A note on measurement issues in type A research: let's not throw out the baby with the bath water

It has been suggested that researchers rely exclusively on the structured interview (SI) to assess Type A behavior instead of using objective self-report measures, because the SI is the only prospectively validated instrument currently available. This article considers the costs and benefits of relying solely on the SI to measure Type A behavior. Although using only the SI would assure that researchers measure, in a relatively unobtrusive fashion, actual Type A behaviors known to be predictive of heart disease, it would dramatically increase research costs, impede longitudinal studies of changes in Type A behavior, reduce the validity of statistical conclusions, restrict the convergent and discriminant validity of the Type A construct, and ultimately inhibit our ability to improve accuracy in predicting heart disease. A set of recommendations is proposed for improving the quality of measurement in Type A research.     

A Note on Measurement Issues in Type A Research: Let's Not Throw Out the Baby With the Bath Water

It has been suggested that researchers rely exclusively on the structured interview (SI) to assess Type A behavior instead of using objective self-report measures, because the SI is the only prospectively validated instrument currently available. This article considers the costs and benefits of relying solely on the SI to measure Type A behavior. Although using only the SI would assure that researchers measure, in a relatively unobtrusive fashion, actual Type A behaviors known to be predictive of heart disease, it would dramatically increase research costs, impede longitudinal studies of changes in Type A behavior, reduce the validity of statistical conclusions, restrict the convergent and discriminant validity of the Type A construct, and ultimately inhibit our ability to improve accuracy in predicting heart disease. A set of recommendations is proposed for improving the quality of measurement in Type A research.     

Challenge seeking and the type A coronary-prone behavior pattern

The present investigation sought to further delineate the Type A coronary-prone behavior pattern and to elucidate the psychophysiological process through which this behavioral disposition is translated into heart disease. Type A and Type B male subjects engaged in tasks that required varying degrees of activity before an assessment of challenge-seeking tendencies. Type A participants sought greater degrees of challenge than did their Type B counterparts. In addition, the more active the person with Pattern A had been immediately before the challenge-seeking opportunity, the greater the degree of challenge sought. Precedent activity level did not significantly influence challenge seeking in the Type B population. The Type A subjects also had significantly faster heart rates during performance of a challenging task. Pattern A behavior may be translated into heart disease through the cumulative deleterious effects of chronic and excessive challenge-induced cardiovascular excitation.     

Personality, type A behavior, and coronary heart disease: the role of emotional expression

The nature of the relation between personality factors and coronary heart disease (CHD, the nation's greatest killer) is one of the most important if controversial issues in the field of psychology and health. Although there is still a great deal of conceptual confusion, progress is being made in refining the key components of a predisposition to heart disease. In this article we examine the construct of a coronary-prone personality in the context of the relations among personality, emotional expression, and disease. Special consideration is given to mode of measurement of the Type A behavior pattern--Structural Interview (SI) versus Jenkins Activity Survey (JAS)--and to components and non-Type A correlates of the general coronary-prone construct. Fifty middle-aged men who had had a myocardial infarction were compared with 50 healthy controls in terms of relevant aspects of their psychological functioning. Results indicate that the SI is better than the JAS as a predictor of coronary heart disease (CHD) because of its attention to emotional expressive style. Traditional emphases on hurry sickness in coronary proneness are deemed wholly inadequate. Furthermore, the results indicate that depression, anxiety, or both may relate to CHD independently of and in addition to Type A behavior. Other aspects of personality and social support are also discussed in the context of improving the construct of coronary proneness.     

Stability and Change in Type A Components and Cardiovascular Reactivity in Medical Students During Periods of Academic Stress1

This study examined the effects of academic stress upon components of Type A behavior and cardiovascular reactivity. In a longitudinal design, heart rate and blood pressure responses to the Type A Structured Interview (SI) and additional laboratory challenges were measured in medical students at three points during an academic semester. Sessions 1 and 3 were scheduled during vacation periods; Session 2 took place during an intensive examination week. Results indicated that three “stylistic” components of Pattern A derived from the SI—loud and explosive speech, short response latency, and potential for hostility—increased significantly during the exam period. Similar increases achieved marginal significance for another stylistic component, rapid and accelerated speech. By contrast, global Type A assessments did not increase with academic demands. Cardiovascular reactivity was significantly but only moderately stable across the three sessions, showing less consistency than has been reported in previous research. In addition, there was little evidence in this study that cardiovascular reactivity was potentiated by academic stress or by Type A behavior. These results demonstrate the influence of naturalistic environmental factors on overt behavioral components that have recently been suggested as coronary risk factors. Therefore, it is advisable for future experimental and epidemiological research to examine the social and environmental context in which these behaviors occur.     

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.     

