Anger expression, hostility, anxiety, and patterns of cardiac reactivity to stress.

The majority of studies investigating the relationships between psychological characteristics and cardiovascular reactivity to stress use a research strategy in which discrete traits are evaluated in isolation. The present study examined the effects of additive and/or interactive relationships among traits on cardiac reactivity to a mental arithmetic task. In addition, impedance cardiographic techniques were employed to examine potential relationships between such psychological traits and a specific measure--pre-ejection period (PEP)--of sympathic influence on the heart. Forty-nine undergraduate men performed a mental arithmetic task while continuous measures of PEP and interbeat interval (IBI) were collected. The subjects then completed questionnaires measuring anger expression, hostility, and trait anxiety. Analyses of variance (ANOVAs) showed a significant main effect for anger-out on PEP change from baseline, but not for IBI. Results also showed that anger-in interacted with anger-out and hostility to affect both PEP and IBI changes significantly. Other results indicated that subjects in the high anger-in/low anger-out and high anger-in/low hostility groups did not show significant PEP change, although they nevertheless showed significant IBI change. These results highlight the importance of the consideration of interactions among traits in predicting cardiac reactivity and of the importance of measuring specific indexes of sympathetic arousal.     

Anger Management Style and Hostility: Predicting Symptom-Specific Physiological Reactivity Among Chronic Low Back Pain Patients

It was hypothesized that anger management style (anger-in or anger-out) and hostility affect the aggravation of chronic low back pain (CLBP) through symptom-specific (i.e., lower paraspinal muscle) reactivity during stress. Subjects were 102 CLBP patients who performed mental arithmetic and an Anger Recall Interview (ARI) while trapezius and lower paraspinal EMG, SBP, DBP, and HR were recorded. Results showed anger-in × hostility and anger-out × gender interactions for lower paraspinal but not trapezius reactivity, and only during the ARI. Further analyses revealed that (1) hostility was related positively to lower paraspinal reactivity among high anger suppressors, (2) hostility was related negatively to lower paraspinal reactivity among low anger suppressors, and (3) anger expression was related positively to lower paraspinal reactivity only among men. Anger management style and hostility may contribute to the exacerbation of CLBP by influencing stress reactivity only in muscles near the site of pain or injury.     

Defensive hostility and anger expression: Relationship to additional heart rate reactivity during active coping

The main purpose of the present study was twofold: (a) to assess the relationship between defensive hostility (high hostility/high defensiveness) and additional heart rate reactivity during active coping and (b) to determine if the construct of anger-out might lend additional, sensitivity to the predictive power of the defensive hostility model. Forty individuals were randomly assigned to complete a mental arithmetic task with or without the threat of shock. Participants also completed the Cook-Medley Hostility Inventory (Ho), the Marlowe-Crowne Social Desirability Scale (MC), and the Spielberger Anger Expression Scale. Defensive hostile subjects (high Ho/high MC) were significantly more reactive than any other subgroup. In addition, the combination of low Ho/high anger-out scores yielded a subgroup significantly less reactive than any other subgroup. These findings clarify the complex relationship of hostility and cardiovascular reactivity.     

Interactive effects of traits,states, and gender on cardiovascular reactivity during different situations

Interactive effects of anger and anxiety traits, negative affect state, different situations, and gender on cardiovascular reactivity (CVR) to stress were examined. Subjects (91 men, 92 women) performed a reaction time task under either a Social Evaluation, a Harassment, or a Control condition; SBP, DBP, and HR were recorded continuously. Hierarchical multiple regressions revealed intricate interactions. The interaction of anger expression style and anger experience was significant only among men, such that anger suppressors with high trait anger showed the largest CVR of any group during Harassment; anger expressors exhibited generally high CVR across conditions. However, anger expression style and state negative affect interacted to affect CVR in both men and women. Finally, the fear of negative evaluation predicted elevated DBP responses only among men in the Social Evaluation condition. Results imply that the extent to which traits of anger and anxiety contribute to coronary risk may depend on interactions with other traits, gender, and the environment.     

Interaction of pentobarbital with gabaergic drugs acting on the Cl(-)-ATPase activity of the plasma membranes from bream brain (Abramis brama L.)

