A behavior pattern marked by a relaxed, easygoing approach to life describes _____

THE PERSONALITY PROFILE

To be successful in communications, it helps to be an extrovert. Type B personalities—the calmer personalities—are better suited for this profession. Remember, you will find yourself in many crisis situations in which you will have to maintain a calm attitude. On the agency side, there is a crisis at every turn, and the ability to maintain one's cool while attending to the many details of a difficult situation is a personality trait that the job demands.

The profile is slightly different when you are in-house. It represents the opportunity to learn a lot about a single company—to fully understand the drug development process, to be a spokesperson for the organization. While you may not have to attend to the volume of potential crisis work, you have to be able to navigate through the corporate structure. Your job and your responsibilities may have a greater likelihood of change as the organization evolves. A drug that is not approved by the FDA can have a severe impact on job viability in the PR area, which is often viewed as the most expendable department in a company.

To deal with this type of change, you need to be flexible and to look for opportunities in an organization where you can add value during crises to help a company rebuild. PR requires a number of skills, many of which can't be learned. You need to be extroverted, gregarious, personable, decisive, and a good and quick writer, and you must demonstrate confidence and a sense of control. While other skills are helpful (including knowledge of the industry, business acumen, and knowledge of science), personality and persona count enormously.

Unlike lab work, where you often work in isolation, PR is a group-oriented profession. In an agency, there may be many individuals focused on different areas. The “gestalt” requires interaction among the group— brainstorming, sending proposals to the client, and distributing actions among the group. You seldom work in isolation.

A corporate setting may have similar strictures, and a hierarchy of approvals may be required before action is taken. In smaller companies, you are able to go directly to the president with a proposal.

The Coronary-Prone (Type A) Behavior Pattern

The coronary-prone (Type A) behavior pattern refers to a complex set of behaviors including hostility, competitiveness, time urgency, impatience, and aggressiveness. Type B behavior is defined as the relative absence of these characteristics. Type A behavior is an independent risk factor for cardiovascular disease as demonstrated in retrospective and prospective epidemiological studies (Brand et al., 1976; Friedman & Rosenman, 1959; Jenkins et al., 1975). Recent prospective data from the Framingham study have demonstrated these associations both for men and for women (Haynes, Feinlieb, & Kannel, 1980). Type A behavior has been related to the incidence and prevalence of clinical coronary heart disease (CHD) in men and women (Haynes et al., 1980), angiographically determined severity of atherosclerosis (Blumenthal et al., 1978; Friedman et al., 1968), and the progression of atherosclerosis in men (Krantz et al., in press).

Of interest in recent years has been the investigation of physiological pathways by which Type A behavior results in disease. Psychophysiological studies demonstrate that Type A men show greater average increases than Type B men in norepinephrine, serum triglycerides, urinary catecholamines, and blood pressures in competitive and challenging situations (Glass et al., 1980; Herd, 1978; Williams, 1978).

Considerable attention has been devoted to the relationship between coronary-prone behavior and blood pressure reactivity. Systolic blood pressure, diastolic blood pressure, and heart rate increases are typically higher in Type A than in Type B subjects when they are performing challenging tasks in competitive situations (Manuck, Craft, & Gold, 1978; Dembroski, MacDougall, Shields, Petitto, & Lushene, 1978).

Type A behavior and blood pressure reactivity have also been related in children and adolescents. Siegel and Leitch (1981) found a positive correlation between elevated systolic blood pressure and Type A behavior in adolescents. Children and adolescents in the Bogalusa Heart Study who reported that they do things quickly showed mean total serum cholesterol levels that were higher than students who gave a negative answer to this question. Students who reported that they felt an exaggerated sense of time urgency had higher mean arterial blood pressure than students who responded negatively to this item (Hunter, Wolf, Sklov, & Berenson, 1980). Lawler, Allen, Critchner, and Standard (1980) asked 18 male and 20 female 6th graders to solve anagrams and at the same time depress a response button as quickly as possible. Type A girls, but not boys, as measured by the Matthews Youth Test for Health (MYTH) (Matthews, 1978) tended to have larger elevations in systolic blood pressure and in heart rate than Type B girls during both tasks.

