Theodore M. Dembroski

Components of type A, hostility, and anger-in: relationship to angiographic findings

&NA; Previous research has linked the Type A coronary‐prone behavior pattern to angiographically documented severity of coronary atherosclerosis (CAD). The present study sought through component scoring of the Type A Structured Interview (SI) to determine what elements of the multidimensional Type A pattern are related to coronary disease severity in a selected group of patients with minimal or severe CAD. Multivariate analyses controlling for the major risk factors showed no relationship between global Type A and extent of disease. Of all attributes measured, only Potential for Hostility and Anger‐In were significantly and positively associated with the disease severity, including angina symptoms and number of myocardial infarctions. Further analysis revealed that Potential for Hostility and Anger‐In were interactive in their association, such that Potential for Hostility was associated with disease endpoints only for patients who were high on the Anger‐In dimension. These findings support previous research in suggesting that anger and hostility may be the critical aspects of the Type A pattern in predisposing individuals to risk of CAD.

Interpersonal Interaction And Cardiovascular Response In Type A Subjects and Coronary Patients

The present study tested the hypothesis that Type A subjects respond with greater cardiovascular response than Type B subjects during the structured interview used to assess the Type A pattern. Coronary patients (n = 31) and patient controls (n = 33) were subjected to the interview and a history quiz while ECG and blood pressure were monitored. As predicted, Type A relative to Type B subjects evidenced significantly greater increases in both systolic and diastolic blood pressure, which were sustained over the course of the entire 12-15 minute interview. Type A subjects compared with Bs also showed significantly greater blood pressure elevations during the quiz. Coronary patients displayed significantly greater Type A attributes than control subjects and tended to show greater blood pressure elevations than controls during the interview. In addition, the quiz induced significant elevations in the blood pressure of coronary patients, but not patient controls, over that displayed during the interview, despite the presence of beta-adrenergic blocking medication. Implications of the findings for coronary-prone behavior and coronary heart disease are discussed.

Gender differences in cardiovascular reactivity

Pronounced cardiovascular reactivity to stress is a behavioral mechanism that may underlie the pathophysiology of coronary heart disease (CHD). Based on the greater incidence of CHD among males than among females, the purpose of the current investigation was to test the hypothesis that in young adults (ages 17–29), males (n=47) show more cardiovascular reactivity than females (n=61) to two stressors, a video game and cigarette smoking. Five of the six comparisons did not support the hypothesis: females were higher on heart rate and diastolic blood pressure reactivity to both Stressors; males were higher on systolic blood pressure reactivity to the video game only. The results suggest that females may be particularly physiologically reactive to cigarette smoking.

Familial resemblance in components of the type A behavior pattern: a reanalysis of the California type A twin study.

&NA; Rosenman and colleagues reported no heritability of global Type A behavior assessed by the Structured Interview (SI) method, although some of the self‐report scales correlated with global Type A behavior did have heritable components. Recent factor analyses of coded SI responses revealed four independent dimensions: clinical ratings, primarily of speech stylistics; and self‐reports of pressured drive, anger, and competitiveness. It may be that some of these dimensions have a heritable base, whereas others do not. We report here reanalyses of the available SI responses from the Rosenman sample. In this subsample, tape recorded interviews with 80 monozygotic and 80 dizygotic twin pairs were scored for the extent of self‐reported Type A behaviors, the major speech stylistics considered to be indicative of Pattern A, and the observable Type A behaviors (e.g., signs of hostility). Then scores for the major dimensions measured by the SI were calculated and scores for which there were sufficient data were subjected to twin analyses by the method of Christian et al. These analyses showed that individual differences in the clinical ratings factor and certain ratings loading on it—specifically, loudness of speech, competition for control of the interview, and potential for hostility—might have a heritable component. These results are discussed in the context of the importance of hostility as a predictor of subsequent coronary heart disease events as well as of total mortality, other data on the heritability of emotionality, and a temperament approach to understanding the origins of the Type A behavior pattern.

Component analysis of the Type A coronary-prone behavior pattern in male and female college students.

Two studies investigated the psychological dimensions encompassed by the Rosenman Structured Interview (SI) method of assessing the Type A behavior pattern. In Study 1, female students completed the SI and Jenkins Activity Survey (JAS). Factor analysis of the verbal stylistic and answer content components of the SI yielded a 5-factor solution, with one factor--Clinical Rating--accounting for most nonerror variance in Type A ratings. The remaining factors were derived from answer content and correlated more substantially with JAS Type A ratings than with SI Type A ratings. In Study 2, male and female college students completed the SI and JAS and a battery of questionnaires that tap trait dimensions implied by the conceptual definition of Type A. For both males and females, SI ratings of Type A could almost be completely predicted by scores on the Clinical Rating factor. For both sexes, content dimensions of the SI related to other measures of Type A and to Type A-consistent traits, whereas the Clinical Rating factor was only modestly associated with such traits. Moreover, sex differences were observed in the trait constellations composing SI and JAS definitions of Type A. These results suggest that a discrepancy exists between conceptual and operational definitions of the Type A pattern.

Definition and Assessment of Coronary-Prone Behavior

Any consideration of assessment issues regarding coronary-prone behavior must begin with a review and evaluation of the evidence that certain psychological/behavioral constructs are “coronary-prone,” i. e., that certain psychological/behavioral characteristics are associated with and/or predictive of such manifestations of coronary heart disease (CHD) as myocardial infarction, cardiac death, angina, and coronary atherosclerosis (coronary artery disease, CAD). On the basis of such evidence it will be possible to draw conclusions regarding the best available means of assessing coronary-prone characteristics, as well as what further research is needed to improve our ability to assess such characteristics.

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.

How many sphygmomanometric cuff inflations are necessary to obtain a hemodynamic baseline

The purpose of this study was to determine the minimum number of consecutive blood pressure cuff inflations required to obtain seated stable resting baseline measurements of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Sixty male college students aged 18 to 31 years volunteered as study subjects. Thirteen observations of HR, SBP, DBP, and MAP were recorded at 90-second intervals for each subject using a Critikon-Dinamap monitor. Stable readings for SBP and MAP were obtained in 6.5 minutes or 3 to 5 cuff inflations in the population tested. Using this procedure, additional age- and gender-specific norms could be established for normal and hypertensive subjects. Knowing the approximate quantity and frequency of blood pressure cuff inflations needed to generate baseline minimum measurements of HR, SBP, DBP, and MAP will be helpful in studies of cardiovascular reactivity, as well as for clinical and psychophysiologic treatment of hypertension.

Effects of Severe and Inescapable Shock on Subsequent Escape Avoidance and Exploratory Behavior

11 rats which experienced severe, inescapable shock were subsequently found to be impaired in the acquisition of a 2-way shuttle-box avoidance task but showed no impairment in open-field exploration. Ss initially allowed to escape/avoid the shock demonstrated enhanced exploration in the open field.