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.     

Social influence, marriage, and the heart: cardiovascular consequences of interpersonal control in husbands and wives.

Human and experimental animal research suggests that social stress in general--and chronic, effortful attempts to exert social control in particular--may contribute to cardiovascular disease. We examined the effects of exerting social influence or control on cardiovascular responses in married couples. Compared to husbands discussing a problem with their wives, husbands attempting to influence or persuade their wives displayed larger increases in systolic blood pressure (SBP) before and during the discussion. Furthermore, these physiological effects were accompanied by increases in anger and a more hostile and coldly assertive interpersonal style. Although wives who engaged in social influence attempts displayed generally similar behavior, they did not show the elevated SBP response or anger. We discuss the results in terms of the social context of cardiovascular reactivity and potential marital factors in cardiovascular health.     

Loneliness accentuates age differences in cardiovascular responses to social evaluative threat

The effects of aging and loneliness on cardiovascular stress responses were examined in 91 young (18-30 years) and 91 older (65-80 years) normotensive adults. Participants completed the revised UCLA Loneliness Scale and a modified version of the Trier Social Stress Test. Piece-wise linear growth-curve analysis was used to model group differences in resting, reactivity, and recovery levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Replicating and extending prior research, analyses revealed age-related increases in resting SBP and DBP. Adjusting for demographics and health covariates, interactions were found for SBP in which age differences in stress reactivity and recovery were greater among lonely than nonlonely participants. Findings provide further evidence that loneliness interacts with age to augment cardiovascular risk to social evaluative threat.     

Hostility and health: current status of a psychosomatic hypothesis.

Recent research has renewed interest in the potential influence of hostility on physical health. This review indicates that the evidence available from prospective studies, although not entirely consistent, suggests that hostile persons may be at increased risk for subsequent coronary heart disease and other life-threatening illnesses. Further, several plausible mechanisms possibly linking hostility and health have been articulated and subjected to initial evaluation. Hostile individuals display heightened physiological reactivity in some situations, report greater degrees of interpersonal conflict and less social support, and may have more unhealthy daily habits. Additional research is needed, and it must address a variety of past conceptual and methodological limitations. Perhaps the most central of these concerns are the assessment of individual differences in hostility and the role of social contexts in the psychosomatic process.     

Cardiovascular reactivity and neuroticism: results from a laboratory and controlled ambulatory stress protocol

A laboratory and controlled ambulatory protocol was used to study whether there are differences in the cardiovascular reactivity of persons varying in neuroticism, the disposition to experience negative subjective emotions. Thirty-six individuals (19 men, 17 women) who scored approximately 1 standard deviation above or below the mean on the NEO PI-R Neuroticism scale (Costa & McCrae, 1992) were recruited from a larger pool of undergraduate students. Participants, who had been outfitted with an ambulatory blood pressure/heart rate monitor, were exposed to 5 laboratory stressors and 7 field stressors during a 6-hour protocol. Results indicated that individuals scoring high in neuroticism showed blood pressure reactivity to laboratory and field stressors that was comparable to that of persons low in neuroticism. Aggregrating responses across stressors, there was evidence of exaggerated heart rate responses. The results suggested that, although neuroticism is related to high levels of negative subjective experience, differences between persons scoring high versus low in neuroticism were not exhibited strongly at the cardiovascular level. The implications for stress, coping, and disease are discussed.     

Cardiovascular reactivity and interpersonal influence: active coping in a social context

Previous studies have demonstrated that effortful attempts to secure positive outcomes or avoid negative outcomes produce significant increases in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Although these effects of active coping on cardiovascular reactivity are central in current psychosomatic theories, virtually all of the research to date has used impersonal, asocial tasks. Our two studies examined the cardiovascular effects of effortful attempts to influence other people. In Study 1, male subjects attempting to influence the opinions of their discussion partner to improve their own chances of winning money displayed significantly greater SBP, DBP, and HR reactivity. In Study 2, we obtained similar effects on SBP and DBP reactivity in men and women, while both preparing an influence attempt and making that attempt. Furthermore, reactivity levels were larger as the magnitude of incentive for successful persuasion increased. Implications of this interpersonal equivalent of active coping for the development of cardiovascular disease are discussed.     

Cardiovascular health in women: the role of anger and its expression

The relationships between anger expression (in, out, and control) and cardiovascular health (emotional distress, cardiovascular symptoms reported, and preventive health behaviors) were analyzed in 327 women (range 17-60 years). The same criteria (N= 218), as well as blood pressure (BP) registered in medical checkups (N= 90) were recorded one year later. Four groups according to anger-in and anger-control scores, going from the most hostile (high anger-in and low anger-control) to the least hostile (low anger-in and high anger-control) were considered. The results indicated that the most hostile group, with the least adaptive anger expression, presented worst cardiovascular health than the other three groups, at both temporal moments. Furthermore, the presence of women with pathological BP levels was higher in the groups of high anger-in. These data ratify the role of anger expression, especially its repression (anger-in) and the lack of adequate canalization or control in women's cardiovascular health from a prospective design. Appropriate management of anger feelings and the practice of preventive health behaviors can protect women from cardiovascular problems.     

