Gender, anger expression style, and opportunity for anger release determine cardiovascular reaction to and recovery from anger provocation

Personality features and vulnerability to stress: a case study on hyperhidrosis

By using the Rorschach test, self-reports, and psychophysiological measures, we investigated thoroughly the psychological functioning in a hyperhidrotic case. Erica, a young female with hyperhidrosis, was assessed in three times at one-week distance. First, specific tools assessing potential psychological and affective distress, and the Rorschach test were administered. About one week later, Electrodermal Activity was recorded during the exposure to a mild laboratory stress-inducing task. Finally, a magnetic resonance imaging exam was performed in order to exclude medical conditions/neurological alterations for potential physiological anomalies. Erica tends to avoid living in the moment and prefers to experience close relationships in her inner world where she can rehearse the future and imagine different contexts and social situations without risks and embarrassment. She reports high capacities to perform goaldirected behaviors and clarity of emotions only in absence of stressful situations. The study has the merit to be the first to combine Rorschach data with physiological data in order to investigate the psychological functioning in a hyperhidrotic case.

Spousal bereavement is associated with more pronounced ex vivo cytokine production and lower heart rate variability: Mechanisms underlying cardiovascular risk?

The loss of a spouse is a highly stressful event that puts people at excess risk of mortality. Excess mortality among those who are widowed is highest in the first six months after the death of a spouse and decreases over time. Heart disease accounts for the largest proportion of these deaths. The psychological stress associated with stressful life events can enhance inflammation and lower heart rate variability (HRV). Both lower HRV and higher inflammation are risk factors for cardiovascular morbidity and mortality. Thirty-two recently bereaved individuals (Mean = 89.68 days since death, SD = 17.09) and 33 age-matched comparisons completed a blood draw, EKG, and self-report questionnaires. In both adjusted and unadjusted models, spousal bereavement was associated with enhanced pro-inflammatory cytokine production by in vitro lipolysaccharide-stimulated peripheral blood leukocytes. Moreover, spousal bereavement was associated with lower HRV in comparison to the comparison group. This study is the first to demonstrate that bereavement is associated with a more pronounced ex vivo cytokine production and lower HRV in a population that exclusively consisted of widows and widowers. These findings add to the growing literature revealing the mechanisms that underlie bereavement-related cardiovascular problems. Future longitudinal studies are needed to determine the temporal relation between these risks. Understanding the biological mechanisms that underlie this stressful life event could allow researchers to create therapeutic targets for interventions to reduce or prevent the toll of a "broken heart."

Convergence in feeling, divergence in physiology: How culture influences the consequences of disgust suppression and amplification among European Americans and Asian Americans

Much empirical work documents the downsides of suppressing emotions. Emerging research points to the need for a more sophisticated and culturally informed approach to understanding the consequences of emotion regulation. To that end, we employed behavioral, self-report, and psychophysiological measures to examine the consequences of two types of emotion regulation (suppression and amplification) in a sample of 28 Asian Americans and 31 European Americans. Participants were shown a neutral film and then a series of disgust-eliciting films during which they were asked to regulate their response by suppressing or amplifying their emotional behavior (counterbalanced). Despite self-reporting equal levels of disgust, European Americans showed greater skin conductance reactivity than Asian Americans in both regulation conditions, but not in response to a neutral film. These findings extend work on divergence in the consequences of emotion regulation across different cultural groups, which could help identify optimal emotion regulation strategies for health and well-being.

Rorschach Performance Assessment System (R-PAS) and vulnerability to stress: A preliminary study on electrodermal activity during stress

This study investigated the predictive validity of the ten Rorschach Performance Assessment System (R-PAS) variables from the Stress and Distress domain, by testing whether they predicted increased sympathetic reactivity to a mild, laboratory-induced stress, occurred one week after Rorschach administration. A relatively small student sample (N=52) contributed to this research: During a first meeting (T1) participants were administered the Rorschach task according to R-PAS guidelines; about one week later (T2) their electrodermal activity (EDA) was recorded during exposure to a mild laboratory stress-inducing task. Based on literature indicating that exposure to stress tends to increase physiological vulnerability/reactivity to stressful situations, we anticipated that Stress and Distress R-PAS variables measured at T1 would positively correlate with increased sympathetic reactivity to stress at T2, as indicated by greater EDA changes from baseline to stress and recovery. Results partially confirmed our hypotheses: (a) the mean of and (b) the majority of the Stress and Distress R-PAS variables were significantly correlated, in the expected direction, with medium and medium to large effect sizes.

Validation of the Novaco Anger Scale–Provocation Inventory (Danish) With Nonclinical, Clinical, and Offender Samples

Anger has high prevalence in clinical and forensic settings, and it is associated with aggressive behavior and ward atmosphere on psychiatric units. Dysregulated anger is a clinical problem in Danish mental health care systems, but no anger assessment instruments have been validated in Danish. Because the Novaco Anger Scale and Provocation Inventory (NAS-PI) has been extensively validated with different clinical populations and lends itself to clinical case formulation, it was selected for translation and evaluation in the present multistudy project. Psychometric properties of the NAS-PI were investigated with samples of 477 nonclinical, 250 clinical, 167 male prisoner, and 64 male forensic participants. Anger prevalence and its relationship with other anger measures, anxiety/depression, and aggression were examined. NAS-PI was found to have high reliability, concurrent validity, and discriminant validity, and its scores discriminated the samples. High scores in the offender group demonstrated the feasibility of obtaining self-report assessments of anger with this population. Retrospective and prospective validity of the NAS were tested with the forensic patient sample regarding physically aggressive behavior in hospital. Regression analyses showed that higher scores on NAS increase the risk of having acted aggressively in the past and of acting aggressively in the future.

