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 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.     

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

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

Component analysis of the type A coronary-prone behavior pattern in male and female college students

Two studies investigated the psychological dimensions encompassed by the Rosenman Structured Interview (SI) method of assessing the Type A behavior pattern. In Study 1, female students completed the SI and Jenkins Activity Survey (JAS). Factor analysis of the verbal stylistic and answer content components of the SI yielded a 5-factor solution, with one factor--Clinical Rating--accounting for most nonerror variance in Type A ratings. The remaining factors were derived from answer content and correlated more substantially with JAS Type A ratings than with SI Type A ratings. In Study 2, male and female college students completed the SI and JAS and a battery of questionnaires that tap trait dimensions implied by the conceptual definition of Type A. For both males and females, SI ratings of Type A could almost be completely predicted by scores on the Clinical Rating factor. For both sexes, content dimensions of the SI related to other measures of Type A and to Type A-consistent traits, whereas the Clinical Rating factor was only modestly associated with such traits. Moreover, sex differences were observed in the trait constellations composing SI and JAS definitions of Type A. These results suggest that a discrepancy exists between conceptual and operational definitions of the Type A pattern.     

The framingham Type A Scale: Cardiovascular and cognitive-behavioral responses to interpersonal challenge

Most of the primary measures of Type A behavior have been found to be associated with physiological reactivity to stressors, as well as coronary heart disease (CHD). While it does predict CHD, the Framingham Type A Scale (FTAS) has not been conclusively linked to physiological reactivity. Similarly, in contrast to other Type A measures, little is known concerning the cognitive behaviors associated with the FTAS in stressful situations. The present study was conducted to evaluate the cardiovascular and cognitive-behavioral responses to interpersonal challenge of Type A versus Type B subjects, as classified by the FTAS. Type A's evidenced increased systolic blood pressure (SBP) reactivity and a greater degree of negatively toned cognitive activity than did Type B's. The SBP findings are consistent with those obtained with other measures of Type A behavior, and with the hypothesis that neuroendocrine reactivity mediates the link between the behavior pattern and CHD. The somewhat unique cognitive-behavior findings, however, may reflect important psychological differences among the various Type A measures.Portions of this paper were presented at the meeting of the Society of Behavioral Medicine, Philadelphia, 1984.     

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

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

Making it without losing it: Type A, achievement motivation, and scientific attainment revisited

In a study by Matthews, Helmreich, Beane, and Lucker (1980), responses by academic psychologists to the Jenkins Activity Survey for Health Prediction (JAS), a measure of the Type A construct, were found to be significantly, positively correlated with two measures of attainment, citations by others to published work and number of publications. In the present study, JAS responses from the Matthews et al. sample were subjected to a factor analysis with oblique rotation and two new subscales were developed on the basis of this analysis. The first, Achievement Strivings (AS) was found to be significantly correlated with both the publication and citation measures. The second scale, Impatience and Irritability (I/I), was uncorrelated with the achievement criteria. Data from other samples indicate that I/I is related to a number of health symptoms. The results suggest that the current formulation of the Type A construct may contain two components, one associated with positive achievement and the other with poor health.     

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.     

Disentangling Type A behavior: The roles of ambition,insensitivity, and anxiety

This study identified stable components of Type A behavior as usually defined, and examined their relationships with more traditional psychological constructs. Overall scores on the most popular Type A measure (a version of the Jenkins Activity Survey) were moderately associated with ambition but largely unrelated to measures of adjustment. An item analysis yielded subcomponents of Drivenness and Involvement. Drivenness was unrelated to ambition, but was positively related to anxiety and negatively related to interpersonal perceptiveness. Involvement was positively related to ambition and to interpersonal competence. It is suggested that the Jenkins Activity Survey measures a heterogeneous mixture of constructive commitment and self-defeating responses that clouds its psychological interpretation.     

