2013. Vol.4, No.6A1, 25-33
Published Online June 2013 in SciRes (
Copyright © 2013 SciRes. 25
Emotions and Emotion Regulation in a Female Couple
Undergoing in Vitro Fertilization Treatment
Tracey J. Devonport, Andrew M. Lane
University of Wolverhampton, Walsall, UK
Received February 19th, 2013; revised March 26th, 2013; accepted April 20th, 2013
Copyright © 2013 Tracey J. Devonport, Andrew M. Lane. This is an open access article distributed under the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Research indicates that women undergoing In Vitro Fertilization (IVF) experience intense unwanted emo-
tions, and that these emotions may result in the decision to abandon treatment. This case-study explored
stressors, emotional responses and emotion regulation strategies of a female couple undergoing IVF pro-
cedures over a ten-week period. A mixed-method approach involved participants completing a daily
open-ended diary and self-report scales to assess emotions and emotion regulation in relation to partner
and self. Diary results indicated both partners experienced frequent stressors resulting from the IVF proc-
ess, stressors that were intensified by perceptual and financial factors. Participants experienced a range of
intense pleasant (e.g., happy, excited) and unpleasant emotions (e.g., depressed, anxious), and sought to
down-regulate unpleasant emotions using a range of cognitive, behavioral, and social strategies. Ques-
tionnaire data indicated complementary styles of emotion regulation that appeared to help sustain pleasant
emotions and down-regulate unpleasant emotions. Future research should test the effectiveness of inter-
ventions to help manage unwanted emotional responses to IVF treatment and corresponding regulatory
Keywords: Emotion Regulation; Emotion; In Vitro Fertilization; Coping; Stress
There has been an increase in the number of couples seeking
assisted-reproduction treatments among western cultures (Walsh,
Collins, Le Du, Walsh, & Sills, 2009). Assisted reproductive
treatment is a general term referring to methods used to achieve
pregnancy by artificial or partially artificial means. The fertility
treatment “In Vitro Fertilization” (IVF) is expensive, complex
and associated with significant side effects (Macklon, Stouffer,
Giudice, & Fauser, 2006). The treatment itself takes between
four and six weeks to complete and constitutes a course of hor-
mone therapy to down-regulate the pituitary, followed by ovar-
ian stimulation to develop follicles in the ovary. These follicles
produce eggs that are fertilized in vitro to create embryos. As in
natural conception, not every embryo implants to become a
pregnancy, as such any surplus embryos are frozen so that a
subsequent transfer might be attempted if the first attempt fails
(Verberg et al., 2008). The treatment itself along with its unpre-
dictable nature/outcomes often presents stressors (Olivius, Fri-
den, Borg, & Bergh, 2004; Verhaak et al., 2007). Problems can
occur at any stage of the IVF process that might lead to unde-
sired outcomes such as the failure to produce viable embryo’s,
failed implantation, or the couple deciding to abandon IVF
(Human Fertilisation and Embryology Authority IVF figures:
Emotions Associated with IVF
Evidence indicates that women undergoing IVF experience
intense unwanted emotions such as anxiety and depression
(Boivin & Lancastle, 2009; Schmidt, 2009) and that emotions
influence physical and subjective well-being (see Consedine &
Moskowitz, 2007 for a review). Emotions can be functional, for
example, the emotions of happiness and excitement can signal
to the individual that they are likely to achieve their goal and
help maintain desirable behaviors. However, emotions can also
be dysfunctional, for example, an individual might be anxious
about following medical procedures such as self-injecting, rec-
ognising that failure to adhere to these procedures will be det-
rimental they may choose withdraw from the process. A number
of studies have reported that the decision to abandon IVF asso-
ciates with feeling intense anxiety and depression (Peddie, Van
Teijlingen, & Bhattacharya, 2005; Van den Broeck et al., 2009).
Therefore, examination of emotional states and how these emo-
tions are managed among couples going through IVF represents
a worthwhile line of enquiry.
