The effects of anger management and social contact on risk of myocardial infarction in type as and type bs

Abstract

The risk of myocardial infarction (MI) associated with Type A behaviour, anger management and social contact was examined using a retrospective case-control design. Binary multiple regression analyses were used to compare 206 male and 67 female MI cases with 454 male and 316 female controls. To examine the potential moderating role of sex and Type A behaviour, moderated and subgroup regressions were run. Type A behaviour was significantly more prevalent in cases than controls. MI risk was further increased in males who combined Type A behaviour and aggressive expression of anger. In females MI risk was associated with the combination of Type A behaviour and not expressing anger. In addition female cases were significantly less likely than controls to discuss their anger, and reported fewer available social contacts. Discussion of results includes consideration of the problems generated by the retrospective case-control design.     

Interpreting coronary-prone behaviour: Relationships among type a behaviour,hopelessness, anger management and social contact

Abstract

Two approaches to interpreting relationships among psychosocial risk factors for coronary heart disease are contrasted: the profile approach which focuses on predictive validity and confounding; and the theoretical approach which emphasises internal validity. These approaches are explored by applying them to a set of correlations found among Type A behaviour, hopelessness, anger management and social contact in a female sample. Type A behaviour was positively correlated with hopelessness and with anger expression, whilst anger management was related to the availability of social contact. The relationships between Type A, anger expression and hopelessness also appeared to be moderated by degree of social contact. These results are interpreted from the profile perspective and from that of Price's cognitive social learning theory. The relative merits of the two approaches are considered and a case is made for encouraging more theoretically based research on coronary-prone behaviour.     

Differences between informants about type a,anger, and social support and the relationship with blood pressure

Abstract

In a study on the influence of different natural environments on self-perception and that of significant others, behavioral manifestations of Type A, Anger, and Social Support were assessed. It was hypothesized that due to different environmental demands, participants will be perceived as displaying differences in Type A behavior, anger, and social support at home and at work. Participants were 45 university employees, constituting a convenience sample. Assessment included Type A Structured Interview scores of participants and questionnaire scores for Type A, anger, and social support of participants who were also evaluated by their spouses and work supervisors. Other risk factors for coronary heart disease (i.e., blood pressure, smoking, previous heart condition, being sedentary, and family history) and their relationships with Type A, anger, and social support were also examined.

Participants and spouses agreed significantly on all measures, whereas participants and work supervisors agreed only on Type A behavior. Spouses' and work supervisors' evaluations of the participants' behavior were not or only marginally associated. Multiple regression analysis showed that the level of disagreement between the different informants with respect to Type A and social support were associated with elevated blood pressure. These results suggest that the perception of Vpe A behavior, anger, and social support may be situationally determined.     

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.     

The distressed (Type D) personality mediates the relationship between remembered parenting and psychological distress in cardiac patients

Objective: Both the distressed (Type D) personality (i.e. the combination of negative affectivity and social inhibition traits) and dysfunctional parenting styles are associated with anxiety and depression. As parenting styles have been related to personality development, dysfunctional parenting styles may also be associated with Type D personality. We examined whether remembered parenting was associated with anxiety and depression in cardiac patients and whether Type D personality mediated this relationship.

Methods: Our sample comprised 435 patients treated with percutaneous coronary intervention (PCI) and 123 patients with congestive heart failure (CHF). Patients completed the Hospital Anxiety and Depression Scale, Type D Scale (DS14), and Remembered Relationship with Parents (RRP¹⁰) scale.

Results: Remembered parenting was significantly associated with higher anxiety and depression levels and Type D personality. In multivariable linear regression analyses, Type D personality accounted for 25–29% of the variance in anxiety and 23–46% of the variance in depression, while remembered parenting was no longer significantly associated with these domains. Sobel tests and bootstrapping indicated that Type D personality mediated the relationship between remembered parenting and anxiety and depression.

Conclusion: Type D personality mediated the relationship between remembered parenting and anxiety and depression in both PCI and CHF patients.     

