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Psychology Type A Behavior Pattern (Coronary Prone Personality)
by
Jeffrey M. Conte, Fiona Cochrum-Nguyen, Mary S. Yama

Introduction

The Type A behavior pattern (TABP) emerged from observations of heart patients by two medical doctors named Meyer Friedman and Ray Rosenman in the 1950s. The term quickly became part of the public vernacular, and research accumulated linking Type A behavior and its subcomponents to physiological outcomes. Specifically, multiple studies have linked TABP to coronary heart disease (CHD), although this association continues to be challenged. Recently, researchers have suggested that it is more a matter of identifying the subcomponents of TABP that are related to CHD, instead of using global TABP as a risk factor. Recent research has also centered on identifying additional physiological effects of TABP and its subcomponents.

General Overviews

Friedman and Rosenman 1974 defined the Type A behavior pattern (TABP) as “a characteristic action-emotion complex that is exhibited by those individuals who are engaged in a relatively chronic struggle to obtain an unlimited number of poorly defined things from their environment in the shortest period of time and, if necessary, against the opposing effects of other things or persons in this same environment” (p. 67). People who exhibit TABP are characterized by ambitiousness, competitiveness, impatience, easily aroused hostility, and an exaggerated sense of time urgency. In contrast, individuals who lack these characteristics are identified as Type Bs. Dembroski and Costa 1987 provided an early overview of the emergence and development of TABP as a construct. Early contradictory research concerning global TABP’s link to coronary heart disease (CHD) and coronary artery disease was reviewed. Dembroski, et al. 1985 is useful in tandem with Dembroski and Costa 1987 in terms of outlining the development of research identifying hostility and anger-in as the most influential subcomponents of TABP on coronary disease. In addition, Wright 1988 examined anger as a significant predictor of CHD, while also exploring time urgency and chronic activation as important factors contributing to CHD. This article provided an early review of the possible physiological responses resulting from TABP that are responsible for cardiovascular diseases. Bettencourt, et al. 2006 provided an in-depth review of how personality traits influence patterns of aggressive behavior. This article focused more on the aggression literature and focused on understanding why and when individuals engage in aggressive behavior. The debate over whether Type A is a changeable behavior (Matthews 1982) or stable personality trait (Booth-Kewley and Friedman 1987, Haslam 2011) continues to this day. Matthews 1982 argued that Type A pattern is not a trait but a set of behaviors and that it exists on a continuum from Type A behavior to Type B behavior.

  • Bettencourt, A., A. Talley, A. Benjamin, and J. Valentine. 2006. Personality and aggressive behavior under provoking and neutral conditions: A meta-analytic review. Psychological Bulletin 132.5: 751–777.

    DOI: 10.1037/0033-2909.132.5.751Save Citation »Export Citation »E-mail Citation »

    An in-depth review of which personality traits influence patterns of aggressive behavior. Particularly useful for those focusing on aggression literature. Available online for purchase or by subscription.

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  • Booth-Kewley, S., and H. Friedman. 1987. Psychological predictors of heart disease: A quantitative review. Psychological Bulletin 101.3: 343–362.

    DOI: 10.1037/0033-2909.101.3.343Save Citation »Export Citation »E-mail Citation »

    An extensive, highly cited meta-analysis examining anger, hostility, aggression, depression, extroversion, anxiety, Type A, and the major components of Type A’s effects on CHD. Among several important findings, this study found support for the notion that TABP was a stable personality trait, and provided strong support for the relationship between Type A and CHD. Available online for purchase or by subscription.

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  • Dembroski, T., and P. Costa. 1987. Coronary prone behavior: Components of the Type A pattern and hostility. Journal of Personality 55.2: 211–235.

    DOI: 10.1111/j.1467-6494.1987.tb00435.xSave Citation »Export Citation »E-mail Citation »

    An early overview of the emergence, development, and contradictory research surrounding the TABP as a construct. Available online for purchase or by subscription.

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  • Dembroski, T., J. MacDougall, R. Williams, T. Haney, and J. Blumenthal. 1985. Components of Type A, hostility, and anger-in: Relationship to angiographic findings. Psychosomatic Medicine 47.3: 219–233.

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    A review of the research identifying hostility and anger-in as the most influential subcomponents of TABP on coronary disease.

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  • Friedman, M., and R. Rosenman. 1974. Type A behavior and your heart. New York: Knopf.

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    A groundbreaking and popular 1974 book introducing “Type A behavior” and linking it to physiological consequences. This spurred controversy in the field of medicine and sparked an explosion of research on this linkage. This book views Type A as a behavior that can be changed and not a stable personality trait.

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  • Haslam, N. 2011. The return of the anal character. Review of General Psychology 15.4 (December): 351–360.

    DOI: 10.1037/a0025251Save Citation »Export Citation »E-mail Citation »

    A recent and interesting analysis of “the anal character” in psychoanalytic theory redefined as perfectionism and Type A personality. Provides support for Type A as a personality trait instead of a set of behaviors. Available online for purchase or by subscription.

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  • Matthews, K. A. 1982. Psychological perspectives on the Type A behavior pattern. Psychological Bulletin 91.2: 293–323.

    DOI: 10.1037/0033-2909.91.2.293Save Citation »Export Citation »E-mail Citation »

    This article reviews the psychological characteristics of TABP and underlines methodological issues in measuring Type A qualities. This article is useful as a measurement review. Available online for purchase or by subscription.

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  • Wright, L. 1988. The Type A behavior pattern and coronary artery disease: Quest for the active ingredients and the elusive mechanism. American Psychologist 43.1: 2–14.

    DOI: 10.1037/0003-066X.43.1.2Save Citation »Export Citation »E-mail Citation »

    Noted that not all components of TABP were “toxic,” and that some Type A personalities were more successful at work without suffering the negative health effects. Precursor to the development of multiple scales measuring Type A subcomponents. Available online for purchase or by subscription.

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TABP Links to Health and Heart Problems

Type A behavior pattern (TABP) is also known as “coronary-prone behavior pattern” because it has been associated with coronary heart disease (CHD) and related ailments (Dembroski and Williams 1989). Haynes and Matthews 1986 reviewed studies that collected data from the general population as well as those only focusing on individuals at high risk for CHD. Specifically, the authors reviewed research that investigated other cardiovascular conditions that may occur in people with TABP. Booth-Kewley and Friedman 1987 provided an extensive meta-analytic review examining multiple aspects of personality as predictors of several different diseases. This review focused on the measurement of TABP, and the structured interview (SI) was found to be a better predictor of CHD than the Jenkins Activity Survey. In 1948, the National Heart, Lung, and Blood Institute began a longitudinal cardiovascular study on the residents of Framingham, a town in Massachusetts. The aim of this study, entitled the Framingham Heart Study, was to examine the effects of lifestyle, environment, and hereditary factors on heart disease across multiple generations. This well-known longitudinal study provided data for the study conducted by the authors of Haynes, et al. 1980, which investigated the effects of behavior types, reactions to anger, situational stress, sociocultural mobility, and somatic strain on instances of CHD. In the third part of the three-part Framingham Heart Study, Haynes, et al. 1980 examined TABP’s associations with CHD development and highlighted the differing levels of risk across age and gender. Hostility has been identified in the research as a strong predictor of CHD, although some research argues that it is an independent risk factor (Miller, et al. 1996), while other research includes hostility as a subcomponent of TABP (Booth-Kewley and Friedman 1987). Chida and Steptoe 2009 examined the associations among anger, hostility, and CHD. They sought to bring clarity to the mixed results of previous reviews regarding the harmful effects of anger and hostility on CHD in both initially healthy and CHD patient populations. In particular, they found that the harmful effects of anger and hostility were slightly greater for CHD patients, leading them to suggest that trait anger and hostility may lead to the recurrence of CHD. Finally, Schwartz, et al. 1979 discussed behavioral medicine approaches to hypertension, and it is important to note that research on TABP provided the impetus for the new field of behavioral medicine in the late 1970s and early 1980s. Today, behavioral medicine is a thriving field with many conferences and journals devoted to this field.

