Introduction  

The results of various studies have shown that the emotional ability of people makes facing with challenges of life easier for them, and as a result, they have more mental health [1]. Emotionally able people recognize their feelings, perceive their implications, and express their emotional states more effectively to others. In comparison with those who cannot perceive and express their emotional states, these people are more successful in coping with negative experiences and show better compatibility with the environment and others [2]. Since emotional expression has a significant impact on mental health, this research was conducted to investigate emotional expression styles such as emotional expressiveness, emotional control, and ambivalence over emotional expression. According to the differentiation of individuals in biological, social, psychological, and personality components, these personal differences can also be seen in specific emotional behaviors. In this regard, studies have shown that people use different emotional expression patterns such as emotional expressiveness, emotional control, and ambivalence over emotional expression [3].

Emotional expressiveness

As one of the primary components of emotion, emotional expressiveness refers to the exterior appearance of emotion regardless of its value (positive or negative) or its manner of manifestation (facial, verbal, physical, and behavioral). The emotional expression also includes facial, sound, gesture, and body movement changes. Smiling, crying, and escaping are examples of emotional expressions. King and Emmons (1990) have introduced three dominant dimensions in emotional expressiveness; these three dimensions include positive emotion expression, negative emotion expression, and intimacy expression [3].

Emotional control

Emotional control is defined as the tendency to inhibition of emotional expression. In this regard, Roger and Najjarian (1989) and Roger and Nesshoever (1987) have introduced four independent substructures for emotional control including emotional inhibition, rumination, aggression control, and benign control [4, 5]. They also consider emotional control as a personality variable that modifies the relationship between disease and tension. Emotional inhibition refers to the reduction of emotional expression (voluntarily or involuntarily). Roger and Najjarian (1989) believe that emotional inhibition tends to assess the tendency to inhibit emotional expression [4]. Rumination is associated with reviewing upsetting emotional events, having specific repetitive thoughts, and probably the inability to stop them. Aggressive control refers to the inhibition of hostility and is independent of the general emotional state which is measured by emotional inhibition. Benign control is controlling turbulent impulses during work. Roger and Najjarian (1989) have proposed benign control as an emotional control structure that is correlated with early arousal [3].

Ambivalence

Ambivalence over emotional expression means a person experiences a combination of positive and negative emotions about emotional experiences and emotional expressions at the same time. Ambivalence has a wide range of emotional expressions including the tendency but the inability to express, express without the real tendency to emotional expression and then regret [3]. Shahgholian, Moradi, and Kafi (2007) have examined the relationship of Alexithymia with emotional expression styles (emotional expressiveness, emotional control, and ambivalence over emotional expression) and the general health of students and the role of gender [6]. The findings of this study have shown that Alexithymia has a significant relationship with all subscales of emotional expressions, so it has a significant positive relationship with emotional inhibition and rumination and a significant negative relationship with aggression control and benign control. Also, Alexithymia has a significant direct relationship with ambivalence over emotional expression. Mirzaei (2010) has examined the relationship between emotional expression styles and general health, as well [7]. The findings of this study have shown a significant positive relationship between emotional control and a significant negative relationship between ambivalence over emotional expression and general health. Another study which was of correlation type has examined the relationship between expressed emotion, interdependence, family stress management styles, and severity and symptoms of OCD patients; the results have indicated that the expressed emotions, interdependence, and family stress management styles have a relationship with severity and symptoms of OCD patients [8]. Regarding type D personality or distress as one of the causes of psychopathology and physical diseases, Hassani and Bemani Yazdi (2015) have concluded that among ambivalence over emotional expression factors, positive ambivalence over emotional expression; and among emotional expressiveness factors, intimacy expression, and negative emotion expression predict negative emotional components and social inhibitions [3]. Also among emotional control, benign control, rumination, and emotional inhibition, components of social inhibition are predicted by negative emotional components, emotional inhibition factor, and rumination. So based on the findings of this study, it can be said that emotional expression styles are from behavioral correlates of D personality. Roger and Najjarian (1989, quoted by Hassani & Bemani Yazdi, 2015) believe that emotional inhibition tends to assess the tendency to inhibition of emotional expression. Rumination is related to upsetting emotional events, having specific repetitive thoughts, and probably the inability to stop them. Aggressive control refers to the inhibition of hostility and is independent of the general emotional state which is measured by emotional inhibition. Benign control is controlling turbulent impulses during work. Rafieinia et al. (2006) have designed a study to examine the relationship among emotional expressiveness, emotional inhibition, and ambivalence over emotional expression as emotional expression styles in normal emotional situations and general health and the difference between men and women in emotional expressiveness [9]. Although, the results have shown that there is no significant relationship between emotional expressiveness and general health. Nonetheless, there is a significant reverse relationship between negative emotional expression (as a component of emotional expression) and general health. In general, emotional inhibition has a significant positive relationship with general health, but higher rumination (as a component of emotional inhibition) is associated with lower general health. Ambivalence over emotional expression has a significant reverse relationship with emotional expressiveness which means that individuals with higher ambivalence over their emotional expression have lower general health. Women also reveal their emotions more than men. Similarly, the findings of this research have emphasized the effective role of emotional expression styles in the prediction of health and disease and gender differences in emotional expressiveness.

