Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2023 Jun 1.
Published in final edited form as: Psychol Sex Orientat Gend Divers. 2021 Aug 16;9(2):214–221. doi: 10.1037/sgd0000503

Emotion Regulation in Context: Expressive Flexibility as a Stigma Coping Resource for Sexual Minority Men

Katie Wang 1, Anthony J Maiolatesi 1,2, Charles L Burton 1, Jillian R Scheer 3, John E Pachankis 1
PMCID: PMC9231373  NIHMSID: NIHMS1738316  PMID: 35757788

Abstract

Although expressive flexibility (i.e., the ability to engage in expressive enhancement and suppression in accordance with situational demands) has been increasingly recognized as an important source of resilience, its role in the context of stigma coping remains under-investigated. The present research examined the role of expressive flexibility as a potential buffer in the association between perceptions of sexual orientation-related discrimination and psychological distress among sexual minority men, a population facing significant mental health problems driven by stigma-related stress. A U.S. sample of sexual minority men (N = 377) completed self-report measures of perceived sexual orientation-related discrimination, expressive flexibility, and psychological distress. Cross-sectional analyses revealed that perceived sexual orientation-related discrimination was positively associated with psychological distress, but the relationship was attenuated for participants with high levels of expressive flexibility. Longitudinal analyses further showed that the association between discrimination and psychological distress measured one year later was significant for sexual minority men with very low levels of expressive flexibility. These findings highlight the role of expressive flexibility as an important resource for coping with sexual orientation-related discrimination and underscore the potential utility of enhancing expressive flexibility in stigma coping interventions that seek to improve sexual minority men’s mental health.

Keywords: sexual minority men, minority stress, emotion regulation, expressive flexibility, coping

Sexual minority men (i.e., gay, bisexual, and other men who have sex with men) are at least twice as likely as their heterosexual counterparts to be diagnosed with a number of stress-sensitive mental health conditions, including major depression and anxiety disorders (Bränström et al., 2018; Rodriguez-Seijas et al., 2019). Clear and consistent evidence suggests that these mental health disparities arise from exposure to sexual minority stressors across the lifespan, including experiences of discrimination and victimization, internalized homophobia, and anticipation of rejection based on one’s sexual orientation (Brooks, 1981; Meyer, 2003; Newcomb & Mustanski, 2012; Pachankis et al., 2008). A small yet growing body of literature further points to the role of maladaptive emotion regulation strategies, such as rumination and suppression, as a key pathway through which minority stressors operate to drive psychological distress among sexual minority men (Hatzenbuehler et al., 2008, 2009; Hatzenbuehler, 2009; Pachankis et al., 2015; Timmins et al., 2020). However, much less is known about how effective emotion regulation might buffer against the adverse impact of sexual minority stress on mental health. This limitation is noteworthy given that emotion regulation has been identified as a transdiagnostic mechanism underlying a wide range of psychopathology symptoms and represents a crucial treatment target in psychotherapy for mood and anxiety disorders, both in the general population (Hofmann et al., 2012) and among sexual minority men in particular (Pachankis, Hatzenbeuehler, et al., 2015). Indeed, as noted by Hill and Gunderson (2015), identifying emotion regulation processes that facilitate coping with sexual minority stress can significantly enrich our understanding of the resilience, agency, and strength observed among sexual minority populations and inform the development of effective stigma coping interventions.

Whereas the emotion regulation literature has traditionally focused on the effects of specific emotion regulation strategies on mental health (e.g., Aldao et al., 2010; Gross & John, 2003; Webb et al., 2012), recent research has increasingly recognized that the ability to flexibly switch between different emotion regulation strategies in response to contextual demands (i.e., emotion regulation flexibility) may be a better predictor of healthy psychological adjustment and resilience (Aldao et al., 2015; Bonanno & Burton, 2013). One aspect of emotion regulation flexibility that has received significant empirical attention is expressive flexibility (EF), which refers to the ability to engage in two specific emotion regulation strategies, enhancement versus suppression of emotional expressions, in accordance with situational demands. EF is assessed via either a behavioral task (in which participants are asked to enhance or suppress their facial expressions of emotion while viewing emotion-eliciting images; Bonanno et al., 2004) or questionnaire (consisting of one’s self-reported ability to enhance or suppress an emotional reaction across several hypothetical situations; Burton & Bonanno, 2016). EF has been consistently associated with positive social and clinical outcomes among diverse populations. For example, in a longitudinal investigation following a sample of New York City college students exposed to the September 11th terrorist attacks, EF predicted lower psychological distress and better adjustment over time (Bonanno et al., 2004; Westphal et al., 2010). Other studies have further linked lower EF to psychopathology symptoms, including complicated grief among bereaved adults (Gupta & Bonanno, 2011) as well as posttraumatic stress disorder and depressive symptoms among combat-exposed veterans (Rodin et al., 2017).