  • Booth-Kewley, S., and H. Friedman. 1987. Psychological predictors of heart disease: A quantitative review. Psychological Bulletin 101.3: 343–362.

    DOI: 10.1037/0033-2909.101.3.343Save Citation »Export Citation »E-mail Citation »

    A highly cited meta-analysis examining anger, hostility, aggression, depression, extroversion, anxiety, Type A, and the major components of Type A’s effects on CHD. This study provided strong support for the relationship between Type A and CHD. Available online for purchase or by subscription.

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  • Chida, Y., and A. Steptoe. 2009. The association of anger and hostility with future coronary heart disease: A meta-analytic review of prospective evidence. Journal of the American College of Cardiology 53.11: 936–946.

    DOI: 10.1016/j.jacc.2008.11.044Save Citation »Export Citation »E-mail Citation »

    A review of findings regarding anger and hostility relationship with CHD. Presents multiple differing perspectives regarding the harmful effects of anger and hostility. Available online for purchase or by subscription.

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  • Dembroski, R. M., and R. B. Williams. 1989. Definition and assessment of coronary-prone behavior. In Handbook of research methods in cardiovascular behavioral medicine. Edited by N. Schneiderman, S. M. Weiss, and P. G. Kaufmann, 553–568. New York: Plenum.

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    Early research on the relationship between TABP and CHD. Breaking Type A down into its components, this article provides support for the argument that TABP is a risk factor for CHD. Dembroski is credited for bringing the focus of research attention away from global Type A and onto hostility as the toxic component of TABP.

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  • Haynes S. E., M. Feinleib, and W. Kannel. 1980. The relationship of psychosocial factors to coronary heart disease in the Framingham study: III. Eight-year incidence of coronary heart disease. American Journal of Epidemiology 111.1: 37–58.

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    The third part of the three-part Framingham Heart Study, this famous longitudinal study of TABP’s associations with CHD development highlights the differing levels of risk across age and gender. Available online for purchase or by subscription.

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  • Haynes, S. E., and K. A. Matthews. 1986. Type A behavior pattern and coronary disease risk: Update and critical evaluation. Journal of Epidemiology 123.6: 923–957.

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    A response to the 1978 meeting of the National Heart, Lung, and Blood Institute that concluded that TABP is associated with an increased risk of CHD in employed middle-age US citizens. This article is useful in extending research beyond people at high risk for CHD and toward more general populations. Available online for purchase or by subscription.

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  • Miller, T., T. Smith, C. Turner, M. Guijarro, and A. Hallet. 1996. Meta-analytic review of research on hostility and physical health. Psychological Bulletin 119.2: 322–348.

    DOI: 10.1037/0033-2909.119.2.322Save Citation »Export Citation »E-mail Citation »

    A highly cited, in-depth meta-analytic review of hostility’s relationship to physical health. Establishes hostility as an independent risk factor of CHD. A good resource evaluating different self-report measures of hostility and the extent to which they predict CHD. Available online for purchase or by subscription.

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  • Schwartz, G., A. P. Shapiro, D. P. Redmond, D. C. Ferguson, D. R. Ragland, and S. M. Weiss. 1979. Behavioral medicine approaches to hypertension: An integrative analysis of theory and research. Journal of Behavioral Medicine 2:311–366.

    DOI: 10.1007/BF00844739Save Citation »Export Citation »E-mail Citation »

    This article described the major behavioral approaches to hypertension and also compared behavioral with biological approaches to managing hypertension. Available online for purchase or by subscription.

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Global TABP

Type A behavior pattern (TABP) has been studied for its potential connection to coronary heart disease (CHD) and is often referred to as coronary-prone behavior. The focus in understanding TABP was initially on global TABP, which has been measured in several different ways, including the structured interview (SI), self-report global TABP measures, and the videotaped clinical evaluation (VCE), each of which will be discussed in this section.

Global TABP Measurement

Early TABP measures assessed characteristics globally to create a single index that represented a person’s coronary-prone personality. These measures collapsed several dimensions without differentiating between them to identify TABP and investigate outcomes. The first type of measurement was the Structured Interview. Later, in an effort to standardize measurement of TABP, several self-report global measures were created (see Bortner 1969 and Jenkins, et al. 1971, both cited under Self-Report Global TABP Measures; and Haynes, et al. 1980, cited under TABP Links to Health and Heart Problems). Later, Videotaped Clinical Evaluation employed the use of a highly SI with additional attention to physiological responses captured in filming, such as pattern of speech, facial movements, and body language. The SI, global self-report measures, and VCE all offer useful ways to collect data; however, there are drawbacks to each method that will be noted in subsequent sections. Ultimately, none of the measures proved to be independently predictive of long-term health.

Structured Interview

The SI was initially used in Friedman and Rosenman 1959 as a format for measuring and diagnosing TABP after observing a pattern of behavior in patients with CHD. The SI was later formalized by Rosenman 1978 as a method for assessing and diagnosing TABP. The interview lasts approximately twenty minutes and is performed by a trained researcher. The administrator makes classifications based on the content of answers, vocal characteristics, and response style. Although this method of assessment allows for interpretation of overt behavioral patterns, it lacks a quantitative scale and allows room for bias due to the subjective nature of the interview, which is a drawback that was noted even by the creator (Rosenman 1978). Although many self-report scales and questionnaires have since been developed (discussed in subsequent section), the SI has remained the primary method of choice of many who are trying to assess TABP, as seen in Bryne, et al. 1985. In addition, del Pino Perez, et al. 1999 translated and validated the SI in Spanish and were able to distinguish heart patients from healthy people using their global TABP measure.