Interpersonal dominance and coronary prone behavior

Type A “coronary-prone behavior” is a risk factor for coronary artery and heart disease. Questionnaire research indicates that interpersonal dominance is one of the strongest behavioral correlates of the Type A behavior pattern, although little effort has been made to demonstrate a link between the behavioral manifestations of interpersonal dominance and Pattern A responding. This study was conducted to establish such a link. All possible combinations of extreme As (N = 42) and Bs (N = 42) were matched in dyads that negotiated extreme bipolar opposite positions on a “teacher dismissal” issue. Analysis of process and outcome behaviors suggested that type A individuals are unilaterally more dominant than their Type B counterparts. Possible physiological mechanisms mediating dominance and cardiovascular disease are discussed.     

Time Urgency and the Type A Coronary-Prone Behavior Pattern1

Two experiments were conducted to examine behavioral consequences of a sense of time urgency, which presumably characterizes individuals classified as manifesting a so-called “Type A” coronary-prone behavior pattern. Experiment I indicated that time-urgent Type A Ss were reliably less successful than noncoronary-prone “Type Bs” in performing a task requiring a low rate of response for reinforcement (DRL). Type As were not only unable to delay their responses; they also showed greater evidence of tension and hyperactivity than Type Bs during DRL performance. Experiment II extended these results to the interpersonal domain. Time-urgent Ss became more impatient and irritated than less urgent Ss when both types were systematically slowed down in their efforts to reach a solution on a joint decision-making task. The results were discussed in terms of a conceptualization of the A-B dimension as reflecting differential expectations of and needs for environmental control. Additional evidence was presented in support of this approach. Consideration was also given to possible physiologic mechanisms mediating the relationship between psychological variables such as the Type A pattern and actual occurrence of coronary heart disease.     

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.     

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.     

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.     

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.     

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%).     

Editorial: Drug Abuse and AIDS

Abstract

The present article presents an overview of the behavioral and psychological components which have been found to be associated with Type A behaviors in children and adolescents. Each component is discussed within the context of the assessment device used to measure it. with methodological concerns being addressed whenever appropriate. Using both observational methods and self-report questionnaires. the four major behavioral components of adult Type A behavior; competitive-achievement striving, time urgency, aggressiveness-hostility and impatience have been found in child/adolescent Type A subjects. Type A children have a lower self-esteem, a more external locus of control and higher anxiety level than their non-Type A counterpart. Coping mechanisms for stress and characteristic cognitions may differ in Type A subjects as they progress from childhood through adolescence. Recommendations for future research are presented.     

Associations among behavior, personality, and traditional risk factors for coronary heart disease: a study at a primary health care center in mid-Norway

The continuing presence of different negative emotions has been suggested as an important factor in the development of coronary heart disease (CHD). The present study was carried out at a medical center to investigate the presence of negative emotions and Type A behavior in a group of 40-yr.-old men and women. The National Institute of Public Health in Norway carried out the data-collection as a part of their CHD risk factor screenings. The correlation between hostility and total cholesterol is negative as is that between systolic blood pressures and the feeling of guilt for women. There was no further support for earlier findings of relationships between either Type A behavior pattern and negative emotions or Type A and elevated cholesterol values. A number of possible explanations are offered. In the study, assessment of hostility was questioned; there was possible support for poor assessment of hostility on the Karolinska Scales of Personality employed in the study.     

EVALUATION OF A TRAINING MANUAL FOR THE ACQUISITION OF BEHAVIORAL ASSESSMENT INTERVIEWING SKILLS

Two procedures were used to teach behavioral assessment interviewing skills: a training manual and one-to-one instruction that included modeling, rehearsal, and feedback. Two graduate students and two advanced undergraduates were trained with each procedure. Interviewing skills were recorded in simulated assessment interviews conducted by each student across baseline and treatment conditions. Each training procedure was evaluated in a multiple baseline across students design. The results showed that both procedures were effective for training behavioral interviewing skills, with all students reaching a level of 90%-100% correct responding. Finally, a group of experts in behavior analysis rated each interviewing skill as relevant to the conduct of an assessment interview and a group of behavioral clinicians socially validated the outcomes of the two procedures.     

The assessment of type a behavior and the prediction of coronary heart disease: A review

The literature regarding the Type A behavior pattern and its association with the incidence of coronary disease has been accumulating for over 20 years. For any researcher contemplating the investigation of this syndrome and its pathological implications, a daunting and time-consuming task is presented in deciding which Type A measurement technique to use to identify Type A individuals. This article is designed to aid this process by presenting a review of all the prospectively validated Type A measures that have been shown to be predictive of coronary disease. Each measure is described, its development is outlined, and its advantages, disadvantages, and limitations are highlighted. This work was supported by a grant from the Health Education Council, London, under the supervision of Professor J.R. Eiser at the Department of Psychology, University of Exeter.     

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.