Reflection and Distraction Defensive Pessimism, Strategic Optimism, and Performance

This research concerns the interaction between performance strategies and imagery conditions. Defensive pessimists (DPs, who set low expectations, feel anxious, and rehearse possible outcomes) and strategic optimists (OPTs, who set high expectations, feel calm, and avoid reflecting) were randomly assigned to three conditions: a coping imagery condition (imagining correcting mistakes), a mastery imagery condition (imagining a flawless performance), or a relaxation condition (relaxation imagery). DPs performed better in the coping imagery condition, which was similar to their typical strategy, than in the relaxation condition, which was hypothesized to interfere with their performance. The opposite was true for OPTs. Both groups performed worst in the mastery imagery condition. Discussion highlights the importance of both reflective process and thought content and the costs and benefits of each strategy.

Laughter as a social rejection cue: gelotophobia and transient cardiac responses to other persons' laughter and insult

Other persons' laughter, normally perceived as a signal that persons are friendly and inviting others to approach, can also be perceived as a cue of social rejection. In this study, prerecorded laughter was placed in a realistic and personally relevant context, and participants' responses were related to gelotophobia, a trait predisposing to perceiving laughter as a cue of social rejection. Individuals with gelotophobia showed marked heart rate deceleration in response to the laughter stimulus, possibly indicating a "freezing-like" response. Moreover, cardiac responses to anger provocation by overtly insulting statements indicated heightened aggressive anger in response to cumulated social threat. The study adds to recent research showing specific cardiac responses to social rejection and to the literature on social rejection sensitivity by demonstrating the value of using well interpretable physiological measures in this research context.

Cardiovascular reactivity, stress, and physical activity

Psychological stress has been proposed as a major contributor to the progression of cardiovascular disease (CVD). Acute mental stress can activate the sympathetic-adrenal-medullary (SAM) axis, eliciting the release of catecholamines (NE and EPI) resulting in the elevation of heart rate (HR) and blood pressure (BP). Combined stress (psychological and physical) can exacerbate these cardiovascular responses, which may partially contribute to the elevated risk of CVD and increased proportionate mortality risks experienced by some occupations (e.g., firefighting and law enforcement). Studies have supported the benefits of physical activity on physiological and psychological health, including the cardiovascular response to acute stress. Aerobically trained individuals exhibit lower sympathetic nervous system (e.g., HR) reactivity and enhanced cardiovascular efficiency (e.g., lower vascular reactivity and decreased recovery time) in response to physical and/or psychological stress. In addition, resistance training has been demonstrated to attenuate cardiovascular responses and improve mental health. This review will examine stress-induced cardiovascular reactivity and plausible explanations for how exercise training and physical fitness (aerobic and resistance exercise) can attenuate cardiovascular responses to stress. This enhanced functionality may facilitate a reduction in the incidence of stroke and myocardial infarction. Finally, this review will also address the interaction of obesity and physical activity on cardiovascular reactivity and CVD.

Cardiovascular responses to stress in Singapore and India

BACKGROUND

Epidemiological studies have shown significant ethnic differences in coronary heart disease death rates with South Asians showing significantly greater coronary heart disease mortality than other groups.

PURPOSE

This research examined ethnic differences in cardiovascular reactivity (CVR) among Chinese, Malays and Indians in Singapore as well as a sample of Indians living in India.

METHODS

Experiment 1 examined differences across 303 Chinese, Malay and Indian undergraduates in Singapore, while Experiment 2 looked at differences in CVR between Indian participants from Singapore, and 145 Indians living in India. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), cardiac index (CI) and total peripheral resistance index (TPRI) were measured during baselines and five laboratory tasks.

RESULTS

Ethnicity main effects for SBP and CI reactivity were obtained in Experiment 1, with Indians showing significantly lower BP and CI reactivity than the Chinese and Malays. Significant main effects for sex were found with females showing lower reactivity than males for TPRI, and greater reactivity than males for HR and CI. Experiment 2 found that participants from India showed higher reactivity for SBP, HR and CI, while Indian participants from Singapore showed higher TPRI reactivity. These differences, however, often varied by task.

CONCLUSIONS

These results point to differences in CVR among ethnic groups in Singapore as well as between Indians living in India and those living in Singapore. These differences may reflect cultural differences and need to be explored further with respect to their relationship to different rates of coronary heart disease among these groups.

Anger suppression and subsequent pain behaviors among chronic low back pain patients: moderating effects of anger regulation style

BACKGROUND

Suppression of anger is linked to subsequent pain intensity among chronic low back patients, but it is not clear whether anger regulation style (trait anger-out, anger-in) moderates these effects or if aroused anger accounts for links between anger regulation style and pain.

METHOD

Chronic low back pain patients (N=58) were assigned to Suppression or No Suppression conditions for a task with harassing confederate and then underwent structured pain behavior procedures. Spielberger Anger Expression Inventory tapped trait anger-out (AOS) and anger-in (AIS).

RESULTS

Regressions tested Emotion Regulation condition × AOS and AIS effects on outcomes. AOS was related to grimacing and sighing for Suppression condition patients. AIS was related negatively to guarding and bracing for Suppression condition patients. Anger report partly mediated effects for AOS and AIS.

CONCLUSIONS

Anger regulation style moderated effects of state anger suppression on subsequent pain behaviors, effects that were partly explained by aroused anger.

Cardiovascular and psychological reactivity and recovery from harassment in a biracial sample of high and low hostile men and women

BACKGROUND

This study emphasizes the importance of studying the emotional, motivational, and cognitive characteristics accompanying and the potential hemodynamic mechanisms underlying cardiovascular reactivity to and recovery from interpersonal conflict.

