Dimensions of anger-hostility and cardiovascular reactivity in provoked and angered men

Anger Expression, Coping Styles, and Well-being

This study examined the role of anger expression in the experience of stress, coping with stress and psychological and physical well-being. Based on a sample of 268 Singaporeans, the results, using structural equation modelling, indicated that anger expression was significantly related to reported stress, mechanisms for coping with stress and psychological wellbeing. Higher levels of anger expression were associated with higher levels of stress as well as lower use of active coping. Active coping was in turn positively related to psychological well-being. In addition, higher levels of anger expression showed a direct negative relationship with psychological well-being as did higher levels of stress. In contrast, the only significant predictor of physical well-being was reported stress, with higher levels of stress related to lower levels of physical well-being. The implications of these results for understanding the role of anger expression in psychological and physical wellbeing are discussed.

Components of the Anger–hostility Complex as Risk Factors for Coronary Artery Disease Severity: A Multi-measure Study

Different forms of anger and hostility have been implicated in the pathogenesis of coronary artery disease (CAD), though previous research has not measured all of these in one sample. To assess their relative predictive utility, a multi-measure study was undertaken of three adult outpatient groups: 97 men identified angiographically with stenosed coronary arteries; 28 men with valvular heart disorders in the absence of CAD; and 28 men attending a fracture clinic with no CAD present. Questionnaires measured: anger expression; anger experience; cynical hostility; ‘Ho' hostility; neurotic hostility; neurotic disagreeableness; resentment; and suspiciousness. The pre-eminent anger–hostility correlate of CAD was found to be expressed anger, with years as a smoker and age also being independently related to disease severity. Thus, seven of these anger/hostility variables do not warrant similar attention as anger expression in CAD aetiology. Further research should identify coronary toxic components of anger expression and of socio-occupational environments that afford or constrain their occurrence.

High Anger Expression is Associated with Reduced Cortisol Awakening Response and Health Complaints in Healthy Young Adults

The extant evidence suggests a robust positive association between expression (anger expression-out) and suppression (anger expression-in) of anger and compromised health. Nevertheless, the underlying psychobiological mechanisms which explain these relationships are not well understood. This study examined whether anger expression would predict general health, cortisol awakening response (CAR) and evening cortisol levels in a community sample of 156 healthy young adults of both genders. Participants were distributed into two groups according to their anger expression scores: high and low anger expression (HAE and LAE, respectively). Findings indicated that those with HAE had worse self-reported health (p = .02) and higher CAR than the LAE group (p = .04). Moreover, high levels of anger expression-out (p < .01) and -in (p < .01, for all) predicted a worse self-reported health in both groups. On the other hand, high anger expression-out was associated with flattened CAR but only in the HAE group (p < .01). This study reinforces the need to develop effective strategies to provide mechanisms to regulate anger expression by promoting personal growth and positive skills that enhance individuals' well-being and quality of life and, in turn, their own health.

Personality as a Source of Individual Differences in Cognition among Older African Americans

Previous research suggests that demographic factors are important correlates of cognitive functioning in African Americans; however, less attention has been given to the influence of personality. The present study explored how dimensions and facets of personality predicted individual variability in cognition in a sample of older African Americans from the Baltimore Study of Black Aging. Cognition was assessed by verbal learning and attention/working memory measures. Personality was measured by the NEO Personality Inventory. Linear regressions controlling for demographic factors showed that Neuroticism, Openness, and Agreeableness were significant regression predictors of cognitive performance. Individual facets of all five personality dimensions were also associated with cognitive performance. These findings suggest personality is important in understanding variability in cognition among older African Americans.

Low life course socioeconomic status (SES) is associated with negative NEO PI-R personality patterns

BACKGROUND

Low socioeconomic status (SES) is associated with poor health. One potential pathway accounting for this relationship may be an association between low SES and personality characteristics that affect health.

METHODS

Associations among parent's education, current SES (education and income), and personality were examined among 233 African Americans and Caucasian, male and female community volunteers.

RESULTS

Using multivariate analysis of variance (MANOVA) to model neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness simultaneously, participant's education, household income, and father's and mother's education each had significant main effects on personality. When examining the life course--the combination of both current and childhood SES--distinctive patterns emerged for each domain, depending upon whether mother's or father's education was used to index childhood SES. When using mother's education as a childhood SES index, a high life course SES (high participant's SES/high mother's education) was associated with high extraversion and openness. Using father's education as a childhood SES index, a low life course SES (low participant's SES/low father's education) was associated with disproportionately high neuroticism and low conscientiousness. These effects did not differ by race or sex.

CONCLUSION

The implications of these findings for the role of personality in the SES-health relationship are discussed.

Does coping mediate the relationship between personality and cardiovascular health in African Americans?