Although EF has not, to our knowledge, been examined in the context of coping with sexual minority stress, there is reason to believe that it might play an important buffering role for sexual minority men. One context in which EF might be of particular relevance is the experience of negotiating public self-conscious concerns by engaging in various impression management strategies (e.g., attempting to appear more masculine, monitoring speech content, avoiding certain locations or being seen with other sexual minority individuals; Pachankis et al., 2020; Yoshino, 2006). On one hand, the ability to enhance one’s emotional expression can facilitate stigma disclosure and promote supportive interpersonal relationships, which are known to facilitate effective coping with minority stress (Frable et al., 1998). On the other hand, the ability to suppress one’s emotional expression can also serve as a protective mechanism, to the extent that it enables sexual minority men to effectively conceal or downplay their sexual identity when necessary in order to avoid discrimination and victimization (Pachankis & Bränström, 2018). For example, sexual minority men who are adept at suppressing their emotions might opt to behave in less emotionally expressive ways, consistent with masculine norms, or to hide emotional distress in response to biased speech and other cues of sexual orientation-based discrimination (Pachankis et al., 2020). Beyond stigma concealment and disclosure, EF can also facilitate effective emotional responding to experiences of discrimination by enabling sexual minority men to down-regulate their negative emotions in the face of rejection and up-regulate positive emotions during identity-affirming interactions. Taken together, these considerations underscore the importance of examining EF as a potential coping resource for sexual minority men as they navigate unique social stressors, such as discrimination associated with their sexual identity.

The present research extends past work on emotion regulation flexibility, minority stress, and mental health by examining the role of EF as a moderator of the association between perceived sexual orientation-related discrimination and psychological distress among a U.S. sample of sexual minority men. We chose to focus on perceived sexual orientation-related discrimination in this study because it is conceptualized as an environmental antecedent that operates through other more proximal minority stress processes, such as expectations of rejection and internalized homonegativity, to undermine sexual minority men’s mental health (Meyer, 2003). We hypothesized that EF would moderate the association between perceived discrimination and psychological distress, such that the relationship between discrimination and distress would be attenuated among participants with higher levels of EF.

Method

Participants and Procedures

Data for the current study were taken from a larger survey that examined minority stress experiences, gender roles and gender-based stressors, and health among cisgender sexual minority men in the U.S. We included only cisgender sexual minority men in this study based on the assumption that their experiences of gender roles and gender-based stressors (e.g., masculinity, gender socialization) would be distinct from those of transgender men or nonbinary persons. Participants were recruited online via Grindr, the U.S.’s largest mobile sexual networking application for sexual minority men. To ensure adequate representation across geographic locales, we adopted three recruitment sampling strategies. First, we recruited from the four largest U.S. cities (i.e., New York, Los Angeles, Chicago, and Houston), which represented four distinct geographic regions (i.e., Northeast, West, Midwest, and South). We then recruited from 20 randomly selected metropolitan areas, defined as the 287 U.S. cities with a population of more than 250,000 excluding the ten most populous cities in the U.S. Finally, we recruited from 20 randomly selected small metropolitan and non-metropolitan counties, defined as U.S. counties with a population of 250,000 or fewer. Participants completed the baseline survey (T1) upon enrollment in the study and a follow-up survey (T2) approximately one year later. Given that EF, the key variable of interest in the current study, was only assessed as part of the follow-up survey, we opted to focus on data from T2 for our primary analyses. Each participant received a $10 gift card for completing the follow-up survey and a $10 gift card for completing the T1 survey.

A total of 427 participants completed the follow-up survey that provided data for the present study. Responses from participants who did not complete at least 50% of the survey questions (n = 40) were omitted. Of those completing at least 50% of the survey (n = 387), 10 were excluded due to missing demographic data or responses on our main variables of interest, resulting in N = 377 for the final analytic sample. Participants ranged in ages from 18 to 68 (M = 29.64, SD = 13.46; see Table 1). A majority of the participants were White, identified as gay, and reported full-time employment and having a bachelor’s degree or higher.

Table 1.

Sample Sociodemographic Characteristics (N = 377)

n (%) M (SD)
Race/ethnicity
 White 243 (64.4)
 American Indian or Alaskan Native 5 (1.3)
 Asian 29 (7.7)
 Black 37 (9.8)
 Native Hawaiian or Pacific Islander 1 (0.3)
 Multiracial 38 (10.1)
 Other 24 (6.4)
Sexual orientation
 Gay 303 (80.4)
 Bisexual 61 (16.2)
 Othera 13 (3.4)
Employment status
 Less than full-time employment 155 (41.1)
 Full-time employment 222 (58.9)
Annual income
 Less than $30,000 178 (47.2)
 $30,000 or more 199 (52.8)
Education
 Less than a bachelor’s degree 157 (41.6)
 Bachelor’s Degree or higher 220 (58.4)
Geographic Region of Current Residence
 Midwest 104 (27.6)
 Northeast 76 (20.2)
 West 82 (21.7)
 South 115 (30.5)
Age (Range: 18 – 68; Median = 28) 29.64 (13.46)
Open in a new tab

Note:

a

Other sexual orientation includes men who identified as queer (n = 12, 3.2%) or unsure (n = 1, 0.3%).

