Defensive hostility, gender and cardiovascular levels and responses to stress

Hostility, Anger, Psycho-emotional Factors and Cardiovascular Disease

The review presents the main aspects of the relationship between psychoemotional factors, hostility, anger and cardiovascular diseases. The first chapter describes the main historical stages in the study of this problem, starting from the Middle Ages and ending with fundamental research of the 19-20 centuries. In the second part, the authors demonstrated that hostility/anger are a risk factor for the CVD development and affect the prognosis and course of CVD (hypertension, ischemic heart disease, various cardiac arrhythmias, etc.). In the third chapter, there were studies that found that high rates of hostility/ anger reduced the effectiveness of cardiovascular therapy. In the fourth part, there are the main correlation mechanisms of negative emotions, hostility/anger and the cardiovascular system, carried out through the relationships with the activation of the hypothalamic-pituitary-adrenal, autonomic nervous system, platelet activation, with the changes in the risk factors characteristics etc. In the final chapter, the authors suggested prospects for further study of the problem, probably associated with the assessment of behavioral interventions, pharmacological or complex effects on the severity of hostility/anger to reduce CVD mortality in individuals with high rates of hostility / anger.

Blood pressure responses of defensive hostile women when facing a real stress task

OBJECTIVE

This study investigated the importance of the combination of the hostility and defensiveness variables as psychosocial factors that predict the risk of cardiovascular dysfunction. We examined the impact of a stressful situation on blood pressure responses, using a continuous psychophysiological assessment approach.

DESIGN

We measured the evolution of these responses over three experimental phases (adaptation, task and recovery), also considering a minute-by-minute analysis within each phase.

MAIN OUTCOME MEASURES

We used the Cook-Medley Hostility Scale and the Social Desirability Questionnaire to form four groups (high hostility and high defensiveness, high hostility and low defensiveness, low hostility and high defensiveness, and low hostility and low defensiveness).

RESULTS

We expected the group of hostile defensive women to record higher activation (task phase: an academic exam) and slower habituation (recovery phase) compared to the other groups. The results confirmed our hypothesis, as the profile of the hostile defensive individuals was one of constant or sensitization during the task phase, while during the recovery phase those individuals underwent a slow recovery.

CONCLUSION

Therefore, it can be indicated that the low hostility and low defensive group is the most adaptive, as recorded very little activation in response, and rapid recovery.

Emotional Disclosure and Closeness Toward Offenders

Two studies tested whether emotional disclosure increases feelings of closeness toward offenders. In Study 1, participants recalled either someone who had offended them or a neutral acquaintance. “Disclosure” participants then expressed their thoughts and feelings regarding their targets, and “suppression” participants described their targets nonemotionally. As predicted, disclosure increased closeness toward offenders but not toward acquaintances. Study 2 extended these results by including a good friend to test whether disclosure selectively increases closeness toward offenders, and not simply toward any person who evokes strong feelings. This prediction was confirmed. Furthermore, the disclosure effect remained reliable even after controlling for mood. Studies 1 and 2 also showed that closeness toward offenders, but not toward friends or acquaintances, was positively related to the proportion of emotion-related words disclosed. Collectively, these findings suggest that confronting the emotions associated with an offense may be an important first step toward forgiveness.

Cognitive hostility predicts all-cause mortality irrespective of behavioural risk at late middle and older age

BACKGROUND

Most but not all evidence supports hostility-related attributes to increase mortality risk. However, studies usually include single attributes, their effects have been studied predominantly in younger populations, and behavioural pathways explaining the mortality effect seem to differ by age. We examined the relationship between all-cause mortality and cognitive hostility, anger, aggression and rebelliousness, and their independence of health behaviours in a late middle-aged and older population.

METHODS

Data were derived from the longitudinal Dutch Study of Medical Information and Lifestyles in the city of Eindhoven, in the Southeast of the Netherlands study among 2679 late middle-aged and older Dutch people. Psychological characteristics were self-reported in 2004/2005, and mortality was monitored from 2005 to 2010. Cox regression analyses were used to calculate the mortality risk by each unique psychological variable with additional adjustments for the other psychological variables and for health behaviours. Baseline adjustments included age, sex, educational level and prevalent morbidity.

RESULTS

Cognitive hostility was associated with all-cause mortality, independent of health behaviours (on a scale ranging from 6 to 30, the hazard ratio (HR) was 1.05; 95% confidence interval [95% CI): 1.01-1.09]. Anger, aggression and rebelliousness were not associated with mortality risk.