Spiga and Petersen (1980) studied 4th and 5th grade children in a Catholic school. The MYTH was used and the 18 highest and the 18 lowest scoring males were selected to participate. These students were matched in dyads so that there were 6 AA, 6 AB, and 6 BB dyads. The dyads played a mixed motive game in which each player could choose to compete or cooperate on each trial; rewards for individual players were contingent upon both players' choices. Type As in AA dyads showed more competitiveness than Type As in AB dyads and Type Bs in BB dyads. Type As in AA dyads also exhibited greater fluctuations in blood pressure during the tasks than other subjects.

Type A Behavior

The type A behavior pattern was originally described by cardiologists Friedman and Rosenman in the 1950s as a behavior pattern characterized by agitation, hostility, rapid speech, and an extremely competitive nature. The contrasting type B behavior pattern consists of a more laid-back style and a lack of the type A characteristics mentioned previously. A structured interview was developed to measure type A behavior based on behaviors such as speech characteristics and subjects' responses to various questions.

In the 1960s and 1970s, many studies were conducted to probe the relationship between type A behavior and heart disease. Most of the studies revealed a correlation between type A behavior and coronary heart disease in both men and women, which is comparable and independent of the effects of smoking and hypertension. For example, two major studies obtained results supporting the findings that type A behavior is a risk factor for heart disease. The Western Collaborative Group Study (WCGS) followed initially healthy men for 8.5 years. The men were given questionnaires and took part in interviews to determine their type A status at the outset of the study. Those individuals who were identified as type A were more likely to have developed heart disease over the course of the 8.5 years of the study than the type B group. The Framingham Heart Study also showed that type A behavior was a predictor of CHD among white-collar men and women who worked outside of the home.

Since the 1980s, however, most studies have not corroborated the relationship between type A behavior and heart disease. The Multiple Risk Factor Intervention Trial (MRFIT) assessed whether interventions to reduce coronary risk factors, such as high blood pressure, smoking, or high cholesterol levels, decreased the potential for coronary disease in high-risk men and women. After 7 years, the results did not show a relationship between these measures of type A behavior and the incidence of the first heart attack. Further, there were reports from research that indicated that, after a heart attack, type B patients were more likely to die than type A patients. This finding could be explained as the result of healthier type A patients being the ones who initially survived their first heart attack. Regardless, however, this result certainly presented doubts about type A behavior as a coronary risk factor.

It is unclear why these studies resulted in such inconsistent findings. Some have suggested that type A behavior may be a risk factor for younger individuals rather than for older or high-risk individuals, such as the ones tested in the MRFIT study. Still, it seems that there are certain aspects of type A behavior, particularly anger and hostility, that remain correlated with coronary disease, even in studies in which overall type A behavior was not related to CHD.

Divergent/Discriminant

Smith et al. (2008) reported that the BRS correlates negatively with measures of anxiety, depression, negative affect, and physical symptoms, when other resilience measures and optimism, social support, and Type B personality (high negative affect and high social inhibition) were controlled (Smith et al., 2013). The BRS correlated negatively with anxiety (–.46 to –.60), negatively with depression (–.41 to –.66), and negatively with perceived stress (–.60 to –.68) (Smith et al., 2013).

J Stress and Autonomic Imbalance

Persons under stress are at an increased risk for CVD. In men, the risk of CHD in type A personalities (competitive, achievement oriented, time urgent, and hostile) is twofold higher than in type B personalities (those who lack type A characteristics) (180). The onset of acute coronary syndromes is more prevalent in awakening hours, 6 am to 9 am, compared with 6 pm to 12 pm. (181–183), and these effects correlate with peak diurnal sympathetic activity (183). Little is known about the effects of stress on CVD and CHD in women.