Type A behavior and processing of social conflict information

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

The Novacco Anger Scale and Jenkins Activity Survey as predictors of cardiovascular reactivity

This study investigated the relationship among anger, the Type A construct, and cardiovascular reactivity. The Novacco Anger Scale and the Jenkins Activity Survey (JAS) were used to measure anger proneness and Type A characteristics, respectively. Twenty-four college males were selected from the upper and lower quintiles of the JAS distribution. During the study, the subjects were exposed to varying levels of experimentally induced challenge, while measurements were taken of heart-rate and blood-pressure changes. The results showed a modest but significant correlation between scores on the Novacco Anger Scale and the JAS. More importantly, scores on the Novacco Anger Scale correlated significantly with heart rate and systolic blood pressure under all challenge conditions, while those on the JAS were unrelated to cardiovascular excitability. These results raise questions about the usefulness of the JAS as a predictor of CHD risk. They are also consistent with the beliefs of other investigators that anger and hostility are the most important Type A behaviors in predisposing patients to coronary heart disease. Additional implications of the study are discussed.     

Achievement-oriented and dependency-oriented parental psychological control: An examination of specificity to middle childhood achievement and dependency-related problems

Middle childhood is considered a sensitive phase for the development of both dependency and achievement-related problems. In order to target efficient prevention and treatment, it is necessary to identify unique associations with possible precursors. This study hypothesized that children’s dependency-related problems (i.e., separation anxiety and generalized anxiety) would uniquely relate to parental dependency-oriented psychological control and that children’s achievement-related problems (i.e., extrinsic motivation and maladaptive perfectionism) would uniquely relate to parental achievement-oriented psychological control. The study included 180 elementary school children. Results showed that higher levels of children’s separation anxiety uniquely related to more parental dependency-oriented psychological control, while higher levels of children’s extrinsic motivation uniquely related to more parental achievement-oriented psychological control. Contrary to the expectations, higher levels of children’s maladaptive perfectionism were associated with both dimensions of parental psychological control, and children’s generalized anxiety was not associated with any dimension. Study implications are discussed.     

Self-report measurement of type A behavior: toward refinement and improved prediction

Self-report measures of Type A personality receive wide research usage despite mounting evidence that they are poor predictors of coronary heart disease. It was proposed that the limited prediction results in part from the failure to restrict measurement to only those Type A characteristics that are demonstrably related to excessive stress. The first study in this article reports a factor analysis of all items on the Jenkins Activity Survey (JAS), the most popular Type A questionnaire, along with 25 stress symptoms. Self-ratings were obtained from both male and female college students. Only one stress-related factor emerged including 12 JAS items out of 44. These were relevant to (a) hard-driving and competitive, (b) time-urgent, and (c) hostile/irritated characteristics. Study 2 reports correlations of +.50 and +.43 between the stress-relevant JAS items and stress for new samples of female and male college students. Study 3 considers the broader personality correlates of scores on the stress-relevant Type A items and reports markedly different patterns for male and female college students. Predicted correlations were found on new samples between these personality correlates, considered as scales, and stress-relevant Type A scores and stress.     

Type A behaviour and its relation to seriousmindedness (telic dominance)

A sample of 222 students in medicine and psychology, of both sexes, completed the Jenkins Activity Survey (JAS: Norwegian translation of a Swedish student version) and the Telic Dominance Scale (TDS). The latter is a measure of an individual's tendency to take life seriously, i.e., to pursue important goals, to plan ahead, and to avoid arousal if possible. The total scores on both scales were found to be orthogonally related over the sample as a whole, and the same was true of the main factor extracted from the JAS in relation to both the TDS total scores and the scores of each of the subscales of the TDS (for the sample as a whole and for each of the subgroups). This implies that the JAS survey for Type A behaviour assessment and the TDS were measuring rather different psychological characteristics. It is argued that there are reasons for supposing that telic dominance may be a factor which predisposes the individual to high cardiovascular reactivity and that, since this factor appears to be different from the Type A personality as measured by the present JAS version, further investigation is called for.     

Stress and Distress as a Function of Jenkins Activity Survey-Defined Type A Behavior and Control Over the Work Environment

Although laboratory studies have demonstrated that situational factors which are particularly threatening to Type A individuals induce both Type A behaviors and cardiovascular reactivity, field studies have failed to demonstrate consistent differences between Types A and B in response to stress. Rhodewalt, Hays, Chemers, and Wysocki (1984) argued that this inconsistency is caused by the failure to take into account the individual's perception of the situation. They demonstrated that Type A individuals who perceived high levels of job stress reported more psychological and physical health problems than Type As under low stress or Type Bs under high or low stress. This study attempted to replicate this earlier finding, as well as identify factors in the situation which lead Type A individuals to perceive their job as stressful. Three hundred thirty-six male school principals (categorized as Type A or Type B by the Jenkins Activity Survey [JAS]) completed questionnaires assessing their degree of control in their work environment, perceived job stress, and physical and psychological well-being. A path mediation analysis indicated that Type A individuals reported more job stress under lower levels of perceived control, and that higher job-stress levels subsequently lead to greater incidence of physical and psychological symptoms, especially for Type As.     

