Examining the relationships among self-report measures of the Type A behavior pattern: the effects of dimensionality, measurement error, and differences in underlying constructs

The most widely used self-report measures of the Type A behavior pattern (TABP) are the Bortner scale, the Framingham scale, and the Jenkins Activity Survey (JAS). Though high scores on each of these measures have been linked to the development of coronary heart disease, their intercorrelations are rather low, suggesting that they may reflect different aspects of TABP. This study indicates that the low correlations among the Bortner scale, the Framingham scale, and the JAS are due not only to differences in underlying constructs but also to measurement error and multidimensionality. These results also identify several psychometric problems, which raise serious questions regarding the use of these measures in TABP research. Suggestions for the development of new measures of TABP are offered.     

Relationship between Type A behavior pattern and mental and physical symptoms: a comparison of global and component measures

Although the Type A behavior pattern (TABP) is typically considered a set of distinct components, most studies of TABP have used global measures, which collapse several components into a single index. These measures are inherently multidimensional and, as such, contain several conceptual and methodological problems. In this study, data from 240 executives were used to compare global and component TABP measures as predictors of mental and physical symptoms. Global measures included the Bortner scale, the Framingham scale, and the Jenkins Activity Survey. Component measures were constructed by recombining items from the global measures on the basis of results from previous confirmatory factor analyses (Edwards, Baglioni, & Cooper, 1990). Results indicate that the component measures were superior to the global measures in terms of number of relationships detected, interpretability, and total explanatory power. Implications for research and practice are discussed.     

Incremental Validity of Time Urgency and Other Type A Subcomponents in Predicting Behavioral and Health Criteria1

Although previous studies have revealed relationships between Type A behavior pattern (TABP) measures and behavioral indexes of time urgency, such studies utilized global TABP measures that have been criticized for their lack of construct validity. The present study linked recently developed measures of time urgency and other TABP subcomponents (e. g., impatience‐irritability) to observable temporal behaviors and health outcomes. In a sample of 194 undergraduate students, the results indicated that the TABP subcomponents provided incremental validity above the contribution of the global TABP measure in predicting behavioral and health criteria. Applied implications and future directions for research on time urgency and other TABP subcomponents are discussed.     

Modifying the Type A behavior pattern

The Type A behavior pattern (TABP), a complex of personality traits characterized by insecurity of status, hyperaggressiveness, sense of time urgency, free-floating hostility, and a tendency toward self-destruction, has been linked to coronary heart disease in both prospective and clinical studies. Attempts to modify the TABP are complicated by conceptual understandings of the behavioral complex. However, intervention studies, such as the San Francisco Recurrent Coronary Prevention Project, have shown that modification is possible. Both psychological and religious factors need to be taken into consideration when exploring the modification of the TABP.     

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     

Coronary Prone Behavior: Components of the Type A Pattern and Hostility

Traditional and nontraditional risk factors for coronary heart disease (CHD) are discussed with special attention devoted to the Type A behavior pattern (TABP). Positive and negative epidemiological evidence bearing on the risk factors status of global TABP is reviewed. Results of the review suggest that component scoring of the multidimensional global TABP in attempts to uncover "toxic" components, particularly Potential for Hostility, is a profitable research strategy. Similarly, evidence is presented that suggests merit in component scoring of hostility, also a multidimensional construct. To explicate more fully the nature of Potential for Hostility and its categories, correlations between the SI-derived ratings and ratings of established dimensions of individual differences based on the five-factor taxonomic model of personality from subsamples of the MRFIT and WCGS studies are presented. Total Potential for Hostility and especially the Style of interaction category show highly significant relations to Low Agreeableness or Antagonism. High ratings of Potential for Hostility identify individuals who can be described as uncooperative, antagonistic, rude, disagreeable, unsympathetic, callous, and the like. Implications of the evolving concept of coronary-prone behavior, as distinguished from TABP, are briefly considered.     