PURPOSE

The relation of dispositional hostility to cardiovascular reactivity during a frustrating anagram task and post-task recovery was investigated.

METHODS

The sample was composed of 99 healthy participants (age, 18-30 years; 53% women; 51% Caucasian; 49% African American)-half randomly assigned to a harassment condition. High and low hostility groups were created by a median split specific to sex and race subgroup score distributions on the Cook-Medley Hostility Scale. It was hypothesized that hostility would interact with harassment such that harassed, high hostile individuals would display the greatest cardiovascular and emotional reactivity and slowest recovery of the four groups. Participants completed a 10-min baseline, a 6-min anagram task, and a 5-min recovery period with blood pressure, heart rate, pre-ejection period, stroke index, cardiac index, and total peripheral resistance index measured.

RESULTS

Harassed participants displayed significantly greater cardiovascular responses and lower positive affect to the task and slower systolic blood pressure (SBP) recovery than did nonharassed participants. The high hostile group, irrespective of harassment, showed blunted cardiovascular responses during the task and delayed SBP recovery than the low hostile group.

CONCLUSION

Although the predicted interaction between hostility and harassment was not supported in the context of cardiovascular responses, such an interaction was observed in the context of blame attributions, whereby harassed hostile participants were found to blame others for their task performance than the other subgroups.

Individual Differences in Vagal Regulation Moderate Associations Between Daily Affect and Daily Couple Interactions

Previous research suggests that cardiac vagal regulation (indexed by respiratory sinus arrhythmia, or RSA) provides a physiological substrate for affect regulation, which presumably underlies adaptive interpersonal functioning.The authors tested these associations in the context of daily interactions between 68 cohabiting couples. Participants underwent a laboratory assessment of RSA during rest and also during a series of psychological stressors. Subsequently, they kept daily measures of affect and interaction quality for 21 days. Individual differences in baseline and stress levels of RSA moderated within-person associations between daily affect and the quality of couple interactions. The pattern of results differed for women versus men. Men with lower vagal tone or higher vagal reactivity had stronger associations between daily negative affect and daily negative interactions, and men with higher vagal tone had more positive daily interactions overall. Women with higher vagal tone had stronger associations between daily positive affect and daily positive interactions.

Anger management style moderates effects of attention strategy during acute pain induction on physiological responses to subsequent mental stress and recovery: a comparison of chronic pain patients and healthy nonpatients

OBJECTIVES

To examine whether high trait anger-out chronic low back (CLBP) patients would show exceptionally large symptom-specific lower paraspinal (LP) responses, compared with healthy nonpatients, during pain induction, a subsequent mental stressor, and recovery when they were urged to suppress awareness of pain and suffering.

METHODS

CLBP patients (n = 93) and nonpatients (n = 105) were assigned randomly to one of four attention strategy conditions for use during pain induction: sensory-focus, distraction, suppression, or control. All participants underwent a cold pressor, and then performed mental arithmetic. They completed the anger-out (AOS) and anger-in (AIS) subscales of the Anger Expression Inventory.

RESULTS

General Linear Model procedures were used to test Attention Strategy Condition x Patient/Nonpatient Status x AOS (or AIS) x Period interactions for physiological indices. Significant interactions were found such that: a) high trait anger-out patients in the Suppression condition seemed to show the greatest LP reactivity during the mental arithmetic followed by the slowest recovery compared with other conditions; b) high trait anger-out patients and nonpatients in the Suppression condition seemed to show the slowest systolic blood pressure recoveries compared with other conditions.

CONCLUSIONS

Results extend previous work by suggesting that an anger-out style moderates effects of how attention is allocated during pain on responses to and recovery from a subsequent mental stressor. Results provide further evidence that trait anger-out and trait anger-in among CLBP patients are associated with increased LP muscle tension during and after pain and mental stress.

Anger expression and sleep quality in patients with coronary heart disease: findings from the Heart and Soul Study

OBJECTIVE

To evaluate if anger expression affects sleep quality in patients with coronary heart disease (CHD). Research has indicated that poor sleep quality independently predicts adverse outcomes in patients with CHD. Risk factors for poor sleep quality include older age, socioeconomic factors, medical comorbidities, lack of exercise, and depression.

METHODS

We sought to examine the association of anger expression with sleep quality in 1020 outpatients with CHD from the Heart and Soul Study. We assessed anger-in, anger-out, and anger temperament, using the Spielberger State-Trait Anger Expression Inventory 2, and measured sleep quality, using items from the Cardiovascular Health Study and Pittsburgh Sleep Quality Index. We used multivariate analysis of variance to examine the association between anger expression and sleep quality, adjusting for potential confounding variables.

RESULTS

Each standard deviation (SD) increase in anger-in was associated with an 80% greater odds of poor sleep quality (odds ratio (OR) = 1.8, 95% Confidence Interval (CI) = 1.6-2.1; p < .0001). This association remained strong after adjusting for demographics, comorbidities, lifestyle factors, medications, cardiac function, depressive symptoms, anger-out, and anger temperament (adjusted OR = 1.4, 95% CI = 1.5-1.7; p = .001). In the same model, each SD increase in anger-out was associated with a 21% decreased odds of poor sleep quality (OR = 0.79, 95% CI = 0.64-0.98; p = .03). Anger temperament was not independently associated with sleep quality.

CONCLUSIONS

Anger suppression is associated with poor sleep quality in patients with CHD. Whether modifying anger expression can improve sleep quality or reduce cardiovascular morbidity and mortality deserves further study.