Self-Report Global TABP Measures

Due to the potential subjectivity and bias in the SI measurement of TABP, researchers began creating self-report global TABP measures. These quantitative measures are useful in that they are easy and inexpensive to administer, require no interviewer training, and report results quantitatively. These qualities make the self-report measures much easier to analyze statistically than qualitative interview data. One of the initial quantitative measures of TABP was the Bortner Scale (see Bortner 1969). The Framingham Study developed a scale to measure Type A patterns as one of several constructs of interest in finding correlates of CHD (Haynes, et al. 1980, cited under TABP Links to Health and Heart Problems). The Bortner Scale and Framingham Type A Scale are two of the most well-known self-report measures of TABP. The first standardized computer self-report measure was the Jenkins Activity Survey (JAS) (see Jenkins, et al. 1971). The JAS was designed to imitate the SI as closely as possible to categorize respondents as either Type A or Type B personalities. Although subsequent research has found the SI and the JAS to be significantly correlated, the size of this relationship is not substantial. Booth-Kewley and Friedman 1987, a meta-analysis of psychological predictors of CHD, revealed that a TABP diagnosis based on the SI was superior in predicting cardiac outcomes than a TABP diagnosis based on the JAS. Edwards, et al. 1990 conducted comparative analyses of the JAS, the Bortner Scale, and the Framingham Type A Scale and found the measures to have low correlations. This finding suggests that the scales may actually measure different underlying constructs rather than global TABP. Other researchers have found similar problems in the measurement of TABP. Bryne, et al. 1985 (cited under Structured Interview) concluded that TABP is very complex and difficult to capture using self-report measures. Thus, for some researchers, the SI has remained the primary choice of measuring TABP.

  • Booth-Kewley, S., and H. S. Friedman. 1987. Psychological predictors of heart disease: A quantitative review. Psychological Bulletin 101.3: 343–362.

    DOI: 10.1037/0033-2909.101.3.343Save Citation »Export Citation »E-mail Citation »

    This meta-analysis provides a quantitative overview of the literature of psychological predictors of CHD. Authors report that negative affectivity is more associated with CHD and they state the need for more research on the interrelatedness of personality factors in CHD. Available online for purchase or by subscription.

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  • Bortner, R. W. 1969. A short rating scale as a potential measure of pattern A behavior. Journal of Chronic Diseases 22.2: 87–91.

    DOI: 10.1016/0021-9681(69)90061-7Save Citation »Export Citation »E-mail Citation »

    This scholarly journal article presents one of the first quantitative measures of global TABP. Although many different measures have been developed since the Bortner Scale, it is an important foundational scale.

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  • Edwards, J. R., A. J. Baglioni, and C. L. Cooper. 1990. Examining relationships among self-report measures of Type A behavior pattern: The effects of dimensionality, measurement error and differences in underlying constructs. Journal of Applied Psychology 75.4: 440–454.

    DOI: 10.1037/0021-9010.76.5.657Save Citation »Export Citation »E-mail Citation »

    This article analyzed the three most popular measures of TABP: the JAS, the Framingham Scale, and the Bortner Scale. Low intercorrelations of the scales are discussed as possible evidence that they measure different underlying constructs. Available online for purchase or by subscription.

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  • Jenkins, C. D., S. J. Zysanski, and R. H Rosenman. 1971. Progress toward validation of a computer-scored test for the Type A coronary-prone pattern. Psychosomatic Medicine 33.3: 193–202.

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    A benchmark journal article presenting the first computer-based, standardized measure of TABP: the JAS. This twenty-one-item assessment provides numerical quantitative response items for more efficient testing.

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Videotaped Clinical Evaluation

Researchers began videotaping SIs early in the development of research of TABP. They were able to use these recordings to study responses, vocal patterns, and reaction times of people displaying Type A behaviors. The VCE was developed by Friedman, et al. 1996 to evaluate TABP. The VCE is extremely structured and requires that the interviewer be highly trained to administer. Questions, responses, and reactions of the interviewer are designed to elicit response patterns indicative of TABP. In addition, this measure includes a component evaluating insecurity, which the authors believe to be at the root of TABP. With advances in technology, researchers and practitioners were able to videotape SIs. The videotaped structured interview (VSI) allowed a more efficient process that enables more thorough examination of interviews after they are completed and a means for comparison of future interviews (Friedman and Powell 1984). VSIs have led researchers to further consider what they were measuring and develop the procedure for measuring it. During this process, the creators of the VSI decided that it was no longer appropriate to refer to the measure as “structured” or as an “interview,” so it was renamed the VCE (Friedman and Ghandour 1993; Friedman, et al. 1996). The early VSI techniques left a great deal of leniency for the interviewer to be flexible, as they were not confined to a rigid set of questions (Friedman and Powell 1984). In addition, videotaping allowed more analysis of psychomotor signs of the interviewee that proved to be useful in diagnosis of TABP, as seen in Friedman, et al. 1996. Progressions in the measure required that the interviewers be highly trained to pick up on psychomotor cues and adhere to an extremely structured format. Questions, responses, and reactions of the interviewer are designed to elicit response patterns indicative of TABP. Another progression in the VCE was the addition of a scale measuring insecurity. Price, et al. 1995 believed insecurity to be at the root of TABP and thus, it was critical to assess insecurity in the VCE. Videotaped evaluations of TABP have been found to have high inter-rater reliability and to be stable across time when interviewers are highly trained, making them a valuable tool for assessing TABP (Friedman, et al. 1996).

  • Friedman, M., and G. Ghandour. 1993. Medical diagnosis of Type A behavior. American Heart Journal 126.3: 607–618.

    DOI: 10.1016/0002-8703(93)90411-2Save Citation »Export Citation »E-mail Citation »

    The SI was developed further and videotaped. It was eventually renamed because it was no longer truly “structured” or an “interview.” The authors of this article discuss the new and improved diagnostic tool, the VCE. Available online for purchase or by subscription.

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  • Friedman, M., and L. Powell. 1984. The diagnosis and quantitative assessment of Type A behavior: Introduction and description of the Videotaped Structured Interview. Integrative Psychiatry 2.4: 123–129.

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    The authors describe the VSI, which builds on the SI by videotaping the SI and thus allows more thorough evaluation.

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  • Friedman, M., N. Fleishman, and V. A. Price. 1996. Diagnosis of Type A behavior pattern. In Heart and mind: The practice of cardiac psychology. Edited by R. Allan and S. Scheidt, 179–195. Washington, DC: American Psychological Association.

    DOI: 10.1037/10210-000Save Citation »Export Citation »E-mail Citation »

    This book chapter outlines the VCE, a SI technique for diagnosing TABP. The authors build on previous video interviewing techniques by including an assessment portion for insecurity, a facet they believe to be at the root of TABP.

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  • Price, V. A., M. Friedman, G. Ghandour, and N. Fleischmann. 1995. Relation between insecurity and Type A behavior. American Heart Journal 129.3: 488–491.

    DOI: 10.1016/0002-8703(95)90273-2Save Citation »Export Citation »E-mail Citation »

    The authors of this article identified insecurity to be an important factor in global TABP. This article presents ten more items to be incorporated in the VCE. Available online for purchase or by subscription.

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TABP Subcomponents

This section centers on research identifying and describing Type A behavior pattern (TABP) subcomponents as more precise predictors of health and work outcomes. The research focuses on identifying the “major facets” or “core elements” of TABP that are most predictive of coronary heart disease (CHD).

