli, data analyst; and Sharon Foster, who made helpful sugges- tions on earlier versions of this article. We are indebted to the women who made this work possible. Correspondence concerning this article should be addressed to Janine Giese-Davis, Department of Psychiatry and Behavioral Sciences, 401 Quarry Room 2318, Stanford University School of Medicine, Stanford, California 94305-5718. E-mail: jgiese@stanford.edu Journal of Consulting and Clinical Psychology Copyright 2002 by the American Psychological Association, Inc. 2002, Vol. 70, No. 4, 916 –925 0022-006X/02/$5.00 DOI: 10.1037//0022-006X.70.4.916 916