The mechanisms by which stress modulates the risk of CHD are unclear. Stress can modify sympathetic neuroendocrine activity and the responses of the coronary vasculature to stimuli (180). Sympathetic hormones and glucocorticoids can promote the development of arteriosclerosis (17). In female animals, stress is associated with hypoestrogenism (185). In women, psychosocial stress exacerbates decreases in estrogen during the menstrual cycle and may lead to menstrual problems and infertility. Stressful life events are predictors of the premenstrual syndrome (PMS), possibly as a result of defective folliculogenesis and relative hypoestrogenism (185–187). Cardiac responses to β-adrenergic sympathetic stimulation decline with age, as does the heart rate response to parasympathetic withdrawal (188). In postmenopausal women, the mean atrial effective refractory period is longer than in premenopausal women and age-matched men. Experimentally, the atrial effective refractory period can be shortened during atrial pacing and during simultaneous atrioventricular pacing, but premenopausal women are relatively resistant to these effects compared with postmenopausal women and age-matched men (189).

Arrhythmias are not considered a direct risk factor for CHD, but they could worsen CVD risk by weakening a failing heart. Most common among arrhythmias is atrial fibrillation (5). The incidence of atrial fibrillation is lower in women than in men (5). The lifetime risk for development of atrial fibrillation is 23% for women 40 years of age and older, and the mean age of developing atrial fibrillation in women is about 74 (5). In contrast to atrial fibrillation, women are at a greater risk for developing symptomatic ventricular arrhythmias and sudden death than men (190). The female gender is considered an independent risk factor for syncope and sudden death in the congenital long QT syndrome. Prolongation of the QT interval is associated with increased risk of arrhythmia CHD and mortality. The higher propensity toward ventricular arrhythmia in females is associated with differences in repolarization and longer rate-corrected QT intervals (191,192).

Type theories

Type theories seek to identify personality categories. This approach to personality is by no means new, and dates back at least to Galen's description of four temperaments (sanguine, choleric, melancholy and phlegmatic) based on Hippocrates’ four humours. More recent examples of type approaches to personality include Type A and Type B Personality Theory (Rosenman & Friedman 1974). According to this theory individuals with Type A personality were considered to be excessively time-conscious, insecure about their status, highly competitive, hostile and aggressive, and incapable of relaxation and were considered to have a higher risk for cardiovascular disease (Rosenman & Friedman 1974). This theory has, however, been subsequently criticized on the grounds that these personality features are not highly correlated, and are not strongly predictive of heart disease. A further type theory of personality in common use is that used in the diagnostic classification of personality disorders in Diagnsotic and Statistical Manual of Mental Disorders (DSM-IV) and International Statistical Classification of Diseases and Related Health Problems (ICD-10).

6.4 Effect of Personality Traits on Experiencing Psychological Stress

Although factors such as a death in the family, divorce, caring for a sick child, discrimination, loss of job, physical and mental abuse, and a high level of stress in a job can initiate chronic stress, people with certain personality traits may also be more prone to stress. Interestingly, one study observed that female but not male caregivers whose parents needed care experienced stress and adverse mental health consequences from the stress [17]. In general, personality types can be classified as type A and type B personality, although many individuals may have a mixture of both traits or show a more complex personality type such as types C and D. It has been speculated that people with type A personality are more prone to stress and stress-related illness as well as higher blood pressure and higher cholesterol levels than people with type B personality [18]. People with type A personality are also more prone to coronary heart disease [19]. Sirri et al. [20] observed in relation to type A personality a significant difference in the prevalence of cardiovascular diseases (36.1%) compared to other diseases (10.8%). Type A behavior was also associated with irritable mood, but, in general among cardiac patients, those with type A personality were less depressed, demoralized, and worried about illness than other personality types. However, these findings have been disputed in the medical literature. Mitaishvili and Danelia [21] found no significant correlation between type A personality and coronary heart disease. Traits expected in type A and type B personality are listed in Box 6.3.