Heart and Lifestyle: A Type A Treatment Program for Myocardial Infarction Patients

Abstract

Despite almost thiry years of research on the Type A Behavior Pattern (TABP), only a few controlled treatment studies have been performed. Even fewer of them have been designed as long-term programs, the best known and most carefully controlled being the Recurrent Coronary Prevention Project (RCPP) at Mt. Zion Hospital, San Francisco (Friedman et al. 1982, Friedman et al. 1984, Thoresen et al. 1982). In Scandinavia, a study on TABP was published in 1980 (Orth-Gomér et al.), comparing the frequency of TABP among myocardial infarction patients, hypertensive patients, and healty controls. The results indicated more TABP among MI patients, thereby suggesting that TABP may be associated with Coronary Heart Disease (CHD) in Sweden.     

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 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.     

Gender differences in type a behavior and hostility within an organizational setting

Abstract

Recent investigations suggest that the hostility component of the Type A behavior patter (TABP) is a greater detriment to health than the overall pattern. Some researchers suggest that certain Type A characteristics (e.g., job-involvement) are actually adaptive. This study compared the relative relationship of the TABP and hostility to career-related achievement and psychosocial adjustment among 223 service-delivery employees. Male and female participants completed the Jenkins Activity Survey and the MMPI Hostility Scale as part of a cardiovascular disease risk factor screening. The TABP was positively associated with managerial status for both men and women. However, the TABP was positively related to psychosocial adjustment variables among men only. Hostility was significantly related to undesirable outcomes including lower job status, life dissatisfaction, and unfavorable perceptions of the workplace for both men and women. Discussion addresses organizational factors which might perpetuate hostility and the TABP, as well as gender differences in the experience of these constructs.     

Individual Differences in Attentional Strategies in Multitasking Situations

This study compared attentional strategies in prioritized and unprioritized multitasking situations using individual differences in the Type A behavior pattern (TABP) as predictors. The study expanded previous studies by using a triple task situation that presented two visual tasks and one auditory task simultaneously. One hundred and eighteen undergraduate students were utilized. One group received instructions for all tasks and their relative importance to each other for achieving a full performance score. The other group received instructions for the visual tasks only, and no information about their relative importance was given, creating ambiguity about priorities among the tasks. Global TABP and its subcomponents (i.e., time urgency, achievement strivings, impatience or irritability, polychronicity) were utilized as predictors of task performance. Significant correlations were found between the TABP subcomponents and different performance indexes, but such a relation was not found between global TABP and performance. Applied implications of these findings and directions for the future research are discussed.     

Predicting psychological health: assessing the incremental validity of emotional intelligence beyond personality,Type A behaviour,and daily hassles

Although some research has linked emotional intelligence (EI) and psychological health, little research has examined EI's ability to predict health outcomes after controlling for related constructs, or EI's ability to moderate the stressor–strain relationship. The present study explored the relationships among EI (as assessed by a trait‐based measure, the EQ‐i), Big Five personality factors, Type A Behaviour Pattern (TABP), daily hassles, and psychological health/strain factors (in terms of perceived well‐being, strain, and three components of burnout). The EQ‐i was highly correlated with most aspects of personality and TABP. After controlling for the impact of hassles, personality, and TABP, the five EQ‐i subscales accounted for incremental variance in two of the five psychological health outcomes. However, the EQ‐i scales failed to moderate the hassles–strain relationship. Copyright © 2005 John Wiley & Sons, Ltd.     

Prevalence and severity of anxiety, depression and Type A behaviors in angina pectoris

The role of psychological factors in coronary heart disease was examined by administering the Bech Rating Scale (BRS) of mood disorders and the Jenkins Activity Survey (JAS) for Type A behavior patterns (TABP) to a consecutive sample of angina patients ( N = 94), to a consecutive sample of noncardiac patients ( N = 47), and to a random sample of adults from the general population ( N = 217). Anxiety and depression were both more frequent and more severe in angina patients than in noncardiac patients or in the general population. There was a tendency for certain components of TABP (i. e. speed, impatience, hard-driving and competitive disposition) to be elevated in angina patients, but a similar trend was noted in noncardiac patients. Although no consistent relations were observed between negative emotions and TABP scores in angina patients, their anxiety and depression scores were reliably related to their use of nitroglycerin. The findings concur with previous studies concerning the presence of anxiety and depression in patients with angina pectoris and indicate that such negative emotions are not closely related to Type A personality traits.     

