People who feel a significant amount of negative emotions (such as marital dissatisfactions) but who struggle to express such feelings are considered Type D personalities. Health psychologists found that Type D personalities can have four times the risk of cardiovascular disease than non-Type D personalities with similar basic risk factors. Many Type D personalities 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.
Type D Personalities
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 called these patients Type D personalities (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 Type D personalities 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 Type D personalities who had also been diagnosed with mild cardiovascular disease. I informed them of the research on Type D personalities 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 Type D personalities 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. A brief tutorial on how to use the Complaint Sandwich can be found here).
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.
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Copyright 2011 Guy Winch
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Additional Reading: I discuss my work with one of these Type D patients in significant detail in Chapter 3 of The Squeaky Wheel-Saving Steve from a Broken Heart.