Personality as a risk factor in coronary heart disease

The pioneering work of the authors of the Type A personality concept has now been shown to be seriously flawed, with only the traits of anger, aggression, and hostility remaining as risk factors for coronary heart disease (CHD). There is now evidence for a much stronger relationship between CHD and personality involving a rather different set of concepts and theories. The evidence for such a relationship is summarized, and a causal link suggested. It is also shown that the CHD-prone type of behaviour can be changed by behaviour therapy, decreasing considerably the risk of dying from CHD.     

Type D personality as a prognostic factor in heart disease: assessment and mediating mechanisms

Type D personality, a synergy between negative affectivity and social inhibition, has established itself as a serious risk factor for morbidity and mortality in patients suffering from cardiovascular disease. In this review, we summarize studies on the validity of the assessment methods of Type D, emphasizing its role as an independent vulnerability factor in the progression of cardiovascular disease. We further present evidence on the physiological characteristics that accompany the 2 psychological traits negative affectivity and social inhibition and may mediate the relation between personality and prognosis in heart disease. Further research needs to determine the mechanisms by which Type D affects the course and outcome of cardiovascular disease as well as how Type D patients may benefit from psychosocial intervention.     

Personality,stress, smoking,and genetic predisposition as synergistic risk factors for cancer and coronary heart disease

Risk factors for cancer have been found in the past to act synergistically in a number of studies. However, these studies were not always designed to test the hypothesis of synergism, and have sometimes failed to equate for important variables, which might influence the results. The present study tests the hypothesis that psychosocial variables and physical ones (personality/stress, smoking, and genetic predisposition) interact in a synergistic fashion in the causation of lung cancer and coronary heart disease (CHD).     

Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II--Effects of treatment

In this article we consider the effectiveness of creative novation behaviour therapy in preventing cancer and coronary heart disease in disease-prone probands, and also its effectiveness in extending life for patients suffering from terminal cancer. In all cases, suitably matched controls are provided as part of the general methodology, and results are reported to testify to the effectiveness of the therapy, whether administered a long-term individual therapy, group therapy, or bibliotherapy plus short-term individual treatment. We also consider the negative effects of psychoanalysis on outcome.     

Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part I--Description of treatment

This paper describes a novel method of behaviour therapy applied to cancer-prone and coronary heart disease-prone patients in a prophylactic manner, to reduce the probability of their dying of cancer or coronary heart disease. The treatment can also be applied to patients already suffering from cancer in order to prolong their lives. The methods used are described in considerable detail, together with the rationale leading to their adoption. In Part II of this paper are the results of several studies showing that the methods are surprisingly successful in preventing death in cancer-prone and coronary heart disease-prone probands, and prolonging life in patients already suffering from terminal disease.     

Personality, stress, smoking, and genetic predisposition as synergistic risk factors for cancer and coronary heart disease.

Risk factors for cancer have been found in the past to act synergistically in a number of studies. However, these studies were not always designed to test the hypothesis of synergism, and have sometimes failed to equate for important variables, which might influence the results. The present study tests the hypothesis that psychosocial variables and physical ones (personality/stress, smoking, and genetic predisposition) interact in a synergistic fashion in the causation of lung cancer and coronary heart disease (CHD).     

The Myers-Briggs type indicator and coronary heart disease

Researchers have for many years attempted to establish a relationship between coronary heart disease (CHD) and personality type. In our study, 103 subjects completed Form G of the Myers-Briggs Type Indicator (MBTI). Comparisons were made between 93 CHD patients and an age-appropriate control group (Group C) on each of the four MBTI dimensions: Extraversion-Introversion, Sensing-Intuition, Thinking-Feeling, and Judging-Perceiving. The comparison between CHD patients and Group C showed that CHD patients were significantly more likely to prefer sensing and feeling.     

Hostility, anger, aggressiveness, and coronary heart disease: an interpersonal perspective on personality, emotion, and health

The related traits of hostility, anger, and aggressiveness have long been suggested as risk factors for coronary heart disease (CHD). Our prior review of this literature (Smith, 1992) found both considerable evidence in support of this hypothesis and important limitations that precluded firm conclusions. In the present review, we discuss recent research on the assessment of these traits, their association with CHD and longevity, and mechanisms possibly underlying the association. In doing so, we illustrate the value of the interpersonal tradition in personality psychology (Sullivan, 1953; Leary, 1957; Carson, 1969; Kiesler, 1996) for not only research on the health consequences of hostility, anger, and aggressiveness, but also for the general study of the effects of emotion, personality and other psychosocial characteristics on physical health.     

