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. Author manuscript; available in PMC: 2021 Mar 1.
Published in final edited form as: Cogn Emot. 2019 May 23;34(2):273–287. doi: 10.1080/02699931.2019.1621803

Is More Emotional Clarity Always Better? An Examination of Curvilinear and Moderated Associations Between Emotional Clarity and Internalizing Symptoms

Juhyun Park 1, Kristin Naragon-Gainey 1
PMCID: PMC6874711  NIHMSID: NIHMS1047400  PMID: 31122138

Abstract

Low emotional clarity has been a target for psychological interventions due to its association with increased internalizing symptoms. However, theory suggests that very high emotional clarity may also lead to increased symptoms, particularly in combination with high levels of neuroticism. As an initial empirical test of this hypothesis, the present study examined curvilinear associations of emotional clarity with internalizing symptoms (i.e., dysphoria, social anxiety, panic, traumatic intrusions) and a moderating role of neuroticism/negative affect in the association across two student samples and two clinical samples (total N = 920). Evidence of curvilinear associations and moderation varied across samples, with some supporting evidence in three samples. Specifically, neuroticism/negative affect moderated the curvilinear association of emotional clarity with traumatic intrusions in Clinical Sample 2 as well as the linear association between emotional clarity and dysphoria in Student Sample 2 and Clinical Sample 1. Simple slope analyses indicated that high emotional clarity was not consistently associated with lower symptoms. Also, the hypothesized quadratic effects of emotional clarity were found in Student Sample 2 and Clinical Sample 1 for panic, and in Clinical Sample 1 for dysphoria. Implications and limitations of these findings for conceptualizations of emotional clarity and current treatments were discussed.

Keywords: emotional clarity, internalizing symptoms, neuroticism, negative affect, curvilinear relationships

Introduction

Emotional clarity refers to “the ability to identify, distinguish, and describe specific emotions” (Gohm & Clore, 2000, p. 686), and it is considered a stable individual difference variable as well as an adaptive skill that contributes to psychological well-being and effective emotion regulation. In the emotional intelligence framework, emotions are regarded as an important source of information, and clearly identifying one’s emotions is required to adaptively utilize the information emotions provide (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995). This suggests that a lack of emotional clarity may interfere with achieving goals in a given situation, rendering individuals susceptible to psychological distress or maladjustment. Similarly, in the extended process model of emotion regulation (Gross, 2015; Sheppes, Suri, & Gross, 2015), emotional clarity is an essential skill involved in the identification stage of emotion regulation, along with other elements of emotional awareness such as attention to emotion and emotion differentiation (Sheppes et al., 2015). This model posits that individuals need to identify specific emotions they experience in order to accurately determine whether emotion regulation is required and how best to attempt regulation. Therefore, a lack of emotional clarity is expected to interfere with initiating adaptive emotion regulation, which, in turn, may contribute to the development and maintenance of psychological symptoms (Park & Naragon-Gainey, 2019; Sheppes et al., 2015; Vine & Aldao, 2014).

Indeed, deficits in emotional clarity have been identified in a variety of internalizing symptoms among non-clinical and clinical samples. For example, lack of emotional clarity was linearly associated with depressive symptoms among college students (e.g., Salovey, Stroud, Woolery, & Epel, 2002; Di Schiena, Luminet, & Philippot, 2011; Vine & Aldao, 2014) and individuals with a wide range of psychological disorders (e.g., Bamonti et al., 2010; Grabe, Spitzer, & Freyberger, 2004). Emotional clarity was also linked to anxiety and related disorders (such as posttraumatic stress disorder; PTSD). In non-clinical and clinical samples, lack of emotional clarity was linearly associated with social anxiety (e.g., O’Toole, Jensen, Fentz, Zachariae, & Hougaard, 2014; Rusch, Westermann, & Lincoln, 2012; Salovey et al., 2002; Thompson, Boden, & Gotlib, 2017), panic attacks (e.g., De Berardis et al., 2017; Tull & Roemer, 2007), and posttraumatic stress symptoms among trauma-exposed individuals (Doolan, Bryant, Liddell, & Nickerson, 2017; Ehring & Quack, 2010; Short, Norr, Mathes, Oglesby, & Schmidt, 2016; Tull, Barrett, McMillan, & Roemer, 2007).1

Notwithstanding the well-documented finding that emotional clarity is linearly and inversely associated with a variety of internalizing problems, some researchers have recently speculated that very high emotional clarity could also be problematic. Gross and Jazaieri (2014) suggested nonlinear associations between constructs related to emotional experiences (e.g., emotional awareness, intensity, duration and frequency of emotions) and psychopathology. That is, although clearly identifying emotions generally contributes to effective emotion regulation and reduced symptoms, too much clarity may also be detrimental or non-beneficial in some cases (Gross & Jazaieri, 2014; Sheppes et al., 2015). For example, individuals with panic disorder often have heightened awareness of bodily sensations associated with anxiety, taking subtle changes in their body as a signal that something is seriously wrong, which leads to greater panic symptoms (Gross & Jazaieri, 2014). While this catastrophic misinterpretation of panic symptoms is inaccurate and counterproductive (Clark, 1986; Clark et al., 1997), it typically leads individuals with panic disorder to be hyperaware of even mild sensations of anxiety or fear. This hyperawareness of emotional experiences likely involves both heightened emotional clarity and attention to emotion, given that emotional awareness can be broken down into these related skills (e.g., Coffey, Berenbaum, & Kerns, 2003; Gohm & Clore, 2002). Indeed, researchers have identified an emotional style characterized by heightened emotional clarity, increased attention to emotion, and high emotional intensity (i.e., ‘hot’ emotional style, Berenbaum, Bredemeier, Thompson, & Boden, 2012; Gohm, 2003) and suggested that this particular combination is associated with anxiety symptoms such as worry (Berenbaum et al., 2012).

