The unexamined assumption that makes you wrong

Forty years. Ten models. Thousands of studies. Nobody checked the one thing they all depend on. And every time it fails, the failure gets dumped on you.

May 14, 2026|Matthew & Chantal

You're sitting in a chair. Across from you is someone with a qualification on the wall and a notepad in their lap. At some point they're going to ask you a question: "Can you tell me what you're feeling?"

Behind that question is an entire field. Therapy. Medication. Mindfulness apps. School counsellors. Employee assistance programmes. Workplace wellness. Self-help books.

The infrastructure is enormous. Years of research underpin it. Clinical guidelines govern it. Insurance systems fund it. Training programmes certify the people who deliver it.

This is the field of emotion regulation.

The emotion regulation field and its architecture

From the mid-1980s to the present, a number of models were developed at universities and research institutions for how humans understand and work with emotions. The therapies and therapeutic approaches that grew out of those models each have their own structure, their own language, their own evidence base.

  • Cognitive Behavioural Therapy (CBT) restructures thoughts.
  • Dialectical Behaviour Therapy (DBT) teaches distress tolerance through cognitive and mindfulness skills.
  • Acceptance and Commitment Therapy (ACT) builds psychological flexibility.
  • Mindfulness-Based Stress Reduction (MBSR) trains non-judgmental awareness.
  • Somatic Experiencing (SE) titrates activation under clinical guidance.
  • Emotional Freedom Techniques (EFT) pairs tapping with verbal statements about the issue.

Six approaches, each built differently. All of them work with emotions through thinking.

Behind these therapeutic approaches sit the academic models that shaped how the field thinks about emotions. In 2024, Consuelo Martinez-Priego and her colleagues at Universidad Villanueva in Madrid examined every major model of emotion regulation from the 1980s to the present. Ten academic models, developed independently over that same period. The cognitive dimension sat at the core of every one.

In practice, that means reappraisal (telling yourself the situation isn't as bad as it feels), cognitive restructuring (changing the thought driving the response), and attentional deployment (redirecting your focus somewhere else).

The most widely used of the ten was developed by James Gross, a psychologist at Stanford University. His extended process model, published in 2015, starts with identification: the person recognises which emotion they're experiencing. Then it lays out what to do about it. Selecting a strategy. Implementing it. Monitoring whether it worked. Researchers built validated questionnaires for each of those stages, wrote treatment manuals, and tested them across hundreds of clinical trials.

What the instruments actually measured

Running in parallel, an older tradition of coping research had built its own instruments to measure whether people engaged with their emotions or avoided them. The Ways of Coping Questionnaire, developed by Richard Lazarus and Susan Folkman at the University of California, Berkeley in 1984. The Coping Inventory for Stressful Situations, developed by Norman Endler and James Parker at York University in Toronto in 1990. For thirty years these were the instruments everyone used.

Then someone looked closely at what the items actually measured. In 1994, Annette Stanton, a psychologist at the University of Kansas, and her colleagues examined the questionnaires item by item. A person reads "I become very tense." Their score gets recorded as evidence that they engaged with their feelings. But they weren't reporting engagement. They were reporting being overwhelmed. The instruments couldn't tell the difference.

Hundreds of studies used those scores. The conclusion was consistent: people who engaged with their emotions did worse. More anxiety. More depression. Worse adjustment across nearly every measure. The people who used thinking strategies did better. Research funding followed the data. Clinical training followed the research. An entire field's direction was set by instruments that couldn't tell the difference between feeling something and being overwhelmed by it.

The conclusion was wrong. The instruments were broken. Emotions were not the problem.

Stanton rebuilt the scales in 2000, pulling apart two things the old questionnaires had mixed together: "I take time to figure out what I'm really feeling" and "I become very tense." The first is someone trying to understand what they feel. The second is someone overwhelmed. Studies using her corrected scales started showing that engaging with emotions improved outcomes. The confirmation came in 2024, when Michael Hoyt at Hunter College in New York and his colleagues published a meta-analysis in Health Psychology pulling together 86 studies spanning three decades. Measured properly, engaging with your emotions makes you healthier. Physically. Biologically. It builds resilience.

The correction took thirty years.