CONCLUSIONS

In diminishing excess mortality risks, hostile cognitions might be acknowledged separately and additionally to the risk posed by unhealthy lifestyles.

The Role of Sensory Gating in the Racism/Blood Pressure Relationship

African Americans bear a disproportionate burden of hypertension with racism postulated as a unique stressor contributing to the noted disparities. Epidemiological studies have found differences in the prevalence of hypertension among African Americans based on the amount of perceived racism reported, and experimental studies have shown increased cardiovascular reactivity to racially-aversive stressors. A difference in individual response to racial stressors may create subgroups of African Americans at highest risk for hypertension and its complications. Although sensory gating is the brain’s capacity to selectively regulate its sensitivity to environmental sensory stimuli, scant research has been done regarding the role of sensory gating in the stress response, and no research has explored sensory gating with racial stressors. To address this gap, we examined whether P50 sensory gating was associated with cardiovascular and central nervous system responses to an experimentally-induced racial stressor among 15 African Americans. A paired-click paradigm was administered prior to the experimental condition, which involved exposure to a neutral and then a racially-aversive photo stimulus. Participants with weak gating showed a significant within-subjects decrease in alpha-band activity when viewing the racially aversive stimulus and had significantly decreased alpha activity when viewing the aversive stimuli compared to participants with strong gating. Increased cardiovascular reactivity occurred with the aversive stimulus, and gender differences were noted. A gating effect on cardiovascular reactivity could not be determined given the small sample size and the fact that few men qualified as having ‘good’ gating. Although subjects reported no conscious awareness of distress when viewing the racially-aversive stimulus, both cardiovascular and central nervous system reactions occurred, with the responses varying based on the level of sensory gating. These results suggest sensory gating as a potential physiologic factor that may influence the relationship between perceived racial stressors and health outcomes.

Impact of defensive hostility in cardiovascular disease

Among the psychosocial factors that may influence the development, maintenance, and progression of cardiovascular disease, defensive hostility as a possible risk factor has received substantial empirical support in recent years. The aim of our study was to analyze the relationship between defensive hostility and cardiovascular response to stress situations, as a better predictor of cardiovascular functioning than hostility alone. The sample was composed of 130 female university students. The Cook-Medley Hostility Inventory (Ho) and the Spanish version (CRP) of the Marlowe-Crowne Social Desirability Scale (MC) were used to measure defensive hostility. We used the registration system MP150 (Biopac) to measure the physiological variables throughout the 3 experimental phases (adaptation, task, and recovery). The stress task was a real exam. We expected cardiovascular responses, heart rate, and systolic and diastolic blood pressure to be higher in subjects with high hostility and high defensiveness in all 3 phases. The results reflect that individuals with high hostility and high defensiveness present the highest values in the physiological variables, thus supporting the hypothesis that defensive hostility shows the greatest predictive power in relation to cardiovascular functioning in stressful situations.

Physiological stress responses in defensive individuals: age and sex matter

The association between defensiveness and physiological responses to stress were evaluated in 81 healthy working men and 118 women, aged 20 to 64 years (M=41; SD=11.45). Participants underwent laboratory testing during which they were exposed to interpersonal stressors. Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and salivary cortisol were measured. Defensiveness was evaluated using the Marlowe-Crowne Social Desirability Scale. In women, higher defensiveness was associated with greater BP and HR reactivity to stress (p<.05). In older men, lower defensiveness was associated with increased systolic BP reactivity to stress (p<.02), delayed HRV recovery (p<.02), and greater salivary cortisol levels (p<.02). In conclusion, greater defensiveness was associated with increased reactivity to stress in women whereas in older men, lower defensiveness was associated with elevated cardiovascular, autonomic, and endocrine responses to stress.

Autonomic characteristics of defensive hostility: reactivity and recovery to active and passive stressors

The autonomic characteristics of hostility and defensiveness were assessed in 55 male undergraduates based on composite Cook Medley Hostility (Chost) and Marlowe Crowne Social Desirability (MC) scores to create 4 groups: Defensive Hostile (DH; high MC, high Chost), High Hostile (HH; low MC, high Chost), Defensive (Def; high MC, low Chost) and Low Hostile (LH; low MC, low Chost). All subjects engaged in a video game (VG) and hand cold pressor (CP) task. Cardiovascular responses in DH subjects were predicted to show enhanced sympathetic alpha and beta-adrenergic activity and the least vagal control compared to others across tasks. DH and LH men showed significant heart rate reactivity to the CP task compared to HH men. LH men showed significant reductions in high frequency power (vagal assessment) to the tasks compared to HH men. Future studies may employ harassment techniques and include the factors of gender and ethnicity in their assessments.

