Stress Management for Type A Individuals

  • Ethel Roskies


Since 1976 my colleagues and I have been engaged in the paradoxical task of seeking to develop a treatment program for apparently healthy men. The individuals who are the target of our therapeutic efforts neither consider themselves sick nor are they so regarded by their families, co-workers, and even doctors. On the contrary, these men are so full of energy and activity that they give the impression of being super-healthy. Even a short interview reveals their mental alertness, emotional expressiveness, and rapid pace of thought and speech. Their ability to fulfill valued social roles is also noteworthy. All hold responsible managerial positions, and most add to their job demands a host of family obligations and community activities. In spite of these multiple pressures, there are remarkably few complaints of anxiety and depression. Some of the men go so far as to state that they thrive on challenge and tight deadlines—the more the better. Even when a man does experience malaise, be it in the form of tight shoulder muscles or difficulty in falling asleep, the usual tendency is to minimize the degree of discomfort and to accept it as a necessary part of the “stress of modern life.”


Coping Strategy Behavior Pattern Behavioral Medicine Stress Management Coronary Risk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ardlie, N. G., Glen, G., & Schwartz, C. J. Influence of catecholamines on nucleotide-induced platelet aggregation. Nature, 1966, 212, 415–417.PubMedCrossRefGoogle Scholar
  2. Bandura, A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 1977, 84, 191–215.PubMedCrossRefGoogle Scholar
  3. Benner, P., Roskies, E., & Lazarus, R. S. Stress and coping under extreme circumstances. In J. Dimsdale (Ed.), Survivors, victims and perpetrators. New York: Wiley, 1980.Google Scholar
  4. Bernstein, D. A., & Borkovec, T. D. Progressive relaxation training. Champaign, Ill.: Research Press, 1973.Google Scholar
  5. Blumenthal, J. A., Williams, R. B., Kong, Y., Thompson, L.W. Jenkins, C. D., & Roseman, R. H. Coronary-prone behavior and angiographically documented coronary disease. Circulation, 1978, 58, 634–639.PubMedCrossRefGoogle Scholar
  6. Blumenthal, J. A., Williams, R. S., Williams, R. B., & Wallace, A. G. Effects of exercise on the type A (coronary-prone) behavior pattern. Psychosomatic Medicine, 1979, 42, 583.Google Scholar
  7. Caffrey, B. Reliability and validity of personality and behavioral measures in a study of coronary heart disease. Journal of Chronic Diseases, 1968, 21, 191–204.PubMedCrossRefGoogle Scholar
  8. Cohen, J. B., Syme, S. L. Jenkins, C. D., Kagan, A., & Zyzanski, S J. Cultural context of type A behavior and risk for CHD: A study of Japanese-American males. Journal of Behavioral Medicine, 1979, 2, 374–384.CrossRefGoogle Scholar
  9. Dembroski, T. M., MacDougall, J. M., & Shields, J. L. Physiologic reactions to social challenge in persons evidencing the Type A coronary-prone behavior pattern. Journal of Human Stress, 1977, 3, 2–10.PubMedCrossRefGoogle Scholar
  10. Dembroski, T. M., MacDougall J. M., Shields J. L., Pettito J., & Lushene, R. Components of the Type A coronary-prone behavior pattern and cardiovascular responses to psychomotor performance challenge. Journal of Behavioral Medicine, 1978, 1, 159–176.PubMedCrossRefGoogle Scholar
  11. Dembroski, T. M., MacDougall J. M., Herd, J. A., & Shields, J. L. Effect of level of challenge on pressor and heart rate responses in Type A and B subjects. Journal of Applied Social Psychology, 1979, 9, 209–228.CrossRefGoogle Scholar
  12. Duguid, J. B. Thrombosis as a factor in the pathogenesis of coronary artherosclerosis. Journal of Pathology and Bacteriology, 1946, 58, 207–212.PubMedCrossRefGoogle Scholar
  13. Dunbar, H. F. Psychosomatic diagnosis. New York: Paul B. Hoeber, 1943.Google Scholar
