Aron Wolfe Siegman

Cardiovascular consequences of expressing, experiencing, and repressing anger

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

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

This study investigated the relationship between two dimensions of anger-hostility-the expression of anger-hostility and the experience of anger-hostility-and cardiovascular reactivity in provoked and angered men. A serial subtraction task was administered to 41 male undergraduates who were provoked and angered. A measure of the expression of anger-hostility correlated positively and significantly with systolic and diastolic blood pressure (BP) reactivity. There were no significant correlations between a measure of the experience of anger-hostility and cardiovascular reactivity. The two types of anger-hostility were also found to relate differentially to life-style variables that have been identified as risk factors for coronary heart disease (CHD), with only the expression of anger-hostility showing positive relationships with these life-style CHD risk factors. These findings are discussed within the context of a similar differential relationship between the two dimensions of anger-hostility and CAD and CHD. Finally, significant negative relationships were obtained between the experience of anger-hostility and resting BP and heart rate levels. These findings are discussed within the context of other data suggesting that trait anxiety-neuroticism may have protective properties.

Antagonistic behavior, dominance, hostility, and coronary heart disease.

Purpose: This study investigated the relationship between antagonistic behavior, dominance, attitudinal hostility, and coronary heart disease (CHD). Methods: One hundred one men and 95 women referred for thallium stress testing were administered the Structured Interview and the Cook-Medley Hostility Scale. The Hostile Behavior Index, derived from the Structured Interview and developed by Haney et al., served as an index of antagonism, and the frequency with which interviewees interrupted their interviewer served as a measure of dominance. On the basis of their medical history and thallium stress test results, patients were classified as having (N = 44) or not having (N = 99) CHD. Results and Conclusions: Multivariate logistic regressions (with age, gender, disease, and lifestyle risk factors in the model) revealed that both the Hostile Behavior Index and dominance were significant independent risk factors for CHD (relative risk [RR] = 1.22 and 1.47, p < .03). Of the two Hostile Behavior Index component scores, indirect challenge and irritability, only the latter correlated significantly with CHD (RR = 1.27, p < .03). Separate logistic regressions for men and women suggest that subtle, indirect manifestations of antagonism confer CHD risk in women and that more overt expressions of anger confer risk in men. A significant univariate correlation between hostility scale scores and CHD became not significant when we adjusted for socioeconomic status.

The Outward Expression of Anger, the Inward Experience of Anger and CVR: The Role of Vocal Expression

Two hypotheses were tested: (1) that only the outward expression of anger, not its mere experience, is associated with heightened cardiovascular reactivity; and (2) that the discussion of anger-arousing experiences in a mood incongruent speech style (soft and slow) attenuates the subjective experience of anger and its cardiovascular correlates. Each of 24 subjects participated in three experimental conditions: (1) Anger-out, in which previously experienced anger-arousing events were described loudly and quickly; (2) Anger-in, in which anger-arousing events were relived inwardly, in subjects imagination; and (3) mood-incongruent speech, in which anger-arousing events were described softly and slowly. Only the Anger-out condition was associated with high cardiovascular reactivity levels. The Anger-in and the mood-incongruent conditions were associated with near-zero and very low reactivity levels, respectively. Subjective anger ratings were highest in the Anger-out condition, moderate in the Anger-in condition, and lowest (not angry) in the mood-incongruent condition. All differences were significant. These findings suggest that the full-blown expression of anger, in all of its paraverbal intensity, is pathogenic and that the mere inner experience of anger is not.

Interviewer specificity and topical focus in relation to interviewee productivity.

An experimental interview was designed in which interviewer specificity and topical focus (neutral topic and anxiety-arousing topic) were the independent variables and interviewee productivity (number of words), the dependent variable. Fifty junior and senior nursing students, ages 20–22, were the Ss. A high level of significance was found for the effects of both independent variables on interviewee productivity. As predicted, the low-specificity questions and the anxiety arousing topic elicited greater productivity than the high-specificity questions and the neutral topic.

Anger, and Plasma Lipid, Lipoprotein, and Glucose Levels in Healthy Women: The Mediating Role of Physical Fitness

The association between anger, lipid profiles, and glucose levels were examined in this study of 103 middle aged, healthy women. A principal component factor analysis of Spielbergers Trait Anger and Anger Expression scales yielded two anger factors: Impulsive Anger-Out and Neurotic Anger. Impulsive anger-out significantly predicted a negative lipid profile (high total serum cholesterol (TSC), low density lipoproteins (LDL), TSC/HDL (high density lipids), and triglyceride levels) and heightened glucose levels, but only in physically unfit women. Neurotic anger did not predict lipid and glucose levels. These findings parallel previous findings regarding the two anger dimensions and CHD, with only impulsive anger-out predicting CHD. Furthermore, our findings indicate that the protective effect of physical fitness, previously documented for men, also occurs in women.

