Relationship between JAS- and FTAS-Type A behavior and non-CHD illness: a prospective study controlling for negative affectivity

In addition to posing a risk for coronary heart disease (CHD), Type A behavior has been suggested as a risk factor for non-CHD illness. Past evidence, however, has relied chiefly on retrospective studies of self-reported illness that failed to control for the potentially confounding effects of negative affectivity. The present investigation was an 18-month prospective study of Type A behavior and medical records of illness in which chronic negative affectivity was also assessed. Negative affectivity was associated with retrospective self-reported illness, but only Type A, as measured by the Jenkins Activity Survey (JAS) and the Framingham Type A Scale (FTAS), predicted medical records of subsequent illness severity and number of illness-related medical visits. Controlling for negative affectivity did not reduce these significant relationships. It was concluded that persons scoring high on the JAS or the FTAS may be a greater risk of minor illness when objective measures of illness are assessed over a period of 1 year or more. Alternative explanations and future directions for research are discussed.     

The inequivalence of self-reports of Type A behavior: Differential relationships of the Jenkins Activity Survey and the Framingham cale with affect,stress, and control

The Jenkins Activity Survey (JAS) and the Framingham Type A Scale (FTAS) have been found to have different psychological correlates. The JAS is typically unrelated to anxiety, while the FTAS is consistently correlated with trait anxiety. The present study of 200 male and female college students clarifies further the psychological heterogeneity of these measures. Enhanced motivation to control the environment has been suggested as an underlying psychological component of Type A behavior (Glass, 1977). Dysphoric emotions and the perception of more environmental stresses, on the other hand, are typical of neuroticism or negative affectivity (Watson & Clark, 1984). Although the results indicate that the JAS and FTAS are highly correlated, the JAS is more closely related to control motivation than is the FTAS. Further, compared to the JAS, the FTAS is more closely correlated with dysphoric emotions and perceived daily stresses. Thus, the results indicate that the JAS is closely correlated with core psychological components of the Type A pattern, while the FTAS has a relatively unique association with general emotional distress. Such differences may account for the fact that these measures are related to different disease end points.     

Type a behavior,irritability, and cardiovascular response

Previous research suggests that high levels of hostility may augment the cardiovascular reactivity and risk of coronary heart disease (CHD) associated with Type A behavior. In contrast, other research indicates that the tendency to deny or suppress anger is associated with enhanced cardiovascular reactivity and risk of CHD. To delineate further the combined role of anger processes and Type A behavior in CHD risk, this study examined the interactive effects of Type A behavior and self-reported irritability on cardiovascular response to a challenging mental task. Type A and Type B college students were further classified as either high or low in self-reported irritability. Type A subjects who were low in self-reported irritability evidenced greater cardiovascular reactivity (i.e., systolic blood pressure and pulse rate) than did Type B subjects low in irritability. However, Type A subjects who were high in irritability tended to demonstrate less cardiovascular response than Type B subjects high in irritability. Further, Type A's low in self-reported irritability evidenced greater cardiovascular response than high-irritability Type A's. It is suggested that reduced reporting of irritability by Type A's may reflect suppression or denial, and further that this reduced reporting is associated with enhanced cardiovascular responsivity.     

Type A behavior, family history of hypertension, and cardiovascular responsivity among black women

The purpose of this study was to determine the effects of Type A behavior and family history of hypertension on cardiovascular reactivity to mental stress in a group of employed black women. Measures of heart rate and of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken at rest, during a mental arithmetic task, and during the Type A Structured Interview (SI). Results indicated that the Type A behavior pattern was associated with SBP and DBP hyperresponsivity during the SI but not during mental arithmetic. Additionally, certain speech components of the Type A pattern, as well as features of the potential-for-hostility component, were also related to cardiovascular responses during the SI. Family history of hypertension did not influence the cardiovascular parameters either alone or in combination with Type A behavior. The results suggest that many of the cardiovascular response characteristics of the Type A pattern that have been observed in predominantly white samples also hold true for blacks. Replication of these findings with other subgroups of blacks, such as young females and middle-aged males, will help document the generality of these findings within the black population.     