Few studies have examined traits or behaviors that may predispose some African Americans to poor cardiovascular health outcomes. While several models of personality exist, the 5-factor model (FFM) is arguably the best representation of personality and provides a useful framework for the study of personality and health. Among personality characteristics associated with health risks among African Americans, a high-effort coping style called John Henryism is among the most thoroughly examined. It is not clear if personality coping and health are connected in a meaningful way. The present study utilized data from the Baltimore Study of Black Aging (BSBA) to examine whether personality was linked to John Henryism, how personality might be linked to cardiovascular health, and how John Henryism might mediate the relationship between personality and cardiovascular health. The sample consisted of 234 older African Americans (mean age, 67 years), 28% of which were men. Regressions were used to examine the questions. The results indicated that those who are more neurotic report more cardiovascular health problems, and that openness and conscientiousness were significant predictors of active coping. The mediation analysis results suggest that coping style did not mediate the relationship between personality and reports of cardiovascular health problems. These findings highlight the importance of personality in accounting for cardiovascular health in African Americans.

Socioeconomic status moderates the association between John Henryism and NEO PI-R personality domains

OBJECTIVE

To investigate associations between John Henryism (JH) and NEO Personality Inventory-Revised (PI-R) personality domains. JH-a strong behavioral predisposition to engage in high-effort coping with difficult psychosocial and economic stressors-has been associated with poor health, particularly among persons in lower socioeconomic (SES) groups. Unfavorable personality profiles have also been frequently linked to poor health; however, no studies have yet examined what global personality traits characterize JH.

METHODS

Hypotheses were examined, using data from a sample of 233 community volunteers (mean age, 33 years; 61% black and 39% white) recruited specifically to represent the full range of the SES gradient. Personality (NEO PI-R) and active coping (12-item JH scale) measures and covariates were derived from baseline interviews.

RESULTS

In a multiple regression analysis, independent of SES, JH was positively associated with Conscientiousness (C) (p < .001) and Extraversion (E) (p < .001), whereas the combination of low JH and high SES was associated with Neuroticism (N) (p = .02) When examining associations between JH and combinations of NEO PI-R domains called "styles," high JH was most strongly associated with a high E/high C "Go-Getters" style of activity, whereas low JH was associated with the low E/high Openness (O) "Introspectors" style. In facet level data, the most robust associations with JH were found for five C and five E facets.

CONCLUSIONS

High JH was associated with higher scores on C and E, but the combination of low JH and high SES was associated with higher scores on N.

Does dissociation of emotional and physiological reactivity predict blood pressure change at 3- and 10-year follow-up?

One of the major theories of psychosomatic medicine is that pervasive dissociations between physiological reactivity and simultaneous emotion awareness may be an important marker for the long-term development of cardiac problems. Subjective autonomic discrepancy (SAD) scores are proposed as a method of capturing the dissociation between physiological and emotional reactivity and increasing the explanatory power of predictive models of cardiac health outcomes. It was found that SAD scores for blood pressure indices show trait-like stability over a period of 3 years. Although linear 3-year prediction of systolic blood pressure came close to traditional definitions of significance, neither a linear nor a quadratic model was found to show significant prospective validity in predicting ambulatory blood pressure change over a 10-year period. Dissociation between physiological arousal and emotional awareness does not appear to be an important variable in the identification of individuals at risk for later cardiovascular health problems.

The Relation Between Anger Coping Strategies, Anger Mood and Somatic Complaints in Children and Adolescents

Attempts to explain the experience of somatic complaints among children and adolescents suggest that they may in part result from the influence of particular strategies for coping with anger on the longevity of negative emotions. To explore these relationships British (n = 393) and Dutch (n = 299) children completed a modified version of the Behavioral Anger Response Questionnaire (BARQ), and two additional questionnaires assessing anger mood and somatic complaints. A hierarchical regression analysis showed that for both the UK and Dutch samples two coping styles, Social support-seeking and Rumination, made a significant contribution to somatic complaints, over and above the variance explained by anger mood. A tendency to repeatedly think or talk about an angering event as a way of coping seems to underlie the observed negative health effects. In addition, tentative support is given for a broader range of strategies to cope with anger than just the traditionally studied anger-out and anger-in styles.

Hostility and serum homocysteine as cardiovascular risk factors in Korean patients with coronary artery disease

AIMS

The aim of this study is to determine the relationships between hostility and serum homocysteine in Korean patients with coronary artery disease and to identify their effects on the occurrence of coronary artery disease.

BACKGROUND

Recently, hostility as a psychosocial factor and serum homocysteine as a biochemical risk factor are gradually accepted as independent risk factors of coronary artery disease but research on the relationship between hostility and homocysteine is rare.

DESIGN

This is a descriptive and correlative study conducted in the single teaching hospital located in South Korea.

METHODS

Eighty-four patients with coronary artery disease participated. Semi-structured interviews were used to measure the level of hostility and the characteristics of participants. Hostility was measured by the Cynical Hostility Scale and fasting blood samples from venous vein was used to measure serum homocysteine level.