Considering that emotional expression has a substantial effect on mental health, this study has examined emotional expression styles such as emotional expressiveness, emotional control, and ambivalence over emotional expression. Because the ability of people to emotional expression leads to their more effective responses to challenges of life and better communication with others and healthier, considering that depression is the most common psychiatric disorder and has a high simultaneity with OCD (which has been recently categorized as anxiety disorder) and since these disorders are two obvious examples of psychological problems in the world which leads to patients occupational and social functioning impairments and consequently reduce mental health of the community, this study responds this question that does emotional expression styles differ among the three groups of OCD patients, depressed patients, and normal subjects?

Materials and Methods

The casual-comparative method was used in this study and its statistical population included adults who were referred to psychiatric clinics in Shiraz. A sample of 40 subjects (20 patients with OCD, and 20 patients with depression disorder) was selected through the purposive sampling method. Also, 20 staff of the same clinics that were matched for their age and education with the patients were selected. The criteria for entering this study were over 18 years old, have at least 8 classes of literacy and residence in Shiraz, and subjects with certain physical diseases (like MS or asthma), mental illnesses other than depression or obsession based on the Diagnostic and Statistical Manual of Psychiatric Disorders (fifth edition) and illiteracy were eliminated from this study. The instrument used in this study was the Emotional Expressivity questionnaire, King and Emmons’s Ambivalence over Emotional Expressiveness questionnaire, and Roger and Nesshoever’s Emotion Control questionnaire.

Research instruments

1. Emotional Expressivity Questionnaire: King and Emmons (1990) designed this questionnaire to assess the importance of emotional expression in health. The emotional Expressivity questionnaire has 3 components and 16 items. 7 items are related to the positive emotional expression component, 5 items are related to the intimacy expression component, and 4 items are related to negative emotional expression components. The reliability of this scale is examined by the internal consistency method and Cronbach’s Alpha, and its value for the whole scale and subscales of positive emotional expression, intimacy expression, and negative emotional expression are 68%, 65%, 59%, and 67%, respectively. And it indicates that this scale has a high and significant internal consistency [9]. The scoring of this questionnaire is based on the five-point Likert scale and is from total agreement (5) to total disagreement (1).

2. Emotional Control Questionnaire: Emotional Inhibition Questionnaire was designed by Roger and Nesshoever (1987) and revised by Roger and Najjarian (1989) [4, 5]. The questionnaire has 4 components (emotional inhibition, aggression control, rumination or rehearsal, and benign control) and 65 items, and its scale validity is examined by the internal consistency method and Cronbach’s Alpha, and its value for whole scale and subscales of emotional inhibition, aggression control, rumination, and benign control are 68%, 70%, 76%, 77%, and 58%, respectively. And it indicates that this scale has a high and significant internal consistency [10]. The scoring of this questionnaire is based on True and False answers.

3. Ambivalence over Emotional Expression Questionnaire: King and Emmons (1990) designed this questionnaire in order to investigate the importance of the role of ambivalence over emotional expression in health. The Ambivalence over Emotional Expression Questionnaire has 28 items which 16 items are related to positive ambivalence over emotional expression and 12 items are related to ambivalence over desirability expression. The scale validity is examined by the internal consistency method and Cronbach’s Alpha, and its value for whole scale and subscales of positive ambivalence over emotional expression and ambivalence over desirability expression are reported 87%, 83%, and 77%, respectively by Rafieinia (2006, quoted by Hassani & Shahgholian, 2014) and it indicates that this scale has a high and significant internal consistency [11]. King and Emmons (1990) found Cronbach’s Alpha coefficient of the above scale and subscales as 0.89, 0.87, and 0.77, respectively. The range of responses to each item is 5 degrees and from Never to Ever Variable and its scoring method is based on the Likert method.

Procedure

For this purpose, the referrals to consulting centers were clinically interviewed and they were chosen for this study after diagnosis of depression and OCD disorders by a psychiatrist, and the questionnaires were completed individually and randomly by them. Also, normal subjects completed the questionnaires after approving their mental and physical health and reviewing their medical records. A written commitment was made by the participants in relation to their voluntary participation in the test and they were allowed to leave the test whenever they want.

Statistical analysis

Multivariate analysis of variance (MANOVA) and descriptive statistics have been used for statistical analysis of data.

Results and Discussion

Table 1 shows the mean and the standard deviation of emotional expression styles in three groups of depressed patients, OCD patients, and normal subjects.

To compare these three groups in terms of emotional expression styles, MANOVA was performed. The results are shown in Table 2. The results of the analysis of variance (ANOVA) show that the differences among these three groups are significant.

A comparison of the scores of these three groups shows that normal subjects get more scores in emotional expression, and OCD patients get more scores in ambivalence over emotional expression. In four subscales of emotional control, some other OCD patients and also depressed patients get higher scores. The Games- Howell post-hoc test and LSD was used to compare the groups to each other. Table 3 shows the results of the post-hoc test.