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Work & Stress: An International Journal

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Emotional labour and emotional

exhaustion: Interpersonal and
intrapersonal mechanisms
a b a
David Martínez-Iñigo , Peter Totterdell , Carlos M. Alcover &
b
David Holman
a
Faculty of Communication Science , University Rey Juan Carlos ,
Spain
b
Institute of Work Psychology , University of Sheffield , UK
Published online: 26 Mar 2007.

To cite this article: David Martínez-Iñigo , Peter Totterdell , Carlos M. Alcover & David Holman
(2007) Emotional labour and emotional exhaustion: Interpersonal and intrapersonal mechanisms,
Work & Stress: An International Journal of Work, Health & Organisations, 21:1, 30-47, DOI:
10.1080/02678370701234274

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 Work & Stress, January
March 2007; 21(1): 30
47

Emotional labour and emotional exhaustion: Interpersonal

and intrapersonal mechanisms

DAVID MARTÍNEZ-IÑIGO1, PETER TOTTERDELL2,

CARLOS M. ALCOVER1, & DAVID HOLMAN2
1
Faculty of Communication Science, University Rey Juan Carlos, Spain, and 2Institute of Work
Psychology, University of Sheffield, UK
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Abstract
In some occupations, particularly in the service sector, dealing with patients or clients may require an
employee to pretend to have emotions that they do not really have, or to actually experience required
emotions. The regulation of emotion can be either automatic or controlled. This study extends
research on the consequences and processes of emotional labour in two ways. First, it examines how
the use of different emotion regulation strategies with patients relates to doctors’ emotional
exhaustion. Second, it tests two mechanisms that may explain those relationships. A survey of 345
general practitioners (GPs) working in a large urban community in Spain was conducted for the study.
Based on Côté’s (2005) social interaction model, GP satisfaction with the responses of their patients
was tested as a potential interpersonal mediator between their use of automatic, surface, and deep
emotion regulation strategies and their emotional exhaustion. Psychological effort was tested as a
potential intrapersonal mediator in the same pathway. Regression analysis indicated that emotion
regulation was negatively associated with GP emotional exhaustion when it was performed
automatically, but that it had a positive and a neutral association when it was performed using
surface and deep acting respectively. The mediating role of interpersonal and intrapersonal factors
helped explain the differential associations between the GPs’ emotion regulation strategies and their
emotional exhaustion.

Keywords: Emotional labour, emotional regulation, primary care, doctors, well-being, emotional
exhaustion, work-related stress

Introduction
Emotional displays have been identified as an important requirement in an increasing
number of jobs due to their role in influencing work-related outcomes for employees and
organizations (Ashkanasy & Ashton-James, 2005; Brotheridge & Grandey, 2002).
Organizations have explicit and implicit display rules that govern employees’ emotional
expressions in order to influence clients’ feelings (e.g., satisfaction), attitudes (e.g., loyalty),
and behaviours (e.g., hiring a service); and thereby improve organizational outcomes
(Cropanzano, Weiss, & Elias, 2004; Grandey, Fisk, Mattila, Jansen, & Sideman, 2005;
Hochschild, 1983; Pugh, 2001; Rafaeli & Sutton, 1991; Taylor, 1998; Tsai, 2001). When
employees’ feelings do not meet the organization’s display rules, complying with those rules

Correspondence: David Martı́nez-Iñigo, Department of Social Science, University Rey Juan Carlos, Paseo
Artillerros s/n Madrid, Spain. E-mail: david.martinez@urjc.es

ISSN 0267-8373 print/ISSN 1464-5335 online # 2007 Taylor & Francis

DOI: 10.1080/02678370701234274
 Emotional labour and emotional exhaustion 31

requires that they engage in emotion regulation aimed at aligning their emotional display
with the emotional requirements of the job role. Emotion regulation refers to the automatic
or controlled processes by which individuals influence different dimensions of their
emotions (Gross, 1998). The ‘‘effort, planning, and control’’ demanded by such emotion
regulation defines emotional labour (Morris & Feldman, 1996, p. 987). Besides having
consequences for the organization, emotional labour also has consequences for the
individual; and of particular interest has been the finding that emotional regulation can
have positive and negative effects on employee well-being (Bono & Vey, 2005; Zapf & Holz,
2006).
Of the different facets of emotional labour studied, the type of emotion regulation
involved emerges as a key determinant of the nature of the relationship between emotional
labour and employee well-being (Grandey, 2000). However, most research has ignored one
common type of emotion regulation, namely that performed in an automatic way
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(Diefendorff, Croyle, & Gosserand, 2005), and has tended to concentrate on more
controlled forms of emotional regulation, normally labelled as deep and surface acting.
Furthermore, little is known about the mechanisms relating emotion regulation to employee
well-being (Côté, 2005).
The present study therefore had two aims. First, it examines the relationship between
automatic and controlled emotion regulation strategies and emotional exhaustion. Second,
it examines whether an interactional mechanism (employees’ satisfaction with clients’
responses) and an intrapersonal mechanisms (psychological effort) mediates the relation-
ships between emotion regulation strategies and emotional exhaustion. Figure 1 presents
our model for the relationships we expect among the emotion regulation strategies,
interpersonal and intrapersonal mediators variables, and emotional exhaustion.
All of the relationships that we have hypothesized apply to situations where emotional
requirements correspond with display rules demanding expression of positive emotions and
suppression of negative ones. We assumed these were the dominant rules for our sample
based on previous results (Martı́nez-Íñigo, Totterdell, Alcover, & Holman, 2006). If
emotional requirements are different to those studied here (e.g., negative emotions must be
displayed) then the valence of relationships between variables may also be different. Next
we explain why we expect these relationships.