RESULTS

Mean scores for hostility of men were higher than women. The difference was statistically significant (p = 0.001). The serum homocysteine level (11.51 SD 5.43 micromol/l) in patients with coronary artery disease was higher than the normal reference value. Findings of this study indicate that serum homocysteine increased in a statistically consistent pattern with the level of hostility (F = 8.37, p < 0.01).

CONCLUSIONS

This result suggests that high level of hostility may increase cardiovascular risk by elevated serum homocysteine concentration.

RELEVANCE TO CLINICAL PRACTICE

The development and applications of nursing interventions for hostility can contribute to reducing the prevalence and mortality rate of coronary artery disease.

Trait aggression and hostility in recovered alcoholics

There is a long-recognized association between alcohol consumption and aggressive behavior. This study was designed to examine aggression in a group of socially well-adapted recovered alcoholics (RA). The question addressed was whether the treatment, together with long-term abstinence from alcohol, could reduce aggression and hostility in RA. A group of male RA (n = 64), who did not meet the DSM-IV criteria for any psychiatric or personality disorder, were recruited to the study from aftercare groups. According to data from their group therapists, they were reliably abstinent for at least 3 years and socially well adapted. The study participants representing the control group (n = 69), diagnosed as being 'reliable nonalcoholics' (NA) by the Munich Alcoholism Test, were recruited from general practice. Data were derived from an in-house questionnaire on general characteristics of both groups, and aggressive and hostility traits were assessed using the Buss-Durkee Hostility Inventory (BDHI). The univariate and multivariate between-groups design was used for data analysis. Taking into account the BDHI dimensions of aggression and hostility, the difference between RA and NA groups was statistically significant [Wilks' lambda (8, 125) = 0.769; p = 0.00004]. There were statistically significant differences in the BDHI scales for indirect aggression, irritability, negativism, suspicion, resentment, and guilt. Both RA and Na groups did not differ significantly in variables that assessed physical and verbal aggression. After a 3-year abstinence, subjects from the RA group displayed signs of hostility and covert aggression.

Anger management style and hostility among patients with chronic pain: effects on symptom-specific physiological reactivity during anger- and sadness-recall interviews

OBJECTIVES

We examined whether anger-in, anger-out, and hostility predicted symptom-specific muscle tension reactivity during anger induction (but not sadness induction) among patients with chronic low back pain (CLBP). For patients with CLBP, relevant muscles are the lower paraspinals (LPs). Anger-in x hostility and anger-out x hostility interactions were tested to determine whether particularly reactive groups of patients could be identified with a multivariable profile approach.

METHODS

Ninety-four patients with CLBP underwent anger recall (ARI) and sadness recall (SRI) interviews, whereas LP and trapezius electromyography and systolic blood pressure, diastolic blood pressure, and heart rate were recorded. They completed anger-in, anger-out, hostility, and trait anger measures.

RESULTS

Hierarchical regressions were used to test anger-in x hostility and anger-out x hostility interactions for physiological changes during the ARI and SRI. A significant anger-in x hostility interaction was found for LP change during the ARI (but not SRI) such that high anger-in/high hostility patients evinced the greatest reactivity. Effects for trapezius reactivity were nonsignificant. Significant anger-in x hostility interactions were also found for systolic blood pressure and diastolic blood pressure changes during the ARI such that high anger-in/low hostility patients showed the smallest changes. The anger-out x hostility interaction for diastolic blood pressure change during ARI was also significant such that high anger-out/low hostility patients showed the smallest changes. All effects remained significant with trait anger controlled.

CONCLUSIONS

A multivariable profile approach may help identify especially vulnerable patient groups. Patients with CLBP who tend to suppress anger and are cynically hostile may be more likely to experience high levels of muscle tension near the site of pain and injury during anger, but not during sadness, than other groups.

Emotion induction moderates effects of anger management style on acute pain sensitivity

Anger management style (AMS) is related to both acute and chronic pain intensity. Recent work suggests that an anger expressive AMS in particular may influence acute pain, and that this effect may be most pronounced during anger provocation. The present study examined whether AMS was related to subsequent pain sensitivity without regard to prior emotion induction, only when a strong negative emotion was evoked, or only when anger was provoked. Sixty-four healthy normals partook in semi-structured interviews in which they recalled and verbally described an event in which either anger, sadness, or joy was elicited. They then underwent a cold pressor pain task. Results of hierarchical multiple regressions showed that an anger expressive AMS was related positively to pain threshold only for participants in the anger-recall condition, and that this effect was largely accounted for by their low SBP reactivity during emotion induction. An anger suppressive AMS was related positively to increases in self-reported pain severity, irrespective of emotion-induction condition, and this effect was not accounted for by reactivity in any cardiovascular index. Results extend those of previous studies by illuminating the potential importance of behavioral anger expression for individuals prone to express anger in modulating their reactivity and pain sensitivity. Findings suggest that the detrimental effects of an anger expressive style on pain sensitivity may be ameliorated under conditions in which behavioral anger expression occurs. Results are discussed in terms of recent work suggesting that an expressive AMS is associated with endogenous opioid dysfunction in the absence of behavioral anger expression.