Hostility and anger in: cardiovascular reactivity and recovery to mental arithmetic stress

BACKGROUND

Hostility and anger have been attributed as psychosocial risk factors for coronary heart disease. Heightened cardiovascular reactivity (CVR), and poor recovery, to provocative stressors are thought to hasten this risk.

PURPOSE

To examine the relationship between hostility and anger inhibition (AI), and the moderating situational influences of harassment and evaluation, in predicting CVR and recovery to mental arithmetic (MA) stress using a multiple regression approach.

METHODS

48 male undergraduate students engaged in the following 3 minute tasks during recording of the electrocardiogram, impedance cardiography, and blood pressure: baseline, MA, and evaluation. Hostility and AI were assessed with the Cook-Medley Hostility Scale and the Speilberger Anger In subscale, respectively.

RESULTS

An interaction between hostility and AI showed high diastolic blood pressure reactivity to the MA task among hostile anger inhibitors. Harassment did not modify this effect. However, harasser evaluation predicted prolonged systolic blood pressure (SBP) responding among men scoring high in AI, and facilitated SBP recovery among those scoring low on AI.

CONCLUSIONS

The findings highlight the interactive influences of AI and hostility in predicting CVR to stress and underscore the importance of recovery assessments in understanding the potentially pathogenic associations of these constructs.

Pain-related effects of trait anger expression: neural substrates and the role of endogenous opioid mechanisms

Literature is reviewed indicating that greater tendency to manage anger via direct verbal or physical expression (trait anger-out) is associated with increased acute and chronic pain responsiveness. Neuroimaging data are overviewed supporting overlapping neural circuits underlying regulation of both pain and anger, consisting of brain regions including the rostral anterior cingulate cortex, orbitofrontal cortex, anterior insula, amygdala, and periaqueductal gray. These circuits provide a potential neural basis for observed positive associations between anger-out and pain responsiveness. The role of endogenous opioids in modulating activity in these interlinked brain regions is explored, and implications for understanding pain-related effects of anger-out are described. An opioid dysfunction hypothesis is presented in which inadequate endogenous opioid inhibitory activity in these brain regions contributes to links between trait anger-out and pain. A series of studies is presented that supports the opioid dysfunction hypothesis, further suggesting that gender and genetic factors may moderate these effects. Finally, possible implications of interactions between trait anger-out and state behavioral anger expression on endogenous opioid analgesic activity are described.

Trait anger management style moderates effects of actual ("state") anger regulation on symptom-specific reactivity and recovery among chronic low back pain patients

OBJECTIVES

We examined whether "state" anger regulation-inhibition or expression-among chronic low back pain (CLBP) patients would affect lower paraspinal (LP) muscle tension following anger-induction, and whether these effects were moderated by trait anger management style.

METHOD

Eighty-four CLBP patients underwent harassment, then they regulated anger under one of two conditions: half expressed anger by telling stories about people depicted in pictures, whereas half inhibited anger by only describing objects appearing in the same pictures. They completed the anger-out and anger-in subscales (AOS; AIS) of the anger expression inventory.

RESULTS

General Linear Model procedures were used to test anger regulation condition by AOS/AIS by period interactions for physiological indexes. Significant three-way interactions were found such that: a) high trait anger-out patients in the inhibition condition appeared to show the greatest LP reactivity during the inhibition period followed by the slowest recovery; b) high trait anger-out patients in the expression condition appeared to show the greatest systolic blood pressure (SBP) reactivity during the expression period followed by rapid recovery.

CONCLUSIONS

Results implicate LP muscle tension as a potential physiological mechanism that links the actual inhibition of anger following provocation to chronic pain severity among CLBP patients. Results also highlight the importance of mismatch situations for patients who typically regulate anger by expressing it. These CLBP patients may be at particular risk for elevated pain severity if circumstances at work or home regularly dictate that they should inhibit anger expression.

Anger inhibition and pain: conceptualizations, evidence and new directions

Anger and how anger is regulated appear to affect acute and chronic pain intensity. The inhibition of anger (anger-in), in particular, has received much attention, and it is widely believed that suppressing or inhibiting the verbal or physical expression of anger is related to increased pain severity. We examine theoretical accounts for expecting that anger inhibition should affect pain, and review evidence for this claim. We suggest that the evidence for a link between trait anger-in (the self-reported tendency to inhibit anger expression when angry) and acute and chronic pain severity is quite limited owing to a number of factors including a inadequate definition of trait anger-in embodied in the popular anger-in subscale of Spielberger's Anger Expression Inventory, and a strong overlap between trait anger-in scores and measures of general negative affect (NA). We argue that in order to determine whether something unique to the process of anger inhibition exerts direct effects on subsequent pain intensity, new conceptualizations and approaches are needed that go beyond self-report assessments of trait anger-in. We present one model of anger inhibition and pain that adopts elements of Wegner's ironic process theory of thought suppression. Findings from this emerging research paradigm indicate that state anger suppression (suppression manipulated in the laboratory) may indeed affect sensitivity to subsequent painful stimuli, and we outline potentially productive avenues of future inquiry that build on this model. We conclude that although studies employing correlational designs and self-reports of trait anger-in have not upheld the claim that anger inhibition affects pain severity, evidence from studies using new models suggests that actually inhibiting anger expression during a provocative event may increase perceived pain at a later time.

