What's so unhealthy about hostility? Construct validity and psychosocial correlates of the Cook and Medley Ho scale

The Cook and Medley (1954) Hostility (Ho) scale, a measure of hostility derived from the Minnesota Multiphasic Personality Inventory (MMPI), was recently found in one cross-sectional study to be related to the severity of coronary artery disease and in two prospective studies to predict the development of coronary heart disease. Unfortunately, little information is available to clarify the meaning of the scale, and little is known about the psychosocial characteristics of individuals with high Ho scores. As a result, interpretation of the previous studies is difficult. Our two studies attempted to address these concerns. In Study 1, the Ho scale demonstrated convergent and discriminant validity. Data indicated that the scale primarily assesses suspiciousness, resentment, frequent anger, and cynical distrust of others rather than overtly aggressive behavior or general emotional distress. In Study 2, individuals with high scores displayed comparatively more anger, less hardiness, more frequent and severe hassles, and fewer and less satisfactory social supports. Thus, we propose that the Ho scale assesses cynical hostility and conclude that high scores are associated with a particularly unhealthy psychosocial risk profile. These findings refine our understanding of the Ho scale and assist in the interpretation of previous studies using this measure.     

Development and Evaluation of an Online Intervention for Reducing Hostile Interpretation Bias: A Randomized Controlled Trial

Hostility is a trait-level construct characterized by a generally suspicious and cynical view of other people that results in a tendency to interpret ambiguous social situations in hostile or threatening ways. Cognitive behavioral treatments for hostility have high dropout rates, which may be due to hostile beliefs interfering with treatment engagement. As such, there is a need for an alternative approach to prevent dropout and enhance engagement. The current study therefore developed and tested a 1-session, 40-minute online intervention targeting hostility. It was hypothesized that the hostility intervention would be rated as acceptable as indexed by self-report and completion rates. It was also hypothesized that the hostility intervention would be associated with greater reductions in hostility as compared to a control intervention. Finally, it was hypothesized there would be indirect effects of intervention condition on anger and aggression via changes in hostility.Undergraduates (N = 101) who reported elevated hostility and hazardous alcohol use were randomized to complete either the hostility intervention or a control condition targeting physical health habits. Results showed that individuals randomized to the hostility intervention found the intervention to be highly acceptable and all participants completed the intervention in its entirety. The hostility intervention was associated with significantly faster reductions in hostile interpretations than the control condition with medium to large effects. There were significant indirect effects of intervention condition on month one follow-up anger and aggression via changes in hostile cognitions. This proof-of-concept study provides initial evidence that a brief, single-session intervention may be a promising approach for reducing hostility and its correlates.     

Associations of blood pressure with self-report measures of anger and hostility among black and white men and women

This study examined associations between blood pressure (BP) and dispositional variables pertaining to anger and hostility. Black and White 25- to 44-year old male and female normotensives and unmedicated mild to moderate hypertensives completed four reliable self-report scales--the Cook-Medley Hostility (Ho) Scale, the Trait Anger subscale of the State-Trait Anger Scale (STAS-T), and the Cognitive Anger and Somatic Anger subscales of the Cognitive-Somatic Anger Scale--plus the Framingham Anger Scale and the Harburg Anger Scale. They also engaged in three laboratory tasks--Type A Structured Interview (SI), a video game, and a cold pressor task--that elicit cardiovascular reactivity. Ambulatory BP readings at home and at work were also obtained from most subjects. Blacks had significantly higher Ho and lower STAS-T scores than did Whites. Women reported higher levels of somatic anger than did men. White women showed significant positive correlations between STAS-T and systolic BP (SBP) and diastolic BP (DBP) both at rest in the laboratory and during the SI. Black women revealed significant positive relationships between STAS-T and SBP and DBP at rest in the laboratory and at work as well as with DBP during the cold pressor test. For Black men, cognitive anger and DBP at rest were positively related. In contrast, White men revealed significant negative correlations between Ho scores and SBP at rest and during the video game; these men also showed significant negative relationships between somatic anger and SBP and DBP reactivity during the cold pressor test. Women, but not men, showed significant positive relationships between all four anger measures and ambulatory BP at work. Whereas main effects relating anger and cardiovascular measures were not apparent as a function of race, Blacks demonstrated significantly greater SBP and DBP reactivity than Whites during the cold pressor test, with the converse occurring during the SI. Men demonstrated significantly greater DBP reactivity than women during the video game. The present findings indicate that self-reports on anger/hostility measures and cardiovascular responses to behavioral tasks differ as a function of race but that relationships between anger and BP regulation need to take into account possible race-sex interactions and selection of anger/hostility measures.     