Emotion regulation and emotional exhaustion

Since the first explicit definition of emotional labour by Hochschild (1983), the very fact
that employees regulate their emotions in exchange for a wage has been identified as a

Automatic regulation +
-
Satisfaction with patients
-
- Emotional
Surface acting + exhaustion
+
+ Psychological effort
+
Deep acting

Figure 1. Proposed intra- and inter-personal mediational mechanisms in the relationship between emotion
regulation and emotional exhaustion.
 32 D. Martı́nez-Iñigo et al.

potential risk to their well-being (Callahan & McCollum, 2002). Most research has
examined the effects of controlled emotion regulation strategies on well-being. In particular
it has focused on the effects of deep acting strategies (changing inner feeling states in order
to display the appropriate emotions) and surface acting strategies (displaying emotions that
are not experienced) on one facet of well-being, emotional exhaustion.
However, even though Hochschild (1983) described a form of unconscious emotion
regulation known as ‘‘passive deep acting’’ as one means of performing emotional labour,
and although Ashforth and Humphrey (1993) pointed out that in many cases emotional
labour involves employees’ spontaneous emotional reactions, research has largely focused
on conscious controlled emotion regulation. More recently however Zapf (2002) has used
action theory to describe a third way of performing emotion labour known as automatic
regulation . Automatic regulation is the automatic display of an organizationally desired
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emotion deriving from an emotion that is spontaneously felt. Diefendorff et al. (2005) have
subsequently confirmed the existence of naturally felt emotion as a third emotion regulation
process distinct from surface and deep acting and from dispositional variables such as
neuroticism and extraversion.
To date, there has been no empirical research on the relationship between automatic
emotion regulation and emotional exhaustion (or on other measures of well-being) but we
expect them to have a negative relationship when the organizational role requirement is for
employees to express positive emotions. Our rationale for this is based on the intervening
influence of an intrapersonal and an interpersonal mechanism (explained further in the next
section). First, automatic regulation is an unconscious strategy and will therefore entail a
low level of intrapersonal psychological effort, and second it involves displaying authentic
(positive) emotions and will therefore elicit positive interpersonal responses from clients.
A negative relationship with emotional exhaustion is therefore hypothesized.

Hypothesis 1a. Automatic regulation will be negatively associated with emotional exhaus-
tion.
Two other emotion regulation strategies have been described in the literature: surface
acting and deep acting. The first one deals with the mismatch between emotional
experience and display rules by altering the expression of an emotions and leaving inner
feeling unchanged (e.g., a fake smile to an abusive patient). Deep acting involves active
regulation too; however it is focused on the antecedents of emotions in an effort to prevent
inappropriate emotions developing and to promote emotional experiences aligned with
display rules (Grandey, 2000).
Empirical studies have demonstrated that surface and deep acting are positively related to
emotional exhaustion, with surface acting generally exhibiting a stronger association. Other
studies, however, have found deep acting to be unrelated to emotional exhaustion (c.f.
Brotheridge & Grandey, 2002; Brotheridge & Lee, 2003; Glomb & Tews, 2004; Grandey,
2003; Kruml & Geddes, 2000; Totterdell & Holman, 2003). We expected surface acting to be
positively associated with emotional exhaustion because it is a conscious controlled strategy
and will therefore entail higher levels of psychological effort, and because it involves
displaying inauthentic emotions and will therefore elicit more negative responses from clients.

Hypothesis 1b. Surface acting will be positively related to emotional exhaustion.

In accordance with the findings of some previous studies for deep acting (Grandey, 2003;
Totterdell & Holman, 2003), we do not expect a significant relationship between deep
 Emotional labour and emotional exhaustion 33

acting and emotional exhaustion, when the organizational role requirement is for employees
to express positive emotions.