Emotion Re gulation
There has been an increase in research on emotion regulation
(see Augustine & Hemenover, 2008; Koole, 2009; Webb, Miles,
& Sheeran, 2012). Emotion regulation is proposed to be an
automatic and controlled process that involves the initiation,
maintenance and modification of the occurrence, intensity, and
duration of feeling states (Eisenberg, Fabes, Guthrie, & Reiser,
2000; Gross & Thompson, 2007). Emotion regulation can be
distinguished according to whether strategies are targeted to-
ward the person’s own feeling states (intra-personal emotion
regulation) or targeted toward another person’s feeling states
(inter-personal emotion regulation). Over 400 different emo-
tion regulation strategies have been identified (Augustine &
Hemenover, 2008; Koole, 2009; Webb, Miles et al., 2012),
however, little is known about the way in which an individual
selects and applies emotion regulation strategies when con-
fronted with potentially stressful situations (Liu, Prati, Perrewé,
& Brymer, 2010; Sheppes, Scheibe, Suri, & Gross, 2011). By
assessing the relationships among individual differences in
emotion regulation of self and others (i.e., habitual tendencies),
the implications of regulatory behaviors for goal pursuit and
healthy adaptation may be better understood (Gross & John,
2003; Tamir, 2011; Webb, Schweiger Gallo, Miles, Gollwitzer,
& Sheeran, 2012).
The focus of much research has been on self-regulation. Re-
cent research has focused on how emotion regulation occurs in
close dyadic relationships (Parkinson & Simons, 2012). Park-
inson and Simons (2012) found that expressing worry may
either serve the interpersonal regulation goal of alerting another
person to a potential concern or may represent empathic com-
munication. However, this observation assumes that the re-
ceiver of the message could decode its meaning, and then initi-
ate appropriate action (Webb, Schweiger et al., 2012). Evidence
shows people vary in the extent to which they can accurately
identify and detect emotions in others and self, and therefore,
the strength of this signal is likely to be influenced by individ-
ual differences.
Research has found people initiate interpersonal emotion
regulation not only to try to change others emotions, but also
their own (Niven, Totterdell, Holman, & Headley, 2012); that is
people initiate strategies to cheer both the agent and themselves
up. However, previous research has not examined whether these
effects occur among dyads experiencing potentially stressful
events. The present study aims to address this gap in the litera-
ture. This seems particularly important given the evidence that
women experience intense emotions (Peddie, et al., 2005; Van
den Broeck et al., 2009) during IVF, suggesting the partner has
an important role to play in identifying when such emotional
episodes occur and initiating an appropriate regulatory strategy.
It is also worth noting that evidence shows that witnessing in-
tense unwanted emotions associates with fatigue (Totterdell,
Hershcovis, Niven, Reich, & Stride, 2012). In the context of a
dyad going through IVF, if one partner experiences stressful
emotions, this could have negative effects on the other partner.
Therefore, attending to each other’s emotional state appears to
be warranted.
Research Ai ms
The aim of the present study was to explore stressors, emo-
tional responses and emotion regulation strategies of a couple
undergoing IVF. Lazarus and Lazarus (2006) cautioned that
research on emotions requires measures that capture conditions
generating emotions and their relational meanings. The use of a
longitudinal mixed methods case study of a dyadic relationship
could facilitate an examination of emotion states, relational
meaning and regulatory behaviors. The value of the case-study
lies in capturing real life transactions that might be lost when
looking to summarize findings into theoretical propositions and
generalizations (Flyvbjerg, 2006; Stake, 1995). Qualitative me-
thods afford the opportunity to analyze and make sense of the
personal experiences of individuals (Smith, 2008), allowing an
exploration of psychological concepts and the mechanisms
underlying them (Bird, Mansell, & Tai, 2009; Higginson &
Mansell, 2008). Flyvbjerg (2006: p. 228) suggested that case
studies are central to learning and scientific development as
they provide “the force of example”. Case studies may contrib-
ute toward a better understanding of the implications of emo-
tions and emotion regulation for goal pursuit and healthy adap-
tation among self and others. Such examples might be particu-
larly useful for practitioners working around the concepts de-
Participants were a white female couple; Partner 1: Age 32
years; Partner 2; Age 38 years. Partner 2 underwent treatment
that followed two failed attempts at Intrauterine Insemination
(IUI) and one failed IVF. These treatments had all taken place
in the five months preceding the present IVF cycle. It is impor-
tant to note that the first author was both participant (undergo-
ing treatment) and researcher in the present study. The study of
the researcher as a subject of scientific investigation is becom-
ing acceptable in many disciplines including sociology (Denzin,
1997; Lucal, 1999), education (Hayler, 2011) and nursing
(Brunner, 2004; Sandelowski, 1994). The researchers adhered
to guidelines advocated when undertaking researcher self-en-
quiry (Denzin, 1997; Denzin & Lincoln, 2005). First, to facili-
tate accurate recall both participants independently completed a
daily emotion and emotion regulation diary. Second, there was
triangulation of data sources (questionnaire and open ended
diaries) and content (independent assessment of self and other)
to increase trustworthiness. Third, multiple data analysis strate-
gies were implemented and fourth, existing literature was used
as a framework to guide analysis and interpretation. In a further
attempt to ensure that data interpretation and presentation was
objective and reliable, the second author collated all data and
was involved in the analysis, presentation and interpretation of
A six-item measure was used to assess emotions with items
selected from the UWIST mood adjectives checklist (Matthews,
Jones, & Chamberlain, 1990). Three items represent pleasant
emotions (calm, energetic, & happy), and three items represent
unpleasant emotions (angry, anxious, & gloomy). Items were
rated on a 7-point scale from 1 (not at all) to 7 (a great extent).