Sex differences in the relation of depressive symptoms, hostility, and anger expression to indices of glucose metabolism in nondiabetic adults.

This study examined the relation of depressive symptomatology, hostility, and anger expression to indices of glucose metabolism and tested whether gender moderates these associations in a sample of 135 healthy, nondiabetic adults (75 men, 60 women). The severity of depressive symptoms, hostility, and anger expression was positively associated with estimated insulin resistance (IR) and insulin in women but not in men. Anger expression was positively associated with glucose in women only. A summary score of depressive symptoms, hostility, and anger expression was positively associated with estimated IR, insulin, and glucose in women but not in men. Hence, in women, IR and elevated levels of fasting insulin and glucose may be one pathophysiological mechanism mediating the increased risk of cardiovascular disease and Type 2 diabetes associated with these psychological attributes.     

Cynical hostility and vulnerability to disease: social support, life stress, and physiological response to conflict

Previous research has indicated that high scores on the Cook and Medley Hostility (Ho) scale are associated with increased risk of coronary heart disease and other illness. Our study attempts to clarify this relationship by providing additional evidence concerning the construct assessed by the Ho scale, examining the level of physiological reactivity during interpersonal conflict in high- and low-Ho groups, and assessing the psychosocial profile associated with this characteristic. Extremely high and low Ho groups were selected from a pool of male undergraduates. Consistent with previous findings, high-Ho participants reported greater anger proneness and a more cynical, disparaging view of others than did low-Ho participants. The high-Ho group also tended to be more hostile and less friendly during role-played interactions involving high and low levels of interpersonal conflict, respectively. High-Ho persons also displayed greater diastolic blood pressure reactivity during interpersonal conflict. Finally, the high-Ho group reported less social support and more negative life events and daily irritants then did the low-Ho group. These results support the interpretation of the Ho scale as a measure of cynical hostility and are consistent with the hypothesis that it is related to disease by way of excessive physiological reactivity and a generally stressful, unsupportive social network.     

Shamed into anger? The relation of shame and guilt to anger and self-reported aggression.

The relation of shame and guilt to anger and aggression has been the focus of considerable theoretical discussion, but empirical findings have been inconsistent. Two recently developed measures of affective style were used to examine whether shame-proneness and guilt-proneness are differentially related to anger, hostility, and aggression. In 2 studies, 243 and 252 undergraduates completed the Self-Conscious Affect and Attribution Inventory, the Symptom Checklist 90, and the Spielberger Trait Anger Scale. Study 2 also included the Test of Self-Conscious Affect and the Buss-Durkee Hostility Inventory. Shame-proneness was consistently correlated with anger arousal, suspiciousness, resentment, irritability, a tendency to blame others for negative events, and indirect (but not direct) expressions of hostility. Proneness to "shame-free" guilt was inversely related to externalization of blame and some indices of anger, hostility, and resentment.     

What does the cook and medley hostility scale measure? Affect, behavior, and attributions in the marital context

The Cook and Medley (1954) Hostility (Ho) scale has been used in several important studies evaluating potential health consequences of hostility. A relative lack of compelling information about the construct validity of the Ho scale, however, has raised concerns about the appropriate interpretation of previous research. In this study, 60 married couples discussed a low conflict topic, a high conflict topic, and then a second low conflict topic. High Ho men responded to the high conflict topic with significant increases in self-reported anger and anxiety and overt hostile behavior, but low Ho men did not. Furthermore, compared to low Ho men, high Ho men blamed their wives more for their usual disagreements on the high conflict topic and saw their disagreement-engendering behavior as more intentional. Among women, Ho scores were weakly related only to overt hostile behavior. Finally, couples consisting of two low Ho persons displayed a uniquely agreeable interactional style.     

Beyond the double-jeopardy hypothesis: Assessing emotion on the faces of multiply-categorizable targets of prejudice

Prior research has shown that race influences perceptions of facial expressions, with hostility detected earlier on young male Black than White faces. This study examined whether the interplay of race and age would moderate perceptions of hostility by having participants evaluate facial expressions of multiply-categorizable targets. Using a facial emotion change-detection task, we assessed evaluations of onset/offset of anger and happiness on faces of young and old Black and White men. Significant age by race interactions were observed: while participants perceived anger as lasting longer and appearing sooner on old compared to young White faces, this relationship was reversed for Black faces, with participants perceiving anger lasting longer and appearing sooner on young compared to old Black faces. Similar results were found for perceived happiness. These results suggest that perception during cross-categorization may be more complex than the simple additive function proposed by the double-jeopardy hypothesis, such that co-activation of other stereotypes may sometimes confer a protective benefit against bias.     

