Type A as a Coping Career — Toward a Conceptual and Methodological Redefinition

Abstract

The conceptualization and measurement of human behavior, which takes into account its variability as well as its interaction with powerful social settings, is an extremely difficult scientific enterprise. In the light of these obstacles, research on Type A behavior pattern (TABP) in its relation to premature manifestation of ischemic heart disease (IHD) must be judged as successful. This holds true despite the fact that new prospective epidemiological studies fail to replicate adequately earlier findings (Shekelle et al. 1983; Ruberman et al. 1984), and despite the fact that the pathophysiology of TABP is still controversial (Dembroski et al. 1983). The focus of shared knowledge created by research on TABP is impressive, and it is evident that certain components or elements in the TABP must be of critical importance for a premature cardiovascular vulnerability to exist. One may argue that the strength of the original concept was in its operational simplicity, as expressed in direct behavioral assessment. On the other hand, theoretical clarification of what is considered “stressful” in TABP has so far been insufficient. At this point, virtually all analyses refer to “enhanced adrenergic activity” or “increased sympathetic arousal” without specifying the different cognitive and emotional concomitants which modulate their neural and neurohumoral consequences. It seems appropriate to re-open the conceptual and methodological discussion on the stressful aspects of TABP. In this framework, we would like to present a condensed version of our work in this field, which has been accumulated over the last 5 years.