More generally, Baker and Berenbaum (2007, 2008) found that individuals who already identified their emotions clearly did not benefit from further clarification and understanding of their emotions, suggesting that more emotional clarity is not always beneficial. Instead, individuals who already exhibited relatively high emotional clarity benefited more from a problem-solving approach (i.e., writing about options to handle a stressful situation), rather than writing about their emotions in detail. In line with Gross and Jazaieri (2014), Baker and Berenbaum (2007, 2008) posited that overidentification of one’s own emotions could lead to a range of problematic psychological outcomes, such as increased negative affect, decreased positive affect, or heightened levels of depression. Thus, despite the widely noted adaptive role of emotional clarity in psychopathology, theory indicates that not only low, but also very high, emotional clarity may be linked to greater internalizing symptoms, suggesting a curvilinear association.

In order to further refine current understanding of the role of emotional clarity in psychopathology, it will also be important to consider variables that could moderate the association between emotional clarity and symptoms. Indeed, there have been a few attempts to identify individual difference moderators of the well-documented adaptive role of emotional clarity (e.g., Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012; Vine & Marroquín, 2018; Vine, Aldao, & Nolen-Hoeksema, 2014). One plausible moderator that has not been sufficiently explored is neuroticism and the closely-related trait negative affectivity, which are both characterized by a tendency to experience negative emotions. Neuroticism/negative affect is a broad personality dimension strongly associated with more severe internalizing symptoms (e.g., Griffith et al., 2009; Kotov, Gamez, Schmidt, & Watson, 2010), and it is also modestly to moderately associated with low emotional clarity (e.g., Coffey et al., 2003; Thompson et al., 2015). Initial evidence suggests that dispositional negative affect intensity interacts with emotional clarity when predicting depression, such that low emotional clarity is more predictive of depression for individuals with more intense negative affect. In other words, emotional clarity may matter more for individuals who frequently experience negative emotions (Vine & Marroquín, 2018). On the other hand, individuals with high neuroticism or negative affect often experience overly persistent or context-inappropriate negative emotions (e.g., Aldinger et al., 2014; Kendler, Kuhn, & Prescott, 2004), such that the utility of information derived from these clearly identified emotions may be minimal for them. Thus, there is also reason to expect that emotional clarity may be less beneficial for some individuals with high neuroticism, who may be better served by distraction from their persistent negative emotional states or behavioral activation, instead of increased emotional clarity and identification.

One way to resolve these conflicting possibilities as to how emotional clarity functions for high-neuroticism individuals is to consider the previously described curvilinear association of emotional clarity with symptoms, which may itself interact with neuroticism. That is, both high and low levels of clarity may be predictive of poorer outcomes especially for individuals with high neuroticism, whereas a more linear (inverse) association may hold for those with lower levels of neuroticism. For example, though many neurotic individuals attempt to eliminate unwanted emotional experiences by suppressing them entirely (likely linked to low emotional clarity) (e.g., Naragon-Gainey & Watson, 2018; Yoon, Maltby, & Joormann, 2013), others may attempt to eliminate them by being hypervigilant in identifying such experiences (high emotional clarity). For the latter group, very high emotional clarity focused upon frequent negative emotions could lead to increased distress, negative evaluations of one’s feelings, or ruminating on them to gain better insight into the cause of one’s negative emotions (e.g., Lyubomirsky & Nolen-Hoeksema, 1993). Supporting this contention, Vine and Marroquín (2018) found that when dispositional negative affect intensity was extremely high, treatment-seeking individuals with high emotional clarity did not differ from individuals with low emotional clarity in terms of their use of maladaptive emotion regulation strategies such as experiential avoidance and non-acceptance. These results are consistent with the idea that both low and high emotional clarity may be associated with negative outcomes (here, avoidant emotion regulation) in the context of extremely high affect intensity. In contrast, increased clarity may be more uniformly beneficial for those who do not have very frequent and strong experiences of negative emotions.

An improved understanding of how emotional clarity relates to symptoms is important in part because it has direct clinical implications. Some interventions, such as Emotion Regulation Therapy (Renna, Quintero, Fresco, & Mennin, 2017) and the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (Ellard, Fairholme, Boisseau, Farchione, & Barlow, 2010), focus specifically on increasing emotional clarity, making it crucial to examine whether increased emotional clarity in fact uniformly reduces symptoms, and whether the association between emotional clarity and symptoms is dependent on other important clinical variables such as neuroticism/negative affect. Researchers showed that individuals who were already clear about their feelings did not benefit from further identifying and describing their feelings and had poorer outcomes, indicating that therapeutic effects of increased emotional clarity may not be beneficial for everyone (Baker & Berenbaum, 2007, 2008). If very high emotional clarity is detrimental or not beneficial for those with high levels of neuroticism, interventions designed to enhance emotional clarity among individuals with emotional disorders (who are likely high on neuroticism) will need to be modified accordingly and tailored to the individual’s optimal level of emotional clarity. Thus far, only linear associations between emotional clarity and symptoms have been examined empirically, so it remains unknown whether there are also non-linear associations consistent with greater symptoms at the extremes of emotional clarity.

