Sunday, August 21, 2005

British Journal of Medical Psychology (1980), 53, 181-186

DISSECTING THE A-B PERSONALITY TYPE


By J. J. Ray and R. Bozek

It is suggested that 'freneticism' might be an appropriate name for the type of personality said by Rosenman, Friedman and Jenkins to be at risk from coronary heart disease. In study 1 the measure of this personality type (the JAS) was given a uniform answer format and, as such, was found to give improved reliability. It was administered to a random postal sample of Australians. A short form of 24 items was also produced. In study 2 a similar sample received the 24-item form and scales to measure achievement motivation, dominance and extraversion. 'A' types were found to be very much achievement motivated and dominant. A factor analysis showed these two traits as the main components of the A-B concept with only a third factor of 'freneticism'. This factor was measured in a third study which showed that the factor could be used as a scale in its own right.


Jenkins, Rosenman, Friedman and their associates (Jenkins et al., 1967, 1971; Zyzanski & Jenkins, 1970) have put forward the hypothesis that one of the important aetiological factors in coronary heart disease is the personality of the patient. They designate as 'A type' the personality most at risk.

The most important question to be asked about this hypothesis, of course, is whether such a personality does in fact provide the degree of prediction that the above authors claim. A prior question, however, has to do with elucidation of the hypothesis itself. What exactly does the A-B personality type consist of? What is it that the Jenkins Activity Survey (the proposed measuring instrument for the at-risk personality) is measuring? It is this question that is the concern of the present paper.

The label 'A type' (and its converse, 'B type') is, of course, deliberately uninformative. The underlying concept, however, would appear to concentrate on what one might call 'hard-driving-ness' -- particularly in relation to time. Friedman & Rosenman (1974, p. 67) define it as: 'Type A Behaviour Pattern is an action-emotion complex that can be observed in any person who is aggressively involved in a chronic, incessant struggle to achieve more and more in less and less time, and if required to do so, against the opposing efforts of other things or other persons.' Later (p. 70) the same authors say: 'Overwhelmingly, the most significant trait of the Type A man is his habitual sense of time urgency or 'hurry sickness'.' In general, then, if one had to find an ordinary English title for the A-B construct, one would perhaps choose 'freneticism' (from the adjective 'frenetic').

The one means so far used to measure this personality type is the Jenkins Activity Survey (JAS) in one of its various forms. Originally the instrument was designed to measure one continuous trait with high scorers termed type A and low scorers termed type B. Subsequently, the above-median scorers and below-median scorers were dichotomized further into A1, A2, B1 and B2 types. Also, factor analyses of the instrument showed that it could be conceived as measuring three fairly separate subfactors in addition to A-B type. The subfactors are: speed and impatience; job involvement and hard-driving-ness. In form the instrument is a behaviour inventory of generally around 60 questions. On some occasions, however, as few as 19 of these questions are used to score A-B type.

The instrument does have several features unusual in a personality scale: its items are a mixed set of Likert-type and forced-choice questions; it is very long and yet tends to have only minimal reliability (around 0.6); its conceptual identity is left vague and its possible relationship to standard psychological traits is not explored. Even in scoring the inventory, its authors took many years to rediscover to their 'chagrin' (Jenkins et al., 1971, p. 199) what Likert had discovered in the 1930s -- that weighted responses and unit-scored responses differ little in predictive power and reliability.

The purpose of the present paper, therefore, is to report the results of a program of research designed to: (1) shorten the JAS and improve its reliability; and (2) identify its relationship with conventional psychological trait measures. With regard to (1) above it should be noted that Shaw & Wright (1967) give 0.9 as the minimum reliability for a test designed to select out individuals for particular treatment and 0.75 as the minimum standard for a test used solely for research purposes. Although apparently used for both purposes, the JAS falls far short of even the lower standard. In Shaw & Wright's terms, it would appear to be only an instrument 'with possibilities for further development'.

Study 1

The JAS was included in a battery mailed out to a random sample of the population of the Australian State of New South Wales. The sample was drawn from the Australian electoral rolls. Electoral enrolment in Australia is compulsory not only for citizens but also for Australian resident citizens of other British Commonwealth countries. The sampling frame, therefore, is unusually comprehensive.