Cardiac autonomic reactivity and recovery in predicting carotid atherosclerosis: the cardiovascular risk in young Finns study.

The present study examined the association of cardiac autonomic task-induced reactivity and recovery to preclinical atherosclerosis. Thirty-three men and 33 women aged 24-39 years participated in the ongoing epidemiological Cardiovascular Risk in Young Finns study. The authors measured heart rate (HR), respiratory sinus arrhythmia (RSA), and preejection period (PEP) during the mental arithmetic and speech tasks in 1999. Carotid atherosclerosis was assessed by measuring the thickness of the common carotid artery intima-media complex (IMT) with ultrasound in 2001. Higher HR, RSA, and PEP reactivity were associated with lower IMT values even after adjusting for cardiovascular risk factors (lipid levels, obesity, and blood pressure). In addition, better HR recovery after the mental arithmetic task was associated with lower IMT values, and this association persisted after all adjustments. Thus, higher task-induced cardiac autonomic reactivity and better HR recovery were related to less preclinical atherosclerosis. The authors concluded that cardiac pattern of reactivity and quick recovery may be associated with better cardiovascular health, and therefore all reactivity occurring in challenging situations should not automatically be considered as potentially pathological.     

Interpersonal workplace stressors and well-being: a multi-wave study of employees with and without arthritis

The within-person influence of interpersonal stressors on affective well-being and physical well-being was investigated for 109 women with and without arthritis. Participants were interviewed on a weekly basis for 12 consecutive weeks, and the prospective data were analyzed by using hierarchical linear modeling. Overall, interpersonal workplace stressors independently predicted both well-being outcomes. Interpersonal stressors outside the workplace were related to negative affect but not to arthritis symptoms. Compared with healthy controls, arthritis patients' ratings of negative affect were equally reactive to workplace stressors. Neuroticism did not moderate stressor reactivity for either dependent variable but did predict mean levels of negative affect. The data support the hypothesis that the psychosocial environment of the workplace contributes unique effects on well-being.     

Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women.

This study examined the relationship of cardiovascular reactivity to both interpersonal mistreatment and discrimination in a community-based sample of African American and European American women (N=363) in midlife. Subtle mistreatment related positively to diastolic blood pressure (DBP) reactivity for African American participants but not their European American counterparts. Moreover, among the African American participants, those who attributed mistreatment to racial discrimination exhibited greater average DBP reactivity. In particular, these women demonstrated greater DBP reactivity to the speech task, which bore similarities to an encounter with racial prejudice but not to a nonsocial mirror tracing task. These findings are consistent with the hypothesis that racial discrimination is a chronic stressor that can negatively impact the cardiovascular health of African Americans through pathogenic processes associated with physiologic reactivity.     

Personality and health habits

Abstract

Four hundred and fifty-five males and 523 females from a community sample participated in a study on the relationship between seven health practices (sleeping; breakfasting; snacking; being at good weight; smoking; alcohol consumption and physical activity) and seven personality factors (Neuroticism; Social Inadequacy; Rigidity; Hostility; Self-sufficiency; Dominance and Self-esteem).

It was found that the seven health habits did not constitute a homogeneous operationalization of a construct “positive lifestyle.” The intercorrelations between the different health practices were typically low. The results of MANOVAs and subsequent ANOVAs revealed small, but statistically significant differences between subjects reporting positive and those reporting poor health habits. The failure to find significant interactions with sex indicated that the results for males and females were generally similar. Neuroticism and hostility discriminated best between the groups with poor or good health behaviors. This held for sleeping, exercising, breakfasting daily and smoking. In addition, sporting people scored lower on social inadequacy and higher on self-esteem. Further, individuals who do not have a daily breakfast were more self-sufficient. Snacking individuals were generally less rigid and less dominant, but more hostile. In conclusion, most negative health habits were found to be associated with personality attributes which are intimately related to symptom reporting (neuroticism, hostility). Given the generally weak associations, it is concluded that, in order to obtain a more complete picture of the individual's psychosocial risk profile, lifestyle data should be collected together with information on the person's stress and his or her coping qualities.     

Individual differences in delayed heart-rate recovery following stress: The role of extraversion,neuroticism and emotional control

The aim of this study was to investigate the effects of individual differences on heart-rate reactivity and recovery following exposure to a laboratory stressor (performance on the Stroop task). The personality scales used were EPI Extraversion and Neuroticism and four subscales comprising the Emotion Control Questionnaire (ECQ). Contrary to predictions the EPI scales were unrelated to the physiological indices, but there were significant correlations between the Benign Control scale of the ECQ and heart rate reactivity and between the Rehearsal scale and heart-rate recovery.     