Single stress induces long-lasting changes in the hypothalamo-pituitary--adrenal (HPA) axis of adult animals. Selective oxytocin (OXT) receptor antagonist was administrated into the cerebroventricle of male rats to test its influence on plasma adrenocorticotropic hormone (ACTH) responses induced by immobilization stress. The ACTH level is significantly higher than the control level (P<0.05) up to 6 days after single stress. Although the OXT antagonist did not change the plasma ACTH level at the end of single stress (P=0.59), the antagonist significantly decreased the ACTH concentration at the end of repeated (3 days) stress and 2 days after single stress (P<0.05) compared with controls. The results suggest that endogenous brain OXT enhances the long-lasting but not immediate HPA axis response to stress.     

Hormonal and behavioral responses to stress in lactating and non-lactating female common marmosets (Callithrix jacchus)

In several mammalian species, hypothalamic-pituitary-adrenal (HPA) and behavioral responses to stressors are down-regulated in lactating females, possibly preventing stress-induced disruptions of maternal care. Experimental elevations of HPA axis hormones have been found to inhibit maternal behavior in lactating common marmoset monkeys (Callithrix jacchus), raising the question of whether lactating female marmosets also have blunted endogenous responses to stress. Therefore, we compared HPA and behavioral responses to standardized stressors in reproductively experienced female common marmosets that were undergoing ovulatory cycles and that either were (N = 7) or were not lactating (N = 8). Each marmoset underwent (1) a restraint stressor during the early follicular phase of the ovarian cycle (approximately 5 weeks postpartum for lactating females) and (2) exposure to a simulated hawk predator during the early to mid-luteal phase (approximately 7 weeks postpartum for lactating females). Lactating females were tested in the presence of one of their infants. Blood samples were collected before, during, and immediately after each test for determination of plasma adrenocorticotropic hormone (ACTH) and cortisol concentrations. Both stressors caused significant elevations in plasma ACTH and cortisol levels, and significant decreases in cortisol:ACTH ratios; however, lactating and non-lactating females showed no significant differences in their endocrine or behavioral responses to either stressor, or in baseline ACTH or cortisol levels. These findings suggest that in contrast to several other mammalian species, lactating female marmosets maintain full behavioral and HPA responsiveness to stress, at least in the presence of their infants.     

Cardiovascular and endocrine reactivity in older females: intertask consistency

Age-related structural and functional changes in the cardiovascular, sympathoadrenomedullary (SAM), and hypothalamic-pituitary-adrenocortical (HPA) systems may affect the ability to reliably identify individual differences in response to stress. Heart rate, preejection period, respiratory sinus arrhythmia, respiratory rate, norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol were assessed in 64 healthy older women (mean = 67 years) in response to a mental arithmetic and public-speaking task. All cardiovascular and endocrine measures changed significantly during the tasks. All measures were consistent across the two tasks (r(s)s = .50 to .97). Moreover, a majority of women in this sample exhibited cross-task consistency in the relative activation of the autonomic, SAM, and HPA systems (i.e., response profiles). Further research is recommended to examine the significance of consistent individual differences in response profile.     

The effects of Neuroticism and Extraversion on cardiovascular reactivity during a mental and an emotional stress task

Evidence suggests that physiological reactivity to mental and emotional stress may be influenced by personality traits.ObjectivesThis study aimed to examine the relationship between, emotionally based personality traits, Neuroticism (N) and Extraversion (E), and cardiovascular reactivity (CVR) during mental arithmetic (MA) and anger recall (AR).MethodsHeart rate, blood pressure, cardiac output and total peripheral resistance were measured in 114 Singaporean male patrol officers from the Singapore Police Force while they performed MA and AR tasks. N and E were assessed using the NEO PI-R.ResultsHigher N was associated with lower DBP and TPRI reactivity during MA as compared to lower N, but higher TPRI reactivity during AR. Lower E scores were associated with heightened CVR while higher E scores were associated with lower CVR. For SBP and HR, E was associated with a reduction in reactivity across tasks; whereas, for DBP and TPRI this reduction was found only during AR.ConclusionIn this population, N had differential effects on CVR depending upon the nature of the stress task, cognitive or emotional. However, higher E was consistently linked to lower CVR during stress tasks and appeared to influence how individuals express and cope with anger.     