To address this gap in the literature, the present study examined the shape of the relationship between emotional clarity and four internalizing symptoms (i.e., dysphoria, social anxiety, panic, and traumatic intrusions). We focused on this subset of common symptoms because they are reflective of either distress (i.e., dysphoria, traumatic intrusions) or fear disorders (i.e., social anxiety, panic), which are two major subfactors of internalizing problems (see Kotov et al., 2017). Specifically, this study tested curvilinear associations of emotional clarity with these symptoms, as well as a moderating role of neuroticism/negative affect in the associations. While these analyses were relatively exploratory due to the lack of previous studies, it was hypothesized that there would be a quadratic or “U-shaped” association between emotional clarity and symptoms (controlling for the linear association of emotional clarity with symptoms), such that low and very high clarity would be linked with increased symptoms. We tentatively hypothesized that the curvilinear relationship of emotional clarity might be more evident for panic, in comparison to other internalizing symptoms, based on prior theory (Gross & Jazaieri, 2014). It was also hypothesized that neuroticism would moderate the curvilinear relationship between emotional clarity and symptoms, with the curvilinear shape being most evident at high levels of neuroticism. Aligned with a focus on replicability, we were interested in examining the robustness and generalizability of these relationships. To this end, we included multiple samples that vary with regard to clinical status (two undergraduate student samples and two clinical samples) and employ different commonly-used emotional clarity measures (i.e., DERS, TMMS, or TAS-20).

Method

Participants

Secondary data analyses of four independent datasets are included in this study. Results from Student Samples 1 and 2 and Clinical Sample 2 have not been published previously. Portions of data from Clinical Sample 1 were reported in Naragon-Gainey and DeMarree (2017), McMahon and Naragon-Gainey (2019), Naragon-Gainey (2019), and Park and Naragon-Gainey (2019), though analyses in these articles focused on intensive longitudinal data that were not examined in the present study. Student Sample 1 consisted of 335 college students at a large Midwestern university and Student Sample 2 consisted of 266 students at a large university in upstate New York (NY). Clinical Samples 1 (N = 163) and 2 (N = 156) were composed of adults who were currently seeking mental health treatment in the greater Buffalo, NY area. Table 1 shows demographic and clinical characteristics of each sample.

Table 1.

Descriptive Information of the Sample Characteristics

Student
Sample 1
(n = 335)		 Student
Sample 2
(n = 266)		 Clinical
Sample 1
(n = 163)		 Clinical
Sample 2
(n = 156)
Age
 Mean (SD) 92.5% between 18 and 21a 19.12 (2.01) 30.75 (12.45) 34.38 (14.25)
 Range 18 – 44 18 – 79 18 – 65
Gender (Female, %) 68.4 41.4 69.9 67.9
Race/ethnicity (%)
 White 90.7 51.1 69.9 69.9
 Asian or Pacific Islander 3.6 33.1 10.4 9.0
 Hispanic 2.4 8.3 8.0 0.0
 African American 2.1 7.5 16.0 11.5
 Other 1.2 5.3 4.3 9.6
Education (%)
 Some high school/high school diploma 0.0 0.0 11.0 5.1
 Some college/university degree 100.0 100.0 60.1 60.3
 Some graduate school/graduate degree 0.0 0.0 26.4 34.6
Employment (%)
 Employed full-time 16.0 14.7
 Employed part-time 25.8 36.5
 Full-time student 38.7 41.0
 Part-time student 3.7 5.8
 Unemployed 31.3 30.1
 Retired/no need for a job 6.7 0.0
Therapy (%)
 Past 7.0
 Current 3.8 65.6 71.8
Psychiatric medication (%) 3.0 56.4 59.6
DSM-5 Diagnosis (%)b
 Generalized anxiety disorder 46.6 33.3
 Social anxiety disorder 39.3 37.8
 Persistent depressive disorder 27.0 10.9
 Major depressive disorder 19.0 11.5
 Panic disorder 18.4 5.1
 Bipolar disorders 13.5 1.3
 Posttraumatic stress disorder 12.3 5.1
 Obsessive compulsive disorder 8.6 6.4
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Note. Multiple categories were possible for the following variables: education, employment, and DSM-5 diagnosis. Variables not assessed in a given sample were left blank.

a

Age in Student Sample 1 was assessed with categories.

b

Participants were evaluated by trained graduate-level interviewers for current disorders using the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5; Brown & Barlow, 2014).

Procedure

Student participants completed the study in small groups (2 to 8 people) and received course credit for compensation. Student Sample 1 completed self-report questionnaires only; Student Sample 2 also completed an eye-tracking task and an assessment of resting heart-rate variability that are not analyzed in the present study. Clinical participants completed the study in the lab individually and received $40 to $50 for their participation. During the lab study, they completed self-report questionnaires, as well as a clinical interview and cognitive tasks that are not analyzed in the present study. The clinical participants were also invited to complete an intensive longitudinal study, which is not analyzed in the present study.

Measures

Emotional Clarity.

Three different measures of emotional clarity were used across samples (though only one was included in each sample). The TMMS (Salovey et al., 1995) was used to measure emotional clarity in Student Sample 1. This scale has a subscale for emotional clarity and two other subscales for attention to emotions and mood repair. The Emotional Clarity subscale has 11 items that measure how clearly individuals identify their emotions on a 5-point scale (1 = Strongly disagree; 2 = Disagree a little; 3 = Neither agree nor disagree; 4 = Agree a little; 5 = Strongly agree). Higher scores indicate greater emotional clarity. Due to an administration error, the present study only included 10 out of the 11 items (“I am often aware of my feelings on a matter” was excluded). The TMMS has demonstrated good internal consistency and test–retest reliability (e.g., Salovey et al., 1995), and Cronbach’s alpha for 10 items of the Emotional Clarity subscale in Student Sample 1 was .82.