Type A behavior, personality hardiness, and cardiovascular responses to stress

Type A behavior and hardiness were examined as predictors of cardiovascular responses to stress in 68 male undergraduates. Systolic and diastolic blood pressure (SBP and DBP) and heart rate were monitored while subjects performed a difficult mirror-tracing task. Type A assessments based on the Structured Interview, but not those based on the Jenkins Activity Survey, were associated with significantly enhanced SBP and DBP elevations. Hardiness was associated with significantly reduced DBP responsiveness. In addition, a significant interaction indicated that the Type B-high hardiness group showed the least DBP reactivity. A near-significant interaction (p = .06) suggested that Type B-high hardiness subjects also reported the least anger. Further exploration of the data indicated that the challenge component of hardiness accounted for its relationship to DBP reactivity. These results have implications both for the psychophysiologic study of Type A behavior and for understanding the health-promoting effects of hardiness.     

Models of personality and disease: an interactional approach to type A behavior and cardiovascular risk

Type A behavior has been established as a risk factor for coronary heart disease. Enhanced cardiovascular and neuroendocrine responsiveness to stressors has been suggested as a pathophysiological link between the behavior pattern and disease. The present article describes a model that places this link in an interactional context. Specifically, it is hypothesized that via cognitive and overt behaviors, Type As construct a subjective and objective environment rich in those classes of stimuli known to elicit enhanced physiological reactivity. This approach differs from previous ones by emphasizing that the Type A pattern represents an ongoing process of challenge and demand engendering behavior. That is, Type A persons do not simply respond to challenges and demands; they seek and create them through their cognitions and actions. This constructed environment also elicits and maintains further Type A behavior. The present view of Type A behavior as a challenge and demand engendering style is contrasted with other conceptual approaches, and implications are discussed.     

A critical evaluation of some commonly-employed methods for the assessment of type a coronary-prone behaviour

Type A coronary-prone behaviour has been repeatedly associated with an increased incidence of coronary heart disease (CHD) amongst middle-aged men and women. This association appears to be independent of other standard CHD risk factors such as smoking, high blood pressure and elevated serum cholesterol levels. This paper presents normative and correlational data for a number of commonly-employed self-report measures of Type A behaviour and the structured interview. These data replicate U.S. findings that self-report measures tend to correlate only moderately with the Structured-Interview method of assessment of Type A behaviour. The implications of these data for researchers attempting to assess Type A behaviour, especially with limited resources, are discussed.     

The nomological validity of the Type A personality among employed adults

The nomological validity of the Type A behavior pattern was explored. The Structured Interview (SI) and a battery of personality trait, physical health, and strain measures were administered to an occupationally diverse sample of 568 workers. Ss were also monitored for physiological reactivity and recovery (blood pressure, heart rate, skin temperature, and electrodermal response) to the SI and a subsequent Stroop Color-Word Conflict Task. A confirmatory factor analysis demonstrated that SI scores can be factored into three distinct dimensions. There was considerable overlap in the patterns of personality traits that characterized the Type A components, but only a Hostility dimension was significantly related to physiological reactivity and recovery. The results have implications for distinguishing coronary-proneness from the more traditional Type A conceptualization.     

Type A personality, self-control, and vulnerability to stress

Type A behavior (hard-driving, competitive, time-urgent, hostile-irritable) has been linked to high stress levels and the risk of eventual cardiovascular problems (i.e., coronary heart disease, CHD). However, this pattern of behavior closely resembles the traditional masculine instrumental (goal-oriented) orientation, and, if kept within limits, may be viewed as adaptive in success-oriented, middle-class college students. Hypothetically then, Type A behavior may be displayed by a broad group of individuals, and only in those cases when it is allowed to reach extreme proportions is stress sufficient enough to confer risk. This article considers two lines of reasoning. Is greater self-control required for college women to be Type As, because it involves crossing into traditional male role behavior? Type A women displayed significantly better self-control then Type B women; the opposite result was disclosed for college men with Type As displaying poorer self-control than Type Bs. The question of whether risk-conferring Type A behavior would result from poorer self-control was answered in the affirmative. Self-control assumed moderator status; poorer self-control in both male and female Type As was associated with high levels of day-to-day stress relative to Type As with better self-control. Self-control did not influence stress level in Type Bs. This moderator effect suggests that only Type As who cannot contain their behavior within adaptive limits will be vulnerable to excessive stress and at risk for CHD.     