Damned if you do, damned if you don't: The differential effect of expression and inhibition of anger on cardiovascular recovery in Black and White males

Appropriate regulation of emotions is an important component of health. The physiological effects of coping with anger are a topic of particular interest. In a pioneering series of studies Hokanson found that the mode of anger expression following anger instigation had differential effects on vascular recovery. These differential effects were thought to be a result of social learning of avoidance responses. The present study examined this hypothesis in the context of ethnic differences in cardiovascular recovery responses to anger instigation. Twenty-four African American (AA) and 26 European American (EA) males engaged in two debates, one racially themed and one non-racially themed, with an EA confederate. Cardiovascular measures were recorded at baseline, during the debates and during 10-minute recovery periods following each debate. Anger expression preceding the recovery period was manipulated such that half the participants could express their anger toward the confederate and half had to inhibit their anger toward the confederate. Results showed that both AA and EA participants that inhibited their anger had delayed total peripheral resistance recovery. Importantly, for the other dependent variables differential recovery responses were observed such that EA participants that expressed their anger recovered more quickly whereas AA participants that expressed their anger recovered more slowly. These results are consistent with Hokanson's social learning theory of recovery from anger instigation and have important implications for research on emotion regulation and health.

Cardiovascular reactivity in patients with essential or renal hypertension under standardized mental stress

Introduction. Patients with essential hypertension react more strongly to mental stress than normotensives. This may be related to the type of stress coping or to increased reactivity associated with the disease. The aim of our study was to examine whether patients with essential or secondary hypertension differ in their reaction to mental stress. Methods. Seventeen patients with essential hypertension (EH), 9 patients with renal hypertension (RH), and 22 normotensive controls (N) with no circulatory disorders were subjected to a psychophysiological examination under mental stress. Blood pressure (BP), heart rate (HR) and electrodermal activity (EDA) were measured. Results. The two hypertensive groups differed in their BP reaction to mental stress from the control group but not from each other. The product of heart rate and systolic blood pressure during the matrix test was significantly higher in essential than renal hypertensives (EH median: 13344; RH median: 12154.5; p = 0.04). This also holds true for the number of spontaneous fluctuations of EDA in the resting phase after the experiment (EH. median: 3.2; RH. median: 1.3; p = 0.01). Conclusion. The results suggest that not only a high blood pressure level but also the sympathetic nervous tone are responsible for the blood pressure response to mental stress. Due to very different (perhaps psychosocially triggered) conditions, essential hypertension leads to a stronger cardiovascular reaction under mental stress than renal hypertension.

Predicting blood pressure and heart rate change with cardiovascular reactivity and recovery: results from 3-year and 10-year follow up

OBJECTIVES

We examined whether cardiovascular reactivity and recovery after laboratory-induced stress is useful in predicting 3-year and 10-year ambulatory blood pressure (BP) and heart rate (HR) among 330 initially normotensive individuals.

METHODS

At baseline, BP and HR measurements were recorded during three 5-minute laboratory challenges and three 5-minute recovery periods after each challenge. Measurements of systolic BP, diastolic BP, and HR were collected throughout this baseline protocol and also at 3-year and 10-year follow up by ambulatory monitoring.

RESULTS

After adjustment for traditional biologic predictors, reactivity was found to explain significant variance in follow-up data across all 3-year indices and two of the 10-year indices. Recovery, entered in a following step after reactivity, was found to explain additional significant variance across all 3-year indices but none of the 10-year indices. Family hypertension history data were not found to be significantly associated with reactivity or recovery nor were they predictive of longitudinal ambulatory data after adjustment for initial resting cardiovascular levels.

CONCLUSION

Overall, from a hierarchical regression model perspective, the data support the use of both reactivity and recovery in clinical predictions of proximal BP and HR and generally support the use of reactivity (but not recovery) in long-term BP predictions.

Anger expression and pain: an overview of findings and possible mechanisms

A tendency to manage anger via direct expression (anger-out) is increasingly recognized as influencing responses to pain. Elevated trait anger-out is associated with increased responsiveness to acute experimental and clinical pain stimuli, and is generally related to elevated chronic pain intensity in individuals with diverse pain conditions. Possible mechanisms for these links are explored, including negative affect, psychodynamics, central adipose tissue, symptom specific muscle reactivity, endogenous opioid dysfunction, and genetics. The opioid dysfunction hypothesis has some experimental support, and simultaneously can account for anger-out's effects on both acute and chronic pain. Factors which may moderate the anger-out/pain link are described, including narcotic use, gender, and genetic polymorphisms. Pain exacerbating effects of trait anger-out are contrasted with the apparent pain inhibitory effects of behavioral anger expression exhibited in anger-provoking contexts. Conceptual issues related to the state versus trait effects of expressive anger regulation are discussed.

Anger expression and lifestyle incongruity interactions on blood pressure in Samoan adults

Prior research on psychosocial stress and blood pressure (BP) in adult Samoans identified the separate influences of lifestyle incongruity and anger expression within the context of societal modernization. The objective of this cross-sectional study was to determine the interactions between lifestyle incongruity and anger expression on BP in 376 men and women 25-65 years of age from Samoa. Participants were randomly selected from nine villages. Body mass index (BMI) and BP were measured by standard techniques. Anger expression was measured with an adapted version of the Spielberger Inventory. Material lifestyle was assessed by inventory of household items, exposure to news media, and off-island travel. Occupation and education lifestyle incongruities were calculated by subtracting the standardized lifestyle scale from the standardized occupation and education scales, respectively. Two-factor analysis of variance models with interactions were estimated within specific subgroups, with age- and BMI-adjusted BP as outcomes. In women <40 years of age with a material lifestyle relatively lower than their educational rank, anger suppression is associated with higher adjusted systolic BP. In young men whose material lifestyle is relatively lower than their occupational rank, those who report frequent experiences of Samoan culture-specific anger feelings have higher adjusted diastolic BP. We hypothesize that among young women, the higher BP may be due to stress arising from both a normative proscription against emotional expression, and a mismatch between their relatively higher educational level and lower material lifestyle. For young men, higher BP levels may be attributed to expected donations of earnings to the extended family that exceed their own material lifestyle, in combination with more frequent Samoan-specific feelings of anger.