Emotion regulation: Interpersonal mechanisms

Despite evidence showing the relationship between emotion regulation strategies and
emotional exhaustion, little research has been conducted on the mechanisms by which
emotional labour affects employees’ well-being (Côté, 2005; Grandey et al., 2005).
According to Côté (2005), earlier explanations rely exclusively on the intraindividual
consequences of emotion regulation, such as psychological effort and emotional dis-
sonance. A core dimension of emotion (its relational nature) has therefore been missed.
Côté argues that, as a result of this omission, models are unable to account for emotional
labour’s positive effects of on employee well-being. For instance, despite being effortful, the
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amplification of positive emotions has been associated with lower levels of strain (Adelman,
1995; Côté & Morgan, 2002), and emotion regulation effort has been found to be positively
related to personal accomplishment (Kruml & Geddes, 2000).
Defining emotions as a relational phenomenon means they convey information about the
intentions of the participants and provide an assessment of social relationships (Ekman,
2003; Keltner & Kring, 1998). When services are delivered, employees’ emotional
expression is one of the variables shaping clients’ evaluation of the social interaction.
Pugh (2001) found that the reaction of clients to positive emotion displays by employees
was positively associated with clients’ positive affect and their evaluation of service quality.
A similar positive relationship was found between employees’ display of positive emotions
and customers’ positive attitudes towards the organization (Tsai, 2001).
Hence, differences in the emotional displays of employees affect clients’ assessment of the
service interaction and hence how they respond; and employees’ evaluation of their clients’
response influences their own behaviour and well-being (Côté, 2005; Rafaeli & Sutton,
1989). According to Côté’s social interaction model, the client’s response to the employee’s
emotional display mediates the relationship between emotion regulation strategies and well-
being.
However, the expression of appropriate emotions does not guarantee a positive response
from clients because individuals are able to discriminate fairly accurately between truly felt
expressions and false ones (Ekman, Friesen, & O’Sullivan, 1988), and clients expect
genuine concern for their needs. Authenticity is considered to be a key factor in the client’s
assessment of the employees’ emotional display (Ashforth & Humphrey, 1993). Grandey
et al. (2005) found evidence that authentic emotional displays by employees enhance
clients’ perceptions of friendliness and satisfaction. It is assumed that higher levels of
perceived friendliness and satisfaction will produce a more positive response from clients
(Côté, 2005).
Automatic regulation, as a strategy operating on naturally felt and hence authentic
emotions, may therefore be a key element in explaining why emotional labour can have a
positive impact on client satisfaction and employee well-being. Specifically, we expect that
employees who use automatic regulation will produce a positive response from clients that
will increase their satisfaction with interactions with patients and will therefore enhance
their well-being. In other words, we expected the relationship between automatic regulation
and emotional exhaustion to be mediated by professionals’ assessment of their relationship
with clients (interpersonal consequences). But as interindividual consequences do not
preclude the effects of intraindividual processes on emotional exhaustion (Côté, 2005), we
hypothesized the mediation to be partial.
 34 D. Martı́nez-Iñigo et al.

Hypothesis 2a. Employees’ satisfaction with interaction with clients will partially mediate the
negative relationship between automatic regulation and emotional exhaustion.
Customers and clients can distinguish between authentic and inauthentic emotional
behaviour, and rate authentic displays of positive emotion more highly (Grandey et al.,
2005; Hennig-Thurau, Groth, Paul, & Gremler, 2006). Since surface acting induces faked
emotional displays, we expected satisfaction with interaction with clients to partially
mediate the positive relationship between surface acting and emotional exhaustion.

Hypothesis 2b. Employees’ satisfaction with interaction with clients will partially mediate the
positive relationship between surface acting and emotional exhaustion.
A significant relationship between deep acting and emotional exhaustion was not
expected, so mediational effects are not hypothesised. However, a positive relationship
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between deep acting and satisfaction with interaction with clients is expected. This
association was expected because this strategy promotes more authentic emotional displays
(Grandey, 2003).

Emotion regulation: Intrapersonal and interpersonal mechanisms

The regulation of emotion requires effort and leads to the resources used for mental control
being depleted (Muraven & Baumeister, 2000). Psychological effort has therefore been
proposed as the intrapersonal mechanism through which emotional regulation has effects
on employee well-being. Nevertheless, every strategy demands a different level of
psychological effort. According to Zapf’s (2002) definition, automatic regulation involves
only the sensorimotor level of action regulation and therefore requires very little effort. In
contrast, surface and deep acting, as non-automatic processes, are more psychologically
taxing, with surface acting requiring more effort than deep acting. This is because dealing
with ongoing emotions, as occurs during surface acting, demands more effort than
preventing the development of emotions still not fully under way, as occurs during deep
acting (Kanfer & Kantrowitz, 2002). Suppressing experienced emotions, as occurs during
surface acting, is also more taxing than regulating the antecedents of emotions, as occurs
during deep acting (Richard & Gross, 2000). So psychological effort was tested as a
mediator in relationships between automatic regulation, surface acting, and emotional
exhaustion.

Hypothesis 3a. Employees’ psychological effort will partially mediate the negative relation-
ship between automatic regulation and emotional exhaustion.

Hypothesis 3b. Employees’ psychological effort will partially mediate the positive relationship
between surface acting and emotional exhaustion.
Social relations have been shown to be an important way of recovering resources spent in
emotion regulation (Brotheridge & Lee, 2002). So in the light of the different effort levels
and client responses thought to be associated with the different regulation strategies, we
speculated that the differential effects of emotion regulation on emotional exhaustion were
likely to be the consequence of the combined influence of the intra- and interpersonal
mechanisms. The mediating effects of inter- and intrapersonal mechanisms were therefore
tested together. With respect to automatic regulation, the anticipated negative relationship
with emotional exhaustion is explained both in terms of higher satisfaction with interaction
with patients, due to clients responding more positively to employees’ emotional displays,
and in terms of automatic regulation requiring very little psychological effort.
 Emotional labour and emotional exhaustion 35

Hypothesis 4a. Psychological effort and employees? satisfaction with interaction with their
clients together will fully mediate the negative association between automatic regulation and
emotional exhaustion.
Applying the same rationale described above to surface acting, it was expected that the
two mediating mechanisms would explain the relationship between surface acting and
emotional exhaustion.