The questionnaire used included a two-paragraph preamble describing the purpose of the survey as: 'Research into how people see themselves and how they see their relationships with others'.

Of the 500 questionnaires sent out, a total of 122 were returned. A notable feature of the resulting sample was that the distribution of the four main demographic characteristics (age, sex, occupation and education) was not significantly different from that observed in contemporaneous random doorstep samples obtained in the Sydney metropolitan area. The postal interview technique did not therefore introduce any unusual biases as far as can be ascertained.

The 54-item version of the JAS was the one used but before inclusion, all items were recast into a uniform Likert format. Other scales included for the purpose of exploring possible relationships with the JAS were the Dominance scale from the Jackson (1967) PRF, the Ray (1976) 'Directiveness' scale (a scale of authoritarianism in behaviour inventory format), a short social desirability scale (Greenwald & Satow; 1970) and Eysenck's (1958) short scales of neuroticism and extraversion.

The reliability of the JAS and other scales was assessed by Cronbach's (1951) coefficient 'alpha'. This statistic is, of course, the mean of all possible split-half reliabilities and can be used as an estimate of test-retest reliability. Nunnally (1967, p. 210 ff.) however regards it as a superior statistic to the more easily understood reliability measures. Readers interested in a fuller discussion of the coefficient's meaning and use should refer to Nunnally's text.

The reliability observed for the JAS was, then, 0.76. This considerable rise over the levels reported earlier does hence suggest that the recasting of the scale into uniform Likert format was well worth while.

The correlations observed with other scales were: dominance 0.54, authoritarianism 0.44, extraversion 0.19, social desirability -0.18, neuroticism 0.02. All but the last are significant at the 0.05 level.

The JAS was then subjected to the automatic item analysis and deletion procedures of program ITRA (Ray, 1972). This produced a reduced 24-item version with a reliability of 0.77. The mean inter-item correlations of the shorter and longer versions of the scale were respectively 0.12 and 0.05. The two versions correlated 0.86. The correlations of the shorter version with other variables were: Dominance 0.42, authoritarianism 0.30, extraversion 0.20, social desirability -0.04 and neuroticism -0.02. The first three correlations are significant at the 0.05 level.


The implication of the correlations is that the 'A' type is dominant, authoritarian and (slightly) extraverted. He is not chronically anxious. These relationships are attenuated slightly with the shorter form of the scale even though it is more reliable. This indicates that the shorter scale has better claims to being a measure of a new and independent construct. The reduced openness of the shorter scale to dissimulation (social desirability responding) also seemed particularly worth while.
Study 2

This study was designed to cross-validate the new 24-item form of the scale. Would the 24 items work as well a second time around without the context of all the other items? Normally this is found to be so when a short form is produced (Ray, 1979), but it cannot of course be assumed.

Another question concerning the A-B construct that had not previously been examined was its relation to achievement motivation. Friedman & Rosenman (1974, p. 68) regarded achievement motivation as an unrelated construct on the grounds that one can be achievement motivated in a quiet as well as a hard-driving way, but the question would not appear to have been tested empirically. Many of the JAS items certainly appeared to embody the sort of sentiments normally associated with achievement motivation.

For the above reasons, then, a second battery was made up including the short A-B scale, the achievement motivation and dominance scales from the Jackson (1967) PRF, the two factors (impulsiveness and sociability) of extraversion according to Eysenck & Eysenck (1963) and the Bortner (1969) short A-B rating scale.

The Bortner scale was included because Jenkins at the time (personal communication) was recommending its use by researchers in lieu of the JAS until the JAS could be properly published.

Extraversion was measured by two scales on this occasion because the relationship observed in the first study appeared rather low given the nature of the A-B concept. It was thought that a break-up of extraversion into its main components might be more revealing. For this reason, the 10 highest loading items on each of Eysenck's two factors were used as scales.

The questionnaire embodying the above items was again administered by mail in exactly the same way (random sample without replacements) as in study 1 above. The resulting sample of 119 again showed a distribution of demographic characteristics similar to that observed in doorstep studies.

The reliability (alpha) of the short A-B scale dropped to 0.61 - a level similar to or below that reported by the original authors for their form of the scale.