Blunted cardiovascular reactions are a predictor of negative health outcomes: A prospective cohort study

The study examined whether cardiovascular responses to psychological stress tests predict future anxiety and depression scores 40‐months later. Hemodynamic measures were obtained from 102 healthy adults before, during and after mental arithmetic, a speech task, and a cold pressor task. The 14‐item Hospital Anxiety and Depression Scale was administered at initial testing and at 40‐months follow‐up. At initial testing analyses revealed that high anxiety symptoms were characterized by blunted cardiovascular reactions to acute mental stress, particularly mental arithmetic. Furthermore, after adjustment for baseline blood pressure (BP ), baseline anxiety levels and traditional risk factors, attenuated systolic BP responses to mental arithmetic were associated with future anxiety levels (ΔR ² = .055). These findings suggest that blunted cardiovascular reactions to stress may be an independent risk factor for future anxiety levels.     

Gender, anger expression style, and opportunity for anger release determine cardiovascular reaction to and recovery from anger provocation.

This study represents an extension of Hokanson's research, which showed that for men anger release after provocation tends to accelerate cardiovascular recovery. The objective of this study was to investigate how gender and habitual style for anger-in or anger-out behavior modulate the effect of anger provocation and release. Male and female subjects (N = 105) were classified as anger-in/anger-out only when a double criterion (i.e., self-report and peer evaluation) was satisfied. Following a state anger rating at pre-test, subjects were harassed during the performance of a 12-minute math task. After task completion, subjects were randomly assigned to one of two 10-minute recovery protocols a) having an opportunity to release negative affect, and b) not not having such an opportunity. All groups (including the anger-ins) that had an opportunity to express negative affect did in fact express similar levels of anger. Men reacted more strongly to the math task performed under anger provocation on all cardiovascular indices. Anger expression style as a trait-type disposition was important for the recovery process in women whereas the situational manipulation (i.e., the opportunity to release anger) had specific effects on the recovery process of men. Opportunity to release anger facilitated heart rate recovery (and to a lesser degree diastolic pressure recovery) in men but not in women. Women with anger-in tendencies on the other hand displayed better systolic pressure recovery than female anger-outs whereas no such effects were observed in men.     

Effects of anger/hostility, defensiveness, gender, and family history of hypertension on cardiovascular reactivity

In this study, we examined the combined effects of anger/hostility and defensiveness on reactivity to three stressors (math, handgrip, cold pressor) and how these effects are moderated by gender and family history of hypertension. The subjects were 209 college students. Low compared with high Spielberger anger-out scores were associated with greater diastolic blood pressure (DBP) reactivity in low-but not high-defensive women with a negative family history. High compared with low hostility scores were associated with greater heart rate reactivity in low-defensive men with an opposite effect in high-defensive men. Gender, family history, and defensiveness each affected differential DBP reactivity to the three tasks. Combined study of biological factors and coping styles can improve our understanding of cardiovascular reactivity and disease.     

Cardiovascular and neuroendocrine adjustment to public speaking and mental arithmetic stressors

In this study, we evaluated cardiovascular. neuroendocrine, and psychological adjustment to repeated presentations of a public speaking and a mental arithmetic task. Brief versions of mental arithmetic tasks have been used widely in previous reactivity studies, and growing attention to more socially salient tasks has led to the increased use of public speaking tasks. However, psychophysiological adjustment during extended and repeated exposure to these tasks has not been delineated. In the present study, 52 healthy men worked on three 8-min presentations of public speaking and of mental arithmetic in a repeated measure design. Both tasks produced substantial cardiovascular, adrenocorticotropic hormone, and cortisol responses; public speaking produced greater changes. Repeated presentations of public speaking produced a stable pattern of cardiac activation, whereas repetitions of the mental arithmetic initially produced large cardiac responses that changed to a more vascular tonus across task periods. Both tasks increased negative moods. However, correlations between the endocrine, cardiovascular, and negative moods were significant only during the public speaking stressor. The public speaking task is a socially relevant experimental protocol for studying reactivity in the laboratory setting and elicits relatively high, stable, and homogeneous responses.     

