Introduction
The Type A behavior pattern, often simply called the Type A personality, identifies behaviors which have been associated with coronary artery disease. Although these behaviors appear to be stress related, they are not necessarily involved with stressful situations or with the traditional stress response. Instead, the behaviors are based on an individual’s thoughts, values, and approaches to interpersonal relationships. In general, Type A individuals are characterized as ambitious, impatient, aggressive, and competitive. Individuals who are not Type A are considered Type B. Type B individuals are characterized as relaxed, easygoing, satisfied, and noncompetitive.
Cardiologists Meyer Friedman and Ray H. Rosenman began work on the Type A behavior pattern in the mid-1950s. It was not until the completion of some retrospective studies in the 1970s, however, that the concept gained credibility. During the 1950s, it was noticed that younger and middle-aged people with coronary artery disease had several characteristics in common. These included a hard-driving attitude toward poorly defined goals; a continuous need for recognition and advancement; aggressive and at times hostile feelings; a desire for competition; an ongoing tendency to try to accomplish more in less time; a tendency to think and act faster and faster; and a high level of physical and mental alertness. These people were classified as “Pattern A” or “Type A.”
Correlation to Heart Disease
Following their work on identifying the characteristics of the Type A personality or behavior pattern, Friedman and Rosenman began conducting studies to determine if it might actually cause coronary artery disease. First they conducted several correlational studies to determine if there was a relationship between the Type A behavior pattern and metabolic function in humans. They found that healthy persons with the Type A behavior pattern had elevated levels of fat in the blood (serum cholesterol and triglycerides), decreased blood-clotting time, increased catecholamine secretion (which increases heart contractility) during normal work hours, and decreased blood flow to some tissues. These studies indicated that the Type A behavior pattern may precede coronary artery disease.
Following these studies, Friedman, Rosenman, and their research team initiated the Western Collaborative Group Study in 1960. This large study, which went on for more than eight years, attempted to determine if the presence of the Type A behavior pattern increased the risk of coronary artery disease. The results of Rosenman and Friedman’s study in 1974 indicated that the subjects with the Type A pattern had more than twice the incidence of the disease than subjects with the Type B pattern. More specifically, Type A individuals (when compared to Type B individuals) were twice as likely to have a fatal heart attack, five times more likely to have a second heart attack, and likely to have more severe coronary artery disease (of those who died). These results were found when other known risk factors, such as high blood pressure, smoking, and diet, were held constant. This study was followed by numerous other studies that linked coronary artery disease to the Type A behavior pattern. In 1978, the National Heart, Lung, and Blood Institute sponsored a conference on the Type A behavior pattern. As a result of the Review Panel on Coronary-Prone Behavior and Coronary Heart Disease, a document was released in 1981 that stated that the Type A behavior pattern is related to increased risk of coronary artery disease.
Identifying Type A Behavior
Another product of the Western Collaborative Group Study was a method for assessing the Type A behavior pattern, developed by Rosenman in 1978. This method was based on a structured interview. A predetermined set of questions was asked of all participants. The scoring was based on the content of the participants’ verbal responses as well as their nonverbal mannerisms, speech style, and behaviors during the interview process. The interview can be administered in fifteen minutes. Because the interview was not a traditional type of assessment, however, many interviewers had a difficult time using it.
In an effort to simplify the process for determining Type A behavior, many self-report questionnaires were developed. The first developed and probably the most-used questionnaire is the Jenkins Activity Survey, which was developed by C. David Jenkins, Stephen Zyzanski, and Rosenman in 1979. This survey is based on the structured interview. It gives a Type A score and three related subscores. The subscores include speed and impatience, hard driving, and job involvement. The Jenkins Activity Survey is a preferred method, because the questionnaire responses can be tallied to provide a quantitative score. Although this instrument is easy to use and provides consistent results, it is not considered as good as the structured interview because many believe the Type A characteristics can best be identified by observation.
The Type A behavior pattern continues to be studied, but research appears to have reached a peak in the late 1970s and early 1980s. Researchers are challenging the whole concept of coronary-prone behavior, because many clinical studies have not shown high correlations between the Type A behavior pattern and the progression of coronary artery disease. Other risk factors for coronary artery disease, such as smoking, high blood pressure, and high blood cholesterol, have received increasing attention.
Biochemical and Physiological Mechanisms
The Type A behavior pattern, or personality, has been used to explain in part the risk of coronary artery disease; however, many risk factors for the disease have been identified. Since the various risk factors interact with one another, it is difficult to understand any one risk factor clearly.
Efforts have been made to explain the mechanism by which the Type A behavior pattern affects coronary artery disease. It has been theorized that specific biochemical and physiological events take place as a result of the emotions associated with Type A behavior. The neocortex and limbic system of the brain delivers emotional information to the hypothalamus. In a situation that arouses the Type A characteristics, the hypothalamus will cause the pituitary gland to stimulate the release of the catecholamines
epinephrine and norepinephrine (also known as adrenaline and noradrenaline) from the adrenal glands, as well as other hormones from the pituitary itself. These chemicals will enter the blood and travel throughout the body, causing blood cholesterol and fat to increase, the ability to get rid of cholesterol to decrease, the ability to regulate blood sugar levels to decrease (as in diabetes), and the time for the blood to clot to increase. This response by the body to emotions is normal. The problem with Type A individuals arises because they tend to maintain this heightened emotional level almost continually, and the constant release of pituitary hormones results in these negative effects on the body being continuous as well.