  14. D’Zurilla, T. J., & Goldfried, M. R. Problem solving and behavior modification. Journal of Abnormal Psychology, 1971, 78, 107–126.PubMedCrossRefGoogle Scholar
  15. Ellis, A., & Grieger, R. (Eds.). Handbook of rational-emotive therapy. New York: Springer Publishing, 1977.Google Scholar
  16. Folkman, S., & Lazarus, R. S. An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 1980, 21, 219–239.PubMedCrossRefGoogle Scholar
  17. Franks, C. M., & Wilson, G. T. (Eds.). Annual review of behavior therapy: Theory and practice. New York: Brunner/Mazel, 1979.Google Scholar
  18. Friedman, M. Modifying “type A” behavior in heart attack patients. Primary Cardiology, 1978, 4, 9–13.Google Scholar
  19. Friedman, M. The modification of type A behavior in post-infarction patients. American Heart Journal, 1979, 97, 551–560.PubMedCrossRefGoogle Scholar
  20. Friedman, M., Byers, S. O., Diamant, J., & Rosenman, R. H. Plasma catecholamine response of coronary-prone subjects (Type A) to a specific challenge. Metabolism, 1975, 4, 205–210.CrossRefGoogle Scholar
  21. Gildea, E. Special features of personality which are common to certain psychosomatic disorders. Psychosomatic Medicine, 1949, 11, 273–277.PubMedGoogle Scholar
  22. Glass, D. C. Behavior patterns, stress and coronary disease. Hillsdale, N. J.: Lawrence Erlbaum, 1977.Google Scholar
  23. Glass, D. C., & Carver, C. S. Environmental stress and the type A response. In A. Baum & J. E. Singer (Eds.), Advances in environmental psychology (Vol. 2). Applications of personal control. Hillsdale, N.J.: Lawrence Erlbaum, 1980.Google Scholar
  24. Glass, D. C., Snyder, M. L., & Hollis, J. F. Time urgency and the type A coronary-prone behavior pattern. Journal of Applied Social Psychology, 1974, 4, 125–140.CrossRefGoogle Scholar
  25. Glass, D. C., Krakoff, L. R., Contrada, R., Hilton, W. F., Kehoe, K., Mannucci, E. G., Collins, C., Snow, B., & Elting, E. Effect of harassment and competition upon cardiovascular and catecholamine responses in type A and type B individuals. Psychophysiology, 1980, 17, 453–463.PubMedCrossRefGoogle Scholar
  26. Haynes, S. G., Feinleib, M., & Kannel, W. B. The relationship of psychosocial factors to coronary heart disease in the Framingham study: III. 8 year incidence of CHD. American Journal of Epidemiology, 1980, 111, 37–58.PubMedGoogle Scholar
  27. Howard, J. H., Cunningham, D. A., & Rechnitzer, P. A. Health patterns associated with Type A behavior: A managerial population. Journal of Human Stress, 1976, 2, 24–33.PubMedCrossRefGoogle Scholar
  28. Ilfeld, F. W. Coping styles of Chicago adults: Description. Journal of Human Stress, 1980, 6, 2–10.PubMedCrossRefGoogle Scholar
  29. Jacobson, E. Progressive relaxation (2nd ed.). Chicago: University of Chicago Press, 1938.Google Scholar
  30. Jenkins, C. D., Rosenman, R. H., & Friedman, M. Replicability of rating the coronary-prone behavior pattern. British Journal of Preventive and Social Medicine, 1968, 22, 16–22.PubMedGoogle Scholar
  31. Jenkins, C. D., Zyzanski, S. J., & Rosenman, R. H. Risk of new myocardial infarction in middle-aged men with manifest heart disease. Circulation, 1976, 53, 342–347.PubMedCrossRefGoogle Scholar
  32. Jenni, M. A., & Wollersheim, J. P. Cognitive therapy, stress management training and the Type A behavior pattern. Cognitive Therapy and Research, 1979, 3, 61–75.CrossRefGoogle Scholar
  33. Kemple, C. Rorschach method and psychosomatic diagnosis: Personality traits of patients with rheumatic disease, hypertension, cardiovascular disease, coronary occlusion and fracture. Psychosomatic Medicine, 1945, 7, 85–89.Google Scholar
  34. Krantz, D. S., Glass, D. C. & Snyder, M. L. Helplessness, stress level and the coronary-prone behavior pattern. Journal of Experimental Social Psychology, 1974, 19, 284–300.CrossRefGoogle Scholar
  35. Krantz, D. S., Sanmorco, M. I., Selvester, R. H., & Matthews, K. A. Psychological correlates of progression of atherosclerosis in men. Psychosomatic Medicine, 1979, 41, 467–476.PubMedGoogle Scholar