Forgiveness, physiological reactivity and health: the role of anger

Research has revealed that forgiveness may have beneficial effects for the forgiver's health. The present research explored whether reductions in anger underlie such effects, or whether forgiveness has beneficial health effects above and beyond the effects of decreasing anger. State and trait forgiveness were examined, along with styles of anger expression, for their relationship to physiological responses during recalled betrayal, and to self-reported health indices. State and trait forgiveness were negatively associated with anger-out; however, with one exception, no other styles of anger expression were linked with forgiveness. Both forgiveness and anger-out were associated with systolic blood pressure, heart rate and rate-pressure product. Partial correlations revealed that trait forgiveness accounted for significant variance in mean systolic blood pressure and rate-pressure product, and state forgiveness predicted mean heart rate, even after gender and anger-out had been controlled. On the other hand, anger-out fully mediated the trait forgiveness-heart rate and state forgiveness-rate pressure product effects. Trait forgiveness was significantly associated with fewer medications and less alcohol use, lower blood pressure and rate pressure product; state forgiveness was significantly associated with lower heart rate and fewer physical symptoms. Neither of these sets of findings were the result of decreased levels of anger-out being associated with forgiveness. These findings have important theoretical implications regarding the forgiveness-health link, suggesting that the benefits of forgiveness extend beyond the dissipation of anger.     

Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological,physiological, and pharmacological stimulation

OBJECTIVES: Subtle alterations of the hypothalamic-pituitary-adrenal (HPA) axis in chronic fatigue syndrome (CFS) have been proposed as a shared pathway linking numerous etiological and perpetuating processes with symptoms and observed physiological abnormalities. Because the HPA axis is involved in the adaptive responses to stress and CFS patients experience a worsening of symptoms after physical and psychological stress, we tested HPA axis functioning with three centrally acting stress tests. METHODS: We used two procedures mimicking real-life stressors and compared them with a standardized pharmacological neuroendocrine challenge test. CFS patients were compared with healthy control subjects regarding their cardiovascular and endocrine reactivity in a psychosocial stress test and a standardized exercise test, and their endocrine response in the insulin tolerance test (ITT). RESULTS: Controlling for possible confounding variables, we found significantly lower ACTH response levels in the psychosocial stress test and the exercise test, and significantly lower ACTH responses in the ITT, with no differences in plasma total cortisol responses. Also, salivary-free cortisol responses did not differ between the groups in the psychosocial stress test and the exercise test but were significantly higher for the CFS patients in the ITT. In all tests CFS patients had significantly reduced baseline ACTH levels. CONCLUSIONS: These results suggest that CFS patients are capable of mounting a sufficient cortisol response under different types of stress but that on a central level subtle dysregulations of the HPA axis exist.     

Cardiovascular Responses to the Combination of Caffeine and Mental Arithmetic, Cold Pressor, and Static Exercise Stressors

The present study examined cardiovascular responses to the combination of caffeine (250mg) and mental arithmetic, cold pressor, and static exercise stressors in 48 healthy males. Subjects were tested in a within-subject, placebo-controlled, double-blind design. Repeated measurements of heart rate, finger temperature, respiratory sinus arrhythmia, forearm blood flow, and blood pressure were obtained during a pre-drug resting baseline, a post-drug resting baseline, the three stressor tasks, and a recovery baseline. The primary analyses were 2(Drug) x 5(Period) x 6(Stress Order) MANCOVAs using pre-drug baseline values as covariates. Significant period main effects were observed for all measures. Significant drug main effects were observed for blood pressure, finger temperature, respiratory sinus arrhythmia, and forearm blood flow. The significant changes in blood pressure and finger temperature produced by caffeine combined in an additive fashion with the effects produced by the stressors. Significantly greater increases in forearm blood flow and heart rate during mental arithmetic on the caffeine day suggested a potentiation of sympathetic, beta-adrenergic activity. Questionnaires administered during baseline periods to assess psychological responses to stress and caffeine revealed a potentiation of anxiety and anger responses to stress on the caffeine day.     

Adult attachment representations predict cortisol and oxytocin responses to stress

There are many factors contributing to individual variations in the response to stressful experiences. The present study evaluated the patterns of stress responses according to attachment representations in 28 adults from a community sample, plus 46 subjects expected to be particularly sensitive to stress, having been exposed during childhood and/or adolescence to traumatizing events such as abuse or potentially lethal illnesses. Subjects were given the Adult Attachment Interview, which provides attachment classifications, and the Trier Social Stress Test (TSST), involving an experimental psychosocial challenge. Subjective responses to the TSST, as well as saliva samples (assayed for cortisol) and blood plasma samples (assayed for ACTH and oxytocin) were collected before, during and after the stress procedure. The stress responses presented specific patterns according to attachment classifications. Subjects with an autonomous attachment classification reported relatively low subjective stress, they presented a moderate response of the hypothalamic-pituitary-adrenal (HPA) axis (ACTH and cortisol), and a high level of oxytocin. Subjects with a dismissing classification reported a moderate subjective stress, they presented an elevated response of the HPA axis, and moderate levels of oxytocin. Subjects with a preoccupied classification presented moderate levels of subjective stress, and of HPA response, and a relatively low level of oxytocin. Finally, subjects with an unresolved classification reported elevated subjective stress; they presented a suppressed HPA response, and moderate levels of oxytocin. These data support the notion that attachment representations may affect stress responses, and suggest a specific role of oxytocin in both the attachment system and the stress system.     