Relative effects of harassment, frustration, and task characteristics on cardiovascular reactivity

Effects of anger induction procedures such as frustration and harassment on cardiovascular reactivity have been demonstrated in a wide range of experimental situations. Similarly, heightened cardiovascular reactivity has been associated with a diverse range of tasks involving active coping, competition and interpersonal interaction. The present study sought to directly compare the relative effects of these two important ways of inducing cardiovascular changes. One hundred and five university students performed two tasks that differed in the degree of active coping and interpersonal competition: a competitive psychomotor task and a problem-solving task. States of anger were induced during both tasks by means of harassment, frustration or frustration+harassment. Task-related changes in heart rate, systolic blood pressure, diastolic blood pressure, pulse volume amplitude and respiratory sinus arrhythmia amplitude were monitored. The competitive psychomotor task produced greater cardiovascular reactivity than did the problem-solving task. Harassment and frustration+harassment provoked more cardiovascular reactivity than did frustration alone. However, harassment and frustration+harassment had the greatest cardiovascular effects in the competitive task, whereas frustration had the greatest cardiovascular effects in the problem-solving task. In this sense, the increases on cardiovascular reactivity seem to depend on the interaction between anger induction procedures and the context in which anger is provoked.

The effects of relationship aversive female partner behavior on attributions and physiological reactivity of verbally aggressive and non-aggressive males

The present study assessed the effects of aversive female partner behavior on cognitive attributions and physiological reactivity in verbally aggressive and non-aggressive college males (N = 39). Participants were presented four audiotaped vignettes which depicted hypothetical dating situations in which the female's behavior was relationship aversive or non-relationship aversive. Participants' physiological reactivity (i.e., systolic blood pressure, diastolic blood pressure, and heart rate) was obtained before and after hearing each vignette. Attributional responses were obtained following the presentation of all vignettes. Relationship aversive partner behavior was expected to produce greater increases in attributional and physiological reactivity than non-relationship aversive partner behavior. Additionally, verbally aggressive males were expected to demonstrate greater negative intent and responsibility attributions and evidence greater physiological reactivity for situations involving relationship aversive partner behavior than were non-aggressive males.As hypothesized, results showed that relationship aversive partner behavior produced greater increases in systolic and diastolic blood pressure than did non-relationship aversive partner behavior. Results also showed that verbally aggressive males evidenced significantly greater negative attributions to relationship aversive partner behavior than did non-aggressive males. The potential interaction between physiological reactivity and attributions in explaining males' verbally aggressive behavior toward their female partners is discussed.

Anger expression and risk of stroke and coronary heart disease among male health professionals

OBJECTIVE

Anger expression is a dimension of anger that may be strongly related to coronary heart disease and stroke. To date few cohort studies have evaluated the role of anger coping style in the development of cardiovascular disease. This study prospectively examined the effects of anger expression on incidence of cardiovascular disease.

METHODS

Participants were male health professionals (N = 23,522), aged 50 to 85 years old and without previous cardiovascular disease, who responded to a mailed questionnaire incorporating the Spielberger Anger-Out Expression Scale in 1996. The cohort was followed for 2 years (1996-1998).

RESULTS

Men with moderate levels of anger expression had a reduced risk of nonfatal myocardial infarction compared with those with lower levels of expression (relative risk: 0.56; 95% confidence interval: 0.32-0.97), controlling for coronary risk factors, health behaviors, use of psychotropic medication, employment status, and social integration. Anger expression was also inversely associated with risk of stroke. The multivariate relative risk of stroke was 0.42 (95% confidence interval: 0.20-0.88), comparing men with higher anger-out scores to men with lower scores. A protective dose-response relationship was observed between anger-out score and risk of stroke (p for multivariate trend test: 0.04).

CONCLUSIONS

Among this cohort of older men with high socioeconomic status and relatively low level of anger expression on average, moderate anger expression seemed to be protective against cardiovascular disease over a limited follow-up period.

Hostility as a moderator of physical reactivity and recovery to stress

This experiment was designed to assess differences in physiological reactivity and recovery to stress among low- and high-hostile men. Specifically, 25 low- and 25 high-hostile undergraduates were identified using the Cook-Medley Hostility Scale (Cook & Medley, 1954). To ensure homogeneity, all subjects were right-handed and had a general right hemibody preference, as indicated by a score of +7 or higher on the Coren, Porac, and Duncan Laterality Test (Corer, Porac, & Duncan, 1979). All subjects underwent a traditional cold-pressor stressor test. Physiological measures--heart rate, systolic blood pressure, and diastolic blood pressure--were recorded before the stressor (Prestress), after the stressor (Poststress), and then again 9 min later (Recovery). Increased physiological arousal between pre- and poststress measurements was used as an indicator of reactivity. Subsequent decreases in physiological arousal were used as recover measures. Given the current models of negative emotion and hostility, it was expected that high-hostiles, relative to low-hostiles, would evidence increased physiological arousal and decreased recovery to stress. Interestingly, high-hostiles experienced significantly greater reactivity to stress in heart rate only, and no group differences were found with regard to recovery. Results are discussed in terms of previous research and current models of emotion.