Box 6.3

Characteristics of Type A and Type B Personalities

Type C personality, also known as cancer-prone personality (first described by Lydia Temoshol in cancer patients), is indicative of a person who represses his or her emotions. Studies have confirmed that having this type of personality may increase the risk of cancer through immune and hormonal pathways [22]. In addition, people with type C personality are not risk takers but have excellent organization skills, and they keep their workplace neat and clean. Although they live inside a shell and do not share their emotions and problems with others, when speaking, they speak less and slowly. Because individuals with type C personality deny their feelings and cannot stand up for their rights, they suffer from stress and depression more than people with any other personality type.

Individuals with type D personality have a tendency to experience negative emotions and to inhibit these emotions by avoiding social contact with others. They are not risk takers. Moreover, they are afraid of rejection and prefer to stick to a routine rather than the uncertainty of change, even if such change could be beneficial to them. This is the reason why this personality type is also termed distress personality. People with type D personality experience a high amount of stress and are prone to major depression. These individuals tend to have higher cortisol, which may be a mediating factor for oxidative stress and increased risk of heart disease. Patients with heart disease who have type D personality are at higher risk of morbidity and mortality [23]. Kupper et al. [24] observed that type D personality patients suffering from congestive heart failure are characterized by increased oxidative stress burden and decreased antioxidant level compared to non-type D personality.

Psychosocial factors in general

Though mental health factors are a factor in CHD, there is also a good deal of evidence that highlights the importance of other psychosocial factors in the onset of CHD and in predicting deaths due to CHD. Early work suggested that Type A behavior, a personality style characterized by anger/hostility, time urgency and competitiveness, and a vigorous vocal style were related to cardiac problems. The Western Collaborative Group study followed men for 8.5 years and found that those with Type A were twice as likely to develop CHD, and to die, than those with the more relaxed Type B personality style. More recently, a meta-analysis of 25 prospective studies (Chida and Steptoe, 2009) suggested that it is the anger hostility component, in initially healthy people (especially men), that is most related to the development of CHD as this component predicted a 19% increased likelihood of CHD onset. Another recent study of 785 Canadians (Davidson and Mostofsky, 2010) goes further in suggesting that it is destructive anger justification (blaming others and ruminating/brooding) that predicts CHD, and not constructive anger expression (i.e., trying to solve the problem). Type D personality style, which is characterized by a combination of negative affectivity and social inhibition, also predicts the onset of MI and increased risk of mortality among cardiac patients (Denollet et al., 1996). Type D also predicts poorer mental health status and self-management in a wide variety of patient populations (Mols and Denollet, 2010). This evidence points to temperament and personality factors as psychological constructs which may influence the onset of CHD in healthy individuals.

Individual Differences in Aggressiveness and Coping with Social Stress

An important concept in aggression research that relates to stress concerns the relationship between aggression and coping. A number of studies in a variety of species show a strong positive correlation between the individual level of offensiveness and the tendency to actively cope with any kind of environmental stressor.38 Aggressive males have a general tendency to actively deal with different kinds of environmental challenges. The antipode of this active problem-focused coping is a reactive or emotion-focused coping style. This is expressed as the absence of aggressive behavior in a social situation and as passivity in other challenging environmental conditions. These coping styles, as observed in several animal species, are also characterized by differential neuroendocrine and neurobiological profiles. They can be considered as important trait characteristics determining the individual adaptive capacity.

Personality factors or trait characteristics have long been recognized as playing a role in human stress psychophysiology as well. For example, the distinction between proactive and reactive coping styles in relation to individual levels of aggression is also made in human beings. The different coping styles as found in animal studies seem to be analogous to the distinction between the human type A and type B personalities used in car diovascular psychophysiology. The type A personality is described as aggressive, hostile, and competitive and is physiologically characterized by a high sympathetic reactivity. Although the A-B typology has been seriously questioned in the human psychological literature, factors related to trait-like aggressiveness such as anger and hostility have been repeatedly shown to play a role in the individual capacity of human beings to cope with environmental challenges. Recent studies in feral populations of various animal species show the ecological and evolutionary basis of individual variation in aggression and coping or personality as an (epi)genetic suite of traits.38

