Many stress-related psychological factors have been studied as possible risk factors for heart disease. One is the Type A behavior pattern (TABP), which refers to a set of behaviors including competitiveness, achievement striving, impatience/time urgency, hostility/anger, and a vigorous speaking style. Type B refers to a more relaxed behavior pattern involving the relative absence of Type A characteristics. The attributes that define Type A are thought to be evoked by stressful or challenging conditions.
Research has shown that Type A and Type B are not discrete categories of people but represent the extremes of continuous variations in people’s behaviors. It has also been shown that the individual components of Type A behavior do not necessarily go together; people can be competitive without being impatient or hostile without having a vigorous speech style.
Anger and Hostility as the Key Type A Attributes
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Most importantly, it appears that anger and hostility are associated with the risk of heart disease. And it is also important to note that while “hostility” can involve aggressive behavior, in this context, it comprises a set of attitudes, including cynicism and mistrust.
These attitudes may provoke anger, increase stress levels, and have a negative effect on social relationships, which may reduce the availability of social support for dealing with stress.
Depression, Anxiety, and Other Emotion-Related Characteristics
Although anger and hostility continue to receive research attention, the investigation of emotion-related factors that may promote heart disease has more recently focused on other characteristics. In particular, depression, both at the subclinical level and in the form of major depressive disorder, has been identified as a potentially important predictor of heart disease. This appears to be the case both in healthy individuals and in heart patients, in whom it may be related to recurrent cardiac events.
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Another emotional disposition that has drawn attention in cardiovascular research is anxiety. Like depression, anxiety has been studied as a subclinical dimension of individual differences and in terms of clinical conditions like post-traumatic stress disorder. Related to anxiety, neuroticism, referring to individual differences in irritability, anger, sadness, and anxiety has been linked to health outcomes, including heart disease.
Dispositional optimism, a generalized expectation for positive outcomes, also has been implicated as a factor that may protect against heart disease. However, recent research has complicated this picture. It turns out that optimism and pessimism are not necessarily polar opposites, as high optimism does not necessarily imply low pessimism, and vice-versa. There is some indication that high levels of pessimism, rather than low levels of optimism, may be a more important predictor of negative health outcomes.
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What This Means for You
One important implication of this research is that we should not think of ourselves as “Type A” or “Type B” since the behaviors that define the Type A behavior pattern are matters of degree and do not form categories of people. Another is that, to the extent that we display any of the behaviors associated with the Type A concept, it is anger and hostility on which we should focus our attention.
But we should think beyond the Type A concept in assessing how our personality may be related to heart health. A tendency to experience depressed mood and anxiety is also relevant, along with the pessimism that might be associated with those attributes. It also should be borne in mind that stress, at least in part, underlies all of these emotional factors and their effects on health. There is promising evidence to suggest that effective stress management can be cardio-protective.
Finally, whereas emotion and stress almost certainly play a role in cardiovascular disease, heart health reflects multiple contributing factors that are potentially modifiable. Major cardiac risk factors include tobacco use, levels of cholesterol in the blood, resting blood pressure, diabetes, and other metabolic factors. Alteration of these variables is, in part, a matter of aspects of lifestyle changes that many of us should be contemplating and enacting not only as New Year’s resolutions but all year round.