Different Types of Circulatory Responses to Mental Tasks

The present study investigated the circulatory responses to two mental tasks. Forty males and females performed a mental subtraction task and a color-word task. During each task, the systolic and diastolic blood pressure, mean arterial pressure, heart rate, stroke volume, cardiac output, and total peripheral resistance were measured as cardiovascular indices for a 5-min baseline, a 5-min task period, and a 10-min recovery period. As for the results, three hemodynamic reactivity patterns were verified: Pattern C, characterized by increased cardiac output and decreased total peripheral resistance; Pattern M, characterized by a moderate increase in both cardiac output and total peripheral resistance; and Pattern V, characterized by increased total peripheral resistance and decreased cardiac output. Also, four response types were found among all subjects: Type 1: cardiovascular responses showed the cardiac pattern for both tasks; Type 2: cardiovascular responses changed between the cardiac pattern and the mixed pattern with a change of tasks; Type 3: cardiovascular responses showed the mixed pattern for both tasks; Type 4: cardiovascular responses changed between the mixed pattern and the vascular pattern with a change of tasks. The comparison between types showed that Type 3 and Type 4 had an elevation in their blood pressure by an increased total peripheral resistance. On the other hand, Type 1 and Type 2 tended to have an increased blood pressure by a rise in their cardiac output. And Type 3 and Type 4 showed higher blood pressure and higher scores on the Type A behavior pattern questionnaire. In conclusion, at least four types of circulation response to the mental tasks existed, with Type 3 and Type 4 having higher blood pressure responses and tending to have an elevated blood pressure by a rise in their total peripheral resistance.

Suppressed hostility predicted hypertension incidence among middle-aged men: the normative aging study

This study tested whether suppressed hostility predicted incident hypertension (HTN) in initially nonhypertensive men, using prospective data from the Normative Aging Study. Six hundred twenty-seven men who completed the MMPI and participated in a subsequent laboratory assessment were included in the study. The Cook-Medley Hostility scale (Ho), a suppression factor, and other risk factors were used to predict incident HTN over a 3-year period. Logistic regression showed a significant three-way interaction among Ho, suppression, and age in predicting incident HTN. Among middle-aged men (<or=60 years) with higher suppression, a 1-point decrease in the Ho score was associated with an 18% increase in HTN risk. This relationship remained significant after controlling for relevant risk factors. Among older participants, the HoxSuppression interaction was not predictive of HTN incidence. These results provide support for the Suppressed Hostility hypothesis in middle-aged men.

Adaptive defense use and resting blood pressure in a population-based sample

OBJECTIVES

There is an accumulating body of research related to the psychosomatic study of blood pressure. One variable that has received attention is defense use. We examined the relation between defense use and blood pressure in men and women of different ages.

METHODS

A random sample of 667 participants was selected from a population-based study. Resting blood pressure was obtained, and each participant was rated for defense use by a trained observer using Defense-Q. An Adaptive Defense Profile (ADP) score was calculated for each participant, and this score was related to blood pressure.

RESULTS

Regression analyses revealed a significant main effect for the ADP score for both diastolic and systolic blood pressure. Those persons with higher ADP scores had lower diastolic and systolic blood pressure. As well, a significant Age x Sex x ADP score interaction was found for diastolic blood pressure. Older women with a less ADP score had higher diastolic blood pressure.

CONCLUSIONS

These findings suggest the continued investigation of defense use and blood pressure.

Defensive hostility and coronary heart disease: a preliminary investigation of male veterans

OBJECTIVE

Research and theory link an interpersonal conflict model to cardiovascular disease. Specifically, persons scoring high on cynical hostility and social defensiveness are thought to manifest a defensive need for approval while harboring basic distrust and hostility toward those who could provide such approval. The objective of this study was to assess whether angiographically determined coronary artery disease (CAD) was associated with this combination of high cynical hostility and high social defensiveness.

METHODS

Fifty-nine male patients of a Veterans Administration Medical Center (86% white, mean age = 59.9 years) participated in the study on the day before their angiographic procedure; these men filled out the Cook-Medley Hostility Scale and the Marlowe-Crowne Social Desirability Scale (social defensiveness). They subsequently were categorized as having defensive hostility (DH), high hostility (HH), high social defensiveness (SD), or low psychosocial risk (LRisk; low on both scales).