Lymphocyte proliferation is associated with gender, caregiving, and psychosocial variables in older adults

We examined lymphocyte responses to mitogens [phytohemagglutinin (PHA), concanavalin A, pokeweed] in spouse caregivers of persons with Alzheimer's disease (n = 82; mean age = 69.4) and noncaregiver spouses (n = 83) group matched on age and gender. Data were collected at study entry (T1) and 15-18 months later (T2). In men (n = 52), a depressed mood factor was negatively related to all mitogen responses at T1 and PHA at T2. Loneliness was the most important variable in the depressed mood factor. No relationships occurred in women (n = 113). At T2 an anger expression factor (anger-out--anger-control) was negatively related to all mitogen responses in caregivers. Anger-out was the most important variable for anger expression. Depressed mood at T1 predicted residualized changes in PHA at T2 in men. In conclusion, men with higher depressed mood and caregivers with higher anger expression may be at risk for lower proliferation responses.

Anger, negative emotions, and cardiovascular reactivity during interpersonal conflict in women

OBJECTIVE

In order to evaluate the relationship between women's subjective emotional discomfort with anger and cardiovascular responses to stress, cardiovascular and affective responses were examined during two anger-provoking conditions: one in which anger would be in self-defense, and one in which anger would be in defense of a significant other.

METHODS

A total of 42 healthy, normotensive women aged 18-35 years recruited a close female friend to participate in the study with them, and were randomly assigned to one of two harassment conditions: (i) Self-Harass, where women were harassed while performing a math task; (ii) Friend-Harass, where women witnessed a close female friend being harassed while their friend performed a math task.

RESULTS

Self-Harass and Friend-Harass women reported feeling equally angry, annoyed, and irritated (all P's<.01) during their respective anger-provocation conditions. However, Self-Harass women reported experiencing significantly greater increases in feelings of depression and guilt during anger provocation (P's<.05) relative to Friend-Harass women. Interestingly, it was also the Self-Harass women who exhibited significantly greater elevations in heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), forearm blood flow (FBF), and significant reductions in forearm vascular resistance (FVR; P's<.001) relative to Friend-Harass women during anger provocation.

CONCLUSIONS

Results suggest that women may experience other negative emotions (e.g., guilt, depression) when anger is in self-defense relative to when it is in defense of others, and that these emotions may play a more important role than anger in moderating cardiovascular reactivity (CVR) during interpersonal conflict.

Crime, hostility, wife battering, and the heart: on the Meehan et al. (2001) failure to replicate the Gottman et al. (1995) typology

Comments on the J. C. Meehan, A. Holtzworth-Munroe, and K. Herron (2001) failure to replicate the J. M. Gottman et al. (1995) results of 2 different types of batterers, defined by heart rate reactivity: Type 1 men lowered their heart rate from baseline to the high-conflict marital discussion, and Type 2 men increased their heart rate from baseline to the high-conflict marital discussion. Discussion is about criminality-psychopathy literature associated hypoarousal and hyporeactivity and the hostility-cardiovascular disease literature, which reports associated hyperreactivity and hostility related to cardiovascular disease. The Type 1-Type 2 distinction should be referred to these two venerable literatures. This article proposes the hypothesis that the Meehan et al. study failed to replicate Gottman et al. because it used a low-conflict marital discussion rather than the high-conflict discussion Gottman et al. used. This article reviews a study that did use a high-conflict marital task and found results generally supporting the Gottman et al. findings.

Linkages between facial expressions of anger and transient myocardial ischemia in men with coronary artery disease

The authors examined whether facial expressions of emotion would predict changes in heart function. One hundred fifteen male patients with coronary artery disease underwent the Type A Structured Interview, during which time measures of transient myocardial ischemia (wall motion abnormality and left ventricular ejection fraction) were obtained. Facial behavior exhibited during the ischemia measurement period was videotaped and later coded by using the Facial Action Coding System (P. Ekman & W. V. Friesen, 1978). Those participants who exhibited ischemia showed significantly more anger expressions and nonenjoyment smiles than nonischemics. Cook-Medley Hostility scores did not vary with ischemic status. The findings have implications for understanding how anger and hostility differentially influence coronary heart disease risk.

