There is still no entirely satisfactory explanation on the conflicting data produced on the pathogenic nature of the Type A behaviour pattern (TABP). Several problems have compounded a clear-cut explanation on the association between the TABP and risk of coronary heart disease (CHD). For example, concerns have been raised on the use of clinical samples or high-risk groups to establish the predictive effect of the TABP on CHD (Miller, Turner, Tindale, Posavac, & Dugoni, 1991). In addition to these problems, a host of other issues have been raised in relation to the contradictory findings (Matthews, 1988). For example, the socio-demographic variables such as level of education, job status, and gender may mediate the strength of the association between the TABP and CHD (Rosenman, 1986), or the TABP may only predict some manifestations of CHD such as angina pectoris and not myocardial infarction (Ragland & Brand, 1988).
In the efforts to clarify these conflicting data, several possibilities were considered. Attempts at isolating individual components of the TABP to identify its most toxic element represents one such possibility in research on TABP and its pathogenic nature. Some researchers questioned if components of the TABP are responsible for CHD instead of the Global Type A (Thoresen & Powell, 1992). Studies have focused on some components of the TABP such as chronic anger and hostility (Kneip, Delamater, Ismond, Milford, Salvia, & Schwartz, 1993), time urgency (Mueser, Yarnold, & Bryant, 1987), and expressive vocal behaviour (Siegman, Feldstein, Tomasso, Ringel, & Lating, 1987) as potential toxic elements of this pattern of behaviour. One component of the TABP, namely hostility, has been extensively investigated compared to these other components combined.
Friedman and Rosenman (1974) first described hostility as a component of the TABP. It was later isolated as a potential pathogenic element of the TABP by Williams and colleagues (Williams, Haney, Lee, Kong, Blumenthal, & Whalen, 1980). Both persuasive and conflicting evidence have emerged on the risk attributed to hostility (Julkunen, Idampaan-Heikkila, & Saarinen, 1993). Booth-Kewley and Friedman (1987) in a meta-analysis concluded that, anger, hostility, and depression emerged as the strongest predictors of CHD compared to other components of the Type A behaviour. A re-analysis of data from the Western Collaborative Group Study further re-affirmed that hostility was linked with the incidence CHD (Hecker, Chesney, Black, & Frautschi, 1988). Part of the results in the Framingham study also showed that “anger-in” (not discussing or expressing anger) was predictive of CHD in both men and women, and this association was independent of the influence of the TABP (Haynes, Feinleib, & Kannel, 1980). Hostility was reported as a significant predictor of the incidence of CHD in 255 physicians studied over a period of 25 years (Barefoot, Dahlstrom, & Williams, 1983). This prospective evidence led to the conclusion that hostility appeared to exert some sort of pathogenic influence on major coronary events.
Some studies have, however, failed to confirm the positive link between hostility and the risk of CHD (Seeman & Syme, 1987). Evidence questioning the pathogenic influence of hostility have been produced in some equally good methodologically designed studies. Barefoot et al. (1989) did not find any evidence confirming the Global Type A and hostility as predictors of non-fatal myocardial infarction. Siegman, Dembroski, and Ringel (1987) reported a negative association between hostility and severity of CHD in patients scheduled for coronary angiography.
Against the background of conflicting evidence produced on the TABP and its components, the potential interactive influence of a host of other environmental, cognitive, psychosocial, and physiological factors have been considered to resolve some of the issues surrounding the risk associated with the TABP and its components. One of those possibilities considered was the mediating effect of negative emotions such as depression and anxiety on the pathogenic nature of the TABP (Byrne & Rosenman, 1986). There is some evidence showing an association between the TABP and reported experiences of negative emotions (Byrne and Rosenman, 1986 and Jamal, 1990). Evidence produced on the association between the TABP and emotional distress have also raised one possibility that CHD risk associated with the TABP could be better explained by considering a confluence of psychosocial factors, and their potency on CHD (Byrne, 1996). This represented a major shift from the epidemiological models on the pathogenic nature of the TABP to more complex multidimensional approaches in assessing the risk associated with the Type A behaviour. The underlying view is that other psychosocial and physiological factors could be acting in concert with the TABP or its components to increase the construct's predictive power on the risk associated with CHD.
Empirical evidence does show an association between the possession of the TABP and experience of affective distress (Byrne & Reinhart, 1990). It is therefore possible that emotional distress could be acting in concert with the TABP or its components in explaining the risk association with CHD (Byrne, 1996). Given this possibility, the present study examined the relationship between expressions of the TABP and emotional distress.