RESULTS

The four groups did not differ significantly on risk factor status or health status. As predicted, a preplanned contrast showed that the DH group's mean number of arteries with at least 50% blockage (mean = 2.5) differed significantly from the combined means of the other groups. The HH and SD groups did not differ from the LRisk group.

CONCLUSIONS

When combined with other reports, the approach-avoidance interpersonal conflict model holds the promise of providing additional information about the psychosocial factors contributing to CAD development among men with high cynical hostility.

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.

Role-played interpersonal interaction: ecological validity and cardiovascular reactivity

Conflictual role-play scenarios have been used to model brief interpersonal interaction and to elicit cardiovascular reactivity in the laboratory. Here we discuss data suggesting that role-played interactions constitute an ecologically valid laboratory task that may improve laboratory-to-field generalization of cardiovascular response. Specifically, our research indicates that young adults perceive the stress associated with role-play scenarios as similar to that encountered in everyday life. Furthermore, these stress appraisals moderate cardiovascular response to role-play in men. We also find that a social stressor (i.e. speech task) is perceived as significantly more similar to a real-life stressor as compared to other standard laboratory tasks. We propose that particular constellations of cognitive, affective, and behavioral responses to laboratory-based social stressors, such as role-played interaction, may elicit different patterns of hemodynamic response. Further understanding of interrelations among cognitive, affective, behavioral, and physiological response patterns may assist in the study of cardiovascular reactivity as a potential mechanism linking personality factors and the development of cardiovascular disease.

Health psychology: mapping biobehavioral contributions to health and illness

Our evolving understanding of how psychosocial and behavioral factors affect health and disease processes has been marked by investigation of specific relationships and mechanisms underlying them. Stress and other emotional responses are components of complex interactions of genetic, physiological, behavioral, and environmental factors that affect the body's ability to remain or become healthy or to resist or overcome disease. Regulated by nervous, endocrine, and immune systems, and exerting powerful influence on other bodily systems and key health-relevant behaviors, stress and emotion appear to have important implications for the initiation or progression of cancer, HIV, cardiovascular disease, and other illnesses. Health-enhancing and health-impairing behaviors, including diet, exercise, tobacco use, and protection from the sun, can compromise or benefit health and are directed by a number of influences as well. Finally, health behaviors related to being ill or trying to avoid disease or its severest consequences are important. Seeking care and adhering to medical regimens and recommendations for disease surveillance allow for earlier identification of health threats and more effective treatment. Evidence that biobehavioral factors are linked to health in integrated, complex ways continues to mount, and knowledge of these influences has implications for medical outcomes and health care practice.

Psychosocial variables, age, and angiographically-determined coronary artery disease in women

The present study explored the relationship between psychosocial measures and the degree of coronary stenosis in a sample of 59 women between the ages of 39 and 84. Coronary occlusion was correlated with elevated cholesterol and marginally correlated with age and was inversely associated with years of education. Based on hierarchical multiple regression, an interview-based measure of hostility was associated with coronary stenosis after controlling for traditional risk factors, and age moderated the hostility-stenosis relationship. Further, a second regression model suggested that trait anxiety was inversely correlated with degree of occlusion, perhaps because low-anxious women are referred for catheterization later in the course of the disease. Contrary to hypotheses, there was no evidence that repression of interview-based hostility or anxiety predicted coronary occlusion. Given the small sample size, results should be considered preliminary. Future studies should explore the degree to which anxiety and hostility are associated with coronary heart disease (CHD) in larger samples of women and the degree to which age moderates the hostility-occlusion association.

Effect of verbal self-disclosure on natural killer cell activity: moderating influence of cynical hostility

One objective of the present research was to examine the immunological effects of self-disclosing personal information regarding a traumatic or stressful experience. A second objective was to examine the hypothesis that the effect of self-disclosure on immune function is moderated by individual differences in cynical hostility. Forty-three male college undergraduates, classified as high or low on the Cook-Medley Hostility scale were randomly assigned to either a verbal self-disclosure or a nondisclosure discussion condition. Task-induced change in natural killer (NK) cell activity (i.e., cytotoxicity) served as the dependent variable. As predicted, a significant interaction between discussion condition and hostility was obtained. Among subjects in the self-disclosure condition, high hostility subjects exhibited a significantly greater increase in NK cell cytotoxicity than low hostility subjects. The effect of self-disclosure on NK cell activity is moderated by an individual's level of cynical hostility. The greater short term enhancement in NK cell activity observed for hostile persons is a likely correlate of a more pronounced acute arousal response elicited by the self-disclosure task.