Anger cognitions and cardiovascular recovery following provocation

The current study describes the creation and validation of the Anger Cognitions Inventory (ACI) to assess the cognitive appraisals associated with resentful and reflective anger. The ACI was created based on a content analysis of self-reports of participants' thoughts and feelings following anger provocation in the laboratory. Exploratory and confirmatory factor analyses on two separate college student samples (N = 267 and N = 276, respectively) revealed five subscales which could validly be grouped into resentful and reflective anger. Convergent and divergent validity data showed that resentful anger correlated positively with anger-out/trait anger and reflective anger correlated positively with anger-in/brooding. A second study showed positive correlations between rumination and delayed cardiovascular recovery following anger provocation. Limitations of both studies include restricted samples which limit generalizability of results and cardiovascular recovery data collected in Study II which does not include assessment of autonomic balance between vagal and sympathetic responsivity.

Anger management style, blood pressure reactivity, and acute pain sensitivity: evidence for "Trait x Situation" models

BACKGROUND

Anger management style is related to acute and chronic pain, but it is not clear whether anger arousal is needed for these associations to emerge or whether physiological mechanisms mediate these links.

PURPOSE

"Trait x Situation" models were examined to determine whether relationships between anger-out and pain and anger-in and pain depended on anger provocation's preceding pain induction and whether pain sensitivity variance explained by anger management style overlapped with variance in harassment-induced blood pressure reactivity.

METHODS

Healthy individuals (N = 53) underwent either mental arithmetic with harassment and then a cold pressor (MA/CP) or vice versa (CP/MA). The Spielberger Anger Expression Inventory assessed anger-out using the Anger-Out subscale (AOS) and anger-in using the Anger-In subscale (AIS).

RESULTS

AOS x Order and AIS x Order interactions for pain tolerance emerged, such that (a) AOS was related negatively to tolerance among MA/CP participants, whereas AOS and tolerance were not related in CP/MA; (b) AIS was related positively to tolerance in MA/CP, whereas AIS was related negatively to tolerance in CP/MA; and (c) tolerance variance accounted for by AOS in MA/CP overlapped substantially with tolerance variance accounted for by diastolic blood pressure reactivity.

CONCLUSIONS

Findings support the notion that anger management style affects pain and are consistent with evidence that deficient endogenous opioid functioning may be one mechanism through which anger-out is linked to both pain sensitivity and cardiovascular stress reactivity, a connection that appears most reliably when anger is provoked.

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.

Expressive/suppressive anger-coping responses, gender, and types of mortality: a 17-year follow-up (Tecumseh, Michigan, 1971-1988)

OBJECTIVES

This study examined prospectively (1971-1988) the relationship between anger-coping responses, gender, and mortality (N = 91) in a representative sample of men (N = 324) and women (N = 372), aged 30 to 69, from the Tecumseh Community Health Study.

METHODS

Anger-coping was measured by responses to hypothetical unfair anger-provoking situations. Cox proportional hazard regressions were used adjusted for seven health risk factors (age, smoking, relative weight, systolic blood pressure (SBP), bronchial problems, FEV1, and cardiovascular (CV) risk).

RESULTS

Men's suppressed anger interacted significantly with SBP and also with bronchial problems to predict both all-cause and CV mortality. Women showed direct relationships between suppressed anger and early mortality (all-cause, CV, and cancer). Women also showed an interaction of spouse-suppressed anger and SBP for all-cause and CV mortality. Data suggest men who expressed their anger died earlier of cancer (N = 16) deaths.

CONCLUSIONS

Suppressed anger at the time of an unjust attack may become chronic resentment (intermittent rage or hatred) about which little is known and requires research. The design for future research should experimentally measure both suppressed anger-coping responses (after an unfair attack) and morbidity (eg, blood pressure, bronchitis, immune disorder, etc.) to predict prospectively to earlier mortality.

There is more to anger coping than "in" or "out"

There is growing dissatisfaction with a dichotomized "anger-in" versus "anger-out" view of anger coping. Three studies using student and community adultsamples revealed a broader understanding of the nature of anger coping styles and led to the development of the new Behavioral Anger Response Questionnaire (BARQ). The BARQ is empirically derived and factorially validated and has good psychometrics. Results suggest that dichotomizing anger responses as "in" versus "out" is too coarse and that a 6-factor model may be more appropriate. The 6 factors identified here are Direct Anger-Out, Assertion, Support-Seeking, Diffusion, Avoidance, and Rumination. Women reported use of a wider range of anger coping styles, especially more social support-seeking and more use of anger diffusion strategies than men.

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.

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.

Biobehavioral responses to interpersonal conflict during anger expression among anger-in and anger-out men

To examine whether typical modes of anger expression (ie., anger-in, anger-out) were related to cardiovascular, affective, behavioral, and cognitive responses to interpersonal conflict, 20 anger-in and 20 anger-out undergraduate men participated in 2 role plays, one in which they were instructed to exhibit their anger overtly and the other in which they inhibited their anger Results showed that anger-in individuals used significantly more repression self-statements than anger-out individuals across both role play interactions (p <.01). Anger-out persons showed exaggerated diastolic blood pressure response in contrast to anger-in participants, but only during the exhibited anger role play (p <.04). When the anger exhibition role play followed anger inhibition, diastolic bloodpressure responses were more intense (p <. 05), and heart rate recovery was significantly slower (p <.03) among anger-outparticipants in contrast to anger-in participants. These findings indicate that modes of anger expression (trait) and contextual demands of the interaction (state) interact in complex ways to influence biobehavioral reactions to anger provocation.