  36. Lazarus, R. S., Psychological stress and the coping process. New York: McGraw-Hill, 1966.Google Scholar
  37. Lazarus, R. S., & Launier, R. Stress-related transactions between person and environment. In L. A. Pervin & M. Lewis (Eds.), Perspectives in interactional psychology. New York: Plenum Press, 1978.Google Scholar
  38. Manuck, S. B., Craft, S. A., & Gold, K. J. Coronary-prone behavior pattern and cardiovascular response. Psychophysiology, 1978, 15, 403–411.PubMedCrossRefGoogle Scholar
  39. Maultsby, M., & Ellis, A. Techniques for using rational-emotive imagery. In A. Ellis & E. Abraham (Eds.), Brief psychotherapy in medical and health practice. New York: Springer Publishing, 1978.Google Scholar
  40. Meichenbaum, D. Cognitive behavior modification: An integrative approach. New York: Plenum Press, 1977.CrossRefGoogle Scholar
  41. Menninger, K. A., & Menninger, W. C. Psychoanalytic observations in cardiac disorders. American Heart Journal, 1936, 11, 10–26.CrossRefGoogle Scholar
  42. Mettlin, C. Occupational careers and the prevention of coronary-prone behavior. Social Science and Medicine, 1976, 10, 367–373.CrossRefGoogle Scholar
  43. Osier, W. Lectures on angina pectoris and allied states. New York: D. Appleton & Company Inc., 1892.Google Scholar
  44. Raab, W., Stark, E., MacMillan, W. H., & Grigee, W. R. Sympathetic origin and antiadrenergic prevention of stress-induced myocardial lesions. American Journal of Cardiology, 1961, 8, 203–211.PubMedCrossRefGoogle Scholar
  45. Raab, W., Chaplin, J. B., & Bajusz, E. Myocardial necroses produced in domesticated rats and in wild rats by sensory and emotional stresses. Proceedings of the Society of Experimental Biology and Medicine, 1964, 116, 665–669.CrossRefGoogle Scholar
  46. The Review Panel on Coronary-Prone Behavior and Coronary Heart Disease. Coronary-prone behavior and coronary heart disease: A critical review. Circulation, 1981, 63, 1199–1215.CrossRefGoogle Scholar
  47. Rosenman, R. H. The interview method of assessment of the coronary-prone behavior pattern. In T. M. Dembroski, S. M. Weiss, & J. L. Shields (Eds.), Proceedings of the forum on coronary-prone behavior. Washington, D. C.: Dept. of Health, Education and Welfare. Publication No. (NIH) 78-1451, 1977.Google Scholar
  48. Rosenman, R. H., & Friedman, M. Modifying Type A behaviour pattern. Journal of Psychosomatic Research, 1977, 21, 323–333.PubMedCrossRefGoogle Scholar
  49. Rosenman, R. H., Friedman, M., Straus, R., Wurm, M., Kositchek, R., Hahn, W., & Werthessen, N. T. A predictive study of coronary heart diesease: The Western Collaborative Group Study. Journal of the American Medical Association, 1964, 189, 15–22.PubMedCrossRefGoogle Scholar
  50. Rosenman, R. H., Brand, R.J. Jenkins, C. D., Friedman, M., Straus, R.,& Wurm, M. Coronary heart disease in the Western Collaborative Group Study: Final follow-up experience of 81/2 years. Journal of the American Medical Association, 1975, 233, 872–877.CrossRefGoogle Scholar
  51. Rosenman, R. H., Brand, R. J., Sholtz, R. I., & Friedman, M. Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study. American Journal of Cardiology, 1976, 37, 902–910.CrossRefGoogle Scholar
  52. Rosenstock, I. M. The Health Belief Model and preventive health behavior. Health Education Monographs, 1974, 2, 354–386.Google Scholar
  53. Roskies, E. Evaluating improvement in the coronary-prone (type A) behavior pattern. In D. J. Osborne, M. M. Gruneberg, & J. R. Eisler (Eds.), Research in psychology and medicine (Vol. 1). New York: Academic Press, 1979.Google Scholar
  54. Roskies, E. Consideration in developing a treatment program for the coronary prone (type A) behavior pattern. In P. Davidson & S. M. Davidson (Eds.), Behavioral medicine: Changing health lifestyles. New York: Brunner/Mazel, 1980.Google Scholar