We calculated a single measure of emotion by subtracting un-
pleasant emotions from pleasant emotions.
Emotion Regulation of Others and Self (EROS: Niven,
Totterdell, Stride, & Holman, 2011)
Niven et al. (2011) developed the Emotion Regulation of
Others and Self scale (EROS) to assess strategies used to in-
crease pleasant emotions and strategies used to increase un-
pleasant emotions in others and one self. Niven et al. reported
that the EROS scale showed factorial and concurrent validity
using confirmatory factor analysis techniques, reporting alpha
values greater than .70. This meets criterion suggested by Ta-
bachnick and Fidell (2001) as demonstrating acceptability.
Copyright © 2013 SciRes.
Subsequent research has found that the scale cross-validated to
a different context (Lane, Beedie, Devonport, & Stanley, 2011).
Examples of items include; “I did something I enjoy to try to
improve how I felt” (increase one’s own pleasant emotions), “I
expressed cynicism to try to make myself feel worse” (increase
one’s own unpleasant emotions), “I gave someone helpful ad-
vice to try to improve how they felt” (increase pleasant emo-
tions in others) and “I told someone about their shortcomings to
try to make them feel worse” (increase unpleasant emotions in
others). Participants rated items on a 5-point scale where 1
equals “not at all” and 5 equals “a great deal”. Participants were
informed to rate the frequency of usage rather than evaluate
whether each strategy was effective. Alpha coefficients in the
present study were greater than .70.
Open-Ended Daily Emotion and Emotion Regulation
Expressive writing was used to capture stressors and the
emotional experiences of the first author and their partner on a
daily basis in the two weeks proceeding, five weeks during and
three weeks following the present IVF cycle. This provides rich
data for the case study and has been shown to result in signifi-
cantly better physical and psychological outcomes for partici-
pants faced with stressful and emotional events (Baikie & Wil-
helm, 2005). The diary used prompts to encourage expressive
reflections concerning stressors, strategies used to manage their
own and partner’s emotions and situational factors perceived as
influencing emotion experiences and regulation.
In the present study, participants rated their emotions and
emotion regulation strategies for the previous 24-hour on a
daily basis. Participants were e-mailed the survey link as a re-
minder to complete the scale each morning.
Data Analysis
Our research sought to explore answers to the following
questions: First, is one partner feeling happier than the other?
Secondly, is there a difference between how I report feeling to
how you think I feel? Third, how does the assessment of my
own and partner’s emotions relate to strategies used to regulate
emotion (in self and partner)? Correlation was used to examine
relationships between own and partner’s emotions and regula-
tion strategies used.
Qualitative data allowed an in depth review of participants’
experiences of IVF including associated stressors, resultant
emotional experiences (self and partner) and strategies used to
regulate own and partner’s emotions. The computer software
QSR Nvivo-8 (2009) was used to facilitate the organization of
quotes into meaningful categories. A content analysis was per-
formed to generate categories of stressors, emotions and emo-
tion regulation strategies collectively experienced before, dur-
ing and following the outcome of IVF.
Quantitative Data
Descriptive statistics for self-rating of own emotions (how I
felt today) and other’s rating (how I thought you felt today) are
contained in Ta b l e 1 . We analysed data in terms of three main
Table 1.
Emotional states and emotion regulation strategies in self and partner.
Partner 1 Partner 2
Own emotion 4.02 1.34 3.96.82
Partners emotion 4.47 1.24 3.721.10
Increase own pleasant emotion 1.93 .58 1.26.29
Increase other pleasant emotion 2.08 .57 1.24.38
Increase other unpleasant emotion 1.25 .00 1.27.07
questions. First, we examined the question is one partner hap-
pier than the other? As Tab le 1 indicates, there were no signifi-
cant differences in the intensity of emotional states between
each partner (t = .30, p = .76). Second, we examined the ques-
tion; did one partner perceive that the other partner was happier?