Measures

Sexual orientation-related discrimination

Perceptions of sexual orientation-related discrimination (i.e., perceived discrimination) was measured using an adapted version of the Everyday Discrimination Scale (Williams et al., 1997). Participants indicated the frequency with which they experienced nine types of interpersonal mistreatment as a result of their sexual orientation. Participants responded to the following items on a six-point scale, ranging from 1 (never) to 6 (almost every day): “You are treated with less courtesy than other people,” “You are treated with less respect than other people,” “You receive poorer service than other people at restaurants or stores,” “People act as if they think you are not smart,” “People act as if they are afraid of you,” “People act as if they think you are dishonest,” “People act as if they’re better than you are,” “You are called names or insulted,” and “You are threatened or harassed.” The nine items were summed to create an overall index of sexual orientation-related discrimination, ranging from 9 to 54, with higher scores indicating more frequent perceived discrimination based on sexual orientation. This measure has been used in several studies among sexual minority individuals and demonstrated consistent associations with psychological distress (e.g., Hatzenbuehler et al., 2009; Mays & Cochran, 2001; Pachankis, Rendina, et al., 2015). The internal consistency for the current sample was good at both time points, αT1 = 0.92, αT2 = 0.90.

Expressive flexibility (EF)

The ability to enhance and suppress emotional expressions in accordance with situational demands was measured using the Flexible Regulation of Emotional Expression Scale (i.e., the FREE Scale; Burton & Bonanno, 2016). The FREE scale consists of 16 items, which are divided into four subscales that measure one’s abilities to enhance positive emotions, enhance negative emotions, suppress positive emotions, and suppress negative emotions. Participants rated their perceived ability to engage in expressive enhancement (i.e., “be more expressive than usual of how you are feeling”) and expressive suppression (i.e., “conceal how you are feeling”) across various hypothetical scenarios (e.g., “a friend is telling you about a break-up that you secretly think is a good thing”) on a six-point scale, ranging from 1 (unable) to 6 (very able). Following guidelines from Burton and Bonanno (2016), we calculated: 1) a sum score by adding enhancement and suppression scores together; and 2) a polarity score by computing the absolute value of the difference between enhancement and suppression (i.e., subtracting the smaller ability score from the larger ability score). EF was calculated by subtracting the polarity score from the sum score, with higher scores indicating greater flexibility in the regulation of emotional expression. The FREE scale, and this scoring approach, has demonstrated good convergent and discriminant validity, is predictive of individual differences in EF measured via a well-validated behavioral task, and is well-suited for assessing the construct of EF outside of the laboratory (Burton & Bonanno, 2016). Internal consistencies for the composite enhancement ability, suppression ability, and flexibility scales were adequate, αenhancement = 0.73, αsuppression = 0.81, αflexibility = 0.82. Enhancement ability was positively correlated with suppression ability, r = .37, p < .001.

Psychological distress

Psychological distress was measured using the 18-item Brief Symptom Inventory (BSI; Derogatis & Melisaratos, 1983). Items assessed symptoms of anxiety (e.g., “nervousness or shakiness inside”), depression (e.g., “feeling blue”), and somatization (e.g., “nausea or upset stomach”) occurring in the past week. Participants indicated the extent to which they were bothered by each symptom on a five-point scale, ranging from 0 (not at all) to 4 (extremely). Because the bivariate correlations among the anxiety, depression, and somatization subscales were very high (T1: rs ≥ .84; T2 rs ≥ .85), the 18 items were summed to create an overall index of psychological distress. The BSI’s internal consistency for the current sample was excellent at both time points, αT1 = 0.94, αT2 = 0.94.

Data Analysis

A missing values analysis was conducted using Little’s (1988) Missing Completely at Random (MCAR) test. Results indicated that Little’s MCAR test was not significant, χ2 = 30.91, DF = 26, p = .23. A non-significant result suggests that there is no evidence that the missing cases are not MCAR; as such, listwise deletion was chosen over imputation for all statistical analyses (Allison, 2001).

Given the small number of participants in some of the demographic categories, the education, income, race/ethnicity, and employment variables were recoded into variables of less than a bachelor’s degree (41.6%) versus a bachelor’s degree or higher (58.4%); less than $30,000 (47.2%) versus greater than $30,000 (52.8%); White (64.5%) versus racial/ethnic minority (35.5%); and full-time employment (58.9%) versus less than full-time employment (41.1%). Following this, bivariate correlations were computed among demographics and all variables of interest (i.e., perceived discrimination, EF, and psychological distress).

To examine the main and interaction effects of perceived discrimination and EF on psychological distress at T2, cross-sectional moderation analyses were conducted using the PROCESS macro in SPSS (Hayes, 2017; Model 1). Bootstrapping was conducted with 5,000 random samples generated from the observed covariance matrix to estimate bias-corrected 95% confidence intervals and significance values. All predictor variables were mean-centered and entered into the model simultaneously; demographic variables that were significant bivariate predictors of psychological distress (i.e., education, income, employment, and age) were entered as covariates. To probe significant interaction effects, we used two techniques. First, following the recommendations of Aiken and West (1991), we conducted a spotlight analysis by plotting the conditional effects of perceived discrimination on psychological distress when EF was one standard deviation above and below the sample mean. This process allowed us to uncover whether perceived discrimination was a significant linear predictor of psychological distress at different levels of EF. Second, we used the Johnson-Neyman (JN) technique to assess the conditional effect of perceived discrimination on psychological distress more robustly (Bauer & Curran, 2005). The JN technique provides information on the exact point(s) at which the conditional effect of perceived discrimination on psychological distress transitions from statistically significant to statistically non-significant along all possible values of EF.