The Montreal Type A Intervention Project: major findings

This article reports a comparison of three short-term treatments (aerobic exercise, cognitive-behavioral stress management, and weight training) in modifying behavioral and cardiovascular reactivity to laboratory psychosocial stressors in healthy Type A men. One hundred seven men completed the treatments and evaluations, 33 in the aerobic exercise group, and 37 each in the cognitive-behavioral stress management and weight-training groups. The stress management group showed significantly greater changes in behavioral reactivity (reductions of 13% to 23% below initial values) than the two physical exercise groups, which did not differ significantly from each other. For physiological reactivity, changes attributable to intervention were trivial for all three treatment groups. The positive finding of reduced behavioral reactivity as a result of the stress management intervention is of potential clinical significance and warrants further exploration. The lack of meaningful reductions in physiological reactivity also requires further exploration in that it raises questions concerning the ability of behavioral treatments in general to modify physiological reactivity, the ability of existing measures to assess accurately changes that are produced and, most fundamental of all, the relevance of physiological reactivity as an outcome measure for treatment efforts with Type As.     

Type A behavior and processing of social conflict information

Research suggests that the Type A pattern as assessed by the Jenkins Activity Survey (JAS) involves a number of stress-engendering cognitive/social responses. To identify potential responses responsible for social stress, the study tested the relationship between JAS Type A behavior and several cognitive/social variables relevant to assertiveness situations. Male undergraduates completed two measures of cognitive complexity and rated the reasonableness of another's request. Also, subjects were evaluated for positive content (i.e., consideration of the other) in role-played assertion responses. Type A behavior correlated with lower differentiation when sorting aspects of an assertion situation, lower integrative complexity when thinking about conflict topics, and less inclusion of consideration content.     

Assessing the relationship of Type A beliefs to cardiovascular disease risk and psychosocial distress

Investigators have begun to take a multimodal approach to the assessment and treatment of psychosocial risk factors for cardiovascular disease (CVD). For instance, cognitive responses have become the focus of contemporary research along with continued examination of overt Type A behaviors. Price (1982) has outlined a set of beliefs purportedly associated with Type A behavior and subsequent CVD risk. The current study examines the validity of this belief set as represented by a newly developed measure, the Type A Cognitive Questionnaire (TACQ). Subjects were 221 employed adults participating in a worksite CVD risk reduction program. They completed the TACQ as part of a pretreatment CVD risk screening protocol. As hypothesized, TACQ scores were significantly associated with Type A behavior, hostility, physiological mediators of CVD, and psychosocial distress. Discussion addresses continued refinement of the Type A belief construct.     

Reasons for the trend toward null findings in research on Type A behavior.

The findings of many studies conducted before 1978 suggest that Type A behavior (TAB) contributes to the development of coronary heart disease (CHD). In contrast, many recent studies have found no association between these variables. Through meta-analysis, several reasons for null findings are identified. First, a type of range restriction bias, disease-based spectrum (DBS) bias, produced many null findings. A study is vulnerable to DBS bias when researchers select only high-risk or diseased Ss for study. Second, self-report measures of TAB were often associated with null findings. Finally, null results were found for all studies that used fatal myocardial infarction as a disease criterion. In addition to identifying the reasons for null findings, this research suggests that TAB, as assessed by the structured interview, is associated with CHD. More Type As (70%) were found in diseased populations of middle-aged men than in healthy populations of middle-aged men (46%).     

