486 Chapter
14
Health Psychology: Stress, Coping, and Well-Being
Type B behavior pattern is characterized by a patient, cooperative, noncompetitive,
and nonaggressive manner. It’s important to keep in mind that Type A and Type B
represent the ends of a continuum, and most people fall somewhere in between the
two endpoints. Few people are purely a Type A or a Type B.
The importance of the Type A behavior pattern lies in its links to coronary heart
disease. Men who display the Type A pattern develop coronary heart disease twice
as often and suffer signifi cantly more fatal heart attacks than those classifi ed as hav-
ing the Type B pattern. Moreover, the Type A pattern predicts who is going to develop
heart disease at least as well as—and independently of—any other single factor,
including age, blood pressure, smoking habits, and cholesterol levels in the body
(Rosenman et al., 1994; Wielgosz & Nolan, 2000; Beresnevaité, Taylor, & Bagby, 2007).
Hostility is the key component of the Type A behavior pattern that is related to
heart disease. Although competition, time urgency, and feelings of being driven may
produce stress and potentially other health and emotional problems, they aren’t
linked to coronary heart disease the way that hostility is (Williams et al., 2000; Boyle
et al., 2005; Ohira et al., 2007).
Why is hostility so toxic? The key reason is that hostility produces excessive
physiological arousal in stressful situations. That arousal, in turn, results in increased
production of the hormones epinephrine and norepinephrine as well as increases in
heart rate and blood pressure. Such an exaggerated physiological response ultimately
produces an increased incidence of coronary heart disease (Eaker et al., 2004; Dema-
ree & Everhart, 2004; Myrtek, 2007).
It’s important to keep in mind that not everyone who displays Type A behaviors
is destined to have coronary heart disease. For one thing, a fi rm association between
Type A behaviors and coronary heart disease has not been established for women;
most fi ndings pertain to males partly because until recently most research was done
on men. In addition, other types of negative emotions besides the hostility found in
Type A behavior appear to be related to heart attacks. For example, psychologist
Johan Denollet has found evidence that what he calls
Type D —for “distressed”—
behavior is linked to coronary heart disease. In this view, insecurity, anxiety, and the
negative outlook Type Ds display puts them at risk for repeated heart attacks (Denol-
let, 2005; Schiffer et al., 2005; Spindler et al., 2009).
Psychological Aspects of Cancer
Hardly any disease is feared more than cancer. Most people think of cancer in terms
of lingering pain, and being diagnosed with the disease is typically viewed as receiv-
ing a death sentence.
Although a diagnosis of cancer is not as grim as it once was—several kinds of
cancer have a high cure rate if detected early enough—cancer remains the second
leading cause of death after coronary heart disease. The precise trigger for the disease
is not well understood, but the process by which cancer spreads is straightforward.
Certain cells in the body become altered and multiply rapidly in an uncontrolled
fashion. As those cells grow, they form tumors; if left unchecked, the tumors suck
nutrients from healthy cells and body tissue and ultimately destroy the body’s abil-
ity to function properly.
Although the processes involved in the spread of cancer are basically physiolog-
ical, some research suggests that the emotional responses of cancer patients to their
disease may affect its course. For example, some fi ndings show that a “fi ghting
spirit” leads to better coping. On the other hand, there is little evidence that long-
term survival rates are better than for patients with a less positive attitude (Watson
et al., 1999; Rom, Miller, & Peluso, 2009).
Despite confl icting evidence, health psychologists believe that patients’ emotions
may at least partially determine the course of their disease. In the case of cancer, it
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