In total, we fit three cross-sectional moderation models to the data. First, we assessed the main and interaction effects of perceived discrimination and enhancement ability on psychological distress. Second, we assessed the main and interaction effects of perceived discrimination and suppression ability on psychological distress. Third, we assessed the main and interaction effects of perceived discrimination and EF on psychological distress.

To supplement the cross-sectional analyses, we also assessed longitudinal associations among perceived discrimination, EF, and psychological distress using data from both T1 and T2. That is, we tested the main and interactive effects of perceived discrimination at T1 and EF at T2 on psychological distress at T2, controlling for psychological distress at T1. In the current study, EF was only assessed at T2; therefore, data were not available to control for EF at T1. However, because EF has been theorized as a trait variable in prior research (Westphal et al., 2010), there is less need to control for EF at T1 given that EF levels should be relatively stable across time.

Results

Cross-sectional Results

Bivariate correlations among all study variables at T2 and demographics are presented in Table 2. As expected, perceived discrimination was positively correlated with psychological distress (r = .33, p < .001), and EF was negatively correlated with psychological distress (r = −.18, p < .001).

Table 2.

Correlations among Variables of Interest and Sociodemographic Characteristics

Variable 1 2 3 4 5 6 7 8 9 10 11
1. Perceived Discrimination (T1) -- .59** −.15* .36** .25** .21** .10 −.12* .07 .12* .07
2. Perceived Discrimination (T2) -- -- −.18** .24** .33** .25** .24** −.07 .11 .16* .20**
3. Expressive Flexibility (T2) -- -- -- −.07 −.18** −.01 .10 .06 −.01 −.01 −.03
4. Psychological Distress (T1) -- -- -- -- .59** .05 .16* −.23** .13 .26** .18**
5. Psychological Distress (T2) -- -- -- -- -- −.01 .02 −.22** .27** .21** .19**
6. Race/Ethnicity -- -- -- -- -- -- .24** −.04 .05 .10 −.03
7. Sexual Orientation -- -- -- -- -- -- -- −.18** .25** .38** .17
8. Age -- -- -- -- -- -- -- -- −.27** −.27** −.23**
9. Employment -- -- -- -- -- -- -- -- -- .72** .49**
10. Income -- -- -- -- -- -- -- -- -- -- .44**
11. Education -- -- -- -- -- -- -- -- -- -- --
Open in a new tab

Note:

*

p < .05.

**

p < .01

The first cross-sectional model, investigating the main and interactive effects of perceived discrimination and enhancement ability on psychological distress, accounted for 18% of the variance in psychological distress, F(7, 369) = 11.75, p < .001, after adjusting for age, income, education, and employment. The model revealed a significant main effect of perceived discrimination, b = 0.66, SE = 0.11, t = 6.21, p < .001, 95% CI: [0.45, 0.86], β = .30, and a marginally significant main effect of enhancement ability, b = −0.13, SE = 0.08, t = −1.71, p = .08, 95% CI: [−0.28, 0.02], β = −.08, on psychological distress. The perceived discrimination × enhancement ability interaction did not reach statistical significance, p = .55.

The second cross-sectional model, investigating the main and interactive effects of perceived discrimination and suppression ability on psychological distress, accounted for 20% of the variance in psychological distress, F(7, 369) = 12.93, p < .001, after adjusting for age, income, education, and employment. The model revealed a significant main effect of perceived discrimination, b = 0.67, SE = 0.11, t = 6.30, p < .001, 95% CI: [0.46, 0.88], β = .31, and suppression ability, b = −0.16, SE = 0.07, t = −2.20, p = .028, 95% CI: [−0.31, −0.02], β = −.11, on psychological distress. The perceived discrimination × suppression ability interaction was statistically significant, b = 0.03, SE = 0.01, t = −2.46, p = .015, 95% CI: [−0.06, −0.01], β = −.12. Spotlight analysis showed that the conditional effect of perceived discrimination on psychological distress remained significant at both low (1 SD below the mean), b = 0.91, SE = 0.15, t = 5.89, p < .001, 95% CI: [.61, 1.22], β = .41, and high (1 SD above the mean), b = 0.43, SE = 0.13, t = 3.27, p = .002, 95% CI: [0.16, 0.69], β = .19, levels of suppression ability. However, parameter estimates showed that the association between perceived discrimination and psychological distress became stronger when suppression ability was low (b = 0.91; β = .41) and was attenuated when suppression ability was high (b = 0.43; β = .19), relative to the main effect parameter estimate for perceived discrimination (b = 0.67; β = .30). Results from the JN technique further showed that perceived discrimination was no longer predictive of psychological distress at suppression ability scores of 42.84 (approximately 1.4 standard deviations above the mean) or greater. Overall, these results suggest that the association between perceived discrimination and psychological distress was attenuated for sexual minority men with higher levels of suppression ability.