WOMEN'S HOSTILITY TOWARD WOMEN

Three studies investigating the self-report correlates of women's hostility toward other women were conducted among a total of 477 college women. In Study 1, hostility toward women was negatively associated with both personal and collective self-esteem and positively associated with hostility toward men, controlling for state anger. In Study 2, hostility toward women was negatively associated with self-efficacy and age and positively associated with emotional dependence on men, but not with self-identification as a feminist or support of the feminist movement. In Study 3, women's hostility toward women was negatively associated with measures of intimacy and life satisfaction and positively associated with acceptance of interpersonal violence. We suggest that women's hostility toward other women not only is an important aspect of women's personal satisfaction, happiness, intimacy, and self-esteem, but also may serve as a barrier to women's progress as a group.     

Motor and cognitive relaxation in the desensitization of anger

Three procedures were assessed to determine their effectiveness in reducing anger. The procedures were: desensitization, desensitization with cognitive relaxation, and desensitization with the absence of relaxation training. Anger was aroused by exposing white males, selected for their reports of anger toward blacks, to black racial stimuli. The desensitization group reported reductions in anxiety and disgust relative to a no-treatment control group. Therapist ratings indicated reductions in anger for Ss in both the desensitization and desensitization with cognitive relaxation groups. In addition the latter group reported reductions in anger concurrently with increases in diastolic and systolic blood pressure. Post-hoc analyses indicated that Ss for whom desensitization was most effective reported less anger after the pretreatment anger arousal procedure, greater depth of relaxation during treatment, and were liked more by their therapists. These Ss also reported a greater reduction in ethnocentrism and a trend toward lower overt hostility following treatment.     

Hostility and distraction have differential influences on cardiovascular recovery from anger recall in women.

This study investigated the relation of dispositional hostility to cardiovascular reactivity during an anger-recall task and of hostility and distraction to posttask recovery in 80 healthy women (ages 18-30). Half were randomly assigned to distraction during recovery. Hostility predicted slower systolic blood pressure and preejection period during recovery. Distraction was related to faster cardiac recovery, higher high-frequency (HF) power, lower low-frequency (LF) power and LF:HF ratios, and lower state anger and rumination during recovery. These results indicate deleterious influences of hostility on cardiovascular recovery but not during anger recall. The findings also show beneficial effects of distraction in expediting cardiovascular recovery, possibly through reducing rumination and anger.     

Cynical Hostility: A Risk Factor in HIV-1 Infection?1

The aims of this study of HIV-1 positive and HIV-1 negative gay males without disease were (a) to determine whether cynical hostility in these groups (measured by the Cook-Medley Ho scale) is associated with psychosocial deficits that potentially could influence the course of HIV infection; and (b) to examine the construct validity of the sum of three Ho subsets in this sample. Correlational analyses on the full samples, and multivariate analyses of high- and low-hostility groups (formed using Ho scale cutoffs from previous research), examined person variables (traits, coping style), environmental variables (social support, stressors), and affect. In all domains other than stressors (traits, coping styles, social support, and affect), cynical hostility was associated with psychosocial deficits, with results generally stronger for the full Ho scale than for the subset sum. Results support previous research on psychosocial deficits of the cynically hostile, extend findings to HIV-infected gay males, and enlarge our understanding of the trait and coping style correlates of cynical hostility. Implications of these findings for HIV infection are discussed.     

Stability and level of self-esteem as predictors of anger arousal and hostility

We examined stability of self-esteem and level of self-esteem as predictors of dispositional tendencies to experience anger and hostility. We reasoned that individuals with unstable high self-esteem would report especially high tendencies to experience anger and hostility, and that individuals with stable high self-esteem would report particularly low tendencies. We expected individuals with stable and unstable low self-esteem to fall between these two extremes. These predictions were derived from an analysis of anger and hostility that emphasized the instigating role of threats to self-esteem. Stability of self-esteem was assessed through multiple assessments of global self-esteem in naturalistic settings. Results revealed the predicted pattern for the tendency to experience anger and a "motor" component of hostility. The importance of considering both stability and level of self-esteem in analyses of anger and hostility is discussed.     

The relationship between hospital restructuring,anger, hostility and psychosomatics in nurses

This study examines the relationship between hospital restructuring, psychosomatic reactions, anger and hostility in nurses. Scales assessed extent of hospital restructuring. Anger was assessed using the State–Trait Anger Expression Inventory (STAXI) Scales. Results suggested that restructuring is a stressful and anger‐provoking experience which increases with more restructuring initiatives. Copyright © 2000 John Wiley & Sons, Ltd.     