The Role of Perceived Social Support and Stress in the Type A Cognition-Symptom Relationship

The two main objectives of this research were to determine whether Type A cognitions are related to a broader range of symptoms than has traditionally been studied and to determine possible mediating variables. Past research and theory suggest that Type A individuals not only experience but also generate stress and interpersonal conflict (i.e., in keeping with a psychosocial vulnerability model). This psychosocial vulnerability may put Type A individuals at greater risk of experiencing a wide array of physical and psychological symptoms well beyond coronary heart disease (CHD), the health outcome typically investigated. Stress, interpersonal and non-interpersonal in nature, and perceived social support, were explored as possible mediators in the Type A cognition-symptoms relationship using structural equation modelling (SEM) in a university sample. Non-interpersonal stress and interpersonal stress mediated both the Type A cognition-psychological symptoms relationship and the Type A cognition-physical symptoms relationship. However, perceived social support only mediated the Type A cognition-psychological symptoms relationship. Results indicate that Type A individuals may experience psychosocial vulnerability, particularly reporting stress, which may put them at risk for the experience of negative health outcomes. Implications for cognitive therapy are discussed.

Type D personality and social relations in adults with diabetes: results from diabetes MILES – The Netherlands

Abstract

Objective: To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes.

Design: In the Diabetes MILES—The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56?±?14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups.

Results: Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259]?=?37.27, p?<?0.001), and relationship adjustment (Welch[3,191]?=?14.74; p?<?0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR?=?8.73; 95%CI?=?5.05?～?15.09; p?<?0.001) and lower relationship adjustment (lowest quartile; adjusted OR?=?3.70; 95%CI?=?2.10?～?6.53; p?<?0.001). Type D was also associated with increased levels of loneliness.

Conclusion: Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.     

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.     

A one-year prospective investigation of Type D personality and self-reported physical health

Objective: Type D personality is characterised by negative affectivity (NA) and social inhibition (SI), and is often associated with poorer physical and psychological health. However, the underlying mechanisms are unclear and the literature lacks longitudinal assessment. Therefore, the aim was to prospectively examine the relationships between Type D and physical symptoms, in addition to aspects of retrospective health.

Design: An online questionnaire-based study (N?=?535) with a one-year follow-up (N?=?160) was conducted with healthy individuals (18–65 years). Type D was assessed as both a categorical and dimensional construct.

Main outcome measures: Participants completed the Type D scale-14 (DS14), Hospital Anxiety and Depression Scale (HADS), Cohen–Hoberman Inventory of Physical Symptoms (CHIPS) and Perceived Stress Scale (PSS) at both phases. Retrospective health questions and the Social Readjustment Rating Scale (SRRS) were also completed at follow-up.

Results: Type D was independently related to cardiac/sympathetic, metabolic, vasovagal, muscular and headache symptoms at baseline. At follow-up stressful events and anxiety mediated the relationships between Type D and particular symptoms. Type Ds were more likely to report poorer health, increased minor illnesses, work absences, and medical information seeking.

Conclusions: Type D is associated with symptoms often linked to stress. Although the relationships appear to be primarily driven by NA, these findings support the theory of a stress-related mechanism potentially underpinning the Type D-health relationship. These findings contribute to the literature continuing to highlight Type D personality as a risk factor for negative health outcomes.     

Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients

Bergvik, S., Sørlie, T., Wynn, R. & Sexton, H. (2010). Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients. Scandinavian Journal of Psychology. The combination of negative affectivity (NA) and social inhibition (SI) – the Type D Personality – is associated with poor outcomes in coronary artery disease (CAD) patients. A Norwegian translation of the standard instrument measuring Type D (DS14) was tested on 432 CAD patients receiving coronary revascularization treatment. Factor analysis produced two factors with high inter‐item reliability, indicating that the Norwegian DS14 has acceptable psychometric properties. Eighteen percent were classified as Type D, lower than has been reported elsewhere. Type D was associated with anxiety, depression, and passive coping. NA correlated positively with depression, anxiety, and passive coping. SI correlated positively with depression and anxiety, and negatively with active coping. The prevalence of Type D was higher among women, and negatively correlated with time since treatment. The variation in Type D prevalence among studies needs further elucidation as does the predictive power of continuous scoring of the Type D trait.     