In spite of the reduced reliability, the correlation with the Jackson Dominance scale remained similar to that observed previously -- 0.42; other correlations observed were achievement motivation 0.66, sociability 0.23, impulsiveness 0.10 and the Bortner rating scale 0.33. The Bortner scale itself showed a reliability of only 0.53. This very low reliability may be one reason why the Bortner scale does not show the correlations it should. If its own items correlate poorly among one another, not much can be expected of its correlation with other variables. It seems a pity that this feature of the Bortner scale has not previously been noted.

To allow for correlations between the other scales used to predict A-B score, a two-step multiple regression analysis was then carried out. Using first all four predictors (achievement motivation, dominance, sociability and impulsiveness) a multiple R of 0.70 was obtained with beta weights respectively of 0.601, 0.177, 0.044 and 0.127. In the second step, the lowest correlation predictor (impulsiveness) was deleted to give a multiple R of 0.69 with beta weights of 0.584, 0-185 and 0-063. The program used was MULTR from Cooley & Lohnes (1962). It will then be seen that the predictors explain just less than 50

per cent of the A-B variance. It must be realized, however, that much (though certainly not all) of the unexplained A-B scale variance will be 'error' variance and, as such, is by definition not predictable by any method. In the context of what is normally observed with psychological data, the R observed is, then, very high. Three predictors only explain most of what the A-B scale systematically measures.

As a further method of getting at what A-B items measure, it was felt that some analysis of latent structure was called for. The method chosen for this was McQuitty's (1961) 'Elementary factor analysis'. In spite of its name, this method is in fact a form of cluster analysis. Several writers have reported it as giving a more interpretable set of factors than orthodox factor analysis does (see the references summarized in Ray, 1973, and also Rump, 1974).

Two cluster analyses were, then, carried out -- an analysis of the scale scores and an analysis of the individual items scores. On the first analysis, all the scale scores (including A-B) were found to come out on the one first-order cluster. In the second analysis, there were three second-order clusters. The first two were clearly achievement motivation and dominance respectively. Both loaded almost all of the respective Jackson scale items as well as A-B items. The third cluster was more interesting. It was also rather clearly a true 'freneticism' cluster -- with most of its items coming from the A-B scale or the Eysenck 'impulsiveness' scale. It comprised 17 items - all worded in the 'A' direction.

The fact that the 'freneticism' cluster came third, however, indicates that it was extracted only after all the really strong relationships (correlation coefficients) in the matrix had been used. It not only contained fewest items but they were more poorly correlated among one another. This cluster does, then, have least importance in summarizing what the A-B scale measures.

Study 3

In this study an attempt was made to explore the further usability of the newly discovered 'freneticisrn' cluster. An attempt was made to explore its usability as a new scale in its own right. Although only the third and weakest element of the JAS, it did seem to be the one that came closest to what the original authors aspired to measure.

A third postal survey similar to the previous two was then carried out. As well as the 17 freneticism items it included scales to measure dominance (the Ray, 1976, 'Directiveness' scale) and 'psychoticism' (Eysenck & Eysenck's, 1976, P scale). The former was included to preserve some point of contact with the previous studies and the latter was included because of the similarity of many of its items to how the A-B type had originally been conceived. The following items, for instance might be noted: 'Do you like to arrive at appointments in plenty of time?'; 'Do people who drive carefully annoy you?'; 'When you catch a train, do you often arrive at the last minute?'; 'Do you stop to think things over before doing anything?' All these items come, not, as might be imagined, from the freneticism or A-B scales but from the Eysenck P scale. The P scale does however contain many other items not so obviously related to the personality type or types being considered here. The implication, however, would be that these other items may correlate with the 'coronary' personality. In Eysenck's terms, then, we are exploring the possibility that the frenetic man may be 'psychotic'. The caveat must however be entered that Eysenck's use of the term 'psychotic' seems to differ somewhat from normal clinical parlance.

Again 500 questionnaires were sent out randomly. This time, however, 140 were returned. Again the demographic structure of the resulting sample was indistinguishable from that observed in contemporaneous doorstep samples.

Item analyses indicated that seven of the 17 freneticism items were not correlating significantly with the total score on the scale. They were therefore discarded to leave a 10-item scale with a coefficient 'alpha' (Cronbach. 1951) reliability of 0.71. A list of these items is given in the Appendix. A reliability of 0.71 is not sufficient for use in selecting out individuals for treatment but it does provide a preliminary research instrument. It may be noted that although it is much shorter than the JAS, it is apparently more reliable.