Achievement Strivings and Impatience-Irritability

Spence, et al. 1987 was among the first to identify achievement strivings (AS) and impatience-irritability (II) as independent dimensions of Type A behavior utilizing the Jenkins Activity Survey (JAS). AS is the tendency to be active and to work hard in achieving one’s goals. II reflects intolerance and frustration, often resulting from being slowed down. AS and II were both shown to differentially predict physical health and job performance outcomes. The II factor was significantly correlated with a number of physical symptoms, including sleep quality, headaches, digestion, respiratory problems, and a total health factor. The AS factor was significantly related to a performance measure and grade point average. Spence, et al. 1987 argued that because these factors are independent, it is possible to manifest more of the desirable qualities of AS while manifesting less of the undesirable qualities of II. Bluen, et al. 1990 reviewed and extended this research with their study predicting sales performance, job satisfaction, and depression in life insurance salespeople. It found that AS was significantly correlated with job satisfaction, whereas II was significantly correlated with depression. Bluen, et al. 1990 suggested that the results of this study may help to explain the equivocal findings (e.g., no relationship, negative relationship, and positive relationship) concerning relationships between the global measures of Type A and job satisfaction. The finding that AS was positively related to job satisfaction while II was negatively related argued for the use of a multidimensional approach to the measurement of Type A. More recent research has also demonstrated the negative relationship between II and health outcomes in both academic and work settings (Barling and Boswell 1995, Spector and O’Connell 1994). More recently, AS and II have been assessed as moderators. Specifically, Day and Jreige 2002 found that AS and II moderated certain relationships between job stressors and psychosocial outcomes such as job satisfaction, perceived stress, and life satisfaction. In particular, the study found that II acted as a moderator for the relationship between lack of control and life satisfaction, the relationship between work-role ambiguity and perceived stress, the relationship between work-role ambiguity and life satisfaction, and the relationship between overload and job satisfaction. Additionally, AS was found to moderate the relationship between job control and job satisfaction and the relationship between job control and stress. Additionally, Landy, et al. 1991 found significant correlations between the time urgency behaviorally anchored rating scale (BARS) and the II scale. Nervous energy and speech patterns were significantly correlated with the II scale, and these dimensions were also conceptually linked to II.

  • Barling, J., and R. Boswell. 1995. Work performance and the Achievement-Strivings and Impatience-Irritability dimensions of Type A behavior. Applied Psychology: An International Review 44:143–153.

    DOI: 10.1111/j.1464-0597.1995.tb01071.xSave Citation »Export Citation »E-mail Citation »

    Development of a proposed model of AS and II as predictors of work performance, both directly and indirectly. A good demonstration of the negative relationship between II and health outcomes in a work setting. Also available in French. Available online for purchase or by subscription.

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  • Bluen, S., J. Barling, and W. Burns. 1990. Predicting sales performance, job satisfaction, and depression by using the Achievement Strivings and Impatience-Irritability dimensions of Type A behavior. Journal of Applied Psychology 75.2: 212–216.

    DOI: 10.1037/0021-9010.75.2.212Save Citation »Export Citation »E-mail Citation »

    An early review and extension of the literature distinguishing AS and II as independent dimensions of Type A behavior that differentially predict physical health and job performance outcomes. One of the first studies to demonstrate the construct validity of AS and II, and among the early studies utilizing the behavior-based, self-report measurement tool, the JAS.

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  • Day, A., and S. Jreige. 2002. Examining Type A behavior pattern to explain the relationship between job stressors and psychosocial outcomes. Journal of Occupational Health Psychology 7.2: 109–120.

    DOI: 10.1037/1076-8998.7.2.109Save Citation »Export Citation »E-mail Citation »

    This study explored AS and II as moderators of the stressor-psychosocial outcome relationships. Available online for purchase or by subscription.

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  • Landy, F., H. Rastegary, J. Thayer, and C. Colvin. 1991. Time urgency: The construct and its measurement. Journal of Applied Psychology 76.5: 644–657.

    DOI: 10.1037/0021-9010.76.5.644Save Citation »Export Citation »E-mail Citation »

    Article on the construct of time urgency and the development of BARS and Likert scales to measure the multiple dimensions of time urgency. Available online for purchase or by subscription.

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  • Spector, P. E., and B. J. O’Connell. 1994. The contribution of personality traits, negative affectivity, locus of control and Type A to the subsequent reports of job stressors and job strains. Journal of Occupational and Organizational Psychology 67:1–11.

    DOI: 10.1111/j.2044-8325.1994.tb00545.xSave Citation »Export Citation »E-mail Citation »

    A longitudinal study of personality variables (negative affectivity, locus of control, and Type A personality) and job stressors. This study provided a demonstration of the negative relationship between II and health outcomes in an academic setting. Available online for purchase or by subscription.

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  • Spence, J., R. Helmreich, and R. Pred. 1987. Impatience versus achievement strivings in the Type A pattern: Differential effects on students’ health and academic achievement. Journal of Applied Psychology 72.4: 522–528.

    DOI: 10.1037/0021-9010.72.4.522Save Citation »Export Citation »E-mail Citation »

    First study to identify and develop scales of AS and II. An early study promoting the existence and importance of Type A behavior subcomponents as more precise predictors of health and work outcomes. Available online for purchase or by subscription.

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Time Urgency

Time urgency has also been identified as an influential subcomponent of Type A behavior. Individuals characterized by time urgency are frequently concerned with the passage of time as well as how they can most efficiently fill that time with productive activity. The literature on time urgency emerged from consideration of the TABP and its relationship to heart disease and other negative health consequences (Rastegary and Landy 1993). Although time urgency has traditionally been viewed as a unidimensional construct, Landy, et al. 1991 illustrated that time urgency was multidimensional through the development of new measures of time urgency utilizing BARS. An early study provided support for the convergent and discriminant validity of time urgency (Conte, et al. 1995), and a follow-up study disentangled the time urgency dimensions in a predictive model using health and performance outcomes (Conte, et al. 1998). Two other studies, Conte, et al. 2001 and Ishizaka, et al. 2001, provided external validity evidence by showing that time urgency is related to (a) task performance, (b) observable temporal behaviors (e.g., time estimation and pace of work), and (c) health outcomes such as stress, sleep problems, and headaches. Across these studies, the results indicated that the deadline control and nervous energy time urgency dimensions were most predictive of negative health outcomes. Focusing on the behavioral consequences of the time urgency TABP component, Glass, et al. 1974 found that Type As react with impatience when the completion of a task is delayed by another person. This intuitive link to the II dimension of TABP lends credence to the importance of the II dimension of TABP in CHD research, as II had yet to be identified as an independent dimension of TABP. The study Jamal and Baba 2003 utilized performance measures as well as health outcomes to determine the effects of TABP subcomponents time pressure and hard-driving competitiveness. Both time pressure and hard-driving competitiveness were found to significantly correlate with job stress, health problems, job satisfaction, organizational commitment, and turnover motivation. However, limited support was found for the differential effects of TABP subcomponents time pressure and hard-driving competitiveness on these outcome variables.