Due to its high emotional character and the high amount of physical activity, aggression is accompanied by a profound activation of the pituitary-adrenocortical system and the SAM. However, the reactivity of these neuroendocrine systems appears to differ as an important trait characteristic between high-aggressive and low-aggressive individuals (see Figure 4). Aggressive males are characterized by a high reactivity of the sympathetic nervous system and the adrenal medulla, whereas non- or low-aggressive males show a higher reactivity of the pituitary-adrenocortical axis and the parasympathetic branch of the ANS.39 Under stress conditions, high-aggressive rats displayed a reduced vagal antagonism and an increased incidence of ventricular tachyarrhythmias compared to nonaggressive rats.30 Recently, hypo-(re)activity of the HPA axis has been associated causally with the development of pathological forms of aggressive behavior in rats.40

Importantly, the long-term behavioral and physiological effects of social defeat stress appear to vary in accordance with the defensive behavior the intruder displayed during the interactive phase of the defeat episode (i.e., the social conflict). In particular, delayed submissiveness and more persistent defensive counterattacks, and guarding behavior by intruders appear to characterize social stress resilient animals.12,41–43

Behavioral Sources of Stress

Stress does not always reside outside of the subject. In many occasions, stress stems from inside depending on the way individuals perceive and respond to their environment. The type A behavior pattern and the personality trait of sensation seeking are good examples of this.

Type A behavior is defined as an action-emotion complex that individuals use to confront challenges.30 This pattern of behavior involves behavioral dispositions such as aggressiveness, competitiveness, and impatience; specific behaviors such as muscle tenseness, alertness, rapid and emphatic vocal stylistics, and accelerated pace of activities; and emotional responses, such as irritation, covert hostility, and above-average potential for anger. Type B individuals are characterized by the relative absence of type A behaviors and confront every challenge with placid nonchalance. The distinction between type A and type B behavior has been proposed by cardiologists to account for individual differences in risk of coronary heart disease. Type A individuals have a higher risk of developing coronary heart disease than type B individuals. The deleterious effects of type A behavior on cardiovascular morbidity and mortality are mediated by the higher physiological reactivity to external demands, especially when there are elements of competition. These findings corroborate the previously mentioned influences of behavioral factors on the physiological response to stress. In accordance with the bidirectional nature of hormone-behavior relationships, type A behavior does not occur at will. It is determined at least in part by biological factors and autonomic hyperactivity. In addition, type A individuals actively contribute to their fate by having a higher tendency to put themselves in situations of competition and take all possible steps to transform the events they are confronted with in challenges that need to be met in a more hostile way than their peers would be inclined to do. Although the type A behavior pattern appears to be the quintessential psychobiological construct in stress theory, unfortunately it has a number of drawbacks. The psychological scales that have been developed to assess the type A behavior pattern are fraught with serious psychometric problems.31 In addition, the importance of type A behavior in epidemiological studies on the relationship between psychosocial factors and health has seen a progressive decline in favor over time. It is now apparent that funding from the tobacco industry aiming at countering concerns regarding smoking and health helped to inflate the only few positive results that were reported during the golden age of research on type A behavior pattern.32

Sensation seeking is part of the extraversion domain of personality and involves the basic need to seek stimulation and thrill independently of the associated risk.33 It contributes to impulsive behavior and has been mainly studied in the context of addiction. There is evidence that sensation seekers display enhanced responses to novelty and danger. The probability for a given individual to be a sensation seeker is determined by innate and experiential factors. However, what is characteristic of sensation seekers is their strong preference for sensation-inducing situations rather than their increased response to such situations.

Independently of their construct validity, the examples of type A behavior pattern and sensation seeking illustrate very well the notion that we are not passively exposed to stress; we actually create our own stress by the way we perceive the environment and ultimately act upon it. This can be reverberating as the experience of stress impacts on decision-making processes by tending to increase risk taking behavior, although the exact outcome depends on whether the risk leads to gains, losses, or mixed options.34,35 Part of these reverberating effects could be due to previous experience as stress biases decision-making toward habitual behavior that is driven by past experience and relatively insensitive to current stimulus-response contingencies.36