The new freneticism scale, then, correlated 0.230 with psychoticism and 0.112 with directiveness. Its mean was 27.35 (SD 5.73). It was thus shown to be independent of the dominance component that had so permeated the JAS but was somewhat similar to what the Eysenck P scale measured. With the given n, the critical level of the correlation coefficient for significance at the 0.05 level was 0.165.

Study 4*

In this study , it was desired to examine how the 10-item freneticism scale might function in routine clinical use. For this purpose, it was included in a questionnaire administered to several weeks' intake of patients at the Sydney Coronary Heart Disease Prevention Programme. Based on the responses of 201 people, the reliability of the scale was found to be 0.65. This indicates that the third 'component' of the A-B scale is no more satisfactory than the A-B scale itself as far as reliability is concerned.

Discussion

It has been shown that Friedman & Rosenman (1974) erred badly in believing their
construct to be unrelated to ambition. The correlation between A-B and achievement motivation is in fact among the higher ones to be found in the psychological literature.

In fact, one must ask whether the A-B scale is measuring anything other than achievement motivation and dominance. Certainly we cannot tell just what component of the A-B scale is providing the prediction of cardiac risk. Perhaps it is the achievement motivation component alone. If this is so, the whole effort of producing a new scale was rather uneconomical.

Aside from its conceptual impurity, there are, of course, also good psychometric reasons why the A-B scale should not continue to be used for predictive tasks. Even in its 54-item Likert form, the JAS shows a quite poor degree of internal consistency. Although a reliability of above 0.7 is an improvement on a reliability of above 0.6, it still corresponds to an average correlation between all the items of 0.05. This again suggests strongly that the A-B scale is not, as its authors claim, measuring a single trait or construct. Nor does the 24-item version of the scale when administered independently of the original much improve on this. The mean r in that case was only 0.06. Even the Bortner scale was only a slight improvement over this -- a mean r of 0.08.

Future research directed towards cardiac risk prediction, then, can surely no longer use the single confounded measure provided by the JAS. Instead, at least two scales should be used to measure its two main components separately. For both these components -- achievement motivation and dominance -- there are already good scales available from the Jackson (1967) PRF.

Whether the third freneticism component is worth further examination must be a matter for individual judgement. It does seem that low reliability is an ineluctable aspect of anything uniquely associated with the A-B scale.

*The authors would like to thank Dr L. Simons, Senior Lecturer in Medicine, University of New South Wales, and director of the Sydney Coronary Heart Disease Prevention Programme, who made this study possible. Further details of the programme can be found in Simons & Jones (1978).


References



{Articles below by J.J. Ray can generally be accessed simply by clicking on the name of the article. I am however also gradually putting online a lot of abstracts, extracts and summaries from older articles by other authors so if an article not highlighted below seems of particular interest, clicking here or here might just save you a trip to the library}



BORTNER, R. W. (1969). A short rating scale as a potential measure of pattern A behaviour. Journal of Chronic Diseases, 22, 87-91.

COOLEY, W. W. & LOHNES, P. R. (1962). Multivariate Procedures for the Behavioural Sciences. New York: Wiley.

CRONBACH, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297-334.

EYSENCK, H. J. (1958). A short questionnaire for the measurement of two dimensions of personality. Journal of Applied Psychology, 42, 14-17.

EYSENCK, H. J. & EYSENCK, S. B. G. (1963). On the dual nature of extraversion. British Journal of Social and Clinical Psychology, 2, 46-55.

EYSENCK, H. J. & EYSENCK, S. B. G. (1976). Psychoticism as a Dimension of Personality. London: Hodder & Stoughton.

FRIEDMAN, M. & ROSENMAN, R. H. (1974). Type A Behaviour and your Heart. New York: Knopf.

GREENWALD, H. J. & SATOW, Y. (1970). A short social desirability scale. Psychological Reports, 27, 131-135.

JACKSON, D. N. (1967). Personality Research Form Manual. New York: Research Psychologists Press.

JENKINS, C. D., ROSENMAN, R. H. & FRIEDMAN, M. (1967). Development of an objective psychological test for the determination of the coronary-prone behaviour pattern in employed men. Journal of Chronic Diseases, 20, 371-379.