  • Conte, J. M., F. J. Landy, and J. E. Mathieu. 1995. Time urgency: Conceptual and construct development. Journal of Applied Psychology 80.1: 178–185.

    DOI: 10.1037/0021-9010.80.1.178Save Citation »Export Citation »E-mail Citation »

    Support for the multidimensional concept of time urgency in Landy, et al. 1991. Suggests five dimensions of time urgency instead of the seven dimensions of Landy, et al. 1991. Available online for purchase or by subscription.

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  • Conte, J. M., J. E. Mathieu, and F. J. Landy. 1998. The nomological and predictive validity of time urgency. Journal of Organizational Behavior 19.1: 1–13.

    DOI: 10.1002/(SICI)1099-1379(199801)19:1%3C1::AID-JOB815%3E3.0.CO;2-ESave Citation »Export Citation »E-mail Citation »

    Support for the multidimensional concept of time urgency in Landy, et al. 1991. Shows that AS, II, and time urgency are relevant predictors of health and performance in college students. Available online for purchase or by subscription.

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  • Conte, J. M., H. H. Schwenneker, A. F. Dew, and D. M. Romano. 2001. Iincremental validity of time urgency and other Type A subcomponents in predicting behavioral and health criteria. Journal of Applied Social Psychology 31:1727–1748.

    DOI: 10.1111/j.1559-1816.2001.tb02748.xSave Citation »Export Citation »E-mail Citation »

    This study examined the incremental validity of time urgency and provided further evidence that the time urgency subcomponent is related to behavior and health criteria. Available online for purchase or by subscription.

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  • Glass, D. C., M. L. Snyder, and J. F. Hollis. 1974. Time urgency and the Type A coronary-prone behavior pattern. Journal of Applied Social Psychology 4.2: 125–140.

    DOI: 10.1111/j.1559-1816.1974.tb00663.xSave Citation »Export Citation »E-mail Citation »

    An early examination of the time urgency component of TABP. Provides some support for time urgency as the significant component of TABP in predicting CHD, and early links to the II component that had yet to be operationalized. Available online for purchase or by subscription.

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  • Ishizaka, K., S. P. Marshall, and J. M. Conte. 2001. Individual differences in attentional strategies in multitasking situations. Human Performance 14:339–358.

    DOI: 10.1207/S15327043HUP1404_4Save Citation »Export Citation »E-mail Citation »

    This study compared attentional strategies in multitasking situations using individual differences in the TABP as predictors. TABP subcomponents (time urgency, AS, II, polychronicity) were utilized as predictors of task performance. Significant correlations were found between the TABP subcomponents and different performance indices. Available online for purchase or by subscription.

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  • Jamal, M., and V. V. Baba. 2003. Type A behavior, components, and outcomes: A study of Canadian employees. International Journal of Stress Management 10.1: 39–50.

    DOI: 10.1037/1072-5245.10.1.39Save Citation »Export Citation »E-mail Citation »

    An examination of global Type A behavior and its subcomponents time pressure and hard-driving competitiveness and their relationships with job stress, health problems, job satisfaction, organizational commitment, and turnover motivation. Study utilizing performance measures as well as health outcomes to determine the effects of time pressure and hard-driving competitiveness. Available online for purchase or by subscription.

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  • Landy, F., H. Rastegary, J. Thayer, and C. Colvin. 1991. Time urgency: The construct and its measurement. Journal of Applied Psychology 76.5: 644–657.

    DOI: 10.1037/0021-9010.76.5.644Save Citation »Export Citation »E-mail Citation »

    This article examines the TABP construct of time urgency and its multidimensionality. The article also describes the process of developing Likert and BARS measures for time urgency dimensions. Available online for purchase or by subscription.

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  • Rastegary, H., and F. J. Landy. 1993. The interactions among time urgency, uncertainty, and time pressure. In Time pressure and stress in human judgment and decision making. Edited by O. Svenson, A. Maule, O. Svenson, and A. Maule, 217–239. New York: Plenum.

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    An extensive chapter on time urgency as related to stress, time pressure, and decision making.

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Hostility

While some researchers initially proposed that time urgency was the most influential subcomponent of TABP, the research evidence indicates that hostility is the TABP subcomponent that is toxic and most clearly related to negative health outcomes. Several investigators (e.g., Booth-Kewley and Friedman 1987 and Matthews 1982) suggested that the focus of TABP research should be on the “AHA! Syndrome” (anger, hostility, and aggression). The adverse effects of the AHA! Syndrome have been demonstrated in studies Booth-Kewley and Friedman 1987 and Diamond 1982. Booth-Kewley and Friedman 1987 extensive meta-analysis examined anger, hostility, aggression, depression, extroversion, anxiety, and other major components of Type As effects on CHD. They found that hostility was the most lethal subcomponent of TABP. Additionally, Dembroski, et al. 1989 provided strong support for hostility as a predictor of CHD, above other behavioral characteristics associated with TABP. Furthermore, Siegman, et al. 1992 was one of the first to introduce hostility as a multidimensional construct and to attempt to distinguish the physiological effects of each hostility dimension. The two factors of experience of anger-hostility and expression of anger-hostility were identified. This study found that the expression of anger-hostility was significantly positively correlated with systolic and diastolic blood pressure reactivity. Siegman, et al. 1992 also found significant positive relationships between the expression of anger-hostility and lifestyle variables that have been identified as risk factors for CHD such as alcohol consumption, body mass, and smoking. However, Landy, et al. 1991 suggests that the disaffection with the construct of time urgency may have been premature. The study stated that “the wisdom of the shift from time urgency to hostility, of course, depends on the assumption that the time urgency measures that were abandoned were psychometrically sound” (p. 645). Thus the work developed multidimensional time urgency measures. These time urgency measures have been shown to be related to short-term health problems, but links have not been established between time urgency and long-term health problems. More recently, the study Nakano and Kitamura 2002 investigated the relationships between different TABP subcomponents and mental health in Japanese students. They found that the anger/impatience subcomponent tended to worsen psychological symptoms such as somatization, obsessive-compulsiveness, interpersonal sensitivity, anxiety, and depression. Other recent research has examined the causes and development of anger in the hopes of identifying the mechanisms that link anger to CHD. The authors of Rebollo and Boomsma 2006 performed a longitudinal study of monozygotic and dizygotic twins and their parents and found that the heritability component of anger varied by gender. Genetic variance explained more than 15 percent more variance in the anger of males than in that of females, which is consistent with previous research demonstrating the high incidence of CHD in males compared to females.