An Empirical Scale for the Measurement of Therapist Specificity in the Initial Psychiatric Interview

Recent studies suggest that s~ecif ic i ty is often a quite significant parameter of the psychotherapists verbal behavior. Lennard, et al. (1960) have proposed a model for the conceptualization of the psychotherapeutic process in which specificity, defined ss the amount of information carried by a verbal message, is an important variable in therapist behavior. The theoretical model proposed by Lennard, et al. leads to the prediction that as the therapist becomes more specific rhe patient will become less productive and less anxious. The feedback feature of their model leads to the further prediction that wich increasing patient productivity therapists specificity will decrease. T h e empirical data reported by these authors support their predictions, and by implication the theoretical model from which they were derived. A study by Pope and Siegman ( i n press) of the initial psychiatric interview, failed to confirm the feedback aspect of the proposed model, but did find that as therapists specificity increased patients productivity (clause units) and anxiety (speech disturbance) decreased. In both studies the specificity level of therapists remarks was rated wich an a priori scale developed by Lennard, et al. ( 1960, pp. 43-48). These authors formulated various categories of therapist remarks to which they assigned numerical values corresponding to different levels of specificity. Although it is possible to apply these categories with a high degree of reliability (Lennard, et al., 1960, p. 43; Pope & Siegman, in press), the a priori nature of the scale was considered to be a limitation. In view of the promising results obtained with the a priori scale (Pope & Siegman, in press) the construction of an empirical scale was considered to be a worthwhile undertaking. The present paper reports the results of such an attempt.

Effects of mutual invisibility and topical intimacy on verbal fluency in dyadic communication

The mutual reduction of visual feedback, which in this study did not interfere with the synchronization of turns, reduced the productivity levels and increased the silent pauses of female speakers, even though it had no effect on their subjective discomfort, anxiety, and ease of communication self-ratings. The same reduction of visual feedback, which was achieved by seating the participants back-to-back rather than face-to-face, caused male speakers to feel anxious and uncomfortable and reduced the duration of their silent pauses, but only in samegender dyads. These findings are explained in terms of previously noted gender differences in the need for visual feedback and in the anxiety-arousing effects of back-to-back interactions. Intimate communications, on the part of both male and female speakers, were associated with a slow pacing of speech but not with a decrease in productivity level, independently of the seating arrangement. These findings are interpreted in terms of the self-monitoring and self-censoring that is usually associated with the communication of intimate messages.

AN INTERCORRELATIONAL STUDY OF SOME INDICES OF VERBAL FLUENCY

This article reports an intercorrelational study of nine variables, assumed to be relevant to the occurrence of hesitation and anxiety in verbal behavior. Six verbal indices are used, including productivity, “Ah” and “non-ah” speech disturbance ratios, silent pauses, reaction time, and articulation rate. In addition Erons rating scale for Affective Arousal in TAT responses, an adaptation of this scale for rating negative affect or anxiety, and a GSR measure are used. These measures are applied to stories given in response to 16 selected TAT cards by 30 nursing students, ages 20 to 22. In the intercorrelations of the variables and their loadings on three orthogonal factors, the relevance of the verbal indices to the concepts of hesitation and anxiety is sought. Some of the correlations are consistent with an uncertainty or hesitation concept; however, no uncertainty or hesitation factor emerges. On the other hand, an anxiety factor, on which negative affect and GSR both load, is present. Unfortunately, there are no verbal index loadings on this factor. The significant relationship of GSR to anxiety and its unrelatedness to a non-directional measure of affective activation is a finding of interest. Because of the degree of independence of each other manifested by the different verbal indices it is necessary to continue to study them separately in investigations of verbal interactions.

Speech rate, loudness, and cardiovascular reactivity

This paper reports the results of two studies that investigated the relationship between speech rate, loudness, and cardiovascular reactivity (CVR). One study involved the separate manipulation of speech rate and loudness and assessed its effects on CVR during a routine reading task. The second study involved the simultaneous manipulation of both loudness and speech rate and studied its effects on CVR within the context of a personal interview. In both studies, the reduction of speech rate and/or loudness was associated with a significant reduction in CVR. On the other hand, increasing speech rate and/or loudness had no, or only a very minimal, effect on CVR. It is suggested that in the absence of emotional arousal, especially anger-arousal, rapid and loud speech per se is not associated with significant cardiovascular hyperreactivity. On the other hand, our findings suggest that training people to speak slowly and softly may be an effective approach for the control of cardiovascular hyperreactivity.