Hostility and the cardiovascular reactivity of women during interpersonal confrontation

In order to explore the association between hostility and women's health, this study examined the relationship of hostility to cardiovascular reactivity during stressful, interpersonal confrontations. Prior to the task, each participant's level of hostility, methods of coping with stress, and perceived social support were evaluated. Blood pressure and heart rate were monitored in ninety females during two discussions with a disagreeing confederate. In one discussion, participants were given positive feedback concerning their performance, while in a second discussion, participants were given non-positive feedback concerning their effectiveness in expressing their viewpoint. The results indicate that low hostile women displayed greater systolic blood pressure and heart rate increases than high hostile women during the discussions. In addition, participants exhibited greater systolic blood pressure and diastolic blood pressure reactivity during the positive feedback condition than during the non-positive feedback condition. However, for diastolic blood pressure, these results were qualified by an interaction, such that low hostile women displayed greater reactivity during the positive feedback condition than during the non-positive feedback condition, while high hostile women were equally reactive in both feedback conditions. State assessment of coping styles indicated that high hostile women may be less reactive due to withdrawal and lack of engagement during the task, while low hostile women may show greater engagement, especially when encouraged by positive feedback.

Cardiac rehabilitation: a review of current developments

An overview is given of the current status of cardiac rehabilitation and its effects on morbidity and mortality. While there is an emphasis in most current programs upon physical exercise as an important autonomous risk factor for Coronary Heart Disease (CHD), there is at the same time a tendency in cardiac rehabilitation to go beyond mere physical exercise towards adding more multimodal psychoeducational modules in rehabilitation programs; those approaches are aimed at educating the patient about a less risky and healthier way of life. Such psycho-education is more and more aimed at the "toxic" aspects of negative emotions. The in-between classic Type A Behavior Pattern (TABP) might, in general, be less powerful in predicting later CHD morbidity or mortality than some specific emotional components of TABP, such as anger and hostility. The literature is reviewed as to risk factors and CHD and the role of negative affectivity in development and or maintenance of CHD. Approaches for modification are discussed against the background of their effectivity in cardiac rehabilitation. The recent Dutch guidelines, issued by the Dutch Heart Foundation, appear to incorporate many of the elements mentioned in the research literature on cardiac rehabilitation. On a scientific level they form an excellent audit to evaluate and to contour efficiently the until-now very heterogeneous field of cardiac rehabilitation.

Adrenocorticotropin responses to interpersonal stress: effects of overt anger expression style and defensiveness

This study evaluated the influence of overt anger expression style and defensiveness on the hypothalamic-pituitary-adrenocortical (HPA) responses to acute psychological stress. These personality traits are thought to modulate the stress cardiovascular response and influence disease risk, however, little is known about their influence on HPA responses. Forty-six young, healthy male volunteers worked on counterbalanced extended public-speaking and mental arithmetic. The sample was dichotomitized into groups low vs. high in anger-out, using Spielberger's Anger-Expression Inventory, and in defensiveness, using the Marlowe-Crown Social Desirability Scale. Serum cortisol and adrenocorticotropic hormone (ACTH) concentrations were measured before and after performing each task. Heart rate (HR) and blood pressures (BP) were obtained continuously in 2-min intervals before, during and after the tasks. Public speaking produced greater adrenocortical and cardiovascular stress responses than mental arithmetic, and the greatest increases in ACTH occurred in subjects high in anger-out and defensiveness. These preliminary findings provide evidence that a mismatch between traits of preferred anger expression style and defensive style produces pronounced adrenocorticotropic responses during socially salient stress.

The relationship between anger-coping styles and lifestyle behaviors in teenagers

PURPOSE

To investigate the relationship between anger-coping styles (anger expression and anger suppression) and lifestyle behaviors (physical activity and consumption of alcohol, cigarettes, and caffeine) in adolescents.

METHODS

A sample of 411 adolescents (198 males: 101 white, 97 black; 213 females: 101 white, 112 black) aged 13-20 years (mean age 15.6 years) completed the Anger Expression Scale and brief self-report questionnaires assessing physical activity (weekly amount, comparison with peers) and consumption of alcohol (frequency and amount over the past 2 weeks), cigarettes (amount over past 2 weeks), and caffeine (from coffee and soda over past week).

RESULTS

Correlational and Chi-square analyses showed teenagers high in anger suppression reported consuming alcohol more frequently, spending fewer hours per week in aerobic activity, and being less physically active than their peers. Teenagers high in anger expression reported consuming more caffeinated soda and coffee.

CONCLUSIONS

Results suggest that excessive anger suppression or expression may be associated with an imprudent lifestyle relatively early in life.

Influence of cholesterol and fasting insulin levels on blood pressure reactivity

OBJECTIVE

This study examined how cholesterol and fasting insulin levels are related to blood pressure reactivity to behavioral stressors.

METHODS

Subjects (N = 116) were 20 to 52 years old, at 80% to 150% of ideal weight, and had an average fasting cholesterol level of 183 mg/dl. Stressor tasks included mirror star tracing and a videotaped speech task. Changes from baseline were calculated for systolic and diastolic blood pressure.

RESULTS

Neither cholesterol nor insulin was independently related to blood pressure change scores. However, after controlling for body mass, a two-way analysis of variance revealed a significant cholesterol-by-insulin interaction for change in diastolic blood pressure (p = .022). Subjects in the high-cholesterol/high-insulin group showed the greatest increase in diastolic blood pressure reactivity.