The DERS (Gratz & Roemer, 2004) was used to measure emotional clarity in Student Sample 2 and Clinical Sample 2. The DERS is a 36-item self-report questionnaire that measure six emotion dysregulation traits including lack of emotional clarity, non-acceptance of emotion responses, difficulties engaging in goal-directed behavior, impulse control difficulties, lack of emotional awareness, and limited access to emotion regulation strategies. This study used the Lack of Emotional Clarity subscale, which assesses difficulty identifying emotions with 5 items on a 5-point scale (1 = Almost never, 5 = Almost always). However, we coded responses such that higher scores indicate greater emotional clarity, to be consistent with the TMMS. The DERS has demonstrated good internal consistency and test-retest reliability (e.g., Gratz & Roemer, 2004), and Cronbach’s alpha for the Lack of Emotional Clarity subscale was .74 in Student Sample 2 and .83 in Clinical Sample 2.

The TAS-20 (Bagby et al., 1994) was used to assess emotional clarity in Clinical Sample 1, and we analyzed the 7 items of the Difficulty Identifying Feelings (DIF) subscale. The DIF subscale has been shown to reflect a latent construct of emotional clarity, along with the TMMS Emotional Clarity subscale (Palmieri, Boden, & Berenbaum, 2009), and thus past studies have used this subscale to measure emotional clarity (e.g., Erbas et al., 2018). Responses are given on a 5-point scale (1 = Strongly disagree, 5 = Strongly agree). As with the DERS, responses were reverse-scored so that higher scores indicate greater emotional clarity. The TAS-20 has demonstrated good internal consistency and test–retest reliability (e.g., Bagby et al., 1994), and Cronbach’s alpha for the DIF subscale in Clinical Sample 1 was .87.

Internalizing Symptoms.

Items from the Inventory of Depression and Anxiety Symptoms (IDAS; Watson et al., 2007) were used to assess the severity of four internalizing symptoms (i.e., dysphoria, social anxiety, panic, and traumatic intrusions) in all four samples. Responses are given on a 5-point scale (1 = Not at all; 2 = A little bit; 3 = Moderately; 4 = Quite a bit; 5 = Extremely). Specifically, this study included 10 items for Dysphoria, 5 items for Social Anxiety, 8 items for Panic, and 4 items for Traumatic Intrusions. Scores on the symptom scales have strong internal consistency (Cronbach’s αs = .80 to .90; Watson et al., 2007) and good test-retest reliability (e.g., Watson et al., 2007). Cronbach’s alphas for the scales across the four samples in this study ranged from .76 to .90.

Neuroticism/Negative Affect.

The 8-item Neuroticism scale from the Big Five Inventory (BFI; John, Naumann, & Soto, 2008) was used to measure neuroticism on a 5-point scale (1 = Strongly disagree; 2 = Disagree a little; 3 = Neither agree nor disagree; 4 = Agree a little; 5 = Strongly agree). The BFI has shown good internal consistency and test-retest reliability (e.g., John et al., 2008), and Cronbach’s alphas for the Neuroticism scale across the three samples in this study ranged from 80 to .86. Negative affect was measured with the 10-item Negative Affect scale of The Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) in Student Sample 2. The PANAS is a self-report questionnaire that assesses both positive affect and negative affect with 20 affect terms on a 5-point scale. Here, we used the trait version of the PANAS. Scores on the PANAS showed strong internal consistency and adequate test-retest reliability (Watson & Clark, 1999), and Cronbach’s alpha for the Negative Affect scale in this study was .86 in Student Sample 2.

Data Analysis

The hypothesized curvilinear relationships of emotional clarity with symptoms, as well as the moderating role of neuroticism/negative affect, were examined using regression analyses in MPlus version 8.0 (Muthén & Muthén, 1998–2017). We used a set of nested models proposed by Cohen and colleagues (Cohen, Cohen, West, & Aiken, 2013) for examining moderated curvilinear effects. In the first model, emotional clarity, the quadratic term of emotional clarity, and neuroticism/negative affect were entered as predictors. In the second model, a) a two-way interaction term between emotional clarity and neuroticism/negative affect, and b) the interaction term between the quadratic term of emotional clarity and neuroticism/negative affect were added to the first model as predictors. We only report and interpret the more comprehensive second model in the Results section, but both models were estimated so that the impact of neuroticism/negative affect as a moderator could be isolated and quantified via change in model R2. All predictor variables were mean-centered before products were constructed and entered into the model. We used robust maximum likelihood estimators to account for missing data without biasing parameter estimates. Significant interactions were plotted using procedures suggested by Dawson (2014) and they were also probed using simple slopes of emotional clarity when applicable, predicting outcome variables at one, two, and/or three standard deviations (SDs) above and below the mean of each moderator.

Results

Preliminary Analyses

Means and SDs of the observed scores in each sample are presented in Table 2 (note that all emotional clarity measures were scored such that higher scores indicate greater emotional clarity, and scale scores were created by summing item responses). Zero-order correlations among the variables in each sample are also presented in Table 3a and Table 3b. Across samples, greater emotional clarity was significantly correlated with fewer internalizing symptoms (rs = −.22 to −.58, ps < .01), as well as less neuroticism/negative affectivity (rs = −.29 to −.44, ps < .001). Neuroticism/negative affect was also positively correlated with all symptoms (rs = .33 to .60, ps < .001), and most internalizing symptoms were moderately intercorrelated (using the Fisher r-to-z transformation, mean r = .58, range = .26 to .69, ps < .001).

Table 2.