Relationship of type A behavior pattern in smokers to carbon monoxide exposure and smoking topography

Stress-related physiological factors have been proposed to mediate the Type A behavior pattern (TABP) and coronary heart disease (CHD). However, collateral behavioral factors, such as the exaggerated consummatory response patterns of Type As, may also be involved. Study 1 examined this hypothesis by comparing exposure to cigarette smoke in 42 graduate and undergraduate student smokers assessed for the TABP. After controlling for smoking rate and Federal Trade Commission cigarette carbon monoxide yield, Type As' alveolar carbon monoxide (COa) levels were higher than Type Bs', and Jenkins Activity Survey scores were correlated with COa. To determine the source of this difference, we measured smoking topography in 10 Type As and 10 Type Bs in Study 2. Type As and Type Bs did not differ in number of puffs taken or puff volume, but Type As' inhalation duration was 70% longer than Type Bs'. These results suggest that consummatory behaviors of Type As may help account for the Type A-CHD relationship for smokers. Due to increased smoke exposure, Type A smokers may also be at greater risk for cancer and lung disease than Type B smokers.     

An interview to measure vital exhaustion. II. reliability and validity of the interview and correlations of vital exhaustion with personality characteristics

Abstract

In the previous paper (Meesters and Appels, this issue) we described the development of an interview to measure feelings of vital exhaustion (VE). The current paper presents data on the reliability and the validity of the interview, which is labeled the Maastricht Interview for Vital Exhaustion (MIVE). Correlations with the Type A behavior pattern (TABP) and hostility are also discussed in this paper. The data were collected in a case-control study of 81 males with first MI and 168 healthy neighborhood controls. The interview was found to have a good reliability, Cronbach's alpha being .90 in the case group and .86 in the control group. The kappa coefficient was .95 in the case group and .91 in the control group. The validity was tested by computing the estimated relative risk of VE, controlling for angina pectoris and the classic risk factors. The odds ratio was found to be 8.11 (p<.001). This indicates that the interview makes a valid assessment of the mental precursors of MI. The interview correlated significantly with TABP (structured interview) and two self-report measures of hostility (Cook-Medley Hostility Scale and Buss-Durkee Hostility Inventory). Although the absolute magnitude of the observed odds ratios may be affected to some extent because the interviews were not scored blind, these results clearly suggest that the MIVE is a reliable and valid method to assess VE.     

Vital exhaustion measures and their associations with coronary heart disease risk factors in a sample of spanish-speakers

Abstract

The main purpose of this research was to study the reliability and conceptual validity of two Spanish language measures of Vital Exhaustion (VE), a short-term risk factor for coronary artery disease (CAD). The English version of the Maastricht Questionnaire for Vital Exhaustion was used to make a Spanish language questionnaire (VEQ) and a Spanish language interview (VEI) whose scoring systems were equal to the original version. These instruments were administered to a sample of healthy working men (n = 100) and women (n = 130) in Caracas, Venezuela. Participants also completed questionnaires designed to measure anger-expression and social support and were assessed by means of the Structured Interview to measure Type A Behaviour Pattern (TABP). Information about other CAD-risk factors, such as age, smoking behavior, and health habits, were collected.

High reliability coefficients, .85 and .91, were found for the VEI and VEQ, respectively. Principal component analysis provided one-factor solutions for each instrument. The pattern of correlations between VE, assessed by the VEI, and other personality characteristics was rather similar to the pattern observed in other cultures. In general significant, but modest, correlations were observed between VE and TABP, anger expression, a negative self-concept, and low social support. We conclude that VE appears to be a meaningful construct in this particular cultural context.     