CONCLUSIONS

In a general population, people with a below-average cholesterol level experience only moderate cardiovascular reactivity to mental stressors regardless of their fasting insulin level. However, for people with an above-average cholesterol level, fasting insulin level is an important factor in determining potential reactivity to mental stressors. These findings highlight the importance of adequate sample size to allow for the analysis of such interactions in future studies of cholesterol, insulin, and blood pressure reactivity.

Repressed anger and patterns of cardiovascular, self-report and behavioral responses: effects of harassment

We hypothesized that anger repressors would show discrepancies between self-reported anger and cardiovascular and behavioral responses only during harassment. Subjects (N=102) were assigned randomly to condition. In the nonharassment condition, subjects told stories about eight Thematic Apperception Test cards without any harassment. In the harassment condition, subjects told four stories without harassment, and then told four more stories with harassment. Words connoting aggressive behavior and angry/hostile affect were coded from story content. Subjects were classified into low anger expressor, anger repressor, high anger expressor, and defensive anger expressor categories based on median splits of the Anger-Out Subscale and Marlowe-Crowne Social Desirability Scale. Results showed that harassed anger repressors reported anger comparable to that of low anger expressors but less than high expressors, whereas their heart rate (HR) reactivity was comparable to high expressors, but greater than low anger expressors. Increases in anger words did not distinguish repressors from other groups. Repressed anger may represent a distinct anger management style characterized by a discrepancy between acknowledged anger and cardiovascular reactivity--effects that become fully manifest only during interpersonal provocation.

Vital exhaustion as a risk factor of myocardial infarction: a case-control study in Venezuela

In this study, 32 first myocardial infarction (MI) cases and 42 healthy controls were compared with respect to vital exhaustion (VE), a state characterized by loss of energy, increased irritability, and feelings of demoralization. This state has been found to precede the onset of cardiac events. Participants also responded to questionnaires on Type A behavior, anger expression (Anger In, Anger Out, and Anger Control), and positive and negative self-concept. Results showed that VE discriminated well between MI patients and controls (Odds Ratio [OR] = 15.42, 95% confidence interval = 3.92-60.67) even when controlling for age, smoking, and exercise. The odds ratio decreased to 12.34 when controlling for socioeconomic status. Groups also differed in Anger In but not in Anger Control, Anger Out, negative or positive self-concept. Anger In was correlated to VE in all participants pointing to the relevance of withholding emotions in relation to exhaustion. Exhaustion was strongly associated with negative self-concept in the MI cases group only but significantly discriminated between cases and controls when adjusted for negative self-concept. Summarizing, the results show that, as has previously been found in other countries, in Venezuela VE is a precursor of MI.

Anger management style and hostility: predicting symptom-specific physiological reactivity among chronic low back pain patients

It was hypothesized that anger management style (anger-in or anger-out) and hostility affect the aggravation of chronic low back pain (CLBP) through symptom-specific (i.e., lower paraspinal muscle) reactivity during stress. Subjects were 102 CLBP patients who performed mental arithmetic and an Anger Recall Interview (ARI) while trapezius and lower paraspinal EMG, SBP, DBP, and HR were recorded. Results showed anger-in x hostility and anger-out x gender interactions for lower paraspinal but not trapezius reactivity, and only during the ARI. Further analyses revealed that (1) hostility was related positively to lower paraspinal reactivity among high anger suppressors, (2) hostility was related negatively to lower paraspinal reactivity among low anger suppressors, and (3) anger expression was related positively to lower paraspinal reactivity only among men. Anger management style and hostility may contribute to the exacerbation of CLBP by influencing stress reactivity only in muscles near the site of pain or injury.

Case study: topographical brain mapping in hostility following mild closed head injury

Previous research suggests that right frontal and temporal lobe arousal may inhibit and elicit hostility, respectively. For example, emotional lability (including rage) has resulted from lesion of the bulbar motor nuclei, and neocortical upper motor neurons in particular (Lieberman & Benson, 1977). Ablation of hypothalamic sites has resulted in sham rage (Flynn, Cummings & Tomiyasu, 1988; Sachdev, Smith, Matheson & Last, 1992; Tonkonogy & Geller, 1992) suggesting that these frontal pathways may inhibit hostility. In the present study, a patient with hostility management problems secondary to closed head injury from a motor vehicle accident was evaluated using topographical brain mapping and quantitative electroencephalograph (QEEG) techniques. Comparisons of beta magnitude were performed between frontal and temporal sites at the right and left cerebrums. The results support the contention of an oppositional anterior to posterior mediation of hostility. The present electroencephalagraphic research supports the predominant neuropsychological theory that the right orbital-frontal region inhibits the right amygdaloid bodies, thereby decreasing hostility level (Kolb & Wishaw, 1990).