Other researchers saw pieces of the same problem. Kim Gratz at the University of Maryland and Lizabeth Roemer at the University of Massachusetts Boston built a questionnaire in 2004 called the Difficulties in Emotion Regulation Scale that has since been used in thousands of studies. Two of its six sections measure "lack of emotional awareness" and "lack of emotional clarity." They showed that some people are far more cut off from what they feel than others. They measured who had it and who didn't. But the field treated this as a variable to score, not as a question about whether its own methods could reach these people.

How the capacity to feel gets lost

Every child arrives knowing how to feel. Nobody teaches a newborn to cry when they're hungry or laugh when they're held. Then we spend the rest of their childhood teaching them to stop feeling.

John Gottman, a psychologist at the University of Washington, documented a parenting style in 1996 that he and his colleagues called "emotion dismissing." The child cries and the parent says stop crying. The child is angry and the parent says calm down. The child is frightened and the parent says there's nothing to be frightened of. The child learns that what they feel is wrong, that it's unwelcome, that the people they depend on most don't want to see it.

At school, the signals continue. In 2019, Asta Cekaite and Disa Bergnehr at Linköping University in Sweden found that in Swedish preschools, teachers treated children's emotional expressions as conduct to be corrected, not as experiences to be understood.

This isn't only a Western problem. David Matsumoto, a psychologist at San Francisco State University, and his colleagues surveyed over 5,000 people across 32 countries in 2008. Every culture regulates emotional expression. Collectivistic cultures suppress for social harmony. Individualistic cultures suppress negative emotions to maintain a positive self-image. The mechanisms differ. The outcome converges. Children everywhere learn that some or all of what they feel is not welcome.

Tara Chaplin at Yale School of Medicine and Amelia Aldao at Ohio State University reviewed 166 studies involving 21,709 children in 2013, tracking how emotional expression changes as children grow up. In early childhood, the differences between boys and girls were small. By adolescence they were pronounced, and they were largest in the presence of peers and unfamiliar adults, exactly the contexts where social pressure to conform is highest. Boys were socialised away from vulnerability, sadness, fear. Girls were socialised away from assertion, anger, defiance. Both lost range.

The feeling had to go somewhere. For boys, it came out as aggression and violence. For girls, it turned inward as depression, anxiety and shame. In 2009, Ronald Levant, a psychologist at the University of Akron, and his colleagues found that men strongly shaped by traditional masculinity norms scored significantly higher on alexithymia, a condition that means literally "without words for emotions." These men couldn't identify what they were feeling. They couldn't describe it. They had spent a lifetime being trained out of recognising it.

Every child arrives knowing how to feel. Nobody teaches a newborn to cry when they're hungry or laugh when they're held. Then we spend the rest of their childhood teaching them to stop feeling.

What emotional suppression does to the body

Holding back what you feel makes you ill. The research literature calls it emotional suppression, and its physical consequences are measured and consistent.

James Gross, working with Robert Levenson at UC Berkeley in the early 1990s, showed that when people suppress emotional expression, heart rate increases, blood pressure rises, and the body's fight-or-flight system activates as though the person is under physical threat.

In 2024, Allison Tyra at Baylor University and her colleagues meta-analysed 24 studies in healthy adults under laboratory stress. When suppression was experimentally induced, it produced the same pattern Gross and Levenson had found three decades earlier: greater physiological reactivity to stress.

Habitual suppression raises levels of inflammation in the bloodstream, the kind of persistent, low-grade inflammation linked to heart disease. That finding came from a 2013 study led by Alison Appleton at the University of Massachusetts Boston and her colleagues.

A separate twelve-year study tracking 729 people, led by Benjamin Chapman at the University of Rochester Medical Center in 2013, found that those who scored higher on emotional suppression had a 35% increased risk of dying from any cause and a 70% increased risk of dying from cancer.

The behaviour solidifies over years. Burying what they feel. Avoiding situations that might trigger feeling. Numbing themselves to get through, BAN-ing emotions. What began as a child's compliance with the world around them becomes, in adulthood, a way of operating so embedded that the person no longer recognises it as a strategy.

What the field assumes

A feeling isn't the same thing as an emotion. A feeling is what's happening in the body: the butterflies in the stomach, the tightness in the chest, the weight behind the eyes. An emotion is what the brain decides that feeling means.

The brain takes the body's raw signal, draws on past experience, learned categories and the current situation, and produces its best guess. Lisa Feldman Barrett, a neuroscientist at Northeastern University, called this process emotional construction in her 2017 book How Emotions Are Made. The same "butterflies in my stomach" can be labelled "nervous" or "excited" or "guilty" depending on the context. The label is a category. The feeling is what's actually there.