  55. Roskies, E., & Avard, J. Teaching healthy managers to control their coronary-prone (type A) behavior. In K. Blakenstein & J. Polivy (Eds.), Self-control and self-modification of emotional behavior. New York: Plenum Press, 1982.Google Scholar
  56. Roskies, E., & Lazarus, R. S. Coping theory and the teaching of coping skills. In P. O. Davidson & S. M. Davidson (Eds.), Behavioral medicine: Changing health lifestyles. New York: Brunner/Mazel, 1980.Google Scholar
  57. Roskies, E., Spevack, M., Surkis, A., Cohen, C., & Gilman, S. Changing the coronary-prone (type A) behavior pattern in a non-clinical population. Journal of Behavioral Medicine, 1978, 1, 201–215.PubMedCrossRefGoogle Scholar
  58. Roskies, E., Kearney, H., Spevack, M., Surkis, A., Cohen, C., & Gilman, S. Generalizability and durability of treatment effects in an intervention program for coronary-prone (type A) managers. Journal of Behavioral Medicine, 1979, 2, 195–207.PubMedCrossRefGoogle Scholar
  59. Sackett, D. L., & Snow, J. C. The magnitude and measurement of compliance. In R. B. Haynes, D. W. Taylor, & D. L. Sackett (Eds.), Compliance in health care. Baltimore: Johns Hopkins University Press, 1979.Google Scholar
  60. Shapiro, A., Non-A, non-B types: A parable for behaviorists (Editorial). Psychosomatic Medicine, 1979, 41, 353–356.Google Scholar
  61. Shekelle, R. B., Schoenberger, J. A., & Stamler, J. Correlates of the JAS Type A behavior pattern score. Journal of Chronic Diseases, 1976, 29, 381–394.PubMedCrossRefGoogle Scholar
  62. Sigg, E. B. The pharmacological approaches to cardiac stress. In R. S. Eliot (Ed.), Stress and the heart. New York: Futura, 1974.Google Scholar
  63. Stuart, R. B. Paper presented at the annual meeting of the Association des Specialistes en Modification du Comportement, Moncton, New Brunswick, June 1974.Google Scholar
  64. Suinn, R. M. The cardiac stress management program for Type A patients. Cardiac Rehabilitation, 1975, 5, 13–15.Google Scholar
  65. Suinn, R. M., & Bloom, L. J. Anxiety management training for Pattern A behavior. Journal of Behavioral Medicine, 1978, 1, 25–37.PubMedCrossRefGoogle Scholar
  66. Theorell, T. Life events before and after the onset of a premature myocardial infarction. In B. S. Dohrenwend & B. P. Dohrenwend (Eds.), Stressful life events: Their nature and effects. New York: Wiley, 1974.Google Scholar
  67. Van Egeren, L. Social interactions, communications and the coronary-prone behavior pattern: A psychophysiological study. Psychosomatic Medicine, 1979, 41, 2–18.PubMedGoogle Scholar
  68. Waldron, I. Sex differences in the coronary-prone pattern. In T. M. Dembroski, S. M. Weiss, & J. L. Shields (Eds.), Proceedings of the forum on coronary-prone behavior. Washington, D.C.: Dept. of Health, Education and Welfare. Publication No. (NIH) 78-1451, 1977.Google Scholar
  69. Waldron, I., Zyzanski, S. J., Shekelle, R. B., Jenkins, C. D., & Tannenbaum, S. The coronary-prone behavior pattern in employed men and women. Journal of Human Stress, 1977, 3, 2–19.PubMedCrossRefGoogle Scholar
  70. Warrenburg, S., Pagano, R. R., Woods, M., & Hlastala, M. A comparison of somatic relaxation and EEG activity in classical progressive relaxation and transcendental meditation. Journal of Behavioral Medicine, 1980, 3, 73–93.PubMedCrossRefGoogle Scholar
  71. Zyzanski, S. J. Associations of the coronary-prone behavior pattern. In T. M. Dembroski, S. M. Weiss, & J. L. Shields (Eds.), Proceedings of the forum on coronary-prone behavior. Washington, D.C.: Dept. of Health, Education and Welfare. Publication No (NIH) 78-1451, 1977.Google Scholar
  72. Zyzanski, S. J., Jenkins, C. D., Ryan, T. J., Flessas, A., & Everist, M. Psychological correlates of coronary angiographic findings. Archives of Internal Medicine, 1976, 136, 1234–1237.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Ethel Roskies
    • 1
  1. 1.Department of PsychologyUniversity of MontrealMontrealCanada

Personalised recommendations