Anger and hostility from the perspective of the Big Five personality model

Sanz, J., García‐Vera, M. P. & Magán, I. (2010). Anger and hostility from the perspective of the Big Five personality model. Scandinavian Journal of Psychology, 51, 262–270. This study was aimed at examining the relationships of the personality dimensions of the five‐factor model or Big Five with trait anger and with two specific traits of hostility (mistrust and confrontational attitude), and identifying the similarities and differences between trait anger and hostility in the framework of the Big Five. In a sample of 353 male and female adults, the Big Five explained a significant percentage of individual differences in trait anger and hostility after controlling the effects due to the relationship between both constructs and content overlapping across scales. In addition, trait anger was primarily associated with neuroticism, whereas mistrust and confrontational attitude were principally related to low agreeableness. These findings are discussed in the context of the anger‐hostility‐aggression syndrome and the capability of the Big Five for organizing and clarifying related personality constructs.     

The assessment of anger and hostility: a critical review

While the emotion of anger has become an increasingly important part of clinical assessment, the theoretical and psychometric adequacy of the instruments used to assess anger and hostility have long been questioned. In the present review, we first provide definitions of anger and hostility in order to provide a theoretical context from which to evaluate the scope of current measures of these constructs. Second, we review the major self-report scales used to assess anger and hostility in light of these definitions and provide a detailed evaluation of psychometric evidence concerning their reliability and validity. Finally, we offer specific recommendations concerning how anger and hostility assessment instruments can be improved and expanded. In particular, we note the need for (a) an expansion of anger assessment methods beyond traditional endorsement approaches, (b) scales to assess specific domains of anger experience, (c) scales that assess unique content domains of anger experience and expressions, such as spouse-specific or driving-related anger scales, and (d) scales that assess the clinical aspects of the anger construct.     

Comparison of two aggression inventories

Two recently developed questionnaire measures of aggression, the Aggression Questionnaire [Buss and Perry (1992; Journal of Personality and Social Psychology 63:452–459]; and the Aggression Inventory [Gladue (1991a); Psychological Reports 68:675–684], were administered to a British sample (N=320) of men and women undergraduates. Both questionnaires contain subscales measuring physical and verbal aggression; the other scales of the Aggression Questionnaire measure anger and hostility, and those of the Aggression Inventory measure impulsiveness and avoidance of aggression. The factor structure of scales were assessed using confirmatory factor analysis. The interrelations of the subscales were calculated in both cases: anger was independently related to verbal and physical aggression and to hostility on the Aggression Questionnaire; impulsivity, and verbal and physical aggression were associated on the Aggression Inventory. Sex differences were largest on the two physical subscales, of lesser magnitude but still significantly different for the two verbal subscales, but absent for anger and hostility. This supports the hypothesis that sex differences in aggression are larger for more escalated forms of aggression. The physical and verbal subscales of the two questionnaires were each highly correlated with one another and the impulsive subscale of the Aggression Inventory highly correlated with the anger subscale of the Aggresion Questionnaire. Thus, two aggression questionnaires developed in the US not only produce similar associations between subscales and sex differences among a British undergraduate sample, but also show high correlations between their respective scales. © 1995 Wiley-Liss, Inc.     

Distinguishing narcissism and hostility: similarities and differences in interpersonal circumplex and five-factor correlates

Narcissism and hostility are both characterized by dysfunctional social interactions, including tendencies to perceive slights, experience anger, and behave aggressively. The aim of this study was to examine the similarities and differences of narcissism and hostility, using 2 conceptual tools-the interpersonal circumplex and the Five-factor model. In a sample of 292 undergraduate men and women, composite measures of hostility (i.e., Buss-Perry Aggression Questionnaire [Buss & Perry, 1992] and Cook-Medley Hostility [Cook & Medley, 1954] total scores) were inversely correlated with affiliation and unrelated to dominance. In contrast, composite narcissism scores (i.e., Narcissistic Personality Inventory) were positively correlated with dominance and inversely correlated with affiliation. Examination of components of these traits revealed additional similarities and differences, as did associations with other dimensions of the Five-factor model. These findings suggest that the traits of narcissism and hostility are distinguishable by their interpersonal referents, as are their components.     

The Relationship Between Aggression and Employment Integrity

The relationship between aggression and employment integrity was investigated, in order to assess the construct validity of a employment screening device. Participants (155 male, 151 female) completed an employment screening test and two aggression scales. For both men and women, general aggression negatively correlated with employment integrity. A negative relationship was also found between employment integrity and physical aggression, anger, and verbal aggression. No significant relationship was found between hostility and employment integrity.