TYPE A Personality Pattern

The type of personality concerns how people respond to stress. However, although
its name implies a personality typology, it is more appropriately conceptualized as
a trait continuum, with extremes Type-A and Type-B individuals on each end.
Research Background - Friedman and Rosenman (both cardiologists) in 1976
labeled this behavior Type A personality. They subsequently conducted research to
show that people with type A personality run a higher risk of heart disease and
high blood pressure than type Bs.
Although originally called 'Type A personality' by Friedman and Rosenman it has
now been conceptualized as a set of behavioral responses collectively known as
Type A Behavior Pattern.
Type A Behavior Pattern (TABP)
Typical responses of TABP include:
Competitiveness
▪ Type A individuals tend to be very competitive and self-critical.
▪ They strive toward goals without feeling a sense of joy in their efforts or
accomplishments.
▪ Interrelated with this is the presence of a significant life imbalance. This is
characterized by a high work involvement.
▪ Type A individuals are easily ‘wound up’ and tend to overreact. They also
tend to have high blood pressure (hypertension).
▪ Time Urgency
▪ Type A personalities experience a constant sense of urgency: Type A people
seem to be in a constant struggle against the clock.
▪ Often, they quickly become impatient with delays and unproductive time,
schedule commitments too tightly, and try to do more than one thing at a
time, such as reading while eating or watching television.
Hostility
Type A individuals tend to be easily aroused to anger or hostility, which they may
or may not express overtly. Such individuals tend to see the worse in others,
displaying anger, envy and a lack of compassion.
When this behavior is expressed overtly (i.e., physical behavior) it generally
involves aggression and possible bullying (Forshaw, 2012). Hostility appears to be
the main factor linked to heart disease and is a better predictor than the TAPB as a
whole.
Empirical Research
Friedman & Rosenman (1976) conducted a longitudinal study to test their
hypothesis that Type A personality could predict incidents of heart disease. The
Western Collaborative Group Study followed 3154 healthy men, aged between
thirty-nine and fifty-nine for eight and a half years. Participants were asked to
complete a questionnaire.
Examples of questions asked by Friedman & Rosenman:
1. Do you feel guilty if you use spare time to relax?
2. Do you need to win in order to derive enjoyment from games and sports?
3. Do you generally move, walk and eat rapidly?
4. Do you often try to do more than one thing at a time?
From their responses, and from their manner, each participant was put into one of
two groups:
Type A behavior: competitive, ambitious, impatient, aggressive, fast talking.
Type B behavior: relaxed, non-competitive.
According to the results of the questionnaire 1589 individuals were classified as
Type A personalities, and 1565 Type B.
Findings - The researchers found that more than twice as many Type A people as
Type B people developed coronary heart disease. When the figures were adjusted
for smoking, lifestyle, etc. it still emerged that Type A people were nearly twice as
likely to develop heart disease as Type B people.
For example, eight years later 257 of the participants had developed coronary heart
disease. By the end of the study, 70% of the men who had developed coronary
heart disease (CHD) were Type A personalities.
The Type A personality types behavior makes them more prone to stress-related
illnesses such as CHD, raised blood pressure, etc. Such people are more likely to
have “flight or fight” response set off by things in their environment. As a result,
they are more likely to have the stress hormones present, which over a long period
of time leads to a range of stress-related illnesses.
Theoretical Evaluation
However, there are a number of problems with the type A and B approach. Such
approaches have been criticized for attempting to describe complex human
experiences within narrowly defined parameters. Many people may not fit easily
into a type A or B person.
A longitudinal study carried out by Ragland and Brand (1988) found that as
predicted by Friedman Type A men were more likely to suffer from coronary heart
disease. Interestingly, though, in a follow up to their study, they found that of the
men who survived coronary events Type A men died at a rate much lower than
type B men.
The major problem with the Type A and Type B theory is actually determining
which factors are influencing coronary heart disease. Some research (e.g.,
Johnston, 1993) has concentrated on hostility, arguing that the Type A behavior
pattern is characterized by underlying hostility which is a major factor leading to
coronary heart disease.
Other research has investigated the way that type A people experience and cope
with stress, which is the major factor leading to coronary heart disease. It would
seem that a much more sophisticated model is needed to predict coronary heart
disease than Friedman and Rosenman's Type A & Type B approach.
Assessment of type A behavior -

The major type A assessment procedure is structured interview. The method of

subject selection in these investigations in the world 2 stage process –

1. Subjects about type A & B behavior pattern in detail.

 2. Ask them to point out those who fit into those Characteristics.

Content of structured interview -

1. health history and status

2. Smoking
3. Work
4. Exercise
5. Sleep
6. dietary habits
7. parental history of CHD and other illnesses.

Rating - dependent answering and body language of the subject.

