Medical Psychology 24.03.2011

1. Medical Psychology 24.03.2011 The role of personality in changes of health status

2. Is there a ConnectionBetween Personality and Disease? ► Workaholics have heart attacks? ► Worriers get ulcers? ► Uptight people get asthma?

3. Stress and Heart Disease: Clinical Evidences ►Highly stressed workers were 2x as likely to die from heart problems(Kivimaki et al 2002) ►Stress-prone individuals with heart problems 3x more likely to die from heart attack(Sheps et al 2002) ►Stress-prone individuals:higher LDL ‘bad’ blood cholesterol(Steptoe et al 2005)

4. Stress & Heart Disease: The „Type-A” Study(Friedman & Rosenman 1974) ►3200 healthy American men ►Characteristics of stress-prone individuals (Type A-s): • Anger & hostility • Competitiveness • Time-urgency

5. Follow-Up Study (Friedman & Rosenman, 1982) After 8½ years, participants were reassessed ►257 had developed CHD ► Of these, 70% were Type As Association remained when smoking and other lifestyle factors were accounted for

6. Type A & Heart Disease (Miller, etal., 1991)

7. Characteristics of the Type A Personality Type A Type B • Strenuous work • Poor sleep pattern • Compulsive tendencies • Aggressive • Depressive and neurotic tendencies • Angry, impatient • Low on introspection • Anxious • Hard driving • Little time for relaxation • Conscientious

8. Type A-s and Type B-s

9. Type A Behavior Patterns in Stress and Illness ► respond more quickly, rapidly to stressors, seeing them as threats. ►greater physiological reactivity ► tend to seek out demanding situations which leads to stress. ► ignore early signs of heart attacks ► often fail to adhere to medical regimens

10. Physical (Facial) Signs of Type A Behaviour ►Facial tension (tight lips, clenched jaw, etc.) ► Tongue clicking or teeth grinding ► Dark circles under eyes ► Facial sweating (on forehead or upper lip)

11. The key factor in the type A personality that makes a person more susceptible to heart disease is: Competition Ambition Hostility Fast pace Upset easily

12. Hostility is a form of angry internal rejection or denial in psychology (George Kelly, 1957). In everyday speech it is more commonly used as a synonym for anger and aggression.

13. Hostility and Coronary Heart Disease Hostility is predictor of CHD and mortality, especially when it is expressed outward and involves cynicism. (Matthews et al. 1998) 200 females over 10 years, high initial hostility -> more likely symptoms of CHD 10 years later(Niaura et al., 2002) • older males with coronary artery blockage: 8% L hostility, 18% H hostility Higher resting blood pressure poorer heart pumping efficiency, and higher heart rate

14. Personality factors may influence health behaviour People high in neuroticism, hostility and Type-A behaviors are more likely to: ► smoke and abuse alcohol ► eat less healthy foods ► avoid exercise ► sleep less ► use more caffeine ► more traffic risk taking behaviors

15. Personality factors, physiological reactions to stress, and cardiovascular response Hostility: higher heart rates and blood pressure– extreme cardiac response to stress (Raikkonen et al., 1999) Hostile persons mistrust others and are on guard – higher physiological arousal and more ware and tear on heart

16. Type DPersonality (Denollet et al 1996) ► Gloomy, socially inactive ►‘Distressed personality’ – associated with depression and social alienation Greater risk of heart attack! ► FOLLOW-UP STUDY: 300 male and female heart attack sufferers. 10 years later Type D-s 4x more likely to have another heart attack (Denollet et al 1996)

17. Type C (Cancer-Prone) Personality(Temoshok, 1987) Lydia Temoshok

18. Characteristics of Type C-s ► Suppress emotions – especially negative ones ► Unassertive ► Likeable – non-argumentative, want to please others ► Generally helpful to others

19. Effects of Type-C Personality Cope with stress in a way that ignores their own needs (even physical ones). Stresses suppressed. More susceptible to cancer because more chronic stressors affect the immune system and increase risk of cancer.

20. Pessimistic explanatory styleand low perceived control correlatewith weaker immune responses -poorer DNA repair

21. Controversies in Cancer and Personality Connections • Population-based cohort study 59,548 Swedish (1974–1999) and Finnish (1976–2004) participants association of personality traits extraversion and neuroticism with risk of cancer • 4,631 cancer cases for a maximum 30 years of follow-up • Extraversion and neuroticism were not significantly associated with risk of cancers at all sites (Nakaya et al, 2010)

22. Is there a Disease-Prone Personality? ►Some personality characteristics make us more vulnerableto the negative effects of stress, while others makes us more resilient.

23. Evidences and Dilemmas ► It is proved that there is an “immune-prone” personality, a personality that is “hardy” to the effects of stress. ► It is proved that emotions play a key role in the outcome (recovery rate) of illness but not in causing illness. ►It is still a question whether there is anypersonality that predicts illness.

24. Research has so far proved only that personality probably plays an important role in determining our health status.