Hypothesis 4b. Psychological effort and employees? satisfaction with interaction with their
clients together will fully mediate the positive association between surface acting and
emotional exhaustion.
For deep acting, we expected the two mechanisms to have a compensatory influence. On
the one hand, deep acting involves a certain amount of cognitive effort in order to regulate
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emotional experience, even if that involves less effort than required by surface acting. But
on the other hand, it should also elicit more positive response from clients because the
emotional display will be authentic. Consequently, no overall significant relationship with
emotional exhaustion was expected for deep acting, and mediation is not hypothesised.
However, positive relationships between deep acting and both satisfaction with interaction
with clients and psychological effort would provide indirect evidence for this account. The
same kind of counteracting effect has been previously proposed for deep acting in relation
to its reduction of emotional dissonance and increase of psychological effort (Grandey,
2003).

Emotional labour in healthcare workers

Working with people, especially when they are suffering or ill, is likely to involve a significant
amount of emotional labour. Healthcare professionals are frequently required to regulate
their own and their patients’ emotions, for example whenever they have to reduce patients’
anxieties or perform an unpleasant procedure (Phillps, 1996; Smith & Kleiman, 1989).
Healthcare organizations have therefore been a common setting for studying emotional
labour (Mann, 2005). Several aspects of emotional labour have been investigated using
different occupational healthcare groups, including physicians (Locke, 1996), nurses (De
Castro, 2004; Smith, 1992), and medical social workers (Nelson & Merighi, 2003).
The present study was conducted in primary health care centres located within the public
health system of a large urban community. Healthcare delivery in primary health is
influenced by a bio-psycho-social framework which stresses the importance of professional

patient relationships in the process of caring. Primary care in the public health service is also
proximal to the community, and hence complaints from patients are treated seriously by
management, and patient satisfaction is considered to be important. This means that
primary healthcare professionals are expected to deliver ‘‘humane’’ personal care and thus
display rules mainly prescribe the expression of positive emotions, empathy, and the
suppression of negative emotions towards patients (Martı́nez-Íñigo et al., 2006). All these
characteristics enhance the relevance of emotion regulation as part of the job role in primary
care services. Understanding the positive and deleterious effects of emotion regulation
strategies on the well-being of healthcare professionals therefore has practical as well as
theoretical implications.
 36 D. Martı́nez-Iñigo et al.

Method
Participants and procedure
Participants were 345 general practitioners (GPs) from a total population of 514 working in
primary health care teams from two different health areas of a large urban community. Of
the participants, 228 were female (66%). The mean age of the participants was 41 years old
(SD 7.2). Employees had an average organizational tenure of 6.8 years (SD 6.5), all of
them working full-time (35 hours per week). The sample was composed of participants
working on morning (44%), evening (55%), or alternately morning and evening (1%)
shifts.
The health care teams were distributed in 40 primary health care centres. In order to
increase response rates, data were collected in person in each primary health care centre by
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one of the members of the research team. Each centre was composed of two different teams,
one working on the morning and the other on the evening shift.
Data collection took place in 2003 over a 3-month period. A time period of ‘‘normal’’
activity was selected to avoid data reflecting unusually high pressure (e.g., vaccination
campaigns) or unusually high conflict (e.g., performance assessment). The survey was
administered in the 1-hour period between shifts, usually used for training purposes, team
meetings, or clinic sessions. Attendance at the survey session was voluntary. The study was
presented as an investigation of the role and consequences of managing one’s own or others’
emotions during primary health care delivery. Participants were informed that an
independent institution was conducting the study, participation was voluntary and that
information given would be anonymous. Questionnaires were completed during the session.
The response rate was 67%. Participation in the different centres ranged from 35% to
100%, with the exception of one centre where it was only 10%.

Measures
Emotion regulation strategies. Participants were asked to rate to what extent they comply with
displays rules through one of three strategies. The surface acting scale was a 5-item scale.
Three items were drawn from Brotheridge and Lee’s (1998) Emotional Labour Scale (ELS;
e.g., ‘‘You pretend to have emotions that you don’t really have’’) and two items were
developed for the present study (e.g., ‘‘To be effective in your job you display the emotions
required, even though they do not agree with your true feelings’’). Deep acting was
measured with three items from Brotheridge and Lee’s ELS Scale (e.g., ‘‘You try to actually
experience the emotions you must show’’) and two items developed for the present study
(e.g., ‘‘You try to match up your inner feeling with the emotional display demanded by the
interaction with patients’’). There were no available scales for automatic regulation at the
time of investigation, so a 4-item scale was developed for the present study. Participants
rated to what extent their emotions ‘‘match up with what an efficient interaction with
patients demands,’’ ‘‘automatically meet job requirements,’’ ‘‘fit with job demands,’’ and
‘‘spontaneously coincide with requirements from the interaction with patients.’’ All items
were rated by participants on a 5-point response scale ranging from 1 (never) to 5 (very
often). The internal consistency reliabilities for these scales were a .73 for surface acting,
a .69 for deep acting, and a .72 for automatic regulation. An exploratory factor analysis
using principal factor extraction with promax rotation confirmed a three-factor structure
corresponding with the three emotion regulation strategies and accounted for 52.6% of the
total variance. All surface acting items loaded above .55 on the first factor, all deep acting
 Emotional labour and emotional exhaustion 37

items loaded above .51 on the second factor, and all automatic regulation items loaded
above .68 on the third factor. One surface acting item cross-loaded (
.30) onto the deep
acting factor, and one deep acting item cross-loaded (
.30) onto the automatic regulation
factor.