Cardiac Psychology—Reducing TABP

Type A behavior pattern (TABP) was the first psychosocial risk factor to be linked to coronary heart disease (CHD), which led to the field of psychological study known as cardiac psychology (Allan and Fisher 2012). As discussed in the subsections of TABP Subcomponents, TABP consists of a pattern of behaviors with key components including time urgency, competitiveness, impatience, achievement strivings, aggressiveness, anger, and hostility. Physicians and researchers such as the authors of Dembroski and Costa 1987 have narrowed down the primary components of TABP that contribute to CHD: anger and hostility. Although TABP was originally thought to be the primary, if not only, psychosocial source of CHD, recent literature suggests otherwise. Allan and Fisher 2012 gives far less credence to global TABP as a source of heightened risk of recurring cardiac events, though the editors and authors of the text maintain that TABP components of anger and hostility play an important role in CHD. Allan and Fisher 2012 noted that additional psychosocial factors that appear prominently in the literature of cardiac psychology include depression, anxiety, post-traumatic stress disorder, vital exhaustion, work-related psychosocial factors, and social support. In recent years, cardiac psychology has turned toward other underlying psychological factors that may predict cardiac events. Given the inconsistent and sometimes conflicting outcomes of TABP in CHD, Denollet, et al. 2010 suggested that more consideration should be given to Type D personality, or distressed personality, as a possible source antecedent of CHD. Distressed personalities (Type D) are defined by negative affectivity and social inhibition and are at higher risk for cardiac events than the general population. Pederson and Denollet 2003 found that Type D individuals experience more negative emotions than the average person across time and situations and tend to not express or share their emotions with others. Allan 2012 noted that some researchers suggest perhaps there is an underlying construct of both TABP and Type D personalities that contributes to an increase in CHD. This notion is supported by medical trials, such as was conducted by Blumenthal, et al. 2005, which aim to reduce heart disease using exercise and stress management techniques that closely align with behavior modification techniques used for the reduction of TABP. Acknowledging varying points of view on the topic of TABP, the subsequent section will focus on cardiac psychology and reducing TABP as an element of CHD treatment.

Clinical Trials

Researchers began to focus on clinical trial intervention projects in the early 1980s. One such project was the Montreal Type A Intervention Project (Roskies, et al. 1986, cited under Lifestyle Heart Trial and Other Clinical Trials), which compared three short-term treatments of behavior and exercise modification for cardiovascular physiological and behavioral reactivity of healthy Type A men. The study found that stress management sessions reduced cardiovascular behavioral reactivity in a lab setting significantly more than aerobic exercise or weight lifting. Total reactivity reduction for the stress management condition was 13 to 23 percent below baseline measurement. This study raised important questions about the implications of behavioral interventions to reduce CHD for people exhibiting TABP, as it found no significant physiological reductions. The summaries of the studies that follow this section directly applied similar behavioral techniques as in the Montreal Type A Project to patients who had suffered at least one cardiac event.

Recurrent Coronary Prevention Project

The Recurrent Coronary Prevention Project (RCPP) was the first major longitudinal clinical trial that focused on the modification of TABP to reduce coronary symptoms in a group of men who had suffered a myocardial infarction (Friedman, et al. 1986). This study followed 1,013 men who had suffered heart attacks for 4.5 years and compared treatment of CHD in three different treatment groups. One group received advice concerning diet, exercise, smoking, cholesterol, possible surgical options, and other standard CHD treatments. The second group received the same advice and additionally participated in support groups that provided guidance on changing TABP and techniques for improving self-esteem. The third group received no advice or counseling and served as a control. At the end of the 4.5-year period, the control group had a 28.2 percent recurrence of heart attacks; the group given medical advice had a 21.2 percent rate of recurrence; and the group receiving medical advice and TABP reduction treatment had a 12.9 percent recurrence rate. The RCPP showed promising results of behavior modification techniques as a facet of treatment for CHD by reducing TABP (Friedman, et al. 1986).

  • Friedman, M., C. Thoresen, J. Gill, et al. 1986. Alteration of Type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: Summary of results of the Recurrent Coronary Prevention Project. American Heart Journal 112.4: 653–665.

    DOI: 10.1016/0002-8703(86)90458-8Save Citation »Export Citation »E-mail Citation »

    This article summarizes the results of the RCPP, which was the first major longitudinal clinical trial that focused on the modification of TABP to reduce coronary symptoms in a group of men who had suffered a myocardial infarction. The RCPP showed promising results of behavior modification techniques as a facet of treatment for CHD by reducing TABP. Available online for purchase or by subscription.

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Lifestyle Heart Trial and Other Clinical Trials

The Lifestyle Heart Trial (LHT; Ornish, et al. 1990) and the Multicenter Lifestyle Modification Demonstration Project (MLDP; Ornish, et al. 1998) were two pivotal studies that utilized lifestyle behavioral modification techniques and group support as interventions for preventing coronary events in high-risk populations. The LHT found that lifestyle changes including smoking cessation, low-fat vegetarian diet, stress management training, and moderate exercise significantly reduced CHD recurrent episodes and symptoms without the use of lipid-lowering drugs (Ornish, et al. 1990). The MLDP built on the LHT by expanding the program to other areas of the United States and sought to achieve the same success in diverse settings. This project was also successful, leading to further implementation of such behavior modification programs for treatment of CHD (Ornish, et al. 1998). A summary of the findings of these two studies, as well as a synopsis of the critical elements of group support and foci of behavior modification, can be found in the chapter Vizza 2012. Group sessions focused on managing stress, building skills, identifying and expressing feelings, and listening and expressing with empathy and compassion. Group members followed a few rules including confidentiality among group members, avoiding giving advice, and avoiding making judgments. Groups gave members social support they may have lacked in other areas of their lives, a sense of community, validation for their feelings and experiences, and helped to sustain other lifestyle modifications through commitment to each other (Vizza 2012). Two additional trials using behavior modification through group psychotherapy were the New Life Project and the Stockholm Women’s Intervention Trial for Coronary Heart Disease (SWITCHD). The New Life Project, conducted in Sweden as described in Burell 1996, randomized post–coronary artery bypass graft patients into either routine care or a condition with additional group psychotherapy for TABP modification. This project showed that group therapy reduced cardiovascular mortality and additional cardiac events. Similarly, SWITCHD found that structured group psychotherapy focused on psychosocial risk factors greatly increased the chances for survival over a group with standard care for cardiac events in a seven-year follow-up. Women with standard care had approximately three times the mortality rate of those who received group therapy. This study was of particular importance as it raised awareness and brought attention to women with CHD (Orth-Gomer 2012). The results of both the New Life Project and SWITCHD were very successful; however, it is important to note that Dr. Burell conducted all of the group sessions for the New Life Project and also directly trained and supervised the two nurses who led the group therapy sessions for SWITCHD. This suggests a critical role of the group facilitator and supervisor involved in such interventions (Allan and Fisher 2012). An additional notable trial, which was called the Montreal Type A Intervention Project, was conducted by Roskies, et al. 1986. This trial compared three short-term treatments of behavior and exercise modification for cardiovascular physiological and behavioral reactivity of healthy Type A men. The results indicated that stress management sessions reduced cardiovascular behavioral reactivity in a lab setting significantly more than aerobic exercise or weight lifting.