Results indicated that partner 1 reported that partner 2 is hap-
pier than she is (t = 2.32, p = .024), that is, when assessing her
own emotional state, she reported that she believed her partner
was happier. In contrast, partner 2 reported no significant dif-
ference in response to the same question (t = 1.98, p = .065).
Thirdly, we examined the question did my rating of your emo-
tions differ significantly to your self-rating? Results indicate
that partner 1 significantly over-estimated the intensity of part-
ner 2’s pleasant emotion (t = 5.52, p < .001), that is, she rated
her partner to be in a more pleasant mood than partner 2’s own
self-rating. As Table 1 indicated, participant 1 rated participants
2 emotional state to be an average of 4.47, which is signifi-
cantly higher than her self-rating average score of 3.96. By con-
trast, partner 2 significantly under-estimated the intensity of her
partner’s pleasant emotions (t = 2.19, p = < .032), that is, she
rated her partner’s emotions as less happy than her partner’s
own self-rating. As Ta bl e 1 indicated, participant 2 reported a
score of 3.72, with partner 1 scoring herself a mean of 4.02.
In terms of strategies used to regulate emotions, results indi-
cated that partner 1 reported using strategies to regulate her
partner’s emotion significantly more than partner 2 (Mann
Whitney U = 917, p < .001). It should be noted that neither
participant reported the use of strategies intended to increase
their own unpleasant emotions and so this variable was dis-
Relationships between emotions and emotion regulation stra-
tegies are contained in Table 2. For both partners, rating of own
emotion correlated with rating of partner’s emotion although
this relationship was stronger for partner 2. For partner 1, self-
rating of the intensity of feeling pleasant emotion correlated
positively with strategies intended to increase one’s own pleas-
ant emotions and strategies to increase pleasant emotions in
one’s partner. By contrast, for partner 2, rating of own pleas-
ant emotion inversely correlated with strategies to increase the
intensity of pleasant emotion in oneself. In addition, partner 2’s
rating of partner’s pleasant emotion inversely correlated with
use of strategies to increase own pleasant emotion and partner’s
pleasant emotion.
Qualitative Data
Over the duration of the present IVF cycle, participants col-
lectively recorded 46,262 words of text (partner 1 = 13,622,
Copyright © 2013 SciRes. 27
Copyright © 2013 SciRes.
partner 2 = 32,649). In order to facilitate the interpretation and
presentation of the substantive qualitative data, data will be
reported in coding hierarchies that represent the key emergent
themes. Direct quotations that represent these themes will also
be presented thereby portraying critical IVF moments and emo-
tion regulatory strategies as determined by participants.
Pertinent Stressors
As Table 3 indicates, participants’ perceptions regarding
treatment protocols, hospital communication and the availabil-
ity of ongoing support presented a range of stressors. Stressors
were clustered under three related themes, those being hospital,
tangible and perceptual stressors. Participants perceived there to
be ambiguity in the treatment process as evidenced by partici-
pant 2:
When she outlined my treatment from here in it differed from
that described by other nurses. This does concern me, whilst I
appreciate that it may vary depending on how your body reacts,
some of the differences that appear a week apart are alarming.
Last week I was told I would not start pessaries until the day of
insemination, today I was told I start them tomorrow... I do not
understand how there can be such differences and it under-
mines my confidence in the service.
As a consequence of the treatment process both participants
experienced a range of pleasant and unpleasant emotions.
Pleasant emotions experienced included overjoyed, excited,
relieved, happy, relaxed, calm and optimistic. However, the
emotions described were predominantly unpleasant on account
of the uncertainty relating to achieving the goal of becoming
pregnant and were experienced throughout a great deal of the
treatment process. Unpleasant emotions identified by partici-
pants included disappointment, depression, worry, fear, anxiety,
downhearted, irritable, anger, confused and pressured. In man-
aging these intense emotions, both participants evidenced a
range of intra-personal and inter-personal regulation strategies
that are presented in Tables 4 and 5 respectively.
Intra-Personal Emotion Regulation
Table 4 presents strategies utilized to regulate one’s own
emotions (intra-personal). The focus of strategies for regulating
unpleasant emotions was to attenuate or eliminate unpleasant
emotions whereas the intention for strategies for regulating
pleasant emotions was to maintain or increase the felt emotion.
Strategies could be described as; 1) cognitive (e.g., re-appraisal,
positive thinking, and cognitive avoidance), 2) behavioral (e.g.,
routines, behavioral distractions, or treats) and, 3) social (e.g.,
seeking support for emotional or informational purposes, shar-
ing positive experiences).