Satisfaction with interaction with patients. This scale consisted of two items from Bravo, Peiró,
and Zurriaga’s (1991) Work Satisfaction Module Questionnaire for Health Professionals.
A sample item was, ‘‘To what extent are you satisfied with the attitudes, dispositions and
usual behaviour of patients in the surgery?’’ Responses were made on a 7-point scale
ranging from 1 (very unsatisfied) to 7 (very satisfied). Internal consistency reliability for this
scale was a .73.
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Psychological effort. The effort involved in emotion control uses resources that could be
allocated to other forms of mental control (Muraven & Baumeister 2000; Muraven, Tice, &
Baumeister, 1998). High levels of effort to control emotions should therefore interfere with
the execution of other tasks. Psychological effort was therefore assessed by a 2-item
measure about the extent to which emotion regulation interferes with other job tasks.
A sample item was, ‘‘Meeting emotional display rules impairs my performance on other
tasks.’’ The measure used a 5-point response scale ranging from 1 (never) to 5 (very often).
Internal consistency reliability for this scale was a .45.

Emotional exhaustion. This was measured using the Spanish version (Seisdedos, 1997) of the
Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996). The scale includes nine
items, for example ‘‘I feel emotionally drained from my work.’’ The measure used a 7-point
response scale ranging from 0 (never) to 6 (every day). Internal consistency reliability for
this scale was a .90.

Control variables. The work conditions that characterized primary health care settings meant
that a number of other job factors needed to be taken into account within the investigation.
They were, specifically, those associated with interaction with patients, autonomy, and
sources of positive feedback other than from patients. Previous studies have found that
workload can affect employees? emotional displays and impact on client’s responses
(Grandey et al., 2005; Rafaeli, 1989; Rafaeli & Sutton, 1989; Sutton & Rafaeli, 1988). In
particular, high contact levels and time pressures are common features of primary
healthcare, so number of clients to be attended and extent of contact with them were
included as control variables in all analyses. The number of patients was measured with one
item that used a 7-point response scale ranging from 1 (less than 5) to 10 (more than 80).
Extent of contact with patients was measured using one item that used a 10-point response
scale ranging from 1 (10% of working day) to 10 (100% of working day).
Previous research has also shown that the relationship between emotion work and well-
being can be influenced by job autonomy (Abraham, 1998; Diefendorff et al. 2005;
Grandey et al., 2005; Morris & Feldman, 1997; Seifert, Mertini, & Zapf, 1999; Wharton,
1993; Zapf et al., 1999). Interaction control and autonomy in the expression of emotions were
included as controls. Interaction control is the extent to which employees can control how
they interact with patients. It was measured using three items from the Frankfurt Emotion
Work’s Scale (FEWS; Zapf et al., 1999). A sample item was, ‘‘How often can you decide
upon the amount of time you devote to a patient, independent of the patient’s needs.’’ The
measure used a 5-point response scale ranging from 1 (very rarely) to 5 (very often).
 38 D. Martı́nez-Iñigo et al.

Autonomy in the expression of emotions assesses the extent to which employees can choose
how they express their emotions (rather than freedom of what emotions to express). Two
items from the FEWS emotional control scale were used. Each item is composed of two
sentences: one describing a job with low emotional autonomy (e.g., Person A has strict
instructions from the organization on how to deal with his/her feelings and those of the
clients) and the other one depicting a high autonomy job (e.g., Person B has hardly any
instructions from the company on how to deal with either his/her feelings nor those of the
clients). Participants rate on a 5-point response scale ranging from 1 (exactly like A) to 5
(exactly like B) which sentence describes more accurately his/her own job. The internal
consistency reliabilities for these scales were a .66 for interaction control and a .67 for
autonomy in the expression of emotions.
Finally, there is evidence that patient interaction is not the only means of regaining
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resources drained in the performance of emotional labour (Brotheridge & Lee, 2002). To
control for resources gained through other means (e.g., organizational rewards and
acknowledgement), we used a distributive justice measure to assess the judgments employees
make on the allocation of outcomes (benefits or punishments) from different sources
(Cropanzano, Byrne, Bobocel, & Rupp, 2001; Cropanzano & Greenberg, 1997; Leventhal,
1976). This was measured using two items from the Distributive Justice Index developed by
Price and Mueller (1986, cited in Moorman, 1991) and two items from Colquitt (2001).
Sample items were, ‘‘Does your outcome reflect what you have contributed to the
organization?’’ and ‘‘Are you fairly rewarded for the work you have done well?’’ Internal
consistency reliability was a .74.