The third cross-sectional moderation model, investigating the main and interactive effects of perceived discrimination and EF on psychological distress, accounted for 20% of the variance in psychological distress, F(7, 369) = 13.07, p < .001, after adjusting for age, income, education, and employment. The model revealed a significant main effect of perceived discrimination, b = 0.64, SE = 0.11, t = 5.43, p < .001, 95% CI: [0.43, 0.85], β = .29, and EF, b = −0.11, SE = 0.04, t = −2.78, p = .006, 95% CI: [−0.20, −0.03], β = −.13, on psychological distress. The interaction between perceived discrimination and EF significantly predicted psychological distress, b = −0.01, SE = 0.01, t = −2.07, p = .039, 95% CI: [−0.03, −0.001], β = −.10. Spotlight analysis showed that the conditional effect of perceived discrimination on psychological distress remained significant at both low (1 SD below the mean), b = 0.82, SE = 0.14, t = 5.73, p < .001, 95% CI: [.54, 1.10], β = .37, and high (1 SD above the mean), b = 0.44, SE = 0.13, t = 3.29, p = .001, 95% CI: [0.18, 0.71], β = .20, levels of EF (see Figure 1). However, parameter estimates showed that the association between perceived discrimination and psychological distress became stronger when EF was low (b = 0.82; β = .37) and was attenuated when EF was high (b = 0.44; β = .20), relative to the main effect parameter estimate for perceived discrimination (b = 0.64; β = .29). Results from the JN technique further showed that perceived discrimination was no longer predictive of psychological distress at EF values of 81.41 (approximately 1.4 standard deviations above the mean) or greater. Overall, these results suggested that the association between perceived discrimination and psychological distress was attenuated for sexual minority men with higher levels of EF.

Figure 1.

Figure 1

Open in a new tab

Spotlight Analysis of Interaction Effect Between Perceived Discrimination and Expressive Flexibility on Psychological Distress

Longitudinal Results

As shown in Table 2, perceived discrimination at T1 was positively correlated with psychological distress at T1 (r = .36, p < .001) and T2 (r = .25, p < .001). The full longitudinal moderation model, including perceived discrimination at T1, EF at T2, and their interaction, accounted for 37% of the variance in psychological distress at T2, F(8, 296) = 21.73, p < .001, after adjusting for psychological distress at T1, income, employment, education, and age. After controlling for psychological distress at T1, there was no main effect of perceived discrimination at T1 on psychological distress at T2, b = 0.03, SE = 0.10, t = 0.27, p = .78, 95% CI: [−0.17, 0.23], β = .01. However, the model revealed a significant main effect of EF on psychological distress at T2, b = −0.09, SE = 0.04, t = −2.19, p = .03, 95% CI: [−0.16, −0.01], β = −.10, and a significant perceived discrimination at T1 × EF interaction, b = −0.02, SE = 0.01, t = −2.09, p = .038, 95% CI: [−0.03, −0.001], β = −.09. Spotlight analysis revealed that the association between perceived discrimination at T1 and psychological distress at T2 remained non-significant at low (1 SD below the mean), b = 0.22, SE = 0.14, t = 1.53, p = .13, 95% CI: [−0.06, 0.50], β = .11, and high (1 SD above the mean), b = −0.16, SE = 0.13, t = −1.26, p = .21, 95% CI: [−0.42, 0.09], β = −.08, levels of EF. The JN technique, however, revealed that perceived discrimination at T1 was significantly associated with more psychological distress at T2 at very low levels of EF (~ 2.7 SDs below the mean). These results suggest that, while perceived discrimination at T1 was not significantly associated with changes in psychological distress from T1 to T2, it became a salient predictor of distress for sexual minority men with very low levels of EF. Together with the cross-sectional results, these findings further point to the attenuating role of EF in the association between perceived discrimination and psychological distress.

Discussion

Utilizing a national sample of sexual minority men, the current investigation examined the buffering role of expressive flexibility (EF), an essential component of emotion regulation flexibility, against the adverse mental health impact of sexual minority stress. Consistent with our hypotheses, both cross-sectional and longitudinal analyses revealed that EF moderated the association between perceived discrimination and psychological distress, such that the positive association between perceived discrimination and psychological distress was significantly attenuated among individuals with higher levels of EF. In other words, sexual minority men with higher levels of EF were less likely to report increased psychological distress, even when they experienced higher levels of perceived discrimination. The longitudinal analyses, in particular, strengthened causal inference by establishing temporal ordering of our hypothesized predictor (i.e., perceived discrimination) and outcome (i.e., distress) while controlling for initial levels of the predictor, thereby lending more robust support for our hypotheses. To provide more context for these findings, we also examined the roles of individual components of EF (i.e., enhancement and suppression abilities) as moderators of the association between perceived discrimination and psychological distress. We found that suppression ability, but not enhancement ability, significantly moderated the association between perceived discrimination and psychological distress, suggesting that sexual minority men who are better able to suppress their emotions in accordance with situational demands might be less likely to experience increased psychological distress in the face of discrimination.