Attentional bias and anxiety in individuals with coronary heart disease

This study examined whether in an emotional Stroop task, individuals with coronary heart disease (CHD) would show greater attention towards the threatening words related to their disease than healthy persons, and if such an attentional bias is associated with anxiety. An emotional Stroop task with threatening words related to CHD as well as positive, negative and neutral words was administered to 35 individuals with CHD and 35 healthy controls. Additionally, the original Stroop task, the Beck anxiety inventory and the state-trait anxiety inventory were administered. The results indicated an attentional bias towards threatening words related to CHD in the individuals with CHD. They experienced higher interference than healthy participants from threatening words related to CHD but not from positive or negative words. Moreover, the level of interference was associated with their level of anxiety, and a vicious circle may exist in this association. In addition, results indicated a possible deficit of executive functioning among individuals with CHD. Attentional bias, as well as its association with anxiety, and an indication of deficit in executive functioning among individuals with CHD might be the risk factors for these individuals’ quality of life and for further development of their disease.     

Assessment of hostility in patients with coronary heart disease

One of the problems in efforts to more clearly conceptualize hostility is the amount of method variance, which ranges from self-report techniques to interview-based methods and mirrors the multidimensional nature of hostility and related constructs. In addition, rather few studies concerned with the assessment of hostility have specifically used samples of coronary heart disease (CHD) patients. The purpose of this study was, therefore, to examine the multidimensionality of the construct of hostility in a sample of male coronary patients with some frequently used instruments. Factor analysis was used to detect the relevant underlying constructs, which were assessed using a variety of hostility measures in a sample of cardiac patients undergoing baseline assessment in an ongoing health-education intervention study. Measurement included both questionnaires and interviews. Participants (N = 235) were divided into 3 diagnostic groups: patients who had recently undergone (a) a myocardial infarction, (b) coronary artery bypass grafting, or (c) percutaneous transluminal coronary angioplasty. A 4-factor solution appeared to provide the best fit, and the following factors were isolated: Anger-Out, Negative Affect, Coping, and Anger-In. All intercorrelations were less than .50. Medical diagnosis did not differ with regard to the 4 factors found. The total hostility construct as measured by the structured interview (SI) did not fit into the 4-factor model. This study was the first to show that dimensions of anger and hostility constitute valid and relevant aspects of the general construct of hostility for a representative group of CHD patients. The 4 aspects of hostility isolated using some well-known hostility questionnaires and the SI explained most of the observed variance. Although the SI appeared to tap more general state anger, the 4 aspects of hostility may be differentially related to health in those who are coronary prone. Future studies on the role of hostile or negative emotions in CHD patients should, therefore, pay greater attention to the multidimensional nature of hostility and may clearly benefit from the use of the 4-factor model described in this article.     

Self-regulation and mortality from cancer, coronary heart disease, and other causes: A prospective study

This article introduces a new personality inventory dealing with self-regulation. This is in some ways the opposite of neuroticism, and measures personal autonomy or independence, particularly as far as emotional dependence is concerned. Our concern was the relation between self-regulation and health, and large samples of healthy men and women were tested and followed up to demonstrate high predictability of mortality from cancer, coronary heart disease and other causes of death from scores on the questionnaire. It was also demonstrated that psychological risk factors were largely independent from physical risk factors, and could be changed by behavioural-cognitive treatment, reducing mortality.     

Associations among behavior, personality, and traditional risk factors for coronary heart disease: a study at a primary health care center in mid-Norway

The continuing presence of different negative emotions has been suggested as an important factor in the development of coronary heart disease (CHD). The present study was carried out at a medical center to investigate the presence of negative emotions and Type A behavior in a group of 40-yr.-old men and women. The National Institute of Public Health in Norway carried out the data-collection as a part of their CHD risk factor screenings. The correlation between hostility and total cholesterol is negative as is that between systolic blood pressures and the feeling of guilt for women. There was no further support for earlier findings of relationships between either Type A behavior pattern and negative emotions or Type A and elevated cholesterol values. A number of possible explanations are offered. In the study, assessment of hostility was questioned; there was possible support for poor assessment of hostility on the Karolinska Scales of Personality employed in the study.     

Psychological perspectives on the development of coronary heart disease

Psychological science has new opportunities to have major input into the understanding of the development of coronary heart disease. This article provides an overview of advances in understanding the etiology of heart disease, recently applied technologies for measuring early stages of heart disease, and an accumulating base of evidence on the psychosocial predictors of clinical and subclinical coronary disease. It suggests that it is now time to develop conceptual models that integrate our understanding of separate psychosocial predictors. It offers and provides preliminary evidence for a model that integrates socioeconomic status, environmental stress, and person-level factors from a life span perspective.     