The following excerpt provided by participant 2 evidences
intra-personal emotion regulation strategies of positive thinking
and putting in perspective when attempting to manage the
process of self-injecting:
The thought of pushing a needle into my own skin for its full
length (just under an inch) made me anxious and uncomfort-
able. I thought about positive aspects of my situation to manage
my moods and behaviors. I thought about the fact we are trying
to have a baby, I thought about people like [states name of a
friend] who have to do this for health reasons.
Table 2.
Correlation between emotion and emotion regulation strategies.
Partner Partner’s emotion
Increase the intensity of
own pleasant emotions
Increase the intensity of partner’s
pleasant emotions
Increase the intensity of partner’s
unpleasant emotions
1 Own emotion .29* .39* .48* .10
Partner’s emotion .16 .21 .16
2 Own emotion .58* .51* .16 .20
Partner’s emotion .33* .33* .14
Note: *p < .01
Table 3.
Stressors associated with IVF.
Raw data example Higher order theme General dimension
“They are hopeless at guiding us through the process and letting us know what to expect” Treatment management
“She sees a bruise and tells me I am injecting on the wrong place,
this is where the other nurse told me to inject” Hospital staff communications
“Others are called in pairs, the female and male partner, I am slightly annoyed that yet again they just
call for me and I have to introduce [partner] again and explain why she is there” Hospital support
“If it’s still there they will abort the IVF (no refund of approx 70% fees)” Finances
“Within the last 11 months I’ve spent around five months on IVF treatments and 8 weeks
waiting to find out if we’re pregnant. This has been a huge commitment in terms of time” Time
“I find myself monitoring physical symptoms” Heightened awareness
“Implantation eve and just not knowing if they will defrost okay and not
wanting any to be damaged makes me anxious” Fears
“I feel totally out of control in this process now” Perceived control
Inter-Personal Emotion Regulation
Table 5 presents strategies used to regulate partners emo-
tions (inter-personal). As with intra-personal strategies, the
focus of strategies for regulating unpleasant emotions was to
attenuate unpleasant emotions whereas the intention of strate-
gies for regulating pleasant emotions was to create, maintain or
increase pleasant emotions. It was apparent that where possible,
strategies were selected based upon their perceived suitability
for the context and to match partners preferences for emotion
The following excerpts evidence inter-personal emotion re-
gulation strategies selected for their known efficacy in relation
to partner preferences or for their perceived suitability for the
context in which they were used:
Partner 2: [Partner] does use and respond to humor... If I can
make a joke out of something where appropriate it does work.
Partner 1: When I got home from work yesterday I found
[Partner] v ery upset as shes been getting symptoms which may
indicate that the IVF hasnt worked. I tried to comfort her; I
didnt want her to get too distraught and wanted her to stay
Table 4.
Intra-personal regulation of unpleasant and pleasant emotions resulting from IVF.
Raw data example Higher order theme General dimension
“I called NHS direct as the internet listed lots of possible reasons and I wanted to be sure” Seeking support
“Try and focus on the positives instead” Positive thinking
“I try not to think about it and concern myself with it” Cognitive avoidance/distraction
“I spent the day clearing out my wardrobe for charity and tidying as a distraction” Behavioral avoidance/distraction
“I felt a little unwell in the evening, and hope it is simply to do with the treatment” Re-appraisal
“I tried to think of nice things I would do to make myself feel better if this does not work” Thinking about nice things
“We had agreed to do lunch as a post injection treat” Treats
“I have a routine that is intended to manage the pessaries which are really not pleasant” Routines
“Trying to think of ways of managing negative moods... hence buying the bike before it all starts”Exercise
“We took a photo of the test stick and e-mailed it to our parents and siblings” Sharing positive experiences
“Focus on the positives” Positive thinking
“I ignored partners mood largely and just got on with things
so I was able to prevent her bad’ mood from influencing me in any way” Cognitive avoidance/ distraction
“Spent time reading and chilling out” Relaxing
Table 5.
Inter-personal regulation of unpleasant and pleasant emotions resulting from IVF.