Taken together, these findings suggest that EF, which has been consistently linked to successful adaptation to stressful life events in prior research (Bonanno et al., 2004; Gupta & Bonanno, 2011; Rodin et al., 2017; Westphal et al., 2010), can also serve as a coping resource for sexual minority men as they navigate experiences of discrimination. More broadly, they highlight the importance of examining the ability to deploy various emotion regulation strategies in the context of minority stress coping, rather than focusing exclusively on the frequency in which such strategies are deployed. Notably, whereas prior research has linked expressive suppression (i.e., inhibition of emotion-expressive behaviors) to increased psychological distress among sexual minority individuals (Hatzenbuehler et al., 2009), the present study showed that the ability to engage in suppression in response to situational demands might in fact buffer the association between discrimination and distress. Recent research on emotion regulation has identified that emotion regulation goals can influence the efficacy of specific regulation strategies (English et al., 2016). Given the social nature of expressive suppression, sexual minority men who use this strategy with the goal of modifying others’ perceptions (e.g., behaving in less emotionally expressive ways in line with masculine norms, hiding emotional distress in response to biased speech and other cues of sexual orientation-based discrimination) may fare better in threatening social contexts than those who use it to regulate their intrapersonal emotional experience. Future research is needed to examine how the effects of expressive suppression on psychological distress might vary as a function of emotion regulation goals, endorsement of masculine norms, and discriminatory contexts commonly experienced by sexual minority men.

Practically, our results suggest that EF might serve as a promising treatment target for psychosocial interventions designed to facilitate minority stress coping. For example, skills training that specifically focuses on strengthening EF can be incorporated into existing cognitive-behavioral interventions that address co-occurring mental and behavioral health conditions among sexual minority men (Pachankis, Hatzenbuehler, et al., 2015). Furthermore, acceptance and mindfulness-based psychotherapy that indirectly facilitates EF by cultivating an open, flexible approach to emotional processing has also shown initial promise in facilitating stigma coping among sexual minority men (Skinta et al., 2019; Yadavia & Hayes, 2012).

The present investigation has several limitations. First, EF only represents one component of emotion regulation flexibility, which is a dynamic, multifaceted construct. Indeed, we acknowledge that the moderating effect of EF in this study, though statistically significant, was relatively small in both the cross-sectional and longitudinal analyses. Given that EF only captures the ability to engage in emotional enhancement and suppression, future research could examine the buffering role of other aspects of emotion regulation flexibility in the context of stigma coping. For example, studies could explore the impact of the ability to engage in a broad repertoire of emotion regulation strategies in response to contextual demands as well as the ability to monitor internal and social feedback throughout the emotion regulation process, while controlling for individuals’ habitual tendency to rely on specific emotion regulation strategies (Bonanno & Burton, 2013). Similarly, given the heterogeneous nature of sexual orientation-based discrimination (e.g., heterosexist comments, social rejection, violence/victimization, discriminatory laws/policies; Meyer, 2003), it is also possible that the salience of EF might vary across different discriminatory situations. Thus, to gain a more nuanced understanding of how EF operates in the specific context of coping with minority stress, future research could examine the interactive effects of EF and specific forms of discrimination on psychological distress.

Second, although a combination of cross-sectional and longitudinal analyses allowed us to examine the moderating role of EF in the concurrent and prospective associations between perceived discrimination and psychological distress, it did not permit causal inference given that EF was assessed only at one time point. Future research could further clarify the associations among perceptions of sexual orientation-related discrimination, EF, and psychological distress by utilizing longitudinal and experimental designs. For example, prospective studies that assess these constructs over time could help elucidate the buffering role of EF against the known adverse causal impact of perceived discrimination on psychological distress. Furthermore, determining whether an intervention designed to improve EF can alleviate the association between perceived discrimination and psychological distress represents another important direction for future research.

Third, the current sample was recruited via Grindr, a sexual networking platform geared towards sexual minority men. Although as many as three-quarters of sexual minority men use sexual networking applications (Grov et al., 2014) and that many do so to meet other sexual minority male friends (Macapagal et al., 2018), given the prominent role of sexual partner seeking on Grindr, participants in this study might have been more likely than the average sexual minority man to be sexually active and currently looking for sexual partners. Further, prior research has shown that participants recruited via sexual-minority-specific venues were likely to be younger, more open about their sexual orientation, have stronger ties to the gay community, and experience higher levels of psychological distress than the general population of sexual minority men (Kuyper et al., 2016). Additionally, although our sample was diverse in terms of age and geographic locales, most participants were White and highly educated, and only cisgender men were included. Future research should carefully examine the generalizability of our results using population-based samples to ensure broader representation of gender and racial/ethnic identities in the sexual minority male population. In addition, future studies that utilize app-based recruitment might consider recruiting across multiple sexual networking apps, including those most commonly used by sexual minority men of color (Duncan et al., 2018).