The connection between Type A behavior and coronary artery disease actually results from the continuous release of hormones controlled by the pituitary gland. Through complex mechanisms, the constant exposure to these hormones causes several problems. First, cholesterol is deposited on the coronary artery walls as a result of the increase in blood cholesterol and the reduced ability to rid the blood of the cholesterol. Second, the increased ability of the blood to clot results in more clotting elements being deposited on the arterial walls. Third, clotting elements can decrease blood flow through the small capillaries that feed the coronary arteries, resulting in further complications with the cholesterol deposits. Fourth, increased insulin in the blood further damages the coronary arteries. Therefore, the reaction of the pituitary gland to the Type A behavior pattern is believed to be responsible for the connection with coronary artery disease.
Modification Techniques
Fortunately, it is believed that people with the Type A behavior pattern can modify their behavior to reduce risk of coronary artery disease. As with many health problems, however, denial is prevalent. Therefore, it is important that Type A individuals become aware of their problem. In general, Type A individuals need to focus on several areas. These include hurry sickness, speed and impatience, and hostility.
Type A individuals try to accomplish more and more in less and less time (hurry sickness). Unfortunately, more is too often at the expense of quality, efficiency, and, most important, health. Type A individuals need to make fewer appointments related to work, and they need to schedule more relaxation time. This includes not starting the day in a rush by getting out of bed barely in time to get hurriedly to work. Finally, Type A individuals need to avoid telephone and other interruptions when they are working, because this aggravates hurry sickness. Therefore, it is recommended that individuals who suffer from hurry sickness avoid scheduling too much work; take more breaks from work (relaxation), including a lunch hour during which work is not done; and have calls screened to get blocks of working time.
Type A individuals typically do things rapidly and are impatient. For example, they tend to talk rapidly, repetitiously, and narrowly. They also have a hard time with individuals who talk slowly, and Type A individuals often hurry these people along by finishing their sentences. Additionally, Type A individuals try to dominate conversations, frequently focusing the discussion on themselves or on their interests. In an effort to moderate speed and impatience, Type A individuals need to slow down, focus their speech in discussions to the specific problem, and cut short visits with individuals who waste their time. They should spend more time with individuals who enhance their opportunities.
The other area is hostility, or harboring destructive emotions. This is highly related to aggressiveness. Aggressive Type A individuals must learn to use their sense of humor and not look at situations only as challenges set up to bother or to upset them. One way to accomplish this is for them consciously to attempt to socialize with Type B individuals. Obviously, this is not always possible, since Type A individuals have certain other individuals with whom they must associate, such as colleagues at work and certain family members. Nevertheless, Type A individuals must understand their hostilities and learn to regulate them. In general, Type A individuals must learn to control their feelings and relationships. They must focus more attention on being well-rounded individuals rather than spending most of their time on work-related successes. Type A individuals can learn the Type B behavior pattern, resulting in a lower risk for coronary artery disease.
Behavior Pattern Versus Personality
Since Friedman and Rosenman defined the Type A behavior pattern in the 1950s, many researchers have studied the Type A behavior pattern. Initially, most of the researchers were cardiologists. Gradually, more and more psychologists have become involved with Type A research.
Since the concept of relating coronary heart disease with human behavior was developed by cardiologists instead of psychologists, it was initially called the Type A behavior pattern rather than the Type A personality. “Personality” relates to an individual’s inner traits, attitudes, or habits and is very complex and generally studied by psychologists. As Type A was defined, however, it only related specific behaviors with disease and was observed openly. Therefore, it seemed appropriate to label Type A a behavior pattern. Over the years, Type A has been assumed to be a personality; technically, this is not accurate, although many people now refer to it as the Type A personality.
Another reason Type A is most accurately considered a behavior pattern rather than a personality relates to the way it is assessed. Whether the structured interview or the written questionnaire is utilized, a predetermined set of questions and sequence is used. While this approach can assess a behavior pattern adequately, different skills, which allow the interviewer to respond appropriately to an individual’s answers and probe specific responses further, are needed to assess personality.
Contributions and Future Research
The Type A behavior pattern was originally identified as a risk factor for coronary artery disease. The original need for this idea was not psychologically based. Instead, it was based on a need to understand further the factors that are involved with the development of coronary artery disease, a major cause of death. Therefore, the role of the Type A behavior pattern in psychology has been limited. Nevertheless, Type A studies have benefited humankind’s understanding of an important disease and, to a certain extent, the understanding of psychology.
The future study of the Type A behavior pattern is in question. Research continually shows conflicting results about its role in coronary artery disease. As more research is conducted by both medical clinicians and psychologists, the true value of the Type A behavior pattern will become evident. Until then, health care professionals will continually have to evaluate the appropriateness of using the Type A behavior pattern as an identifier of the risk of artery or heart disease.
Bibliography
Chesney, Margaret A., and Ray H. Rosenman, eds. Anger and Hostility in Cardiovascular and Behavior Disorders. Washington, D.C.: Hemisphere, 1985. Print.
Deaux, Kay, and Mark Snyder. The Oxford Handbook of Personality and Social Psychology. New York: Oxford UP, 2012. Print.
Friedman, Meyer. Type A Behavior: Its Diagnosis and Treatment. New York: Springer, 2008. Print.
Houston, B. Kent, and C. R. Snyder, eds. Type A Behavior Pattern: Research, Theory, and Intervention. New York: John Wiley & Sons, 1988. Print.
Kazdin, Alan E. Behavior Modification in Applied Settings. Long Grave: Waveland, 2013. Print.
Price, Virginia Ann. Type A Behavior Pattern. New York: Academic Press, 1982. Print.
Siegman, Aron Wolfe, and Theodore M. Dembroski. In Search of Coronary-Prone Behavior: Beyond Type A. Hoboken: Taylor and Francis, 2013. Digital file.
Watson, Neil. Mind's Machine: Foundations of Brain and Behavior. Sunderland: Sinauer, 2012. Print.
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