Type D personality,but not Type A behavior pattern,is associated with coronary plaque vulnerability

Personality traits are associated with major adverse coronary events (MACE) in patients with coronary artery disease (CAD). However, the link between personality traits and intravascular morphology in CAD patients is poorly understood. This study investigated the relationship between personality traits, specifically Type A behavior pattern and Type D personality, and plaque vulnerability. After adjustment for demographic and clinical factors, multivariable regression analysis showed no association between Type A and optical coherence tomography indices. However, Type D personality was independently associated with lipid plaque, thin cap fibroatheroma (TCFA), and fibrous cap thickness. More specifically, negative affectivity of Type D was related to lipid plaque, TCFA and fibrous cap thickness, and social inhibition was associated with plaque rupture. Our results show that Type D personality was associated with plaque vulnerability, independent of clinical factors. Measurement of negative affectivity and social inhibition will increase our understanding of the progressive phase of the plaque vulnerability, which can contribute to the early identification of high risk patients and reduce the incidence of MACE.     

The role of risk perception in explaining parental sunscreen use

Objective: This study assessed: (1) whether risk perceptions about skin cancer were related to parent's use of sunscreen on their children; (2) which combination of assessments susceptibility and severity best explain parental sunscreen protection behaviours and (3) whether risk perceptions influence behaviour directly through intentions or through attitudes, subjective norms and self-efficacy.

Design: Two longitudinal studies assessed sunscreen protection behaviours of parents for their toddlers (N?=?391) and young children (N?=?436).

Main outcome measure: Parent's use of sunscreen on their children.

Results: Risk perceptions correlated with future sunscreen protection behaviours of parents but were lower than those of attitude, social influence and self-efficacy. Treating susceptibility and severity as an additive function resulted in the best model fit. Risk perceptions were related with future intention and future sunscreen protection behaviour, but the effects were mediated through attitude, social influence and self-efficacy.

Conclusions: Our path analyses suggest treating susceptibility and severity as an additive function. A multiplicative model without main effects – although often used – had the poorest fit. Risk perceptions influence behaviour by influencing attitudinal and self-efficacy beliefs. Addressing risk perceptions in health communication programs is relevant when the purpose is to increase awareness and to influence attitudes and self-efficacy.     

Failure to alter psychophysiological reactivity in type a men with physical exercise or stress management programs

Abstract

Psychophysiological reactivity has been associated with heightened risk of coronary heart disease. Since behavioral processes may contribute to disease etiology, the possibility arises that they might also contribute to disease prevention. The capability of behavioral interventions to modify exaggerated reactivity in Type A men. was therefore, brought under experimental scrutiny. Subjects were 107 male managers. who met the following criteria: (1) no history or current signs of heart disease. (2) presence of Type A behavior pattern, and (3) exaggerated psychophysiological reactivity to mental stress. After matching for age and physical fitness level. participants were randomly assigned to one of three 10-week intervention programs: aerohic training, weight training and cognitive-behavioral stress management. Heart rate and blood pressure were monitored while challenging mental tasks were performed in pre-training and post-training laboratory sessions before and after the intervention programs. Although participants in the two physical activity programs showed the expected physical adaptations, no changes in psychophysiological reactivity were seen in the three groups. This negative result may indicate either that reactivity was not altered owing to the conditions of the present experiment, or that these behavioral interventions are truly without effect.     

Type A behaviour and psychophysiological arousal

The "coronary prone" or Type A behaviour pattern, characterized by e.g., hard-driving competitiveness, impatience and aggressiveness, is associated with elevated systolic blood pressure and catecholamine secretion during challenge. In experiments at our laboratory, elevated psychophysiological arousal was found in Type A subjects during understimulation, but not during active performance on a self-paced reaction time task. Results suggest that differences in cardiovascular and behavioural reactivity between Type A and B persons tend to be related to the pace of the environment to which they are exposed. Studies of antecedents of Type A behaviour in children show that "Type A children" respond to challenge with a greater increase in sympathetic arousal than "non-Type As". This suggests the possibility that genetic dispositions and/or conditioned sympathetic reactivity play an important role in the development of the Type A behaviour pattern.     

Self-efficacy for health-related behaviour change in patients with TIA or minor ischemic stroke

Abstract

Objective: To assess levels of self-efficacy for health-related behaviour change and its correlates in patients with TIA or ischemic stroke.

Methods: In this prospective cohort study, 92 patients with TIA or ischemic stroke completed questionnaires on self-efficacy for health-related behaviour change and fear, social support and depressive symptoms. Relations between fear, social support, depressive symptoms, cognitive impairment, vascular risk factors and history and demographic characteristics and low-self-efficacy were studied with univariable and multivariable logistic regression.