Suppressed anger, evaluative threat, and cardiovascular reactivity: a tripartite profile approach.

Despite decades of theory and research implicating suppressed anger in the development of cardiovascular disorders involving cardiovascular reactivity (CVR), to date the theoretical components of low anger expression, guilt feelings over agonistic reactions, and defensive strivings to avoid social disapproval have not been used conjointly to profile suppressed anger for the prediction of CVR. The purpose of this study, then, was to cluster analyze measures of anger expression, hostility guilt, and social defensiveness to create a suppressed anger profile (low anger expression, high hostility guilt, high social defensiveness) and a non-suppressed profile from a sample of college males. Social evaluative threat may be a potent stressor for people who defensively suppress anger expression. Thus, to examine the combined effects of suppressed anger and social evaluative threat, participants, prior to telling a story to a Thematic Apperception Card (TAT), were randomly assigned to either a high-threat (story will be compared to stories created by the mentally ill) or a low-threat condition (story used to study effects of talking on cardiovascular responses). Blood pressure (BP) and heart rate (HR) were monitored during a rest period and the subsequent TAT card period. As predicted, suppressed anger males in the high-threat condition showed the highest levels of diastolic BP and HR change from the rest period. The suppressed anger group's systolic BP reactivity was independent of threat manipulation. Research implications are discussed.     

An investigation of the effects of maternal separation and novelty on central mechanisms mediating pituitary-adrenal activity in infant guinea pigs (Cavia porcellus)

In mammalian species in which the young exhibit a strong filial attachment (e.g., monkeys, guinea pigs), numerous studies have shown that even brief separation from the attachment figure potently elevates circulating concentrations of glucocorticoids and adrenocorticotropic hormone (ACTH). However, effects of separation on central regulation of this stress response are not known. Therefore, we investigated central mechanisms mediating pituitary-adrenal activation during maternal separation and novelty exposure in guinea pig (Cavia porcellus) pups. Corticotropin-releasing factor (CRF) mRNA expression in the hypothalamic paraventricular nucleus (PVN), and plasma cortisol and ACTH levels, were elevated only during separation in a novel environment. C-Fos activity was elevated in the medial amygdala (MeA) and reduced in the bed nucleus of the stria terminalis (BNST) during novelty exposure, regardless of separation. On the other hand, c-Fos activity was elevated in the PVN during separation, regardless of novelty exposure. These results demonstrate independent and combined effects of separation and novelty in regions of the guinea pig CNS that regulate pituitary-adrenal activity. Moreover, they suggest that a pathway from MeA to BNST to PVN mediates responses to novelty in the guinea pig pup, as in the adult rat, though inputs from other cell populations appear required to fully account for the HPA activity observed here.     

Anger Expression and Pain: An Overview of Findings and Possible Mechanisms

A tendency to manage anger via direct expression (anger-out) is increasingly recognized as influencing responses to pain. Elevated trait anger-out is associated with increased responsiveness to acute experimental and clinical pain stimuli, and is generally related to elevated chronic pain intensity in individuals with diverse pain conditions. Possible mechanisms for these links are explored, including negative affect, psychodynamics, central adipose tissue, symptom specific muscle reactivity, endogenous opioid dysfunction, and genetics. The opioid dysfunction hypothesis has some experimental support, and simultaneously can account for anger-out’s effects on both acute and chronic pain. Factors which may moderate the anger-out/pain link are described, including narcotic use, gender, and genetic polymorphisms. Pain exacerbating effects of trait anger-out are contrasted with the apparent pain inhibitory effects of behavioral anger expression exhibited in anger-provoking contexts. Conceptual issues related to the state versus trait effects of expressive anger regulation are discussed.