Individual differences in type A behavior and cardiovascular responses to stress

The purpose of this study was to predict heart rate and blood pressure responses to a stressor task in 166 male and female university students using the multidimensional approach of the Survey of Work Styles. The Survey of Work Styles is comprised of scales for Impatience, Anger, Time Urgency, Work Involvement, Job Dissatisfaction, and Competitiveness. Systolic blood pressure, diastolic blood pressure, and heart rate were measured before and during a 5 min serial subtraction task. Three bipolar Survey of Work Styles profiles were identified for each sex. In males, similarity to each profile was uniquely related to one task cardiovascular measure. In females, two of the three profiles were uniquely related to one physiological measure assessed during the task. The data thus support separate treatment of male and female data. Consideration was given to the possible influence of TABP components, such as Anger, in the differences in the patterns of physiological responses for different Type A profile types. Implications of the physiological results for future studies on psychophysiological differences between Type A and B individuals, and the pathological links between Type A behavior and coronary heart diseases are discussed with emphasis on the recognition of the heterogeneity of personality profiles associated with Type A behavior.     

Cognitive-affective assets and vulnerabilities: Two factors influencing adaptation to Fibromyalgia

The present article describes the associations between hostility and serum lipids in Coronary Artery Disease (CAD) patients. A sample of 212 male coronary patients was used of which 127 recently suffered a Myocardial Infarction (MI), and 85 had undergone either a Coronary Artery Bypass Grafting (CABG) or a Percutaneous Transluminal Coronary Angioplasty (PTCA). Total Cholesterol (TC), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL) and triglyceride concentrations were measured as well as four hostility factors: ‘Negative Affectivity’ (NA), ‘Anger-In’ (AI), ‘Anger-Out’ (AO) and Coping, i.e. behaviors to control feelings of anger and anxiety. The results indicated that the effects of hostility on lipids were mediated by various factors such as body weight in relation to body length (BMI), Socio-Economic Status (SES), Left Ventricle Ejection Fraction (LVEF) and Age. In subgroups of highly exhausted patients or of patients scoring high on the Type A Behavior Pattern (TABP), however, more direct (unilinear) associations between lipids and hostility were found. The findings of the present study confirm the rather weak association between hostility and blood lipids found elsewhere. Furthermore, a low level of triglycerides was consistently associated with low AO, be it again in interaction with BMI (AO × BMI), both in the group of non-MI patients and in the total sample for those patients who score high on vital exhaustion and/or TABP. This finding provides an extra argument against the popular notion of the healthfulness under all circumstances of anger expression. Until now the exact role of triglycerides as a function of anger/hostility has been under-explored. This issue merits further attention in future research.     

Identifying components of type-A behaviour: “toxic” and “non-toxic” achieving

Measures of the Type-A behaviour pattern (TABP) have generally failed to distinguish between different components of the construct, some of which may not constitute risk factors at all. Based on the responses of a total of 632 subjects, the present paper reports on the development of student and working adult questionnaires which comprise discrete and unambiguous indices of “toxic” and “non-toxic” behaviour. Both components reflect high achievement motivation, but in the toxic scale this is compounded by hostile competitiveness and impatience. The scales were related in predictable ways to other relevant indices of personality, and while the toxic factor was significantly associated with deterioration in health status during adaptation, the non-toxic factor conferred a protective effect.     

the role of personality in stress perception across different vocational types

In this study, the authors investigated the relationship between personality (measured by the subscales of the NEO Five‐Factor Inventory [NEO‐FFI]; Costa & McCrae, 1992) and stress (measured by the Overall Job Satisfaction scale [Warr, Cook, & Wall, 1979], and Cooper's Job Stress Scale [Cooper, 1981]) across different vocational types as described in Holland's (1966, 1997) theory. A sample of 729 employees participated in the survey. Individuals with high NEO‐FFI scores on neuroticism more often perceived distress across several vocational types. Individuals with high NEO‐FFI scores on conscientiousness more often perceived eustress across several vocational types. Extraversion was related to more eustress in Social and Conventional vocational types, openness to experience to more distress in Realistic and Social vocational types and to less eustress in Conventional vocational types; agreeableness was related to more eustress in Investigative and Conventional vocational types. A relation conclusively exists between personality and perception of distress and eustress for different vocational types.