Means and Standard Deviations of the Observed Scores of All Variables across Samples

Student Sample 1
(n = 335)		 Student Sample 2
(n = 265 ~ 266)		 Clinical Sample 1
(n = 161 ~ 162)		 Clinical Sample 2
(n = 153 ~ 156)
Emotional Claritya 33.17 (6.84) 18.47 (3.71) 23.66 (6.58) 17.82 (4.35)
Neuroticism 22.71 (5.86) 29.37 (6.95) 28.20 (5.50)
Negative Affect 18.28 (6.06)
Dysphoria 21.10 (6.87) 19.91 (6.94) 24.60 (8.31) 26.56 (8.35)
Social Anxiety 9.48 (4.02) 9.90 (3.98) 12.54 (5.58) 11.64 (5.05)
Panic 12.01 (4.31) 12.35 (4.31) 14.20 (5.84) 13.71 (28.39)
Traumatic Intrusions 7.01 (3.19) 7.11 (3.23) 8.77 (4.38) 8.90 (18.56)
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Note. Variables not assessed in a given sample were left blank. Standard deviations are presented in parentheses.

a

Emotional clarity was measured with TMMS Emotional Clarity subscale (Student Sample 1), DERS Lack of Emotional Clarity subscale (Student Sample 2 and Clinical Sample 2), and TAS-20 Difficulty Identifying Feelings subscale (Clinical Sample 1). Emotional clarity measures were scored such that higher scores indicate greater emotional clarity.

Table 3a.

Zero-order Correlations Among Variables in Student Samples 1 and 2

1. 2. 3. 4. 5. 6.
1. Emotional Clarity – −.30 −.46 −.36 −.35 −.43
2. Neuroticism/NAa −.44 – .55 .42 .44 .41
3. Dysphoria −.37 .60 – .69 .62 .63
4. Social Anxiety −.36 .40 .65 – .50 .53
5. Panic −.22 .33 .57 .46 – .55
6. Traumatic Intrusions −.33 .44 .65 .49 .59 –
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Note. Student Sample 1 (N = 335) is shown below the diagonal, and Student Sample 2 (N = 266) is shown above the diagonal. Emotional clarity measures were scored such that higher scores indicate greater emotional clarity. All correlations are significant at p < .001. Correlations greater than |.50| are shown in bold.

a

In Student Sample 2, negative affect (NA) was included instead of neuroticism.

Table 3b.

Zero-order Correlations Among Variables in Clinical Sample 1 and 2

1. 2. 3. 4. 5. 6.
1. Emotional Clarity – −.29 −.41 −.37 −.28 −.23
2. Neuroticism −.44 – .59 .39 .36 .32
3. Dysphoria −.58 .60 – .53 .63 .59
4. Social Anxiety −.46 .47 .68 – .56 .26
5. Panic −.55 .40 .68 .55 – .59
6. Traumatic Intrusions −.48 .41 .65 .52 .62 –
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Note. Clinical Sample 1 (N = 163) is shown below the diagonal, and Clinical Sample 2 (N = 156) is shown above the diagonal. Emotional clarity measures were scored such that higher scores indicate greater emotional clarity. All correlations are significant at p < .001, except for the correlation between emotional clarity and traumatic intrusions in Clinical Sample 2 (p < .01) and the correlation between social anxiety and traumatic intrusions in Clinical Sample 2 (p < .01). Correlations greater than |.50| are shown in bold.

Moderating Role of Neuroticism/Negative Affect in the Associations of Emotional Clarity with Internalizing Symptoms

Results from the final regression model that included interaction terms of emotional clarity with neuroticism/negative affect are presented in Table 4, along with 95% confidence intervals (CIs) and model R2s (see Online Supplementary Table A for results from the first set of models that excludes interaction terms). The hypothesized interaction between the quadratic effect of emotional clarity and neuroticism was significant only for traumatic intrusions in Clinical Sample 2, controlling for the linear and curvilinear effects of emotional clarity, the linear effect of neuroticism, and the linear interaction between emotional clarity and neuroticism (∆R2 relative to the first model without the interaction terms = .03; see Table 4). This interaction was not observed for any other symptoms or in any of the other samples. As seen in Figure 1, the curvilinear relationship between emotional clarity and traumatic intrusions depends on the level of neuroticism in Clinical Sample 2. For individuals with high neuroticism, the association was primarily inverse and linear at high levels of emotional clarity while the relationship levelled off at low levels of emotional clarity. In contrast, for individuals with low neuroticism, the inverse relationship levelled off at high levels of emotional clarity. These findings provide initial support that neuroticism may moderate the curvilinear associations of emotional clarity with symptoms like traumatic intrusions, but the observed nature of this moderated curvilinear association was not consistent with our hypothesis that the “U-shaped” curve would be more evident for those with high neuroticism.

Table 4.

Regression Analyses Predicting Symptoms from the Curvilinear Effect of Emotional Clarity and Its Interaction with Neuroticism/NA