Analyses
Hypotheses 1a and 1b were tested using hierarchical multiple regression. Mediational
analyses were conducted to test hypotheses concerning the interpersonal mechanism and
intrapersonal mechanism separately (Hypotheses 2a and b and Hypotheses 3a and b) and
those concerning both inter- and intrapersonal mechanisms (Hypotheses 4a and b). To test
for single and multiple mediation we followed the recommendations of Baron and Kenny
(1986) and Wood, Goodman, Beckmann, and Cook (in press). First, the predictor variable
(e.g., automatic regulation) has to be related to the criterion variable (e.g., emotional
exhaustion). Second, there has to be a significant relation between the predictor and
mediator variables (e.g., satisfaction with interaction with patients). Third, the mediator
and criterion variables must be significantly related. Finally, evidence for a full mediation
occurs when the predictor becomes non-significant when the mediator is added. Partial
mediation occurs when the significance of the predictor is merely reduced when the
mediator is entered. In all the regression analyses, the control variables were entered into
the model first.

Results
Table I presents descriptive information, reliabilities, and bivariate correlations for the study
variables. As participants were nested within teams, multilevel analysis was conducted to
test for team-level effects. Results show the amount of variance between groups was not
significant (chi-square 71.5; df 56, p .07).
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Table I. Means, standard deviations, reliabilities (in parenthesis), and correlations for study variables.

Variable M SD 1 2 3 4 5 6 7 8 9 10 11

1. Number of patients 5.99 1.13

2. Extent of contact 84.82 10.15 .31**

3. Autonomy in expression 4.08 0.68 .13* .04 (.67)
4. Interaction control 3.22 0.74 .15** .23** .20** (.66)

Emotional labour and emotional exhaustion

5. Distributive justice 2.70 0.73 .07 .22** .03 .24** (.74)
6. Automatic regulation 3.43 0.59 .07 .08 .24** .25** .30 (.72)
7. Deep acting 3.13 0.63 .03 .03 .13* .05 .10 .25** (.69)
8. Surface acting 2.97 0.60 .02 .14* .01 .22** .20** .26** .16** (.73)
9. Satisfaction with patients 4.87 1.19 .10 .15** .18** .27** .36** .35** .16** .23** (.73)
10. Psychological effort 2.60 0.79 .11* .01 .20** .11* .09 .08 .11 .18** .12* (.45)
11. Emotional exhaustion 3.46 1.33 .22** .32** .00 .32** .47** .27** .00 .29** 44** .22** (.90)

* p B.05, ** p B.01.

39
 40 D. Martı́nez-Iñigo et al.

Emotion regulation and emotional exhaustion

Hypothesis 1a, which predicted that automatic regulation would be negatively related to
emotional exhaustion, was confirmed, F(6, 322) 24.05, b.12, p B.01. Surface acting
also exhibited a positive relationship with emotional exhaustion, thereby confirming
Hypothesis 1b, F (6, 324) 25.82, b .17, p B.001). As expected, the relationship between
deep acting and emotion regulation was not significant.

Emotion regulation: Interpersonal mechanisms

Hypothesis 2a proposed that the relationship between automatic regulation and emotional
exhaustion would be partially mediated by employees’ satisfaction with interaction with
patients. All the conditions for mediation were met, and when satisfaction with interaction
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with patients was entered, the significant effect of automatic regulation on emotional
exhaustion was no longer significant (b .062, p.21) (see Table II). This means that
satisfaction with interaction with patients fully mediated the relationship between automatic
regulation and emotional exhaustion. The hypothesized partial mediation was not supported.
Hypothesis 2b proposed the same mediational effects with surface acting as the predictor.
All the conditions for mediation were met, and when satisfaction with interaction with
patients was entered, surface acting remained significantly related to emotional exhaustion
(b.12, p B.05), but its beta coefficient was substantially reduced (z 2.48, p B.05). The
relationship between surface acting and emotional exhaustion was therefore partially
mediated by this interpersonal factor, which supported Hypothesis 2b (see Table III).
Mediation effects could not be tested for deep acting because its relationship with
emotional exhaustion was not significant. However, as expected, deep acting was positively
associated with satisfaction with interaction with patients (r .16, p B.01).

Emotion regulation: Intra- and interpersonal mechanisms

Hypothesis 3a proposed that the relationship between automatic regulation and emotional
exhaustion would be partially mediated by employee’s psychological effort. Automatic
regulation was not significantly associated with psychological effort, so the conditions for
mediation were not met. Hypothesis 3a was not therefore supported. Hypothesis 3b
described the same mediational effect for surface acting. All the conditions for mediation
were met, and when psychological effort was entered, surface acting remained significantly
related to emotional exhaustion (b .12, p B.05), but its beta coefficient was substantially
Table II. Regression model showing satisfaction with interaction with patients as a mediator in
the relationship between automatic regulation and emotional exhaustion, N331.

Step Predictor Step1 Step2 Step3

1 Number of patients .12* .12* .12*

Extent of contact .16** .16** .15**
Autonomy in expression .05 .07 .10**
Control interaction .18** .16** .13**
Distributive justice .38** .36** .28**
2 Automatic regulation (AR) .12* .06
3 Satisfaction with patients .26**
DR2 at each step .32** .01* .05**

* p B.05, ** p B.01.
 Emotional labour and emotional exhaustion 41
Table III. Regression model showing satisfaction with interaction with patients as a mediator in
the relationship between surface acting regulation and emotional exhaustion, N333.