Narcissism and Cardiovascular Reactivity to Rejection Imagery1

This study examined the interactive effects of imagined rejection and narcissism on cardiovascular reactivity (CVR). Participants completed measures of overt narcissism (Narcissistic Personality Inventory, NPI; Raskin & Hall, 1979 ), overt–covert narcissism ( Margolis & Thomas, 1980 ), and trait self‐esteem. They then imagined 2 scenarios culminating in either interpersonal acceptance or rejection. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were assessed before, during, and after the imagery. Overt–covert narcissism was positively associated with task increases in SBP and DBP and recovery elevation of HR following rejection, but not acceptance. Similar effects on SBP were found for the Entitlement/Exploitativeness dimension of the NPI. Lower self‐esteem predicted greater task increases in SBP, DBP, and HR across conditions. Implications for health are discussed.     

Sympathetic arousal to a vestibular stressor in high and low hostile men

The aim of the present experiment was to extend the literature on hostility and a cerebral systems based model of sympathetic arousal to a vestibular-based stress. Several authors have concluded that autonomic stress reactivity in high hostile individuals must be interpersonally based, whereas healthy vestibular system functioning does not depend on interpersonal features. Utilizing a vestibular activation paradigm, skin conductance levels of 15 high hostile and 15 low hostile men were recorded after brief passive rotation about the vertical neuroaxis. It was expected that hostile individuals would exhibit higher skin conductance levels after rotation compared with low hostile individuals. The results confirmed expectations of heightened sympathetic tone among high hostiles subsequent to vestibular stress. Overall, the findings are interpreted to support a cerebral model of frontal region capacity limitation for regulation of vestibular stress that is independent of psychosocial mechanisms.     

Are Large Physiological Reactions to Acute Psychological Stress Always Bad for Health?

How we react physiologically to stress has long been considered to have implications for our health. There is now persuasive evidence that individuals who show large cardiovascular reactions to stress are at increased risk of developing cardiovascular disease, particularly hypertension. By implication, low reactivity is protective or benign. However, there is recent evidence that low reactivity may predict elevated risk for a range of adverse health outcomes, such as depression, obesity, poor self-reported health and compromised immunity. In addition, low cortisol and cardiovascular reactivity may be a characteristic of individuals with addictions to tobacco and alcohol, as well as those at risk of addiction and those who relapse from abstinence. Our ideas about reactivity may have to be revised in the light of such findings.     

Social status,everyday interpersonal processes,and coronary heart disease: A social psychophysiological view

Lower socioeconomic position is associated with increased risk of coronary heart disease. This robust gradient is found across levels of socioeconomic position and after controlling access to health care and traditional biological and behavioral risk factors. Thus, previous theory and research has examined the role of other, relatively static psychosocial factors (e.g., social isolation and negative emotional traits) that may account for this association. Utilizing an interpersonal perspective on psychosocial risk (Smith & Cundiff, 2011 ; Smith, Gallo, & Ruiz, 2003 ; Smith, Glazer, Ruiz, & Gallo, 2004 ), this review examines the role of recurring interpersonal experiences and their physiological effects as a pathway linking socioeconomic position and coronary heart disease. Specifically, we focus on proximal interpersonal experiences that may not only explain the increased prevalence of more chronic psychosocial vulnerabilities in lower socioeconomic environments and individuals but may also link those psychosocial vulnerabilities to the momentary physiological mechanisms (i.e., stress responses) that directly contribute to coronary heart disease. Recurring experiences of reduced support and increased conflict in important personal relationships, work stress, multiple aspects of interactions with higher‐status others, the effects of negative stereotypes about lower socioeconomic groups and individuals, greater use of suppressive strategies for emotion regulation and greater negative consequences for more direct and expressive social behavior, and greater engagement in perseverative cognition all plausibly combine to perpetuate psychosocial risk and produce overall greater physiological burden at lower levels of socioeconomic position.     

Interpersonal orientation in context: correlates and effects of interpersonal complementarity on subjective and cardiovascular experiences

Interpersonal orientation (IO) generally refers to individual differences in preference for social interaction. The influence of IO, however, likely depends on the nature of complementarity within the interpersonal context. Using the interpersonal circumplex and Five-Factor Model, we first selected a measure of IO characterized by affiliation and neuroticism. Second, we examined the influence of IO on subjective, physiological, and nonverbal experiences as a function of experimentally manipulated complementarity or noncomplementarity. We hypothesized that women in noncomplementarity conditions (i.e., women low in IO working with a friendly confederate, women high in IO working with an unfriendly confederate) would experience the interpersonal situation more negatively compared to women in complementarity conditions. Study results confirmed this prediction, with noncomplementarity in IO resulting in greater physiological reactivity, greater likelihood to attempt nonverbally to restore complementarity, more partner-related thoughts, and a reduced desire to seek out attention compared to women working in complementarity conditions. Implications for research on IO as a person variable are discussed.