Student Sample 1 (n = 335) Student Sample 2 (n = 265) Clinical Sample 1 (ns = 159 ~ 160) Clinical Sample 2 (n = 153)
Outcome: Dysphoria
 Clarity −.13* [−.25, −.01] −.29*** [−.41, −.18] −.41*** [−.54, −.28] −.27*** [−.41, −.13]
 Clarity2 .10 [−.02, .22] .01 [−.08, .10] .20** [.07, .33] .01 [−.11, .14]
 Neuroticism/NA .52*** [.42, .63] .44*** [.31, .56] .37*** [.23, .52] .54*** [.39, .69]
 Clarity × Neuroticism/NA −.01 [−.12, .11] .12* [.00, .24] .14* [.03, .26] −.001 [−.12, .12]
 Clarity2 × Neuroticism/NA .02 [−.11, .15] .07 [−.04, .19] −.03 [−.18, .12] −.04 [−.19, .10]
 Model R2 (SE) .38 (.04)*** .40 (.05)*** .50 (.06)*** .41 (.06)***
Outcome: Social Anxiety
 Clarity −.23** [−0.41, −.06] −.27*** [−.38, −.15] −.30** [−.48, −.11] −.30*** [−.46, −.14]
 Clarity2 .12 [−.05, .29] −.07 [−.16, .03] .08 [−.10, .26] −.11 [−.29, .08]
 Neuroticism/NA .33*** [.20, .45] .34*** [.18, .51] .29** [.11, .48] .29** [.10, .48]
 Clarity × Neuroticism/NA .03 [−.16, .21] .06 [−.05, .18] .06 [−.13, .24] −.04 [−.20, −.13]
 Clarity2 × Neuroticism/NA −.04 [−.25, .17] −.004 [−.14, .14] .03 [−.18, .24] .04 [−.18, .26]
 Model R2 (SE) .21 (.04)*** .24 (.04)*** .30 (.06)*** .23 (.06)***
Outcome: Panic
 Clarity −.11 [−.24, .03] −.30*** [−.43, −.16] −.44*** [−.59, −.28] −.21* [−.36, −.05]
 Clarity2 .05 [−.08, .18] −.12* [−.22, −.02] .29*** [.14, .44] −.02 [−.18, .14]
 Neuroticism/NA .29*** [.16, .42] .36*** [.21, .51] .17* [.02, .32] .33** [.12, .53]
 Clarity × Neuroticism/NA −.03 [−.15, .09] −.10 [−.24, .04] .11 [−.08, .30] −.01 [−.17, .15]
 Clarity2 × Neuroticism/NA −.02 [−.17, .13] −.06 [−.19, .06] −.02 [−.22, .18] −.04 [−.23, .15]
 Model R2 (SE) .12 (.03)*** .25 (.05)*** .39 (.07)*** .16 (.05)***
Outcome: Traumatic Intrusions
 Clarity −.21** [−.33, −.08] −.31*** [−.45, −.17] −.38*** [−.55, −21] −.22* [−.40, −.05]
 Clarity2 −.03 [−.15, .10] .11† [−.01, .22] .09 [−.06, .24] −.05 [−.21, .11]
 Neuroticism/NA .43*** [.30, .55] .38*** [.25, .51] .24** [.09, .40] .44*** [.25, .63]
 Clarity × Neuroticism/NA −.07 [−.19, .05] .05 [−.08, .19] .03 [−.16, .22] −.08 [−.21, .06]
 Clarity2 × Neuroticism/NA −.11 [−.25, .04] −.09 [−.22, .04] −.04 [−.24, .17] −.26* [−.46, −.05]
 Model R2 (SE) .23 (.04)*** .29 (.05)*** .28 (.06)*** .16 (.06)**
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Note. Clarity = emotional clarity; NA = negative affect; Standardized estimates are presented with 95% confidence intervals in brackets.

†

p = .06.

*

p < .05.

**

p < .01.

***

p < .001.

Figure 1.

Figure 1.

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Moderated quadratic effect of emotional clarity on traumatic intrusions in Clinical Sample 2. This shows high or low emotional clarity (one SD above or below the mean respectively) predicting traumatic intrusions at one SD above (high) and below (low) the mean of neuroticism.

We also interpreted significant interactions between the linear term of emotional clarity and neuroticism/negative affect observed across two samples; note that the moderated curvilinear estimates were not significant in these models. Linear emotional clarity significantly interacted with neuroticism/negative affect in predicting dysphoria in Student Sample 2 (b for the interaction term = .12, p < .05) and Clinical Sample 1 (b for the interaction term = .14, p < .05) (Table 4), while this interaction was not significant for any other symptoms or samples. See Figure 2 for a depiction of the associations in Student Sample 2 and Clinical Sample 1. Simple slope analyses indicated similar patterns across the two samples. For individuals with low levels of neuroticism or negative affect (i.e., 1, 2, or 3 SDs below the mean), there were inverse linear associations between emotional clarity and dysphoria (bs for the linear association = −1.16 to −0.55, ps < .001). Emotional clarity was marginally (Student Sample 2: b = −0.34, p = .06) or significantly (Clinical Sample 1: b = −0.34, p < .001) associated with low dysphoria for individuals with high neuroticism (i.e., 1 SD above the mean). In contrast, there was no significant association between emotional clarity and dysphoria for those with very high neuroticism or negative affect (i.e., 2 or 3 SD above the mean).

Figure 2.

Figure 2.

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Two-way interaction between emotional clarity and neuroticism/negative affect. This shows high or low emotional clarity (one SD above or below the mean respectively) predicting dysphoria at one SD above (high) and below (low) the mean of neuroticism or negative affect.

Curvilinear Associations of Emotional Clarity with Internalizing Symptoms

Last, there were significant curvilinear associations of emotional clarity with dysphoria and panic (but not social anxiety or traumatic intrusions) in some samples; no curvilinear moderation by neuroticism/negative affect was observed in these analyses. As seen in Table 4, the quadratic effect of emotional clarity on dysphoria was significant only in Clinical Sample 1 (b = .20, p < .05), controlling for the linear effect of emotional clarity, neuroticism, and the interaction terms. Regardless of levels of neuroticism, the association between emotional clarity and dysphoria was primarily inverse and linear at low levels of emotional clarity whereas the relationship levelled off at high levels of emotional clarity (Figure 3a). Also, there were significant curvilinear associations between emotional clarity and panic in Student Sample 2 (b for the quadratic term of emotional clarity = −.12, p < .05) and Clinical Sample 1 (b for the quadratic term of emotional clarity = .29, p < .001), controlling for the linear effects of emotional clarity, neuroticism/negative affect, and the interaction terms (Table 4). While the curvilinear association of emotional clarity with panic in Clinical Sample 1 was similar to the association with dysphoria in Clinical Sample 1, the curvilinear association of emotional clarity with panic in Student Sample 2 showed a different pattern (Figure 3b). That is, across all levels of negative affect, the inverse linear association of emotional clarity with panic was more evident at high levels of emotional clarity, whereas the association was weaker at lower levels of emotional clarity. Taken together, these findings provided partial support for the hypothesized curvilinear relationship between emotional clarity and symptoms, but they did not support the tentatively hypothesized “U-shaped” association between emotional clarity and symptoms.