  • Allan, R., and J. Fisher. 2012. Conclusions and future directions. In Heart and mind: The practice of cardiac psychology. Edited by R. Allan and J. Fisher, 487–492. 2d ed. Washington, DC: American Psychological Association.

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    This chapter in the second edition of Heart and Mind provides conclusions about the findings discussed in the book and discusses future directions for work in cardiac psychology.

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  • Burell, G. 1996. Group psychotherapy in Project New Life: Treatment of coronary-prone behaviors for patients who have had coronary artery graft bypass surgery. In Heart and mind: The practice of cardiac psychology. Edited by R. Allan and S. Scheidt, 291–312. Washington, DC: American Psychological Association.

    DOI: 10.1037/10210-000Save Citation »Export Citation »E-mail Citation »

    This book chapter describes Project New Life, which used a group psychotherapy intervention to reduce reoccurrence of cardiac events in patients who had received bypass grafts. The trial was successful and gave further support of the role of social support in TABP modification.

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  • Ornish, D., S. E. Brown, L. W. Scherwitz, et al. 1990. Can lifestyle change reverse coronary heart disease? The Lifestyle Heart Trial. The Lancet 336:129–133.

    DOI: 10.1016/S1470-0140-6736(90)91656-USave Citation »Export Citation »E-mail Citation »

    This scholarly journal article discusses the results of the LHT, which found support for reduction of CHD symptoms without the use of lipid-lowering drugs, even in severe cases. This study led to the MLDP, which added a group support component to treatment. Available online for purchase or by subscription.

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  • Ornish, D., L. W. Scherwitz, J. H. Billings, et al. 1998. Intensive lifestyle changes for the reversal of coronary heart disease. Journal of the American Medical Association 280:2001–2007.

    DOI: 10.1001/jama.280.23.2001Save Citation »Export Citation »E-mail Citation »

    This scholarly journal article reviews the outcomes of the MLDP, a lifestyle change treatment intervention with a group social support component, in reducing TABP symptoms associated with CHD. Available online for purchase or by subscription.

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  • Orth-Gomer, K. 2012. A look at women with coronary heart disease and the Stockholm Women’s Intervention Trial for Coronary Heart Disease. In Heart and mind: The practice of cardiac psychology. 2d ed. Edited by R. Allan and J. Fisher, 355–363. Washington, DC: American Psychological Association.

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    The author summarizes the SWITCHD trial in this book chapter, in which women with CHD had improved outcomes if treated with a group psychotherapy element following a cardiac event. This study was done under the supervision of Dr. Gurilla Burell, who also headed the New Life Project.

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  • Roskies, E., P. Seraganian, R. Oseasohn, et al. 1986. The Montreal Type A Intervention Project: Major findings. Health Psychology 5.1: 45–69.

    DOI: 10.1037/0278-6133.5.1.45Save Citation »Export Citation »E-mail Citation »

    A scholarly article of a Montreal-based intervention of healthy males displaying TABP. Researchers tested if aerobic exercise, weight lifting, or stress management interventions helped in reducing behavioral and physiological reactivity. The study supports the recommendation of stress management for cardiac event prevention. Available online for purchase or by subscription.

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  • Vizza, J. 2012. Comprehensive Lifestyle Intervention and Group Support. In Heart and mind: The practice of cardiac psychology. 2d ed. Edited by R. Allan and J. Fisher, 401–416. Washington, DC: American Psychological Association.

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    This book chapter reviews the outcomes of two major lifestyle intervention and group support treatment trials: the LHT and the MLDP. The chapter also emphasizes the more recent literature identifying social support as a key component of reducing CHD events and includes a format for support groups.

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Reducing TABP through Behavior Modification

Friedman and Rosenman 1959 was the first scholarly article published on TABP. Sapolsky 1994 recounted the story of how Friedman and Rosenman noticed that patients in their cardiac practice were wearing down the upholstery on the waiting room chairs on the front edge of the seat and arm rests. This unusual posture of cardiac patients sitting on the edge of the chairs was the TABP behavior that the cardiologists noticed and is still relevant when considering the behaviors manifested in people with Type A personalities. As the literature on TABP and CHD has developed in terms of research and treatment options, several self-help books and programs emerged to aid in identifying and reducing TABP. The most well-known self-help treatment book for TABP is Friedman and Rosenman 1974. This book helps laypersons identify how TABP that may put them at risk for CHD in a language that is easily understood by those without a medical or research background. It includes a self-report survey to detect if the reader falls into an at-risk category. Nearly four decades later, this book is still highly regarded, though the field has progressed greatly. Friedman and Ulmer 1984 provided behavior modification techniques and additional updated information on lifestyle changes associated with reducing TABP as it relates to CHD. Friedman, et al. 1986 summarized the results of the RCPP, the first major clinical trial focused on reducing TABP as treatment for recurring CHD events. This trial helped TABP and other behavior modification techniques gain value as CHD treatment. Although these sources books are historically important and still hold value, it is important to recognize that the field of cardiac psychology is ever expanding and that other psychosocial interventions, such as support groups (Vizza 2012), are important to consider as well. More recent and updated self-help, educational, and stress management books include information on TABP and behavior modification and stress reduction techniques. Not all of these books are exclusively targeted to TABP and CHD but offer chapters and useful information application to behavior modification as a crucial component to addressing TABP as it affects cardiac health. Sapolsky 1994 provides an informative guide to stress and stress-related diseases, as well as coping strategies. This book includes information on how TABP is linked to CHD. A second popular book on stress reduction and behavior modification is Seaward 2012. This textbook is also geared toward students and general audiences. It is accompanied by two DVDs and an additional workbook. Seaward 2012 reviews a variety of psychological and behavioral factors, including TABP, that potentially can result in stress-related illness. A variety of behavior modification techniques are covered, as well as some nontraditional methods of holistic therapies for stress reduction.

  • Friedman, M., and R. Rosenman. 1959. Association of specific overt behavior pattern with blood and cardiovascular findings. Journal of the American Medical Association 169:1286–1296.

    DOI: 10.1001/jama.1959.03000290012005Save Citation »Export Citation »E-mail Citation »

    The original article written by the pioneers of TABP research. Outdated in some ways, but a benchmark article on TABP that carries historical relevance and importance. Available online by subscription.

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  • Friedman, M., and R. Rosenman. 1974. Type A behavior and your heart. New York: Knopf.

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    This best-selling book, written by the two cardiologists who developed TABP, serves to help individuals understand how TABP is associated with CHD risk. The book includes a self-report test to identify if the reader falls into an at-risk population. The information is slightly dated but is of historical importance in the field.

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  • Friedman, M., C. Thoresen, J. Gill, et al. 1986. Alteration of Type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: Summary of results of the Recurrent Coronary Prevention Project. American Heart Journal 112.4: 653–665.

    DOI: 10.1016/0002-8703(86)90458-8Save Citation »Export Citation »E-mail Citation »

    This article summarizes the results of the RCPP, the first major clinical trial focused on reducing TABP as treatment for recurring CHD events. The trials helped TABP and other behavior modification techniques gain value as CHD treatment. Available online for purchase or by subscription.

