Emotional Flexibility May Affect PTSD, Depression Severity


ATLANTA, Georgia – Posttraumatic stress disorder (PTSD) is unique among stress-related psychiatric illness in that exposure to a traumatic event is a required component of the diagnosis. Symptoms of PTSD include negative alterations in cognition and mood, hyperarousal, avoidance behavior, and re-experiencing of trauma. Furthermore, a significant minority of individuals who are exposed to trauma may also develop comorbid mental health issues such as major depressive disorder (MDD).1 Although most people experience a traumatic event in their lifetime, not everyone develops PTSD or MDD, which raises the question as to why some individuals are more susceptible to the effects of traumatic stress than others.2

“A growing body of evidence indicates that the ability to flexibly express and suppress emotions, also known as expressive flexibility,3 supports successful adaptation to trauma and loss”, Rebecca Rodin, MSc, of McMaster University located in Hamilton, Ontario, Canada, noted in a poster presented at the 2016 Annual Meeting of the American Psychiatric Association (APA), in Atlanta, Georgia.

In a collaborative research effort, with a team of investigators from the New York University Langone Medical Center, Ms Rodin assessed whether individuals diagnosed with PTSD or depression, and who were previously exposed to combat trauma, exhibit alterations in expressive flexibility. To the best of their knowledge, the protective effect of emotional flexibility was yet to be examined in this group.

The researchers recruited 59 veterans with and without PTSD and assessed the symptom severity of both PTSD and depression by using the Posttraumatic Stress Diagnostic Scale (PDS) and the Beck Depression Inventory-II (BDI-II), respectively. Individuals diagnosed with PTSD scored significantly higher on both tests compared with participants without the diagnosis (P<.001 for both). They next used the Expressive Flexibility Task, developed by Bonanno and colleagues in 2004,4 to assess both expressive enhancement ability and expressive suppression ability. The researchers determined that lower levels of emotional enhancement, but not emotional suppression, were associated with both PTSD and depression. The findings indicate that both combat exposure and lower levels of emotional enhancement ability significantly predict increased symptom severity of PTSD and depression.

This study did have certain limitations. The authors acknowledge limited generalizability to populations other than their sample due to the lack of a non-trauma exposed group and a majority male participant sample.

Nevertheless, “these findings shed light on previously unrecognized affective mechanisms underlying the pathogenesis of PTSD and MDD and may help to inform future intervention,” the authors concluded.


  1. Flory JD, Yehuda. Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues Clin Neurosci. 2015;17:141-150.
  2. Bowes L, Jaffee SR. Biology, genes, and resilience: toward a multidisciplinary approach. Trauma Violence Abuse. 2013;14:195-208.
  3. Westphal M, Seivert NH, Bonanno GA. Expressive flexibility. Emotion. 2010;10:92-100.
  4. Bonanno GA, Papa A, Lalande K, Westphal M, Coifman K. The importance of being flexible: the ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychol Sci. 2004;15:482-487.

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