JENKINS, C. D., ZYZANSKI, S. J. & ROSENMAN, R. H. (1971). Progress towards validation of a computer-scored test for the type A coronary-prone
behaviour pattern. Psychosomatic Medicine, 33, 193-202.

MCQUITTY, L. C. (1961). Elementary factor analysis. Psychological Reports, 9, 71-78.

NUNNALLY, J. C. (1967). Psychometric Theory. New York: McGraw-Hill.

RAY, J.J. (1972) A new reliability maximization procedure for Likert scales. Australian Psychologist 7, 40-46.

RAY, J.J. (1973) Factor analysis and attitude scales. Australian & New Zealand Journal of Sociology 9(3), 11-13.

RAY, J.J. (1976) Do authoritarians hold authoritarian attitudes? Human Relations, 29, 307-325.

RAY, J.J. (1979) A quick measure of achievement motivation -- validated in Australia and reliable in Britain and South Africa. Australian Psychologist 14, 337-344.

RUMP, E. E. (1974). Cluster analysis of personal questionnaires compared with principal components analysis. British Journal of Social and Clinical Psychology, 13, 283-292.

SHAW, M. E. & WRIGHT, J. M. (1967). Scales for the measurement of attitudes. New York: McGraw-Hill.

SIMONS, L. A. & JONES, A. S. (1978). Coronary risk factor screening and long-term follow-up. Year one of the Sydney Coronary Heart Disease Prevention Programme. Medical Journal of Australia, 2, 455-458.

ZYZANSKI, S. J. & JENKINS, C. D. (1970). Basic dimensions within the coronary-prone behaviour pattern. Journal of Chronic Diseases, 22, 781-795.

Received 17 April 1979; revised version received 3 September 1979.

Requests for reprints should be addressed to Dr J. J. Ray, School of Sociology, University of New South Wales PO Box 1, Kensington, NSW, Australia 2033.

R. Bozek is at the same address.

Appendix

The items of the new freneticism scale. All items are answered 'Yes' (scored 3), '?' (scored 2) or 'No' (scored 1).

(1) Do you often long for excitement?
(2) Would you rate yourself as an impulsive individual?
(3) Would you be unhappy if you were prevented from making numerous social contacts?
(4) Do you often act on the spur of the moment without stopping to think?
(5) Do you often have trouble finding time to get your hair cut or styled?
(6) Do you often find yourself facing things such as: Unexpected changes, frequent interruptions, inconveniences and 'things going wrong'?
(7) Do you like to have many social engagements?
(8) Would people who know you well agree that you tend to do most things in a hurry?
(9) Would you do almost anything for a dare?
(10) Are you given to acting on impulses of the moment which later land you in difficulty?


POST-PUBLICATION ADDENDUM

Replication is one of the cornerstones of science. A new research result will normally require replication by later researchers before the truth and accuracy of the observation concerned is generally accepted. If a result is to be replicated, however, careful specification of the original research procedure is important.

In questionnaire research it has been my observation that the results are fairly robust as to questionnaire format. It is the content of the question that matters rather than how the question is presented. It is nonetheless obviously desirable for an attempted replication to follow the original procedure as closely as possible so I have given here samples of how I presented my questionnaires in most of the research I did.


FINIS

Thursday, August 18, 2005

British Journal of Medical Psychology, (1982), 55, 215-218.

IS AUTHORITARIANISM THE MAIN ELEMENT OF THE CORONARY-PRONE PERSONALITY?




By J. J. Ray and L. A. Simons

Clients at the Sydney Coronary Heart Disease Prevention Programme were screened for actual CHD and sufferers were compared with non-sufferers an four personality scales to measure respectively: A--B. dominance, achievement motivation and 'Freneticism'. There were 112 sufferers and 201 controls. Sufferers were found to have significantly higher scores an dominance -- the Ray (1976) Directiveness scale -- but also to have significantly lower scores on the A--B measure. This latter reversal of the usual relationship was an artifact of the fact that older people are both more CHD prone and get lower A-B scores. When age was controlled for there was no relationship between A-B type and CHD. This left the authoritarian style of dominance measured by the Directiveness scale as the sole predictor of CHD. This was held to be a belated vindication of claims made in the pioneering work of Dunbar (1943)