Type A behavior and parenting stress in mothers with young children

Type A Behavior Pattern (TABP) is characterized by competitiveness, a sense of time-urgency, impatience, and aggression/hostility and it has been associated with coronary heart disease and occupational stress in men. Recently, research had begun to examine TABP in women. However, the majority of studies focus on women as student or employee and not in the role of mother. Thus, although women spend a significant proportion of their adult lives bearing and raising children, little is known about TABP relationships in these roles. Further, the parenting adjustment literature amply describes the stressful nature of parenting a young child but with little attention paid to the relationship between maternal individual characteristics and parenting stress. This study investigated maternal adjustment and TABP in order to provide a clearer picture of Type A women as mothers as well as to expand information on individual characteristics which contribute to or mediate a woman’s adjustment to motherhood. Because of its presumed relationship to TABP and stress, maternal employment status was a control variable. One hundred twenty-six women with children between the ages of 9–24 months completed questionnaires reporting maternal stress, maternal perceptions of her child and somatic complaints. TABP was assessed by two measures, the Framingham Type A Scale (FTAS) and a recent measure, the Adolescent/Adult Type A Behavior Scale (AATABS), which yields factor scores as well as a global TABP rating. Overall, Type A women reported higher levels of child-related stress and personal stress than Type B women. Certain factors such as Hurry, Control, and Hostility were also associated with stress indices. There was qualified support for a relationship between the TABP factor, Hurry, and self-reported somatic complaints. Directions for future research are discussed.     

Type A behavior, attentional style, and symptom reporting among adult men and women

Type A behavior and its components (measured on the JAS) were examined in relation to attentional style and symptom reporting in 294 healthy adult men and women. The results showed that for both men and women the JAS Type A, Job Involvement, and Hard Driving factors were all associated with self-reported attentional effectiveness as measured by the Nideffer Test of Attentional and Interpersonal Style. However, a fourth JAS factor, Speed and Impatience, was associated with Nideffer measures of cognitive overload. For both men and women, the Type A, Speed and Impatience, and Hard Driving factors were all positively associated with the number of medical and psychological symptoms reported on the Cornell Medical Index. In addition, acute psychological distress (Hopkins SCL-90R) was associated with Type A behavior for men and with Speed and Impatience for both sexes. Attention differences did not account for the observed positive relationships between Type A factors and symptom reporting with one exception; attentional overload (internal) appeared to partially explain the relationships between symptom reporting and Speed and Impatience in women. In summary, Type As described themselves as having a broader attentional focus and reported more naturally occurring physical and psychological symptoms than did Type Bs.     

Type A behavior and parenting stress in mothers with young children

Type A Behavior Pattern (TABP) is characterized by competitiveness, a sense of time-urgency, impatience, and aggression/hostility and it has been associated with coronary heart disease and occupational stress in men. Recently, research had begun to examine TABP in women. However, the majority of studies focus on women as student or employee and not in the role of mother. Thus, although women spend a significant proportion of their adult lives bearing and raising children, little is known about TABP relationships in these roles. Further, the parenting adjustment literature amply describes the stressful nature of parenting a young child but with little attention paid to the relationship between maternal individual characteristics and parenting stress. This study investigated maternal adjustment and TABP in order to provide a clearer picture of Type A women as mothers as well as to expand information on individual characteristics which contribute to or mediate a woman’s adjustment to motherhood. Because of its presumed relationship to TABP and stress, maternal employment status was a control variable. One hundred twenty-six women with children between the ages of 9–24 months completed questionnaires reporting maternal stress, maternal perceptions of her child and somatic complaints. TABP was assessed by two measures, the Framingham Type A Scale (FTAS) and a recent measure, the Adolescent/Adult Type A Behavior Scale (AATABS), which yields factor scores as well as a global TABP rating. Overall, Type A women reported higher levels of child-related stress and personal stress than Type B women. Certain factors such as Hurry, Control, and Hostility were also associated with stress indices. There was qualified support for a relationship between the TABP factor, Hurry, and self-reported somatic complaints. Directions for future research are discussed.     