Results: Median total self-efficacy score at baseline was 4 (IQR 4–5). Older age (OR 1.05, 95% CI 1.01–1.09), depressive symptoms (OR 1.09, 95% CI 1.03–1.16), presence of vascular history (OR 2.42, 95% CI 0.97–6.03), higher BMI (OR 1.15, 95% CI 1.01–1.30), fear (OR 1.06, 95% CI 1.01–1.12) and low physical activity (OR 1.49, 95% CI 1.01–2.21) were significantly associated with low self-efficacy.

Conclusion: Patients with recent TIA or ischemic stroke report high self-efficacy scores for health-related behaviour change. Age, vascular history, more depressive symptoms, higher BMI, less physical activity and fear were correlates of low self-efficacy levels.

Practice implications: These correlates should be taken into account in the development of interventions to support patients in health behaviour change after TIA or ischemic stroke.     

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.     

Response of the pituitary-adrenal axis in terms of type a behaviour,hostility and vital exhaustion in healthy middle-aged men

Abstract

Pituitary-adrenal axis was studied in terms of Type A behaviour, hostility and vital exhaustion among 69 healthy middle-aged men. The results showed that psychological factors could explain a significant proportion of the biologically manipulated responses of HPA axis, but they worked in different ways. Type A behaviour was related to a high level of mean basal ACTH and a low level of cortisol response to ACTH stimulation after dexamethasone suppression; hostility was related to a high level of mean basal cortisol and a high cortisol in cortisol/ACTH ratio, while vital exhaustion was characterized by a low level of mean basal ACTH and a decreased ACTH in relation to cortisol. The adrenocortical patterns, i.e. a high ACTH-low cortisol; a high cortisol; and a low ACTH-low mean basal cortisol, as related to Type A behaviour, hostility and exhaustion, respectively, are in line with the traditional physiological stress model and suggest that different adrenocortical responses might be able to identify different mental stress processes. Sense of control has been suggested to be a key concept for psychological understanding of this finding.     

The assessment of type a behaviour: A critique

Abstract

The validity of type A behaviour (TAB) as a precursor to heart disease is now increasingly subject to debate. This review examines some issues in the assessment of TAB that may have confused rather than clarified such debate. The status and interrelations between four widely used measures of TAB (Jenkins Activity Survey, Framingham Type A Scale, Bortner Rating Scale, and Structured Interview) are described, and a number of problems in their use discussed, including: differing conceptualisations of TAB, drifting criteria of assessment, failure to obtain accurate self-report of TAB, and difficulties associated with the measurement of TAB in populations other than male non-manual workers. Future research should attempt to obviate such difficulties, while elucidating pathogenic behaviours and attitudes, and how these interact with other variables to increase the risk of heart disease. Finally, the value of a state measure of TAB is discussed.     

Type A behaviour and school achievement

Type A behaviour related to school achievement was studied in 1640 randomly selected 12-, 15-, and 18-year-old subjects. Type A behaviour was both self-assessed by the subjects and evaluated by their mothers. Results indicated that school achievement was not related to the global score of Type A behaviour but correlated with three Type A dimensions, i.e. positively with Responsible Hard-driving and Leadership Competitiveness, and negatively with Aggressive Competitiveness. It has previously been shown that hard-driving correlates with a high level of somatic CHD risk factors, while leadership competition is a protective factor, i.e. it is associated with a low level of somatic CHD risk. So, school achievement differentiated adjusted and maladjusted Type A competitors, but not individuals with high and low somatic CHD risk. The results were manifest for boys and girls and for all age groups. Moreover, it was shown that the results were obtained independently of the methods used.     

Coronary heart disease and psychological variables: is Type A enough to increase the risk?

A group of coronary patients (89 males and 19 females) suffering from angina pectoris and a control group (157 males and 95 females) were psychometrically studied before and after being matched by age and sex, in order to test if psychological variables other than Type A could be related to the coronary risk. Type A behaviour was assessed through the Jenkins Activity Survey, form C (JAS-C) and the Borther questionnaire. Other psychological variables studied were hostility-aggressivity, assessed through the Buss-Durkee Inventory, and Psychoticism (P), Neuroticism (N) and Extraversion (E). Results supported the authors' hypothesis that CHD events are more probable in Type A people with neurotic and aggressive features (coronary-prone behavior) than in people showing only Type A traits. Neuroticism scores were significantly higher in coronary patients, in whom the aggressive features could be related to a ‘hostile-paranoid’ structure, more prominent in men.