In their recent comprehensive review article, Matteson & Ivancevich (1980) report a strong preponderance of studies confirming that the A-B personality type is implicated in coronary heart disease. They also find several lacunae in the research to date. One of their concerns is that the nature and identity of the A-B construct have been insufficiently identified. In particular, how is it related to conventional psychological personality tests? Since their paper went to press a series of four studies addressed to just this question has been reported (Ray & Bozek, 1980). In this paper the Jenkins Activity Survey (one of the main measures of the A-B construct) was subjected to the sort of psychometric refinement usual in psychological test construction. The correlations of each item in the scale with the total score on the scale were calculated and only those items showing the highest correlation were retained -- thus leading to an improvement in scale reliability. It was also found that the items of this shortened scale clustered very clearly with items from two conventional psychological personality scales -- measuring respectively dominance and motivation to achievement. There was also a third unique component in the JAS tentatively labelled 'Freneticism' (from the adjective 'frenetic'). The question as to which of these three components might be providing the prediction of CHD (coronary heart disease) was left open. Are coronary-prone people dominant, ambitious, frenetic, or all three together? The present study was devised in the hope of throwing some light on this question.

One of the difficulties in ascertaining whether CHD victims are high on some attribute is to specify in relation to whom they may be considered high. In theory, of course, one wishes to compare them with the population norm, but this is a difficult parameter to derive. We cannot examine the whole population so we must use a sample of it. Yet most conventional sample types contain serious biases. Other hospital patients have some type of illness. People who respond to public calls to come forward, people who return mail questionnaires and people who cooperate with doorstep interviewers, are all minorities who might be quite unrepresentative of their less cooperative brethren. Particularly when it comes to questions measuring things like freneticism, dominance and ambition, volunteers must almost be expected to differ from non-volunteers.

In these difficult circumstances, the most common strategy adopted in past published research in this area has been to take same large available group that is hopefully not too unlike the general population and dissect it into those who have had CHD and those who have not. The non-victims can then act as a control group with which to compare the victims. It is then this pattern into which the present research falls. We examine not whether the CHD victims are high on some variable in relation to the general population but, rather whether they are high on the variable in relation to their non-victim controls. Such a study need not of course be retrospective but, as Matteson & lvancevich (1950) point out, most such studies have in fact been retrospective.

METHOD

The present work took advantage of the fact that there exists in Sydney, Australia, a voluntary public programme of screening for CHD risk factors which annually attracts around 10000 Australians from all walks of life. Details of the programme are available elsewhere (Simons & Jones, 1978). A small minority of screenees already have CHD. There is thus avaiIable a useful experimental and control-group situation.

A questionnaire was prepared which contained four personality self-report scales: the Ray ( 1976, 1980) 14-item Directiveness scale -- one of the dominance scales used in previously reported research (Ray & Bozek. 1980), the Ray (1979a) AO scale -- a 14-item scale also as used previously; the 10-item 'Freneticism' scale, produced and reported on as the third JAS component in Ray & Bozek (1980), and an 18-item short form of the JAS itself. This short form was a further reduction of the 24-item short form reported in Ray & Bozek (1980) based on the item analysis from the third study there reported. The further reduction was designed to increase reliability by deleting less central items. It may be noted that it is quite usual for only a small number of the full set of JAS items to be scored (Matteson & Ivancevich, 1980).

This questionnaire was administered to a standardization sample of the first two weeks' attenders at clinic and any actual CHD victims separated out. This gave a control group sample of 201 people. In subsequent weeks only CHD patients completed the questionnaire. Over a 12-month period a total of 112 questionnaires from actual CHD sufferers were accumulated.

Confirmation of the diagnosis of CHD (previous myocardial infarction or angina pectoris) was made by history and by assessment of the Rose & Blackburn (1968) Cardio-vascular Questionnaire.

RESULTS

Means and standard deviations for the two patient groups were calculated for each of the four scales. The means of only two scales differed significantly across the two groups. It was found that the CHD sufferers had significantly lower scores on the modified JAS (t = 2.29; p < .05) and significantly higher scores on the Directiveness scale (t = 3.05; p < 0.01). As in previous research it was also found that the JAS correlated significantly with scores on the Directiveness scale: 0.463 among the CHD cases and 0.358 among the controls.