Figure 3.

Figure 3.

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Quadratic effects of emotional clarity on dysphoria and panic while there were no significant interactions between the quadratic effects and neuroticism/negative affect. This shows emotional clarity predicting the symptom at one SD above (high) or below (low) the mean level of emotional clarity across all levels of neuroticism/negative affect.

Discussion

Although emotional clarity has been linked to better psychological outcomes (e.g., reduced psychological symptoms, adaptive emotion regulation) in the literature, some researchers have speculated and/or demonstrated that emotional clarity may not always be beneficial (e.g., Baker & Berenbaum, 2007, 2008; Gross & Jazaieri, 2014; Vine & Marroquín, 2018). Further expanding this idea, the present study was the first to examine whether higher emotional clarity is uniformly adaptive by testing curvilinear associations of emotional clarity with internalizing symptoms, as well as a moderating role of neuroticism/negative affect in the association.

As hypothesized, the present study showed that the association between emotional clarity and internalizing symptoms could be dependent upon the level of neuroticism or negative affect, though results varied somewhat across samples and symptoms (see below for discussion of this inconsistency). First of all, neuroticism moderated the curvilinear relationship of emotional clarity with traumatic intrusions in Clinical Sample 2. Emotional clarity was inversely associated with traumatic intrusions at low levels of clarity only for those with low neuroticism, whereas it was inversely associated with traumatic intrusions at high levels of clarity only for those with high neuroticism. These findings suggest that high emotional clarity may not necessarily be beneficial in the presence of low neuroticism, and low emotional clarity may not be so detrimental in the presence of high neuroticism when it comes to traumatic intrusions. In addition, the linear association of emotional clarity with symptoms such as dysphoria was also qualified by neuroticism/negative affect in two samples. Simple slope analyses suggested that emotional clarity might be beneficial only for those with low neuroticism or negative affect, whereas it may be neither adaptive nor maladaptive for those with high neuroticism or negative affect. These findings suggest that emotional clarity might not be adaptive for individuals with high neuroticism or negative affect, perhaps because of the limited informational value during overly-persistent negative affective states. However, this is in contrast to a previous finding in a non-clinical sample where emotional clarity was most strongly inversely associated with symptoms for individuals with high negative affect intensity (Vine & Marroquín, 2018). Of note, Vine and Marroquín (2018) assessed perceived strength or power of negative emotions, whereas the current study focused on their frequency or occurrence. Further research is needed to more definitely test competing hypotheses about the impact of emotional clarity on symptoms in the presence of high neuroticism.

Based on prior theory, we had hypothesized a “U-shaped” association of emotional clarity with symptoms, but none of the observed curvilinear associations between emotional clarity and symptoms reflected this specific shape. Thus, the present findings do not suggest that high emotional clarity could be as detrimental as low emotional clarity (e.g., Baker and Berenbaum, 2007, 2008; Gross & Jazaieri, 2014). Instead, they indicate that high emotional clarity may be neutral or not associated with symptoms. This was particularly the case in Clinical Sample 1, in which emotional clarity was not significantly associated with panic and dysphoria at high levels, whereas it was inversely associated with the symptoms at low levels. This indicates that low emotional clarity can be a vulnerability factor for panic and dysphoria as suggested in previous studies (e.g., Grabe et al., 2004; Tull & Roemer, 2007), but very high emotional clarity may not be a protective factor for these symptoms. Although we examined one potential moderating variable, it is possible that the lack of an association of high emotional clarity with symptoms reflects the influence of other moderating variables with opposite effects. Regardless, before we draw any conclusions with confidence, it should be noted that Student Sample 2 showed a different pattern in the curvilinear relationship between emotional clarity and panic. In this non-clinical sample, emotional clarity seemed to play a protective role at high levels whereas low emotional clarity was not necessarily maladaptive. These inconsistent results across Student Sample 2 and Clinical Sample 1 might be in part due to a restricted range of scores in panic in the student sample.

What could account for the inconsistent findings across samples? None of the hypotheses were supported in Student Sample 1, and significant findings were observed in only one or two samples for each hypothesis. Given that we used three different measures to assess emotional clarity and the measures were only moderately intercorrelated (e.g., Coffey et al., 2003; Kökönyei et al., 2014; Palmieri et al., 2009), one possibility is that some idiosyncratic features of each measure contributed to inconsistent findings. For example, most of the items in the TMMS Emotional Clarity subscale used in Student Sample 1 are positively worded (e.g., “I am usually very clear about my feelings”, Salovey et al., 1995), whereas most items in the other two measures used in the rest of the samples – the DERS and the TAS-20 – are negatively worded (e.g., “I have no idea how I’m feeling”, Gratz & Roemer, 2007). Interestingly, the significant findings were observed only for the measures primarily with negatively worded items (i.e., the DERS and the TAS-20). This suggests that the TMMS Emotional Clarity subscale may capture a slightly different aspect of emotional clarity from the other two measures (e.g., subjective confidence about identifying one’s emotions versus perceived confusion/difficulty identifying one’s emotions). Furthermore, findings were inconsistent even between the DERS and the TAS-20. Although these two measures assess meta-cognition about one’s emotions with similarly worded items, the TAS-20 DIF subscale does include items regarding meta-knowledge about physical sensations (e.g., “I am often puzzled by sensations in my body”, Bagby et al., 1994) that are missing in DERS. Taken together, each measure of emotional clarity possibly has different coverage of the construct of emotional clarity, and this may have contributed to inconsistent findings.