Step Predictor Step1 Step2 Step3

1 Number of patients .12* .12** .12*

Extent of contact .17** .16* .15**
Autonomy in expression .06 .05 .09
Control interaction .19** .16** .13**
Distributive justice .37** .35** .28**
2 Surface acting (SA) .15** .12*
3 Satisfaction with patients .26**
DR2 at each step .32** .02** .07**

* p B.05, ** p B.01.
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reduced (z 2.52, p B.01). The relationship between surface acting and emotional
exhaustion was therefore partially mediated by this interpersonal factor, which supported
Hypothesis 3b (see Table IV).
Hypothesis 4a described the mediating effects of intra- and interpersonal factors in the
relationship between automatic regulation and emotional exhaustion. As for Hypothesis 3a,
automatic regulation was not significantly associated with psychological effort, so the
conditions for testing mediation were not met. Hypothesis 4a was not supported.
Hypothesis 4b described the mediating effects of intra- and interpersonal variables in the
relationship between surface acting and emotional exhaustion. All the conditions for
mediation were met. Table V shows that when psychological effort and satisfaction with
interaction with patients were entered into the regression equation, the relationship between
surface acting and emotional exhaustion became non-significant. Psychological effort and
satisfaction with interaction with patients fully mediated the relationship between surface
acting and emotional exhaustion, thereby confirming Hypothesis 4b. Interaction between
satisfaction with interaction with patients and psychological effort was tested, but the
interaction terms beta coefficient was not significant (b.076, p .74).
A mediational analysis was not conducted for deep acting, because it was not significantly
related to emotional exhaustion.

Discussion
This study explored the relationships that automatic and controlled emotion regulation
strategies have with healthcare workers’ emotional exhaustion, and investigated an

Table IV. Regression model showing psychological effort as a mediator in the relationship
between surface acting and emotional exhaustion, N328.

Step Predictor Step1 Step2 Step3

1 Number of patients .12* .13* .11*

Extent of contact .17** .16** .16**
Autonomy in expression .05 .04 .07
Control interaction .18** .15** .15*
Distributive justice .37** .35** .34**
2 Surface acting (SA) .15** .12*
3 Psychological effort .16**
DR2 at each step .32* .02* .02*

* p B.05, ** p B.01.
 42 D. Martı́nez-Iñigo et al.
Table V. Regression model showing inter- and intra-personal variables as mediators in the
relationship between surface acting and emotional exhaustion, N328.

Step Predictor Step1 Step2 Step3

1 Number of patients .12* .13* .11*

Extent of contact .17** .16** .16**
Autonomy in expression .05 .04 .10*
Control interaction .18** .15** .12*
Distributive justice .37** .35** .27**
2 Surface acting (SA) .15** .09
3 Satisfaction with patients .25**
Psychological effort .15**
DR2 at each step .32* .02* .07*

* p B.05, ** p B.01.
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interpersonal and an intrapersonal mechanism that might explain such relationships. Our
findings confirm that emotion regulation is a relevant process for explaining how the
emotional demands of the job are related to emotional exhaustion at work (Grandey, 2000;
Totterdell & Holman, 2003); and they also support previous findings demonstrating
emotion regulation in emotional labour as having both positive and negative effects on
employee well-being (e.g., Adelman, 1995; Ashforth & Humprey, 1993; Diefendorff &
Richard, 2003; Tolich, 1993). However, a particular contribution of this study is the result
showing that, when the job requirement is to express positive emotions, emotion regulation
may be positively related to employees’ well-being when it is performed in an automatic
way. Negative associations between emotion regulation and well-being may therefore have
been over-represented because automatic regulation has not been studied.
In addition, this study has further illuminated the intra- and interpersonal mechanisms
that explain how emotion regulation is related to job well-being (Côté & Morgan, 2002).
Concerning the interpersonal mechanisms, in accordance with Côté’s (2005) social
interaction model, perceived feedback from clients in the form of satisfaction with
interaction with patients fully mediated the relationship between automatic regulation
and emotional exhaustion and partially mediated the relationship between surface acting
and emotional exhaustion. Moreover it can be noted that automatic regulation was
associated with more positive satisfaction with interaction with patients, whereas surface
acting was associated with less satisfaction with interaction with patients; a difference that
may be caused by patients reacting positively to authentic emotional displays and negatively
to inauthentic emotional displays. These findings point to the interactional character of
emotional labour. However, our results also show that, for surface acting, both intra- and
interpersonal mechanisms play a role in mediating its relationship with emotional
exhaustion, because psychological effort and satisfaction with interaction with patients
fully mediated the relationship between surface acting and emotional exhaustion.
Our results suggest a plausible model of how interpersonal and intrapersonal mechanisms
mediate the effects of emotion regulation on emotional exhaustion. Emotional labour can
be simultaneously considered as an effortful process that drains mental resources and as a
process for recovering resources by contributing to the development of rewarding
relationships (Brotheridge & Lee, 2002). The overall effect of emotion regulation on
emotional exhaustion depends on the balance of these two processes. For automatic
regulation, little effort is expended but resources are gained from rewarding relationships,
thereby leading to an improvement in well-being, i.e., lower emotional exhaustion. Surface
acting is both effortful and does not promote resource gain, leading to reduced well-being.
 Emotional labour and emotional exhaustion 43