The finding that the JAS correlates with CHD in the opposite direction to that usually reported seems at first odd but is in fact nothing more than an artifact of the correlation of the scale with age -- the one variable that does without dispute increase one's CHD risk. This is most clearly seen if the findings are re-expressed in terms of correlations -- with CHD incidence scored as a 'dummy' variable (0 for being in the control group; and 1 for being in the victim group). Among the 313 subjects we then find that the correlations with CHD are 0.173 for Directiveness, -.130 for the JAS and 0.488 for age. Age in turn correlates 0.013 with Directiveness and -.263 with the JAS. Age then is far and away the main variable predictive of CHD and, as one gets older, one gets lower scores on the JAS (i.e. one slows down). We must then control for age if we are to examine the true impact of the A-B variable alone. This is most easily done by means of partial correlation. When this is done we find that the correlation of the JAS with CHD drops to --0.002 -- totally non-significant. Directiveness score, on the other hand, is unaffected by age.

DISCUSSION

Although generically a dominance scale, the Directiveness scale was in fact written to measure the authoritarian style of dominance (Ray, 1976). It has in fact been used in a wide variety of studies of authoritarianism (e.g. Heaven, 1980; Ray, 1980). It differs from the California 'F' scale (Adorno et al., 1950) in that it is a good predictor of actual authoritarian behaviour (Ray. 1976). It is perhaps ironical that although Adorno et al in their pioneering work termed authoritarianism a disease, it was in fact a form of mental abnormality they had in mind. Just when this allegation has been fairly convincingly laid to rest (Masling, 1954: Roberts & Jessor, 1958; Elms, 1970: Richek et al., 1970: Crabbe. 1974; Ray. 1979b) it turns out that authoritarianism is in fact implicated in illness after all -- but illness of a physical kind.

It is not hard to surmise why authoritarianism might lead to heart disease. A life devoted to imposing one's own will on others must be one filled with all kinds of
stresses -- particularly emotional. Since the heart is automatically affected by many kinds of emotional stress, it is plausible to see it as just simply harder worked among authoritarians.

The failure of the JAS or any of its other 'components' to predict CHD is not of course new. In fact many researchers outside the Jenkins--Rosenman--Friedman-Zyzanski group report what Rime & Bonami (1979) politely call 'inconsistent' results in studies of the personality correlates of CHD. Where the American group reports CHD sufferers as very active, European studies in particular show some tendency to find precisely the opposite -- that CHD victims are particularly passive. Rime & Bonami have summarized some of the findings of this type and from their own work conclude that CHD victims are passive, dependent and ego-defensive. Siltanen et al. (1975) report similar findings for their group of 'mild' CHD sufferers.

The present findings do of course look as if they fit precisely in this 'European' mould if we look at the correlation between the JAS and CHD before controls for age are applied. This may suggest that the 'European' pattern of results is an artifact of failure to control for age also and that the real picture is simply one of no relationship.

In conclusion, then, it would appear that the JAS and the construct it measures (A-B) have been far too general and inclusive, and that where positive results have in the past been found it has been due to only one of the many components embedded in the larger measure -- and that component is authoritarianism. This does in fact constitute something of a belated vindication of the work of Dunbar (1943). In her pioneering work, Dunbar described the coronary personality as compulsive, dominating and aggressive. As Matteson & Ivancevich (1980) point out, this view has tended to lack current acceptance because of a variety of methodological problems in the original work. The present confirmation of Dunbar's theories from a quite different starting-point and a quite independent source must then be seen as giving them fresh claims to careful consideration. At the very least, the Directiveness scale would seem to have been given a strong claim for inclusion in future research into the personality precursors of CHD.

Acknowledgement

The authors would like to thank Robert Bozek for assistance with the earlier stages of this project.

REFERENCES

Adorno,T.W., Frenkel-Brunswik, E., Levinson, D.J. & Sanford, R.N. (1950). The authoritarian personality New York: Harper.

Crabbe, B.D. (1974) Are authoritarians sick? In J.J. Ray (Ed.) Conservatism as heresy. Sydney: ANZ Book Co.

Dunbar, F. (1943) Psychosomatic diagnosis. N.Y.: Hoeber Press.

Elms, A.C. (1970) Those little old ladies in tennis shoes are no nuttier than anyone else, it turns out. Psychology Today 3, 27-59.