Raw data example Higher order theme General dimension
“I focussed on helping her feel better” Providing emotional support
“I pointed out solutions to resolving the anger” Providing practical support
“She agreed I had put her in a bad mood... I did notice after this talk her mood got much better
quickly” Talking about emotions
“I told her some gossip from the street which would make her laugh, I could see [partner] de-stressing
which was good” Using humor
“I encouraged her to ride and spent time with her whilst she did because I knew she would enjoy this
and I was aware that she was feeling frustrated”
Facilitate activities known to
enhance emotions
“I suggested that this was all the more reason to enjoy relaxing and just being at home. This was in an
attempt to get her to re-appraise the situation” Encourage re-appraisal
“I tried to put her mind at rest by saying ‘no news’ in good news” Encourage positive thinking
“I'm trying to look after [partner] as much as possible and avoid any disputes, even trivial ones” Avoiding confrontation
“I was conscious of hiding my tension when she first got home so not to contaminate her good mood”Hiding own emotions
“I knew [partner] would enjoy cycling yesterday” Facilitate activities associated with
pleasant to emotions
“I did her hair while we watched a film” Pampering
“We both felt very lucky over the weekend and this helped with positive mood” Conscious appreciation
Copyright © 2013 SciRes. 29
positive. Im inclined to think positive until I know otherwise
but its easy for me to say that when its not me having the
treatment. [Partner] was very tearful most of the night and was
probably wondering why I wasnt equally upset. I just contin-
ued to try and take her mind off things.
The first excerpt highlights the conscious use of strategies
relative to partner preferences, whereas in the second example,
there was a clear lack of control over treatment outcome. As
such, the inter-personal strategies selected were to encourage
positive thinking, comforting and the use of distraction from
the stressors.
An observation made by participants regarding the recogni-
tion and regulation of emotions was that the process maintain-
ing a daily mood diary increased awareness of actions and con-
sequences. It also facilitated the early recognition of emotional
changes and timely regulatory efforts to maintain desired states.
These consequences are evidenced in the following excerpts:
Partner 1: This questionnaire makes me very mindful of what
Im writing but also mindful of my actions throughout the day. I
think this is a good thing because I can be selfish and fail to
contemplate other peoples perspective on things until its too
Partner 2: Today and yesterday afternoon was most definitely
my most difficult day in terms of sadness, worry and anxiety.
Completing this diary has made this more overt and as such I
have acted more quickly at times to try and manage these
These findings highlight the potential benefits of daily mood
diaries for participants.
The present study explored stressors, emotional responses
and emotion regulatory strategies used in relation to partner and
self in a lesbian couple undergoing IVF. Both partners ex-
pressed a strong desire to have children and self-funded the
relatively high treatment cost of IVF. In terms of the question,
is one partner happier than the other? Quantitative results indi-
cated no significant differences between emotion data. Previous
research has found that women undergoing IVF experience
intense unwanted emotions (Peddie et al., 2005; Van den
Broeck et al., 2009). A possible explanation for this result is
that partners in the present study did not find IVF to be a
stressful experience. However, daily-diary results indicated
both partners experienced frequent stressors stemming from in-
teractions with medical staff, the course of treatment and the
communication of information. As Ta b le 3 indicates, stressors
were clustered into three broad categories of hospital, tangible
and perceptual stressors. The illustrative quotes provided dem-
onstrate how the clear and highly meaningful personal goal of
having children impacted upon participants stress appraisal,
emotions and subsequent coping processes (Carver, 2004; La-
zarus, 1999). Participants monitored events in relation to this
goal, and experienced unpleasant emotions such as worry or
anxiety, a finding consistent with notion that stress and emotion
are inextricably linked (Lazarus, 1999, 2000). Consistent with
the findings of Parkinson and Simons (2012) data indicate that
by expressing worry or anxiety the individuals partner was
alerted to a potential concern and this prompted the provision of
emotional support. Participants engaged in a great deal of emo-
tion regulation intended to increase pleasant emotions (Niven et
al., 2009), hence suggesting that regulation strategies were
implemented relatively early in the process (Webb, Miles et al.,
2012), otherwise intense unpleasant emotions would be evident.
Consistent with previous research, both participants per-
ceived a lack of control regarding aspects of IVF treatment (e.g.,
support offered by the hospital, responses to treatment). This
perceived lack of control was found to be an antecedent of in-
creased stress levels and intense unpleasant emotions (Jerusa-
lem & Schwarzer, 1992; Terry & Hynes, 1998). For example,
participants perceived the treatment schedule to be unclear in
terms of what medication to take, when to take it, and for how
long, even though the importance of adhering to the schedule
was emphasized by medical staff. This uncertainty and associ-
ated consequences produced a high degree of threat along with
a reduced sense of control (Lazarus & Folkman, 1984; Mendes,
Blascovich, Hunter, Lickel, & Jost, 2007). This resulted in a
corresponding increase in unpleasant emotions, particularly
anxiety and anger, hence indicators of the unpleasant emotions
reported in previous literature (Peddie et al., 2005; Van den
Broeck et al., 2009). When participants were unable to clarify
the treatment schedule, they used strategies including avoidance,
distraction and positive thinking to regulate these unpleasant
emotions. However, in this instance, hospital staff might have
engendered greater perceptions of control by clarifying the
treatment plan from the outset and explaining where deviations
in treatment might occur (e.g., as a result of responses to treat-
ment). In turn, this might have alleviated some of the stressors
and unpleasant emotions perceived by both participants. In-
creasing control where possible, and enhancing the ability to
regulate emotions where there is, and more importantly is not
control over events, might prevent or reduce stress and help
regulate unpleasant emotions.