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  • Friedman, M., and D. Ulmer. 1984. Treating Type A behavior—and your heart. New York: Knopf.

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    A decade after he co-authored a best-selling book on TABP, Meyer Friedman, MD, collaborated with Diane Ulmer, RN, MS, for this book based on results from the RCPP. The self-help style book guides people in identifying Type A behaviors as well as providing information on lifestyle changes and behavior modification techniques.

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  • Sapolsky, R. M. 1994. Why zebras don’t get ulcers: A guide to stress, stress-related diseases, and coping. 3d ed. New York: Holt.

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    This book uses witty humor and simple language to communicate complex scientific knowledge about how stress affects physical and mental well-being. The book offers practical information regarding a variety of factors, including TABP, which can lead to negative physical outcomes, including heart disease.

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  • Seaward, B. L. 2012. Managing stress: Principles and strategies for health and well-being. 7th ed. Sudbury, MA: Jones and Bartlett.

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    This textbook comes with two DVDs, and an additional stress reduction workbook is available. Appropriate for an academic setting and general audiences looking for a stress reduction resource that includes behavior modification techniques for TABP, in addition to holistic and other therapies.

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  • Vizza, J. 2012. Comprehensive lifestyle intervention and group support. In Heart and mind: The practice of cardiac psychology. 2d ed. Edited by R. Allan and S. Scheidt, 401–416. Washington, DC: American Psychological Association.

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    Book chapter that explains and demonstrates the role of social support in cardiac patients and details the specific kinds of social support used in programs designed to reduce heart disease.

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Demographic Differences in TABP

In order to provide relevant information about health risk factors for men, women, minorities, and different age groups, it is increasingly important to recognize how gender and ethnicity influence mental and physical health.

Gender Differences in TABP

Arguably the most influential component of Type A behavior pattern (TABP), hostility has been the focus of many studies that have also examined gender differences. Sherman and Walls 1995 explored the effects of the four moderator variables of hostility, social support, Type A behavior, and optimism on stress, and whether these moderating effects differed by gender. The results indicated that social support was a significantly influential moderating variable to females’ perceptions and symptoms of stress but that this was not so for males. Additionally, hostility was significantly related to symptoms and perceptions of stress for both males and females. This evidence supports the impression that hostility is an equally toxic component of TABP for both sexes. Watkins, et al. 1992 examined how TABP and hostility were related to career-related achievement and life satisfaction in males and females. Utilizing the Jenkins Activity Survey (JAS), Watkins, et al. 1992 found that both male and female managers reported high levels of TABP and low levels of hostility. The authors concluded that Type A behaviors can be conducive to managerial success when unaccompanied by hostility. More recently, research has shown that stress may relate to cardiovascular disease (CVD) through inflammatory processes. Shivpuri, et al. 2012 examined how the inflammatory marker C-reactive protein (CRP) was affected by chronic stress and how this consequently affected individual’s CVD risk. This study found significant gender differences in types of stress experienced as well as CRP levels. Results indicated that women with sympathetic/care-giving stress, a domain of stress surrounding a close friend or family member’s health problems, had higher CRP than women without such stress. There was no difference in CRP according to stress type for men. This suggests that stress may be linked more strongly to inflammatory markers in women than men or that women may tend to be more responsive to stress than men. Pradhan and Misra 1996 investigated gender differences in TABP’s relationship with burnout in fifty dual-career medical professional couples. Results showed that TABP’s relationship with burnout was significantly stronger for females than for males. Alternatively, in Rebollo and Boomsa 2006, a study examining the genetic and environmental influences on TABP, whereas TABP was shown to be largely hereditary, with 45 percent of the variance in TABP being the result of genetic factors, nevertheless no evidence of gender differences was observed.

Ethnic and Cultural Differences in TABP

Levine and Bartlett 1984 provides an early review of the cross-cultural differences in the attitudes and behaviors concerning time, punctuality, and pace of life in six different countries. An exaggerated sense of time urgency is a critical component of TABP. Levine and Bartlett 1984 also examined how these attitudes and behaviors relate to coronary heart disease (CHD). Measuring the accuracy of a country’s clocks, average walking speed, and average working speed it was determined that overall pace of life was fastest in Japan and the countries of Western Europe. Pace of life was found to be slowest in economically undeveloped countries. Results from this series of studies showed an increase in CHD for countries with a faster pace of life. Additionally, faster pace of life countries held higher smoking rates and greater subjective well-being. This study provides an interesting early look at how cultural influences might play a role in TABP. Delehanty, et al. 1991 contributes to a sizable literature examining the stressor reactivity of African Americans and Caucasians. This study explored the relationship among cardiovascular reactivity, hostility, depression, and ethnicity. It was found that among Caucasians, systolic and diastolic reactivity were related to lower levels of hostility. The relationship was not observed among African Americans. Additionally, heart rate reactivity was found to be related to high levels of depression among Caucasians; however, this relationship was not observed among African Americans. Lastly, heart rate reactivity was found to be related to higher levels of indirect anger among African Americans. This study provided an important first step in the theory that the expression of emotion and reactivity to a psychosocial stressor may be socioculturally mediated. TABP has also been studied in relation to physical activity, although results have been inconsistent in the literature. Eason, et al. 2002 examined the relationship between TABP and physical activity among older minority women. Findings suggested a positive association between TABP and physical activity, although the overall model did not suggest a significant correlation. No significant differences between ethnic groups were observed.

  • Delehanty, S., J. Dimsdale, and P. Mills. 1991. Psychosocial correlates of reactivity in black and white men. Journal of Psychosomatic Research 35.4–5: 451–460.

    DOI: 10.1016/0022-3999(91)90040-USave Citation »Export Citation »E-mail Citation »

    An early contributor to the literature comparing the stressor reactivity of African Americans and Caucasians. This study examines the relationship among cardiovascular reactivity, hostility, depression, and ethnicity. Available online for purchase or by subscription.

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  • Eason, K. E., L. C. Mâsse, S. R. Tortolero, and S. H. Kelder. 2002. Type A behavior and daily living activity among older minority women. Journal of Women’s Health & Gender-based Medicine 11.2: 137–146.

    DOI: 10.1089/152460902753645272Save Citation »Export Citation »E-mail Citation »

    Article on the association between TABP and physical activity among older minority women. Provides support for no significant differences between ethnic groups. Available online for purchase or by subscription.

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  • Levine, R., and K. Bartlett. 1984. Pace of life, punctuality, and coronary heart disease in six countries. Journal of Cross-Cultural Psychology 15.2: 233–255.

    DOI: 10.1177/0022002184015002009Save Citation »Export Citation »E-mail Citation »

    A series of cross-cultural studies examining how attitudes and behaviors concerning time, punctuality, and pace of life relate to CHD. This study provides an interesting early look at how cultural influences can severely impact the individuals’ personalities. Available online for purchase or by subscription.

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LAST MODIFIED: 03/19/2013

DOI: 10.1093/OBO/9780199828340-0117

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