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.     

Self-Reported Psychological Well-Being and Disease-Related Strains among Adults with Diabetes

The study was designed to describe self-reported psychological well-being among adults with Type 1 and Type 2 diabetes and to explore associations of psychological well-being with disease-related strains, such as self-reported long-term complications, frequency of hypoglycaemia and disablement or sick-leave. A sample comprising 534 Norwegian adults with Type 1 and Type 2 diabetes aged 25-70 years participated in the study. Psychological well-being was assessed using three different scales; the WHO (Ten) Well-Being Index, the Short Zung Depression Rating Scale and four items from the anxiety sub-scale of the Hopkins Symptom Checklist. Findings indicate that adults with both types of diabetes reported relatively poor psychological well-being. There was a tendency for younger persons to report the worst psychological well-being. For symptoms of anxiety this tendency was most evident among people with Type 2 diabetes. People being disabled due to diabetes reported relatively markedly impaired psychological well-being, whereas self-reported diabetes-related complications and the number of episodes with hypoglycaemia were weakly associated with psychological well-being. Findings may indicate that healthcare practitioners should pay more attention to the psychological needs of people with diabetes. This applies especially to younger people with Type 2 diabetes.     

The relationship between relative levels of motivation and intrapersonal, interpersonal, and academic functioning among older adolescents

Using cluster analysis to combine specific adaptive measures related to mastery motivation (intrinsic motivation, self-adequacy, and locus of control), a total of 654 high school students were placed into distinct adaptive motivation groups. Mean scores on a variety of self-reported and peer-reported measures of interpersonal, intrapersonal, and academic functioning were compared across the groups. Results found that youth in the “high adaptive” motivation group reported significantly higher global and family satisfaction, self-esteem, interpersonal relations, grade-point average and school belonging, and significantly lower depression, anxiety and social stress than youth in the other two motivation groups. Peer-reported prosocial and academic behaviors were significantly related to higher levels of adaptive motivation. Collectively, these findings suggest a number of psychological, social, and academic benefits that are associated with incremental levels of adaptive motivation. The implications of these findings for research and practice conclude the paper.     

The relation between type A behavior and chronic emotional distress: a meta-analysis

A meta-analysis was conducted of studies examining the relation between Type A behavior and chronic emotional distress as measured by standard psychological scales. Aggregating across all studies, the average effect size was .27, indicating a positive association between Type A and chronic dysphoria; however, there was considerable variability in the size of the relation among studies. Partitioning by Type A measure revealed that Structured Interview-assessed Type A was unrelated to chronic dysphoric emotions; however, most of the self-report measures of Type A behavior were moderately correlated with upset. The Framingham Type A Scale and the Bortner Scale showed the strongest relations. Thus, contrary to the traditional view, Type A measured by self-report does have some emotional concomitants, although they are not in the pathological range. Also discussed are how the results bear on the proposal that the maladjusted personality confers coronary risk, the implications for reported associations between Type A and illness complaints, and for the study of the Type A as a social psychological construct.     

Effects of consistent aerobic exercise on the psychological functioning of women

Effects of consistent aerobic exercise on depression, anxiety, and health locus of control for a group of nonclinical inactive women were investigated. Type A and Type H (hard-driving) behavioral styles were evaluated to determine whether these traits were related to exercise improvement. 26 women were randomly assigned to either an exercise group (n = 10) or exercise with cognitive strategy instructions (n = 16). All subjects increased distance run in 12-min. run test from pre- to posttest. Women improved in depression and trait anxiety. Depression was significantly correlated with body mass index at end of program. Posttest state-anxiety was significantly correlated with 6-wk. follow-up of exercise frequency. No significant difference in pre- and posttest health locus of control was found. Type H scores were significantly correlated with number of exercise sessions attended. Consistent aerobic exercise had a positive effect on psychological functioning, and some characteristics may affect exercise improvement.