In contrast to the daily diary data that clearly evidenced
stressors and unpleasant emotions, questionnaire data indicated
that participants reported feeling pleasant emotion states during
the treatment process. Reconciliation of these results is ex-
plained by daily diary data that show each participant used re-
appraisal strategies, which have been found to regulate emo-
tions before they intensify (Gross & Thompson, 2007; Webb,
Miles et al., 2012; Webb, Schweiger et al., 2012). Having ex-
plored some of the key stress perceptions and associated emo-
tions, the questionnaire data allows an examination of emo-
tional states and the influence of detection errors on strategies
used to regulate emotion (Niven et al., 2009, 2011).
Questionnaire results demonstrate both partners made esti-
mation errors in rating their partner’s emotion. As Table 1
shows, partner 1 tended to over-estimate her partner’s pleasant
emotions, whereas partner 2 under-estimated her partner’s plea-
sant emotions. Previous research has found evidence for indi-
vidual differences in the ability to detect emotions in others
(Petrides et al., 2009). Tabl e 2 indicates that in both partners,
the relationship between their own emotion and the perceived
emotion of their partner correlated positively; in short, they
indicated that if I feel happy, then I believe you do also. How-
ever, it is worth examining this relationship alongside the direc-
tion error.
Partner 1 perceived her partner to be feeling in a more
pleasant emotional state than her own self-rating, however cor-
relation results indicate that it was her own emotions which
correlated to usage of regulation strategies, rather than her part-
ners. Partner 1 tended to use regulation strategies to increase
the intensity of her own and partners’ pleasant emotions when
she felt in a pleasant emotional state; the happier she felt, the
Copyright © 2013 SciRes.
more she used strategies to increase pleasant emotions in her-
self and her partner (Niven et al., 2012). These strategies used
to maintain her own and partner’s pleasant emotion are desir-
able for the couple because partner 1 seeks to maintain pleasant
emotions where pleasant emotions are present. In contrast,
partner 2 reported using strategies to increase her own emotion
and her partner’s emotions when she felt in an unpleasant emo-
tional state or perceived unpleasant emotional state in her part-
ner. When these results are seen in the context of a dyadic rela-
tionship, partner 2, uses emotion regulation strategies to in-
crease pleasant emotions when unpleasant emotions are de-
tected, whereas partner 1 seeks to maintain pleasant emotional
states. Thus, the interaction between emotions and emotion re-
gulation strategies used were complementary, and reduced the
likelihood of either partner sustaining an unpleasant emotion.
We propose that examining the combination of emotion and
emotion regulation profiles in dyadic relationships will contrib-
ute to a better understanding of inter-personal and intra-per-
sonal emotion regulation. In doing so, it may be possible to
predict where dyadic emotion regulation may be effective and
ineffective relative to the attainment of desired emotional states.
It may then be possible to propose suitable interventions to
enhance dyadic emotion regulation.
Qualitative data indicate that an apparent perception under-
pinning many of the strategies identified for regulating own and
others emotions was a perceived lack of control over events
(see Tables 3-5). This was evident not only by explicit refer-
ence to a lack of control, but also by the strategies identified for
emotion regulation. Intra-personal emotion regulation strategies
were clustered under three broad categories of cognitive, be-
havioral and social strategies. Within the specific strategies
identified there was a dominance of strategies focused on dis-
traction, avoidance, and positive thinking (see Tab le s 4 and 5).
Such strategies are focused on creating psychological distance
from the stressor or managing the appraisal of events rather
than addressing the circumstances producing the emotions. In
accordance with previous literature, this would seem suitable
for stressors perceived to be beyond control (Lazarus, 1999,
2000). Inter-personal regulatory strategies also demonstrated an
alignment with a perceived lack of control but, in addition, ap-
peared to take into conscious consideration partner’s prefer-
ences for emotion regulation.