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.

Similar patterns of cardiovascular response during emotional activation as a function of affective valence and arousal and gender

OBJECTIVE

Laboratory studies of emotion-induced cardiovascular responses have been conducted predominantly with a specific affects approach rather than a dimensional approach. The purpose of this study was to apply the principles of the Circumplex Model of Affect (i.e., valence and arousal) to investigate cardiovascular reactivity during emotional activation in men and women.

METHODS

Forty-two healthy university students (mean age = 19.45, 52% women, 58% Caucasian) engaged in personally relevant recall tasks that varied as a function of valence and arousal. Self-reported valence and arousal, systolic and diastolic blood pressure (SBP and DBP, respectively), heart rate (HR), preejection period (PEP), stroke index (SI), cardiac index (CI), and total peripheral resistance (TPR) were measured during baseline and task periods.

RESULTS

Cardiovascular responses were found to be largely comparable across the recall tasks and were characterized by significant increases in blood pressure, HR, and TPR, and decreases in SI (Ps < .001). In addition, SBP during negative valence tasks was significantly higher than during positive valence tasks (P < .03), and PEP lengthened more during low as compared to high arousal tasks (P < .03).

CONCLUSIONS

These results highlight the similarity of hemodynamic adjustments during the verbal expression of emotion across gender and the dimensions of valence and arousal. The overall response pattern suggests alpha-adrenergically mediated sympathetic activation and vagal withdrawal.

Cardiovascular (CV) responsivity and recovery to acute stress and future CV functioning in youth with family histories of CV disease: a 4-year longitudinal study

Blood pressure (BP) and heart rate (HR) data obtained during supine rest, in response to and recovery from four laboratory stressors in a baseline year were used to predict supine resting BP and HR values obtained during each of four consecutive annual follow-up evaluations. Subjects were 385 normotensive youth [95 African American (AA) males, 106 AA females, 92 European American (EA) males, 92 EA females] (mean age 12.7+/-2.6 at baseline year) with a positive family history of cardiovascular disease (CVD). During the baseline evaluation subjects were presented with four laboratory stressors (namely, postural change, video game challenge, social competence interview, and parent--child conflict discussion). The BP and HR values taken during each of the laboratory stressors and during the post stressor recovery periods were converted to z-scores which were averaged to yield aggregate measures for systolic and diastolic BP and HR responsivity and recovery. The data obtained during the baseline evaluation were subsequently used to predict the follow-up values of supine resting BP and HR. The prediction models were fairly consistent across each of the 4 follow-up years. Responsivity or recovery accounted for up to 6% of the total variance after accounting for baseline values. Within the prediction models responsivity or recovery accounted for 4--56% of the variance. The predictive value of the derived models did not decline from one annual evaluation to the next over the length of the study. CV recovery may supplement resting and responsivity in the prediction of future development of CVD

Cardiovascular recovery from acute laboratory stress: reliability and concurrent validity

OBJECTIVE

We assessed the value of laboratory measures of cardiovascular recovery across four criteria: reliability across multiple tasks, reliability across a 3-year time interval, ability to predict daily ambulatory blood pressure, and interrelationships with coronary risk factors and psychosocial variables.

METHODS

Three hundred twenty-nine healthy adults (mean age = 27.1 years) completed a two-part protocol consisting of 1 day of laboratory testing and 1 day of ambulatory monitoring. The laboratory protocol included a 15-minute baseline assessment followed by three 5-minute laboratory challenges (mental arithmetic, speech, and handgrip). Five-minute recovery periods followed each exercise. One hundred twenty-five participants returned after 3 years to repeat the protocol.

RESULTS

When aggregated across tasks, cardiovascular recovery showed acceptable levels of internal consistency (alpha values = 0.7) and proved relatively stable across time (r values = 0.22-0.35). Recovery values statistically improved the prediction of daily ambulatory readings above baseline and stress reactivity laboratory values (p values < .001) but were largely unrelated to coronary risk factors or psychosocial measures.

CONCLUSION

These results suggest that cardiovascular recovery from acute laboratory stress can be treated as a stable individual difference variable that can -improve standard laboratory-based predictor models of ambulatory readings.

Psychological risk factors may moderate pharmacological treatment effects among ischemic heart disease patients. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators

BACKGROUND

Numerous research findings support the proposed connection between such psychological characteristics as stress and hostility and the manifestation of disease. However, less evidence is available concerning the role(s) psychological factors might play in the process of disease recovery.

METHODS

Eighty patients with known coronary disease and exercise-induced ischemia underwent treadmill exercise testing and 48-hour ambulatory electrocardiographic monitoring and completed a battery of standardized psychological tests assessing hostility, depression, and daily stress on four occasions during a 12-week pharmacological treatment study. After withdrawal of antiischemic drugs at baseline, patients returned for subsequent tests at 3-week intervals. During the second and third intervals, patients were prescribed one of two antiischemic medications, atenolol or amlodipine, or given a placebo. All patients were then placed on a combination treatment protocol for the 3 weeks before the final testing date.

RESULTS

The combination treatment produced highly significant benefits across all measured cardiac variables (20.3% improvement in exercise performance, 13% reduction in reported angina, 64.0% reduction in the frequency of ischemic episodes; for all, p < .01). However, results showed that high baseline levels of daily stress were associated with reliably smaller treatment effects on measures of ischemia frequency and treadmill exercise time and with a significantly greater likelihood of reporting angina after treatment (r = -0.24, -0.25, and -0.33, respectively; p <.05). In addition, high baseline hostility predicted significantly smaller diastolic blood pressure improvements (r = -0.29, p < .05).