In sum, emotion regulation flexibility has been increasingly recognized as an important source of resilience (Aldao et al., 2015; Bonanno & Burton, 2013), yet its role in the context of stigma coping has remained largely unexamined. The present research contributes to the existing literature by providing initial support for the moderating role of EF, an important component of emotion regulation flexibility, in the association between perceived sexual orientation-related discrimination and psychological distress among sexual minority men. Further, findings underscore the potential utility of enhancing EF, and emotion regulation flexibility more generally, in stigma coping interventions that seek to improve sexual minority individuals’ mental health.

Public Significance Statement:

This study suggests that the ability to enhance and suppress one’s emotional expressions in accordance with situational demands might be helpful for sexual minority men as they navigate experiences of discrimination associated with their sexual orientation. It also highlights the potential utility of enhancing flexible responding to emotions in stigma coping interventions that seek to mitigate the deleterious mental health impact of sexual minority stress.

Funding:

Preparation of this manuscript was supported by the National Institutes of Health grants K01DA045738 and T32MH020031-20.

Disclosure:

John Pachankis receives royalties from Oxford University Press for books related to LGBTQ mental health treatments.

References

  1. Aiken LS, West SG, & Reno RR (1991). Multiple regression: Testing and interpreting interactions: Sage. [Google Scholar]
  2. Aldao A, Nolen-Hoeksema S, & Schweizer S (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237. 10.1016/j.cpr.2009.11.004 [DOI] [PubMed] [Google Scholar]
  3. Aldao A, Sheppes G, & Gross JJ (2015). Emotion regulation flexibility. Cognitive Therapy and Research, 39(3), 263–278. 10.1007/s10608-014-9662-4 [DOI] [Google Scholar]
  4. Allison PD (2001). Missing Data. Thousand Oaks, CA: Sage Publications, Inc [Google Scholar]
  5. Bauer DJ, & Curran PJ (2005). Probing interactions in fixed and multilevel regression: Inferential and graphical techniques. Multivariate behavioral research, 40, 373–400. [DOI] [PubMed] [Google Scholar]
  6. Bonanno GA, & Burton CL (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science, 8, 591–612. 10.1177/1745691613504116 [DOI] [PubMed] [Google Scholar]
  7. Bonanno GA, Papa A, Lalande K, Westphal M, & Coifman K (2004). The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15, 482–487. [DOI] [PubMed] [Google Scholar]
  8. Bränström R, Hatzenbuehler ML, Tinghög P, & Pachankis JE (2018). Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings. European journal of epidemiology, 33(6), 591–599. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Brooks VR (1981). Minority Stress and Lesbian Women. Lexington, MA: Lexington Books. [Google Scholar]
  10. Burton CL, & Bonanno GA (2016). Measuring ability to enhance and suppress emotional expression: The Flexible Regulation of Emotional Expression (FREE) Scale. Psychological Assessment, 28, 929–941. 10.1037/pas0000231 [DOI] [PubMed] [Google Scholar]
  11. Derogatis LR, & Melisaratos N (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13, 595–605. [PubMed] [Google Scholar]
  12. Duncan DT, Park SH, Hambrick HR, Dangerfield Ii DT, Goedel WC, Brewer R, … & Hickson DA (2018). Characterizing geosocial-networking app use among young black men who have sex with men: a multi-city cross-sectional survey in the southern United States. JMIR mHealth and uHealth, 6(6), e10316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. English T, Lee IA, John OP, & Gross JJ (2017). Emotion regulation strategy selection in daily life: The role of social context and goals. Motivation and Emotion, 41(2), 230–242. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Frable DE, Platt L, & Hoey S (1998). Concealable stigmas and positive self-perceptions: Feeling better around similar others. Journal of Personality and Social Pssychology, 74, 909–922. 10.1037/0022-3514.74.4.909 [DOI] [PubMed] [Google Scholar]
  15. Gross JJ, & John OP (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362. 10.1037/0022-3514.85.2.348 [DOI] [PubMed] [Google Scholar]
  16. Grov C, Breslow AS, Newcomb ME, Rosenberger JG, & Bauermeister JA (2014). Gay and bisexual men’s use of the Internet: research from the 1990s through 2013. Journal of Sex Research, 51(4), 390–409. 10.1080/00224499.2013.871626 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gupta S, & Bonanno GA (2011). Complicated grief and deficits in emotional expressive flexibility. Journal of Abnormal Psychology, 120, 635–643. [DOI] [PubMed] [Google Scholar]
  18. Hatzenbuehler ML (2009). How does sexual minority stigma “get under the skin”? A psychological mediational framework. Psychological Bulletin, 135, 707–730. 10.1037/a0016441 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hatzenbuehler ML, McLaughlin KA, & Nolen-Hoeksema S (2008). Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. Journal of Child Psychology and Psychiatry, 49(12), 1270–1278. doi: 10.1111/j.1469-7610.2008.01924.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hatzenbuehler ML, Nolen-Hoeksema S, & Dovidio J (2009). How does stigma “get under the skin”? The mediating role of emotion regulation. Psychological Science, 20(10), 1282–1289. doi: 10.1111/j.1467-9280.2009.02441.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Hayes AF (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications. [Google Scholar]