Loneliness, social support and cardiovascular reactivity to laboratory stress

Self-reported or explicit loneliness and social support have been inconsistently associated with cardiovascular reactivity (CVR) to stress. The present study aimed to adapt an implicit measure of loneliness, and use it alongside the measures of explicit loneliness and social support, to investigate their correlations with CVR to laboratory stress. Twenty-five female volunteers aged between 18 and 39 years completed self-reported measures of loneliness and social support, and an Implicit Association Test (IAT) of loneliness. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) reactivity indices were measured in response to psychosocial stress induced in the laboratory. Functional support indices of social support were significantly correlated with CVR reactivity to stress. Interestingly, implicit, but not explicit, loneliness was significantly correlated with DBP reactivity after one of the stressors. No associations were found between structural support and CVR indices. Results are discussed in terms of validity of implicit versus explicit measures and possible factors that affect physiological outcomes.     

Cognitive-behavioral modification of coronary-prone behaviors: Proposal for a treatment model and review of the evidence

The Type A behavior pattern (TABP) has been proposed as a causal risk factor in coronary heart disease (CHD), and Cognitive-Behavioral treatment procedures have been proposed as a means of altering TABP. However, recent research suggests that only one component of TABP, hostility and anger, is the primary pathogenic factor in CHD. We review the research literature addressing the relationship of cognitive dysfunction and TABP and the relationship between cognitive dysfunction and anger expression. We then review the cognitive-behavioral therapy research literature regarding the modification of cognitive dysfunction, TABP and anger expression. While sparse, the research suggests that cognitive-behavioral treatments for anger and hostility hold promise for the treatment of individuals at risk for CHD.Jeffrey M. Lohr, Ph.D., is an Associate Professor of Psychology at the University of Arkansas-Fayetteville. His research interests are in the assessment of irrational beliefs and their association with dsyphoric motivational statesL. Kevin Hamberger, Ph.D., is an Associate Professor in the Department of Family Medicine of the Medical College of Wisconsin. His clinical and research interests are in the cognitive-behavioral treatment of male spouse abusers     

Type A behavior in employed women: relation to work, marital, and leisure variables, social support, stress, tension, and health

Ninety-one women employed full-time were administered the Jenkins Activity Survey (JAS; Jenkins, Rosenman, & Zyzanski; 1974) and the Framingham Type A Scale (FTAS; Haynes, Levine, Scotch, Feinleib, & Kennel, 1978). Information concerning various work and nonwork-related variables was obtained via questionnaire or interview. Type A women had higher occupational levels and reported more demanding jobs and higher stress and tension than Type B women. Type A and B women did not differ in their reports of marital adjustment or in total hours spent in leisure activities. Type A behavior was related to both self-reported stress and tension--and for married women only, poorer self-reported physical health. Social support from various sources was not found to be related to Type A or Type B. Curiously, Type A was related to more reported stress and tension for women who felt they had many sources of support but not for women who did not perceive their having many sources of support.     

The role of masculinity in a prognostic predictor of heart attack severity

Coronary heart disease (CHD) is the leading cause of mortality and morbidity in the United States for both men and women. Men, however, are more likely that women to suffer from CHD at all ages. While previous research has linked Type A behavior to CHD, investigators have failed to note the role traditional masculinity plays in the development of that behavior pattern and in the development of other psychosocial risk factors for CHD. In the present study, 90 postmyocardial infarction patients were interviewed shortly before hospital discharge. The masculinity-CHD relationship was hypothesized to be mediated by masculinity's link to Type A behavior, poor health practices, and impaired social networks. Masculinity, along with these mediating variables, was then expected to be related to the Peel prognostic indicator of heart attack severity. Results indicated that negative or extreme masculinity was related to each of the mediating variables and to heart attack severity, but the effect of masculinity on heart attack severity was not mediated by Type A behavior, poor health practices, or impaired social networks.