You may be wondering why any of this matters. Why review the field's models, trace what happens to children's capacity to feel, and document what emotional suppression does to the body.

Here is why. If you can't feel something, you can't manage it. You can talk about it in a therapist's office for an hour a week. You can fill in a questionnaire rating your distress on a scale of one to five. You can learn to reappraise it, restructure the thoughts around it, deploy your attention away from it, monitor whether your strategy worked, and report back at the next session. You can journal about it, meditate on it, apply a label to it, track it in an app. But if the feeling itself, the actual sensation in your body, is something you lost access to years ago, then every one of those tools has very little to work with.

The entire field of emotion regulation made this assumption. Ten academic models. Four decades. Thousands of studies. Hundreds of clinical trials. Training curricula for therapists, counsellors and coaches. Diagnostic manuals. Treatment protocols. Intake forms. Insurance billing codes. Undergraduate textbooks. Continuing professional development programmes. Aaron Beck, the psychiatrist at the University of Pennsylvania who created CBT, calls emotion identification "a cardinal therapeutic process" in his own manual.

The capacity to feel has been educated, socialised and culturalised out of most people to one degree or another, starting in childhood, across most cultures studied. Trying to think your way out of a feeling problem is like trying to read your way to fitness. You can study the science, understand the principles, memorise the programmes. Eventually you have to get down and do it. The field built thinking tools for a feeling problem. The tools don't match the job.

When the assumption doesn't hold

You go to therapy. One in five people don't finish.

You try CBT. One in three drop out.

You try trauma-focused treatment. One in two leave before it's done.

Across all forms of psychotherapy for major depression, fewer than half achieve remission.

Alexithymia, the clinical term for being unable to identify what you feel, affects roughly 10% of the general population and one in four psychiatric patients.

These are people sitting in the chair being asked a question they have no answer to.

The field has a vocabulary for these numbers. Treatment-resistant. Treatment-refractory. Non-compliant. Non-adherent. Poorly motivated. Hard to reach. Dropped out. Non-responder. Inadequate response. Failed treatment. Every term points at the person. None of them point back at the field or the assumption.

When you can't produce the word the intake form asks for, the clinical response is to teach you to label what you feel. CBT offers structured exercises in emotion identification. DBT adds mindfulness and distress tolerance skills. ACT reframes the relationship with the feeling through language and metaphor. Each approach adds more cognitive scaffolding around the same absent foundation.

When none of this works, the field has one more step. Medication. The clinical guidelines use what they call stepped care: if therapy doesn't produce improvement, prescribe. If the first drug doesn't work, increase the dose, switch to a different drug, or add a second one.

The prescribing spans multiple classes. Drugs for depression, drugs for anxiety, drugs for psychosis, drugs to stabilise mood, drugs to sedate. Finding the right drug is acknowledged in the clinical literature as largely trial and error.

The drugs carry their own consequences for feeling. Patients on antidepressants report becoming emotionally numb. They can no longer cry. Pleasure disappears. They feel detached from the people around them. Clinicians call it emotional blunting, and multiple studies estimate that between 40% and 70% of people on antidepressants experience it.

The dampening extends beyond antidepressants. Antipsychotics produce apathy, indifference and flattened affect. Benzodiazepines induce emotional numbness and detachment. Lithium produces dysphoria, lethargy and cognitive slowing.

In 2013, Joanna Moncrieff, Professor of Critical and Social Psychiatry at University College London, reviewed the psychoactive effects across every major class of psychiatric medication, from antidepressants to antipsychotics to sedatives. Her conclusion was that the emotional alterations these drugs produce aren't side effects. They are the primary mechanism by which the drugs operate. The drugs don't fix feeling. They reduce it.

The field's final answer for a person who cannot access what they feel is medication that further reduces their capacity to do so.

Forty years of models, research, training, clinical trials, treatment protocols, diagnostic manuals, and prescribing guidelines. All of it built on the belief that the person could feel.

The question remains

You're back in that chair, across from the notepad and qualification.

And the question remains.

Someone is asking you what you're feeling. The entire field assumed you'd have an answer.

That assumption is extraordinary.

Matthew & Chantal
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Matthew & Chantal

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