  22. Hill CA, & Gunderson CJ (2015). Resilience of lesbian, gay, and bisexual individuals in relation to social environment, personal characteristics, and emotion regulation strategies. Psychology of Sexual Orientation and Gender Diversity, 2, 232–252. 10.1037/sgd0000129 [DOI] [Google Scholar]
  23. Hofmann SG, Sawyer AT, Fang A, & Asnaani A (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and anxiety, 29, 409–416. [DOI] [PubMed] [Google Scholar]
  24. King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, & Nazareth I (2008). A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70–86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Kuyper L, Fernee H, & Keuzenkamp S (2016). A comparative analysis of a community and general sample of lesbian, gay, and bisexual individuals. Archives of Sexual Behavior, 45, 683–693. 10.1007/s10508-014-0457-1 [DOI] [PubMed] [Google Scholar]
  26. Little RJ (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. [Google Scholar]
  27. Macapagal K, Moskowitz DA, Li DH, Carrión A, Bettin E, Fisher CB, & Mustanski B (2018). Hookup app use, sexual behavior, and sexual health among adolescent men Who Have Sex with men in the United States. Journal of Adolescent Health, 62(6), 708–715. 10.1016/j.jadohealth.2018.01.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Mays VM, & Cochran SD (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91(11), 1869–1876. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Meyer IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. 10.1037/0033-2909.129.5.674 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Newcomb ME, & Mustanski B (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30, 1019–1029. doi: 10.1016/j.cpr.2010.07.003 [DOI] [PubMed] [Google Scholar]
  31. Pachankis JE, & Bränström R (2018). Hidden from happiness: Structural stigma, sexual orientation concealment, and life satisfaction across 28 countries. Journal of Consulting and Clinical Psychology, 86(5), 403–415. [DOI] [PubMed] [Google Scholar]
  32. Pachankis JE, Mahon CP, Jackson SD, Fetzner BK, & Bränström R (2020). Sexual orientation concealment and mental health: A conceptual and meta-analytic review. Psychological Bulletin, 146, 831–871. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Pachankis JE, Goldfried MR, & Ramrattan ME (2008). Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. Journal of Consulting and Clinical Psychology, 76, 306–317. doi: 10.1037/0022-006X.76.2.306 [DOI] [PubMed] [Google Scholar]
  34. Pachankis JE, Hatzenbuehler ML, Rendina HJ, Safren SA, & Parsons JT (2015). LGB-affirmative cognitive behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83, 875–889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Pachankis JE, Rendina HJ, Restar A, Ventuneac A, Grov C, & Parsons JT (2015). A minority stress—emotion regulation model of sexual compulsivity among highly sexually active gay and bisexual men. Health Psychology, 34(8), 829–840. Doi: 10.1037/hea0000180 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Rodin R, Bonanno GA, Rahman N, Kouri NA, Bryant RA, Marmar CR, & Brown AD (2017). Expressive flexibility in combat veterans with posttraumatic stress disorder and depression. Journal of Affective Disorders, 207, 236–241. 10.1016/j.jad.2016.09.027 [DOI] [PubMed] [Google Scholar]
  37. Rodriguez-Seijas C, Eaton NR, & Pachankis JE (2019). Prevalence of psychiatric disorders at the intersection of race and sexual orientation: Results from the National Epidemiologic Survey of Alcohol and Related Conditions-III. Journal of consulting and clinical psychology, 87(4), 321–331. [DOI] [PubMed] [Google Scholar]
  38. Skinta MD, Hoeflein B, & Ryu D (2019). Acceptance, vulnerability, and compassion: Contextual and behavioral approaches for sexual and gender minority clients. In Pachankis JE, & Safrin SE (Eds.), Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities (pp. 381–407). Oxford University Press. [Google Scholar]
  39. Timmins L, Rimes KA, & Rahman Q (2020). Minority stressors, rumination, and psychological distress in lesbian, gay, and bisexual individuals. Archives of Sexual Behavior. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Webb TL, Miles E, & Sheeran P (2012). Dealing with feelings: A meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychological Bulletin, 138, 775–808. 10.1037/a0027600NY: [DOI] [PubMed] [Google Scholar]
  41. Westphal M, Seivert NH, & Bonanno GA (2010). Expressive flexibility. Emotion, 10, 92–100. 10.1037/a0018420 [DOI] [PubMed] [Google Scholar]
  42. Williams DR, Yu Y, Jackson JS, & Anderson NB (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2, 335–351. [DOI] [PubMed] [Google Scholar]
  43. Yadavaia JE, & Hayes SC (2012). Acceptance and commitment therapy for self-stigma around sexual orientation: A multiple baseline evaluation. Cognitive and Behavioral Practice, 19, 545–559. [Google Scholar]
  44. Yoshino K (2006). Covering: The hidden assault on our civil rights. New York, NY: Random House. [Google Scholar]

RESOURCES