Anger in type a women: Implications for coronary heart disease

The present study examines the relationship between Type A behaviour and anger in a sample of managerial women. The Type A behaviour pattern is hard driving, job-devoted lifestyle which is associated with a significantly increased risk of coronary heart disease in men as in women. Anger and hostility have been reported to be critical components of the Type A behaviour pattern which contribute to coronary heart disease. This research also examines the relationship between occupational demands and job anger in managerial women. Occupational demands include demands particularly unique to women in non-traditional occupational roles such as inequity of pay, underutilization of skills, low boss support and perceived sex discrimination. State (job) and Trait Anger were also assessed as were various psychological and behavioural outcomes such as state anxiety, depression, job satisfaction, absenteeism, and “intention to turnover”. Results showed that sex discrimination was a significant occupational stressor in Type As only. Further results of a multiple regression analysis indicated tha for Type As only, sex discrimination was positively associated with job anger when social support from one's boss was low. However, with increasing support, Type As were less likely to report anger when discrimination was high. In conclusion, the results of this study have demonstrated that social support can function as a buffer against anger, thus extending the buffering hypothesis originally put forth to refer to the buffering effects of social support and anxiety.     

Depressive symptoms in outpatients with heart failure: Importance of inflammatory biomarkers,disease severity and personality

Objective: Depressive symptoms are highly prevalent in heart failure (HF) patients, however the underlying etiology of depression in HF patients remains yet unclear. Hence, the goal is to examine the relative importance of inflammation, disease severity and personality as predictors of depression in HF patients. Design: Depressive symptoms (Hospital Anxiety and Depression Scale, depression subscale) were assessed at baseline and one-year follow-up in 268 HF patients (75.6% men; mean age?=?66.7?±?8.7). Markers of inflammation (TNFα, sTNFr1, sTNFr2, IL-6 and IL-10), disease severity (e.g. New York Heart Association (NYHA) classification) and personality (Type D personality, loneliness) were assessed at baseline. Results: At baseline, NYHA class, body mass index, educational level, Type D personality and loneliness were significantly associated with depression. Higher NYHA class (B?=?2.25; SE?=?.83), higher educational level (B?=?1.41; SE?=?.48), Type D personality (B?=?2.56; SE?=?.60) and loneliness (B?=?.19; SE?=?.05) were also independently associated with higher depression levels at one-year follow-up (all p-values?<?.005). Inflammation, brain natriuretic peptide and left ventricular ejection fraction were not related to depression over time. Conclusions: Personality factors, but not inflammation, were independent concomitants of depressive symptoms in patients with HF. Gaining more insight into the etiology of depression in HF patients is important in order to identify potential targets for novel interventions.     

The synergistic effect of smoking and serum cholesterol on coronary heart disease

Cigarette smoking is a strong predictor of coronary heart disease (CHD), but much of the variance in determining which smokers will, and which will not, suffer from CHD remains unexplained. This review examines evidence of a synergistic interaction effect of smoking and elevated serum cholesterol on CHD morbidity and mortality. Evidence is also presented to support the notion that, in part, serum cholesterol, like smoking, is an index of a behavioral risk factor. Such a synergistic interaction is determined to exist, although improvements in methodology are needed to more clearly identify its magnitude. The review suggests that behavioral treatments aimed at smoking cessation and dietary modification should be focused specifically on the more than 25 million young and middle-aged Americans who smoke and have elevated serum cholesterol. In this way, such treatments may increase their effectiveness in lowering the risk of CHD (benefit) without necessarily increasing their effort (cost).     

Sport participation,screen time,and personality trait development during childhood

This investigation explored the contribution of extracurricular sport and screen time viewing (television viewing and electronic gaming) to personality trait stability and change during childhood. Two independent samples of 3,956 young children (age 6) and 3,862 older children (age 10) were taken from the Longitudinal Study of Australian Children. Parent‐reported child sport participation, screen time, and personality traits were measured at baseline and again 24 months later. Young children who were more active recorded more of a decrease in introversion, less of a decrease in persistence, and less of an increase in reactivity, than those who were less active. Older children who were more active recorded less of an increase in introversion and more of an increase in persistence than those who were less active. In addition, young children who continued participation in extracurricular sport had greater intra‐individual stability of personality for introversion. These finding suggest that an active lifestyle might help to facilitate desirable personality trait stability and change during childhood.