CONCLUSIONS

These results indicate that psychological risk factors may have globally negative effects on the course of treatment and suggest particular factors that may warrant attention in trials targeting cardiac symptom reduction.

A case for the usefulness of laboratory social stressors

Although laboratory stress research is a popular and vibrant area of research activity, there is surprisingly little evidence that laboratory stress models are clinically useful (i.e. that they can explain and predict the development of disease). This article summarizes evidence that the usefulness of lab stress research can be improved with the use of social stressors. Two lines of evidence are presented in support of this argument: (a) studies comparing physiological reactivity to different lab stressors with ambulatory activity, and (b) a meta-analysis of investigations of cortisol responses to laboratory stressors. Further issues of importance in understanding social stressors are gender differences and the vulnerability (i.e. weak reliability) of social stressor impact to relatively small changes in the experimental protocol itself.

Anger inhibition, cardiovascular recovery, and vagal function: a model of the link between hostility and cardiovascular disease

A model of the association between hostility and cardiovascular disease (CVD) is proposed based upon anger inhibition, slow cardiovascular recovery, and low parasympathetic activity (vagal tone). This model is opposed to the more conventional model that emphasizes anger expression, cardiovascular reactivity, and high sympathetic tone. We argue that in social reality, incidences of anger inhibition outnumber incidences of anger expression to a great extent, irrespective of preferred expression style. Moreover, slow cardiovascular recovery, rather than high reactivity, may be the mechanism underlying the CVD risk associated with anger inhibition. Both anger inhibition and slow cardiovascular recovery are associated with a persistently low vagal tone. Thus, the anger inhibition/vagal inhibition model seems more consistent with the actual nature of anger in daily life and with the known cardiovascular control mechanisms. The model may better account for the chronic pathophysiological state that is believed to lead to CVD. Importantly, an experimental inhibition/recovery paradigm might also allow to test potential behavioral and cognitive accelerators of cardiovascular recovery. As an example of an important socially-mediated health risk that may be elucidated using the anger inhibition/vagal inhibition model, we discuss Black-White differences that have been found in CVD.

Differential effects of harassment on cardiovascular and salivary cortisol stress reactivity and recovery in women and men

To explore the differential effects of harassment on cardiovascular and neuroendocrine stress reactivity and recovery, 28 men and 32 women were randomized to a harassment or no-harassment control condition (four groups in total). The harassment consisted of three scripted statements delivered during performance of a mental arithmetic stress task. The harassing statements were delivered on a fixed schedule during the task by a same-gender experimenter. Cardiovascular, salivary cortisol, and state affect measures were taken at baseline, immediately posttask, and throughout an extended recovery period. In comparison to the control condition, harassment accentuated the stress reactivity responses on all measures, physiological and self-report of subjective affect. In addition, several gender differences in response to the stressor and during the recovery period were observed. Harassed men had the largest reactivity on cortisol and diastolic blood pressure, whereas the harassed women showed a more pronounced response on heart rate and self-reported hostility. The harassed groups were the only ones to show significant cortisol responses. Within the harassed condition, comparison of effect sizes revealed that cortisol reactivity in men was twice that of women. Control groups did not exhibit significant cortisol changes. During the recovery period, harassed men exhibited attenuated return to baseline on cardiovascular indices and cortisol, whereas women, overall, tended to exhibit an overcompensation response on cardiovascular measures. These results contribute to showing a pathway that may link negative affect (i.e., hostile or angry feelings) with the development of cardiovascular disease.

Effects of race, sex, and socioeconomic status upon cardiovascular stress responsivity and recovery in youth

Cardiovascular (CV) responsivity to and recovery from acute laboratory stressors, as derived from aggregate scores of CV functioning during and after postural change, video game challenge, social competence interview, and parent-child conflict discussion, were evaluated in 272 youths [mean age 13.5 +/- 2.6 years; 162 Blacks (77 males, 85 females), 110 Whites (60 males, 50 females)], all with a positive family history of essential hypertension. Blacks demonstrated greater systolic and diastolic blood pressure (SBP, DBP) and lower heart rate responsivity compared to Whites (all P values < 0.05). A race by neighborhood socioeconomic status (SES) interaction for SBP responsivity was also observed where low SES Whites and high SES Blacks had the greatest responsivity compared to their same race cohorts. Additionally, upper SES Whites had the lowest total peripheral resistance responsivity. For recovery, Blacks and males exhibited higher SBP during recovery compared to Whites and females, respectively. These findings extend previous studies and provide further support for the hypothesis that recovery from stress is a potentially informative component of the contribution of stress responsivity to cardiovascular disease.

To eat or not to eat: affective and physiological mechanisms in the stress-eating relationship

The current study aggregated methods from the cardiovascular reactivity and dietary restraint paradigms in an attempt to advance our understanding of stress-induced eating behavior. Seventy-seven female subjects completed a protocol consisting of distinct baseline, stress-induction, and recovery phases during which we monitored blood pressure, heart rate, and self-reported affect. Food was inconspicuously made available to participants during the recovery phase. Our results replicated the restraint x affect level interaction observed in the restraint literature, while showing that physiological measures could further explain distressed eating behavior. Physiological arousal was found reliably to predict reduced food consumption, but only among unrestrained eaters. Analysis of the recovery data showed that food consumption was associated with impaired physiological recovery rates for restrained but not for unrestrained participants. We believe that our results help to reconcile findings in the stress, eating, and dietary restraint fields and offer support for recently developed theories of stress-induced overeating.