| dc.description | Medical interventions for preventing coronary heart disease (CHD) typically target traditional risk factors (e.g., cholesterol, blood-pressure or BP). As these risk factors partially predict CHD, medical interventions may only partially prevent CHD. Hostility, the tendency to behave antagonistically, think cynically and feel anger, predicts CHD independently of traditional risk factors, and better than the original "coronary-prone" Type-A behavioral pattern. Hostility is cross-sectionally and prospectively significantly related to CHD outcomes (e.g., myocardial infarction or MI). However, no psychological treatment focusing on hostility alone has been tested with CHD patients. Thus, the purposes of this research were to develop a brief, cognitive-behavioral hostility-treatment focusing on antagonism, cynicism and anger, and to test its efficacy at altering CHD-predictive hostility and CHD-related outcomes. Self-reported and observed hostility measures were employed in two single-blind, matched-randomized-controlled trials. In Study 1, 22 high-hostile healthy males were matched on age and hostility and then randomly assigned to the hostility-treatment (N = 11) or to an information control group (N = 11), After controlling for pre-treatment levels, subjects' group status accounted for an additional and significant 19% and 28% of the variance in change scores of self-reported and observed hostility, respectively. Reactive-BP was not affected in the hypothesized manner. Study 2 replicated and extended Study 1 by including a two-month follow-up and CHD-related measures (e.g., resting-BP, quality of life), and by employing CHD patients. Twenty-two high-hostile CHD males were matched on age and hostility and then randomly assigned to the hostility-treatment (N = 10) or to a control group (N = 12). After controlling for pre-treatment levels, patients' group status accounted for an additional and significant 20% of the variance in change scores of self-reported hostility at post-treatment, and 18% of the variance in change scores of observed hostility at follow-up. At post-treatment only, a significantly lower percentage of treatment patients (10%) were hypertensives than controls (50%). Patients' group status accounted for an additional and significant 28% and 16% of the variance in increased life-satisfaction and reduced depression scores, respectively, and this was maintained at follow-up. Finally, reduction in hostility was significantly correlated with improvements in resting-BP, life-satisfaction and depression. In conclusion, the hostility treatment repeatedly reduced self-reported and observed CHD-predictive hostility, and positively affected resting-BP and quality of life. Evidence for causal relations between hostility and CHD-related measures support the etiological role of hostility in CHD. However, the samples were small and many statistical tests were conducted. Future trials with larger samples and long-term outcomes (e.g., MI) should test the treatment's preventative value. It is hypothesized that epinephrine may mediate the hostility-BP relation and that social support may mediate the hostility-quality of life relation. | en_US |
