Unexpressed marital complaints can lead to cardiovascular health risks
People who feel a significant amount of negative emotions (such as marital dissatisfactions) but who struggle to express such feelings are considered to have a type D personality. Health psychologists found that a type D personality can have four times the risk of cardiovascular disease than a non-type D personality with similar basic risk factors. Many people who have a type D personality have limited social spheres outside of their marriages and home lives. As such, marital complaints and dissatisfactions often constitute a significant proportion of the negative emotions they experience. In other words, the limited ability Type D’s have to express their abundance of marital complaints could be literally killing them.
The Type D Personality
In the 1990’s Dr. Johan Denollet of the Netherlands found that people who experienced a lot of hostility and anger but who also had trouble expressing these negative feelings were extremely vulnerable to hypertension and chronic distress and even had far higher mortality rates than other high-risk cardiac patients. He referred to these patients as having a type D personality (the D was for ‘distressed’), to distinguish them from Type A personalities, who also experienced hostility and anger but did not have trouble expressing it.
My background in complaining psychology made me wonder if teaching those with a type D personality to voice marital complaints constructively and in ways that minimized conflict and arguments could help them become more emotionally expressive over time and by doing so, lower their levels of stress and hypertension.
Over the past couple of years, I’ve had several patients with a type D personality who had also been diagnosed with mild cardiovascular disease. I informed them of the research on people with a type D personality and suggested they take on the challenge of trying to express their marital complaints both gently and productively (each of them had many such dissatisfactions of which in typical fashion, they expressed few to none). Of course, while it sounded like a good idea to them, they also had a significant amount of trepidation about their partners’ reactions (interestingly, they expressed no trepidation about getting a heart attack). Together, we came up with a plan that addressed their trepidations and also maximized their likelihood of success.
Steps for Learning How to Express Marital Complaints Productively
We decided that their rate of progress would be continually adjusted such that they would be required to stretch their comfort zones but not step outside them entirely. Attaining early successes was considered crucial for confidence and motivational purposes.
1. Inform spouse. In each case, their spouse knew they were coming to psychotherapy and also of their cardiovascular disease. I coached my patients on how to inform their spouse or partner about the research on people with type D personality and how to let their spouse know they would be working on becoming more emotionally expressive.
2. Rank marital complaints. I had my patients make a list of their marital complaints and rank them according to the amount of emotional distress they caused both them and (separately) their spouse.
3. Start with low ranking complaints: Because Type D’s have poor emotional regulation skills, it is important to start with complaints that are least distressing both to them and their spouse.
4. Practice voicing complaints using the Complaint Sandwich. Sandwich each complaint between two positive statements.
So far, each of my patients has been able to improve their ability to express marital complaints and doing so has made them more emotionally expressive in other ways as well. However, my efforts at using complaining therapy in this way by no means constitute a scientific study. Because of the anecdotal nature of this work (i.e., I have to rely on what my patients report and cannot measure their emotional expressiveness objectively), it is impossible to generalize these findings to reach broader conclusions. I should also note that each of my patients discussed our plan with their cardiologist and got their approval before proceeding.
Guy Winch, Ph.D., is a licensed psychologist, keynote speaker, and author whose books have already been translated into thirteen languages. His most recent book is Emotional First Aid: Practical Strategies for Treating Failure, Rejection, Guilt and Other Everyday Psychological Injuries (Hudson Street Press, 2013). The Squeaky Wheel: Complaining the Right Way to Get Results, Improve Your Relationships and Enhance Self-Esteem (Walker & Company) was published in January 2011.
Dr. Winch received his doctorate in clinical psychology from New York University in 1991 and completed a postdoctoral fellowship in family and couples therapy at NYU Medical Center. He has been working with individuals, couples and families in his private practice in Manhattan, since 1992. He is a member of the American Psychological Association.
In addition to the Blog on this site, Dr. Winch also writes the popular Squeaky Wheel Blog on Psychology Today.com, and blogs for Huffington Post.