Dimensions of hostility and cardiovascular response to interpersonal stress

Emerging research suggests that hostility is a multidimensional construct with different dimensions conferring different cardiovascular disease risk. This study examined two dimensions of hostility, expressive and neurotic, and their hemodynamic response patterns upon exposure to interpersonal stress. Fifty-seven male undergraduates were categorized into high and low expressive hostility (HiEH, LoEH) and high and low neurotic hostility (HiNH, LoNH) groups based on their Buss-Durkee Hostility Inventory scores. Subjects engaged in a mathematical subtraction task, with half of the subjects harassed through anger-provoking statements. Separate analyses were conducted for the expressive and neurotic hostility groupings. For expressive hostility, results indicated that HiEH/harassed subjects exhibited greater systolic blood pressure, heart rate, and cardiac output responses than did HiEH/nonharassed subjects or LoEH subjects irrespective of harassment. Neurotic hostility analyses revealed elevated forearm blood flow in HiNH/harassed subjects as compared to HiNH/nonharassed subjects or LoNH subjects in either harassment condition. The hemodynamic response pattern of expressive hostiles is consistent with their risk for heart disease. The response pattern of neurotic hostiles may indicate risk for hypertension, though this remains to be established.

Anger management style, degree of expressed anger, and gender influence cardiovascular recovery from interpersonal harassment

The hypothesis that the degree to which individuals expressed anger during harassment would mediate relationships between anger management style and cardiovascular recovery from harassment was examined in a college sample of 31 men and 32 women. Subjects told stories about Thematic Apperception Test cards during nonharassment and harassment phases. Words spoken during the storytelling reflecting "aggressive behavior" and "angry/hostile affect" were coded from audiotapes. Responses on the Anger-out subscale (AOS) of the Anger Expression Inventory were positively correlated with expression of angry/hostile affect words, and with SBP increases during harassment. During recovery, high AOS men and low AOS women showed sustained SBP, while men who expressed much anger and women who expressed little anger showed sustained SBP. Additional tests provided support for the hypothesis: SBP responses of high AOS men and low AOS women during recovery were partly mediated by the degree to which subjects expressed anger during harassment.

Dimensions of hostility and myocardial infarction in adult males

The present case-control study investigated the association between dimensions of hostility and myocardial infarction (MI) in adult males. Hostility was measured with the Buss-Durkee Hostility Inventory (BDHI), which assesses two distinct dimensions of hostility, namely experiential and expressive hostility. Cases were 81 males who were admitted in hospital because of a first MI. The reference group consisted of 168 age-matched, healthy male neighbourhood controls. Analyses revealed that especially experiential hostility (comprised of the subscales Resentment and Suspicion) was significantly associated with MI. These results are in contrast with the findings of previous studies, which showed expressive hostility to be positively related to coronary heart disease (CHD). Explanations for these contradictory findings are discussed.

Interactive effects of traits, states, and gender on cardiovascular reactivity during different situations

Interactive effects of anger and anxiety traits, negative affect state, different situations, and gender on cardiovascular reactivity (CVR) to stress were examined. Subjects (91 men, 92 women) performed a reaction time task under either a Social Evaluation, a Harassment, or a Control condition; SBP, DBP, and HR were recorded continuously. Hierarchical multiple regressions revealed intricate interactions. The interaction of anger expression style and anger experience was significant only among men, such that anger suppressors with high trait anger showed the largest CVR of any group during Harassment; anger expressors exhibited generally high CVR across conditions. However, anger expression style and state negative affect interacted to affect CVR in both men and women. Finally, the fear of negative evaluation predicted elevated DBP responses only among men in the Social Evaluation condition. Results imply that the extent to which traits of anger and anxiety contribute to coronary risk may depend on interactions with other traits, gender, and the environment.

Women, anger, and cardiovascular responses to stress

Cardiovascular reactivity (CVR) to stressful stimuli is predictive of future development of cardiovascular disease (CVD). Anger appears to be an important mediator of this relationship. Unfortunately, the majority of research in this area has utilized predominantly male subjects, leaving the relationship between CVD and anger in females largely unexplored. To address the dearth of research among females, the present study examined the relationship between Anger-In, as well as Anger-Out, and CVR to stressors among women. Females reporting moderate levels of Anger-Out exhibited lower blood pressure reactions to a mental arithmetic stressor than females reporting high and low levels of Anger-Out. Females reporting moderate levels of Anger-Out also exhibited lower heart rate reactions than individuals reporting high levels of Anger-Out. Anger-In was not related to CVR in the present study.

Cardiovascular consequences of expressing, experiencing, and repressing anger

Psychoanalytic theory's pathogenic view of repression gave rise to the widely held belief that the expression of anger is beneficial to mental and physical health. The present paper reviews a number of experimental and correlational studies which demonstrate that the full expression of anger, with its vocal manifestations, is associated with significant cardiovascular hyperreactivity. Furthermore, epidemiological studies indicate that such expression of anger are also related to coronary heart disease (CHD) and to some physiological and hormonal changes that have been implicated in the pathophysiology of CHD. On the other hand, neither the mere experience of anger nor its repression has any of the above negative cardiovascular consequences, although the repression of anger seems to have other untoward health consequences.