We contend that the mixed method daily diary design offers a
strength within the present study as it facilitates a comprehen-
sive and timely collection of data pertaining to those stressors,
emotions and regulatory strategies associated with IVF treat-
ment. The quantity and quality of data captured within this case
study design might not be possible within large sample cross-
sectional studies. When exploring intra-personal and inter-per-
sonal emotion regulation, a mixed-methods approach enabled
meaningful conclusions to be drawn from the data. Although
quantitative data evidenced the use of strategies intended to
regulate pleasant emotions experienced by self and partner,
qualitative data indicated that this regulation occurred in the
early stages of emotion detection. The conscious monitoring of
emotion and associated regulation required in order to record
daily emotion diary entries appeared to facilitate the early rec-
ognition and regulation of unpleasant emotions thereby pre-
venting these emotions from intensifying further or enduring
for longer. It appears that writing about stressful or emotional
events not only helped to acknowledge the associated emotions
(Baikie & Wilhelm, 2005; Pennebaker & Francis, 1996), but
also enabled an understanding of the events and the associated
requirements for emotion regulation, thereby lessening inhibi-
tion and rumination (Pennebaker, 1985).
The effective regulation of unpleasant emotions is described
in the quantitative and qualitative data. Quantitative data indi-
cates that both partners maintained a relatively pleasant emo-
tional state during the treatment process and as such unpleasant
emotions must have been transient. Qualitative data clearly
identifies a plethora of strategies intended to regulate emotions,
and offers an indication of the efficacy of these in the qualita-
tive excerpts and tables (3-5) provided. Based on these findings,
we contend that the process of maintaining a daily emotion
diary, which should prompt reflection, in itself offers an inter-
vention that might be utilized to enhance emotion awareness
and regulation during IVF treatments, or indeed any emotive
event (Frattaroli, 2006; Pennebaker, Colder, & Sharp, 1990).
A limitation of present study is the generalizability of find-
ings. We acknowledge that the use of a participant researcher
may be perceived as both a desirable and undesirable aspect of
the method. Both partners were motivated to provide honest
and open accounts of the IVF experience. However, it might be
perceived as a limitation because it may be suggested that the
participant-researcher is unconsciously reinforcing her own bias
in the interpretation of data. Attempts were made to minimize
this limitation by adhering to guidelines advocated when un-
dertaking researcher self-enquiry (Denzin, 1997; Denzin &
Lincoln, 2005). This included the second author taking the lead
in data interpretation.
In conclusion, the present study harnessed the advantages
offered by a mixed methods case study design to capture stress
perceptions, emotions and emotion regulation of self and part-
ner prior to, during and post IVF treatment in a female couple.
The rich data highlighted the emotive nature of fertility treat-
ments largely resulting from the importance of the goal to pro-
duce children and the lack of control over treatment outcomes.
In a seemingly novel contribution to the emotion regulation
literature, this study demonstrated that perceptual errors from
both participants regarding their partner’s emotions may have
inadvertently contributed to the successful management of un-
pleasant emotions. Partner 2 underestimated partner 1’s pleas-
ant emotions, whilst partner 1 overestimated partner 2’s pleas-
ant emotions. The regulatory disposition of partner 1 was to use
strategies intended to maintain pleasant emotions. Partner 2 was
disposed to eliminate or attenuate unpleasant emotions. These
regulatory dispositions therefore appear to complement one an-
other and we would argue contribute to the successful regula-
tion of emotions experienced to a more desired state.
Based on the findings presented we offer the following rec-
ommendations for practitioners. First, health care providers
engaging in direct contact with recipients of assisted conception
treatments should endeavour to keep patients informed of the
treatment plan and changes to the schedule. Frequent opportu-
nities should be presented for patients to seek clarification and
reassurance. We propose that such actions might help patients
gain greater clarity regarding treatment and more confidence in
their control of known stressors. Second, in order to assist pa-
tients in managing treatment stressors and resultant emotions,
patients should be appropriately counselled and informational
resources provided on strategies associated with the effective
regulation of stressors and unpleasant emotions. As evidenced
in the present study, daily emotion diaries might in themselves
present an emotion regulation intervention to those undertaking
Copyright © 2013 SciRes. 31
assisted conception treatments. This might help raise awareness
of unpleasant emotions and the efficacy of strategies intended
to regulate them. In conjunction with the counselling and pro-
vision of informational resources, this might further enhance
patients’ confidence in their ability to manage treatment stress-
ors and resultant emotions. In doing so, should the treatment be
unsuccessful, the individuals concerned might be more inclined
to engage in further treatments. This is important as research
indicates that many individuals choose to cease fertility treat-
ments after a single failed attempt (Peddie et al., 2005).
The support of the Economic and Social Research Council
(ESRC) UK is gratefully acknowledged (RES-060-25-0044:
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