It is also plausible that differential characteristics of each sample contributed to the inconsistent findings. For example, Clinical Samples 1 and 2 were similar in terms of clinical status (i.e., currently treatment seeking or receiving it) and symptom severity as measured with IDAS items. However, the disorder clinical severity ratings (CSRs; dimensional disorder ratings assigned by interviewers using the ADIS-5, see Brown & Barlow, 2014) were significantly higher in Clinical Sample 1 than in Clinical Sample 2. This suggests that participants in Clinical Sample 1 were likely more distressed or impaired by their symptoms than those in Clinical Sample 2. Although we included neuroticism in order to test any moderating role (and account for main effects) of elevated negative emotions, there may also be other clinical traits such as anxiety sensitivity that could have affected the results in the present study. Another possibility is that effects are small and thus inconsistently emerged, or that sample sizes yielded low power in these secondary data analyses. Future studies are needed to examine these possibilities and test replicability, in order to better answer when and how emotional clarity can be beneficial and detrimental.

The current findings can help to refine psychological interventions that target low emotional clarity in an attempt to reduce internalizing symptoms. Given the (moderated) curvilinear relationships of emotional clarity with symptoms such as panic, dysphoria, and traumatic intrusions, high emotional clarity may not uniformly be linked to desirable outcomes. Clinicians may need to closely monitor changes in clients’ ability to identify their emotions across each session and decide whether it is indeed helpful, taking into account each client’s level of neuroticism or negative affect. The two-way interaction between emotional clarity and neuroticism/negative affect with regard to dysphoria suggests that for clients with very high neuroticism or negative affect, it may not be effective to try to increase emotional clarity first; instead, clinicians may want to target clients’ tendency to readily get caught up in negative emotions so that later effort to increase emotional clarity can contribute to symptom reduction more effectively. For social anxiety, however, the current findings (i.e., no curvilinear or moderated associations, but linear associations across all of the samples) support the practice of helping all clients to better identify their emotions.

There are several limitations that should be noted. First, the present study is a cross-sectional study and thus we cannot make any causal inferences from the findings. To draw strong conclusions about a nonlinear causal relationship between emotional clarity and symptoms, future research should take into consideration experimental designs in which levels of emotional clarity are carefully manipulated. Second, although emotional clarity and attention to emotion are correlated facets of emotional awareness, we did not examine attention to emotion in this study. Further studies are needed to determine whether emotional clarity and attention to emotion independently contribute to the observed curvilinear effect, or if one of these constructs is more important in this regard. In addition, the present study tested only one possible moderator (i.e., neuroticism/negative affect), and it was only significant for certain symptoms. Future studies should examine other clinical traits that moderate the association of emotional clarity with a variety of internalizing symptoms (e.g., eating problems, OCD-related symptoms, excessive worry) in order to obtain more thorough understanding of the role of emotional clarity in psychopathology.

Finally, all of the variables (i.e., emotional clarity, internalizing symptoms, and neuroticism/negative affect) in this study were measured with retrospective self-report questionnaires that are subject to recall biases and response styles. Future studies should incorporate multiple measures such as clinical interviews, observation, and behavioral/physiological measures in order to better capture the constructs. In particular, there have been increasing attempts to indirectly assess emotional clarity with reaction times to emotion items in naturalistic settings in order to overcome the limitations of global self-report measures mentioned above (e.g., Arndt, Lischetzke, Crayen, & Eid, 2018; Lischetzke et al., 2011; Thompson et al., 2015). To test generality of the current findings, the hypothesized curvilinear association and the moderating role of neuroticism should be tested using these measures.

In conclusion, the results of the present study indicate that the way emotional clarity is linked to internalizing symptoms may be more complex than the linear associations documented thus far. This study is the first to test these effects that have been suggested by theory, examining several samples that used different measures of emotional clarity. These findings provide some initial evidence for a more nuanced understanding of emotional clarity’s impact on psychopathology, but also suggest that effects may be small and may differ across samples or measures. Future research is warranted to fully delineate the exact nature of the role of emotional clarity in psychopathology.

Supplementary Material

Supplemental

Acknowledgments

Funding

This research was supported in part by the National Center of Complementary & Integrative Health of the National Institutes of Health under award R21AT009470 (PIs: Naragon-Gainey and DeMarree). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Disclosure statement

No potential conflict of interest was reported by the authors.

1

While these findings are generally consistent, one caveat that complicates this literature is that different studies used different self-report measures to assess emotional clarity (i.e., Difficulties in Emotion Regulation Scale [DERS], Gratz & Roemer, 2004; Trait-Meta Mood Scale [TMMS], Salovey et al., 1995; 20-item Toronto Alexithymia Scale [TAS-20], Bagby, Parker, & Taylor et al., 1994), and some of these measures are only moderately associated (e.g., rs = |.43| to |.68|, Coffey, Berenbaum, & Kerns, 2003; Gohm & Clore, 2002; Kökönyei, Urban, Reinhardt, Józan, & Demetrovics, 2014; Palmieri, Boden, Berenbaum, 2009). A similar issue is found in more recent studies that employed experience-sampling methods to assess emotional clarity with momentary behavioural measures such as reaction times to affect ratings (e.g., Lischetzke, Angelova, & Eid, 2011; Thompson, Kuppens, et al., 2015). In these studies, dispositional emotional clarity was at best modestly associated with the behavioural measure of emotional clarity (e.g., rs = |.05| to |.29|, Lischetzke et al., 2011; Thompson et al., 2015). Taken together, these findings suggest that associations may differ somewhat depending upon which emotional clarity measure was used.

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