Deep acting is effortful but leads to resource gain. There is therefore no net gain or loss on
resources, with one process compensating for the other, so well-being remains unaffected.
However, it should be noted that these relationships are most likely to occur when the
organizational requirement is to express positive emotions.
Overall, our study has addressed some of the current limitations in research on work-
related emotion regulation and well-being. First, it offers empirical evidence on the relevance
of social interaction to understanding the effects of emotional labour (Côté, 2005). Second,
it suggests that both intra- and interpersonal factors may be needed to account for the
positive, negative, and neutral consequences associated with different types of emotion
regulation at work. However, this study has a number of limitations. Although previous
theoretical and empirical studies support the assumed direction of relationships between
variables, the cross-sectional nature of the data means that causality cannot be inferred.
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A second limitation is the low reliability coefficient for the psychological effort scale. Another
limitation is that we tested a social interaction model using data based only on measures from
the actors and not the targets. The lack of a direct measure of patients’ reaction could cover
up the influence of other variables responsible for the relationship between emotion
regulation and satisfaction with patients’ response. For instance, it is possible that attitudes
related to emotion regulation strategies (such as acting in ‘‘bad faith’’) were related to poorer
evaluations of patients’ reactions. Also, satisfaction with interaction with patients could be
influenced by factors not directly related to feedback from patients, such as patient’s traits.
Future research should therefore explore the relationship between the actual behaviour of
patients and employees’ assessments of them. However, employee assessments will still be
required in order to understand the final impact of patients’ behaviours on emotional
exhaustion. Finally, the role of emotional dissonance as an alternative intrapersonal
mechanism responsible for negative consequence of emotional labour was not considered
in this study. Although previous research confirms its relationship with emotional regulation
strategies and well-being, there are serious doubts about the validity of this explanation due
to the way in which emotional dissonance has been conceptualized and measured (Glomb &
Tews, 2004; Zerbe, 2000). In particular, it seems that the effects of emotional dissonance are
a result of the emotion felt, rather than the difference between felt and displayed emotion.
Future studies should explore the effects on emotional exhaustion that result from
sequences of interactions between employees and clients. For example, the responses from
one client could change an employee’s emotion regulation strategy in the interactions that
follow with the same or a different client. Several studies have successfully applied
intraindividual methodology to analyse relations between emotions and work-related
outcomes such as well-being and performance (Beal, Trougakos, Weiss, & Green, 2006;
Beal, Weiss, Barros, & MacDermid, 2005; Totterdell & Holman, 2003). This methodo-
logical approach could contribute to understanding the temporal dynamics of the
relationships between emotion regulation and well-being. In particular, this approach can
be used to test how specific the receiver’s response has to be to particular emotional displays
of the sender, and whether the sender needs to be aware that the favourability of the
feedback is a reaction to what he or she has done. Studies with an experimental design could
be conducted to supply additional evidence concerning the mechanisms and their joint
effects on well-being. For example, procedures could vary the level of positive feedback
from others and the level of psychological effort and assess this with regard to its impact on
emotional exhaustion.
The study also has practical implications related to the potential role of the clients’
response in influencing employees’ well-being. The design of training interventions oriented
 44 D. Martı́nez-Iñigo et al.

to improve job well-being in the service sector could include the development of
competences and skills that help professionals to efficiently manage clients and obtain
more positive responses from them. Despite its relevance, this kind of training is usually
neglected in healthcare occupations. Caring relationships are complex, and obtaining
appropriate responses from patients (e.g., treatment adherence, anxiety-reduction) requires
specific training. Short-cut solutions or lay responses (e.g., minimizing patient’s fears or
worries) may produce unwanted results (e.g., increased service demand). Training of
emotional competencies may also facilitate the use of automatic emotion regulation, and
thereby reduce emotional exhaustion.
Specific interventions also need to be designed for those occupations where the goal of
interaction reduces considerably the chance of obtaining a positive response from clients or
customers For example, debt collectors sometimes use strategies that are intended to invoke
a negative response in customers in order to increase compliance (Sutton, 1991). Positive
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relationships with colleagues, team, and leader support would be among the proximal
alternatives for obtaining positive interactions in such roles. In addition, organizations
might acknowledge and reward the effort involved in performing emotional labour of this
kind, because employees’ perception of outcomes from compliance with display rules are
related to emotional exhaustion (Grandey & Fisk, 2005).
We make a final point about the coherence of organizational policies concerning attention
to clients. Many employees are now required to be ‘‘authentically’’ pleasant in order to
persuade clients or customers to engage services they don’t need, or they are required to
interact in a friendly and calming manner in response to hostile complaints about an
unsatisfactory service. Under these circumstances, positive responses from clients are
unlikely and the probability of employees perceiving unfairness in the organization’s
emotion rules is high, which will potentially lead to emotional exhaustion (Grandey & Fisk,
2005). A coherent and proportional relationship between organizational standards of
service quality (e.g., demanding authentic displays and personal treatment), job conditions
(e.g., autonomy and control), and organizational resources (e.g., interaction time) is
therefore needed to protect employees’ well-being.

Acknowledgements
The authors are grateful for the financial support of the Spanish Agency of Science and
Technology Research (BSO2002-00789/PSCE) and the Economic and Social Research
Council (ESRC) UK.

Note
All items developed for the emotional regulation strategies measure are available to the reader on request.

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