that control-enhancing manipulations (such as the ability to choose when to participate in activities or when to have visitors) are associated with improved health and longevity (Schulz, 1976; Langer and Rodin, 1976). One study found that rats implanted with a cancerous tumor preparation and exposed to inescapable electric shock were less likely to reject the tumor preparation than animals exposed to no shock or to escapable electric shock (Visintainer et al., 1983). Experiences of control or self-efficacy affect health outcomes across the life span and in manifold ways, ranging from initial vulnerability to adherence to treatment.
Emotion regulation is implicated in the early stages of health disorders, ties that have been most clearly demonstrated in investigations of anger and hostility. Hostility is a risk factor for coronary heart disease in adult men (Dembroski et al., 1985), and in women antagonistic hostility is related to high levels of low-density lipoprotein cholesterol, high levels of triglycerides, and a higher ratio of high-density lipoprotein cholesterol to total cholesterol (Suarez et al., 1998). Emotional suppression, a form of emotion regulation, reduced expressive behavior in adult men and women and produced a mixed physiological state characterized by decreased somatic activity and decreased heart rate, along with increased blinking and indications of increased sympathetic nervous system activity (Gross and Levenson, 1993).
The antecedents of emotion regulation are laid down in early childhood. A high frequency of negative interactions between parents and sons predicted the sons' later hostile attitudes and outward expressions of anger (Matthews et al., 1996). Children of hypertensive parents show elevated systolic blood pressure reactivity to angry exchanges between adults, which may be a precursor of later difficulties in stress management and risk for hypertension (Ballard et al., 1993). A large body of literature suggests that a genetic risk for heightened sympathetic-adrenal-medullary reactivity to stress is exacerbated by familial transmission of hypertension through repeated exposure to such hostile episodes, resulting in a hostile interpersonal style in adulthood (Ewart, 1991). The fact that hostility can be significantly modified in interventions for people diagnosed with coronary heart disease and the subsequent effects these interventions have on risk factors (Blumenthal et al., 1988) suggests the potential importance of modifying emotional regulation early.
Temperamental states such as optimism interact with physiological states to moderate predisease pathways. For example, optimism was associated with higher numbers of helper T cells and higher natural killer cell cytotoxicity in students undergoing the stress of first-year law school (Segerstrom et al., 1998). Because these immune changes can be precursors to significant clinical states, including depression, anxiety, and vulnerability to infectious disorders, these results suggest potentially protective effects of