In 1960, a pilot study was carried out before this study where interviewers noted -
● Mental alertness
● speed of motion
● Body’s restlessness
● Facial gestures

Rating was done on a 5-point scale -

A1 - Fully developed type A behavior pattern
A2 - Many types A characteristics but not the complete pattern
X - mixture of type A and B behavior
B3 - many type B characteristics with some type A characteristics
B4 - Relative absence of type A characteristics

time duration: 10 -15 minutes

AV observation was made.

During the administration of the structured interview, the interviewer creates a

challenge situation and presents an environmental stimulus that will result in type
A behavior.

The interviewer must be trained to conduct the interview to assess the sample.

Control variables are Vocal style (of the interviewer), speed, volume, length of the
interview, question content, behavior of the interviewer and style of interaction.
Other tools –

Jenkins activity survey (JAS) is a paper pencil test (easy method)

Self-report questionnaire to assess the behavior patterns more objectively and
efficiently than structured interviews. It is developed from items based on the
structured interview questions and clinical experience.

Items chosen that have discriminate values (of type A and B). It was further refined
to yield a composite type A Scale & 3 factor analytically derived subscales -
1. Speed & impatience
2. job involvement
3. Harsh driving at any cost.

There are other scales available but do not have predictive values.
1. Adjective checklist
2. Thurston temperaments schedule
3. Framingham type A scale

Apart from the testers use physiological values (example - blood pressure) along
with structured interview.

Relationship between type A behavior and CHD -

Few characteristics of type A behavior leads to CHD.

2 Approaches for modification -

1. to change the complete type A behavior pattern
2. only characteristics which are directly related to CHD can be modified.
(But the actual characteristics cannot be defined)

Relation of type A & CHD -

Recent studies indicate that not all aspects of type A behavior but some like
hostility is more strongly implicated as a risk factor is coronary heart disease. A
particular type of hostility named cynical hostility indicates strong correlation with
CHD.

Cynical hostility is characterized by -

● Suspiciousness
 ● Resentment
● frequent anger
● Antagonism (Active hostility)
● distrust of others

Other negative emotions such as depression, anger, hostility and anxiety rather
than a hurried, workaholic, impatient picture may be responsible for developing
CHD.

Mechanism linking type A behavior with CHD-

1. Enhanced reactivity to stress - these people are hyper responsive in
anticipation and in early stages of adjusting to stress.
2. They return slowly to the baseline after stress.
3. Lapse studies indicate the possibility of genetic involvement. Type A people
enhanced sympathetic nervous system responsiveness to stress. This
generates excess neuro endocrines in the blood.

In a comparative study between type A and B patients undergoing bypass

surgery, more rise in blood pressure is seen in type A people. So, this indicates that
type A is physically determined or it can be said that they generate more stress for
themselves. They smoke more, drink more, meet more with accidents and have less
social support.

Some studies indicate way of expressing anger to have a link with CHD -

1. Mechanical theory - Eliot and Buell (1983)

According to this theory, in some individuals, stress causes vasoconstriction

near the heart and at the same time increasing heart rate causing more blood
to be transformed through narrowed blood vessels, this causes wear and tear
to coronary arteries.

2.Hormone based reaction - Denbroski (1974)

Catecholamines (dopamine, adrenaline, norepinephrine) during sympathetic

activity may exert a direct chemical effect on blood vessels. Fluctuation of
catecholamines changes the blood pressure continuously which harms the blood
vessels. Sympathetic activity causes lipids to mix in bloodstream which in
turn generate atherosclerosis. (Narrowing of arteries).

Development of type A behavior -

● Personality develops in childhood.

● Type A children are more talkative than type B.
● Type A children are more likely to attribute their performance to their efforts
when standards are not clear.
● Adolescence anger is a predictor of anger - physical measure of
cardiovascular disorders.
● There are strong chances of genetic predisposition. Early environment or
genetic factors are responsible for type A rather than conditions later in life.
● Modeling of parental behavior - Type A Children get more encouragement
to try harder from significant others but did get fewer positive remarks for
their performance. These children are repeatedly asked to do better but not
given any specific criteria for achievement thus, they cannot develop internal
standards by which they can evaluate their own achievements.
● Upbringing of Type A children is characterized by demands for continuous
improvements of performance with constant disapproval.