Type A behaviour, hostility and CHD: Rise and fall of a

good idea?

Reading

There is material on Type A and hostility in the standard texts and general papers. See also

Johnston DW 1993. The current status of the coronary prone behaviour pattern. J. Roy. Soc. Med. 86, 406-409. Dated (but short).

Matthews, K 1988. Coronary heart disease and Type A behaviors: update on and alternative to the Booth-Kewley and Friedman (1987) quantitative review. Psychol. Bull. 104, 373-80. Plus reply 381-384. Interesting discussion of Type A as risk factor. Worth reading

Miller et al 1991 Reasons for the trend toward null findings in research on Type A behaviour. Psychol. Bull, 110, 469-485. Serious stuff, follows up on Matthews.

reading (cont.)

Miller TQ et al, 1996. A meta-analytic review of research on hostility and physical health. Psychol. Bull., 119, 322-348. A comprehensive review. Best read after Matthews. Don’t get bogged down in tables.

Type A Behaviour (Friedman & Rosenman)

Characterised by:

•Competitiveness

•Time Urgency

•Hostility

Questions from Structure Interview to

Measure Type A Behaviour1. Does your job carry heavy responsibility?

4. Are you satisfied with your present job?

6. When you play competitive games with children do you purposely let them win?

13. Do you get impatient when you are watching a slow worker?

14. Do you often do two things at a time, like reading while eating?

Western Collaborative Group Study Rosenman, Brand, Jenkins, Friedman & Straus 1975

3154 men aged 30-59yrs classified on Structured Interview as either Type A or Type B

Extensive measurement of other risk factors

Followed up initially for 8.5 years for evidence of CHD, i.e., prospective study

Were Type A’s more likely to experience CHD?

Type A Type B

Number 1589 1565

No. with CHD 178 79

Incidence 13.2 5.9

(annual per 1000)

Could other risk factors explain the Type A & CHD link?

Analysed using multivariate statistics but also by simpler stratified analysis. Effects still present. See incidence rates for MI (39-49)

Type A Type B

Non smokers 7.4 3.4

Smokers 15.4 11.4

Normotensives 7.6 1.4

Hypertensives 33.1 12.6

Low Cholesterol 5.8 2.1

High Cholesterol 20.3 11.5

What happened to the WCGS later?

Ragland & Brand 1988 studied survival of 257 men who had experienced CHD in original 8.5 yr follow upRagland,DR,Brand,RJ,(1988) Type A behaviour and mortality from coronary heart disease. The New England Journal of Medicine 318, 65-69Ragland & Brand 1988 looked at mortality over 22 years in original sampleRagland,DR,Brand,RJ (1988) Coronary heart disease mortality in the Western Collaborative Group Study: follow-up experience of 22 years. American Journal of Epidemiology,127,462 - 475.

Ragland & Brand, 1988

Ragland & Brand, 1998

Williams et al, 1988

Mechanisms linking Type A or Hostility and CHD

Could be any of the mechanisms we discussed linking stress and CHD

CV reactivity : extensively studied. Mixed finds

Effects of clotting process (Markovitz)

Other (see Kop)

Intervention evidence (Important in establishing causality)

Usual texts. Also chapter by Krantz & Lundeman on Cardiovascular disorders in Johnston & Johnston good on interventions (& other parts of course). See also Krantz & McCeney Annual Rev Psychol 2002 53: 341-369.

There is discussion of interventions in CHD in Schiederman, Antoni, Sabb & Ironson (2001) Health Psychology: psychosocial and biobehavioural aspects pf chronic disease management. Annual Rev Psychology, 52: 555-580. Especially 555-560

Friedman,M,Thorensen,CE,Gill,JJ,Powell,LH,Ulmer,D,Thompson,L,Price,VA,Rabin,DD,Breall,WS,Dixon,T,Levy,R,Bourg,E( 1984) Alteration of Type A behaviour and reduction in cardiac recurrences in postmyocardial infaction patients American Heart Journal,108,237,248

Recurrent Coronary Prevention Project (RCPP- Friedman & Thoresen, 1985)

Questions

Can Type A behaviour be reduced?

Does reducing Type A reduce risk of recurrent MI

Design

Patients who had experienced an MI

Type A Change + cardiac care (592)

Cardiac care only (270)

Outcomes

Type Behaviour

New MI

Components of Type A Change 1. Environmental 2. Behavioural 3. Cognitive

Environmental

Speak to neighbours Drive more slowly No new tasks without dropping old Relax regularly

Behaviour

Speech: talk more slowly Listening: less fidgeting, listen Waiting: practice waiting in

queues Modelling: pretend to be Type B

Drills Monday Look at faces Tuesday Remove grimace Wednesday Walk more slowly

than spouse Thursday Eat more slowly Friday No knee jiggling Saturday Linger at table Sunday Speak more slowly

Cognitive

Use feelings to examine beliefs How you see things is the problem Practice self- talk Do not see events & people as threats