Heaven, P.C.L. (1980) Authoritarianism, prejudice and alienation among Afrikaners. J. Social Psychology, 110, 39-42.

Masling, M. (1954) How neurotic is the authoritarian? J. Abnormal & Social Psychology 49, 316-318.

Matteson, M.T. & Ivancevich, J.M. (1980) The coronary-prone behavior pattern: A review and appraisal. Social Science & Medicine 14a, 337-351

Ray, J.J. (1976) Do authoritarians hold authoritarian attitudes? Human Relations, 29, 307-325.

Ray, J.J. (1979) A quick measure of achievement motivation -- validated in Australia and reliable in Britain and South Africa. Australian Psychologist 14, 337-344.

Ray, J.J. (1979) The authoritarian as measured by a personality scale Solid citizen or misfit? J. Clinical Psychology 35, 744-746.

Ray, J.J. (1980) Authoritarianism in California 30 years later -- with some cross-cultural comparisons. Journal of Social Psychology, 111, 9-17.

Ray, J.J. & Bozek, R.S. (1980) Dissecting the A-B personality type. British Journal of Medical Psychology 53, 181-186.

Richek, H. J., Mayo, C.D. & Puryear, H. B. (1970) Dogmatism, religiosity and mental health in college students. Mental Hygeine, 54, 572-574.

Rime, B. & Bonami, M. (1979) Overt and covert personality traits associated with coronary heart disease. British J. Medical Psychology 52, 77-84

Roberts, A. H. & Jessor, R. (1958) Authoritarianism, punitiveness and perceived social status. Journal of Abnormal and Social Psychology, 56, 311- 314.

Rose, G. A. & Blackburn, H. (1968). Cardiovascular Survey Methods. Geneva: WHO Monograph Series. no. 56.

Siltanen, P., Lauroma, M., Nirrko, O., Punsar, S., Pyorala, K., Tuominen, H. & Vanhala, K. (1975) Psychological characteristics related to coronary heart disease. J. Psychosomatic Research 19, 183-195.

Simons, L. A. & Jones, A. S. (1978). Coronary risk factor screening and long-term follow-up. Year One of the Sydney Coronary Heart Disease Prevention Programme. Medical Journal of Australia, 2, 455-- 455.



FINIS

Tuesday, August 16, 2005

British Journal of Medical Psychology (1984), 57, 385.

CONFUSIONS IN DEFINING 'A-B' PERSONALITY

TYPE: A rejoinder to Jenkins & Zyzanski





John J. Ray

Ray & Bozek (1980) suggested that the Jenkins Activity Survey or 'JAS' (for measuring A-B personality) contained items measuring three different qualities: dominance, achievement motivation and 'freneticism'. Although freneticism was found to be only a minor component of the JAS, it seems to correspond most closely to what the JAS is said to be measuring.

Jenkins & Zyzanski's (1982) reply to that paper suggests, however, vacillation over whether there is any such thing as a single 'A-type' at all. Although patients are assigned a single score representing their degree of 'A-ness', Jenkins & Zyzanski (1982, p. 219) say: 'We conceive of the type A behaviour pattern as a configuration of psychological traits involving independent components' (italics added). This is confusing. Is there one trait (A-ness) that predicts CHD (coronary heart disease) or are there several independent traits? If there are several independent traits should they not be described and studied separately? If they are independent, what might be true of the one might not be true of all. Only if they were related traits would it make sense to group them together. Is there, in fact, a 'Type A' personality?

I originally thought that the items of the JAS were designed to measure aspects of a single personality type (or 'behaviour pattern') called 'A-B' and therefore Studies II, III and IV of Ray & Bozek (1980) used only items which could be shown to be central to what the inventory as a whole was measuring. This practice was continued in Ray & Simons (1982), where only the 18 most discriminating items of the JAS were used. Jenkins & Zyzanski (1982), however, suggest that this shortening makes my results non-comparable with theirs. However, in their own work they have used many different forms of their inventory and usually score only 21 items to get the A-B score (see the JAS manual). Their practice gives the impression that satisfactory results are obtained with a wide variety of forms of the inventory. They mention that I did not use their weighting system to score each item but they fail to mention their own earlier finding (see Ray & Bozek, 1980) that unweighted additions of item scores give results that are indistinguishable from those derived by weighting formulas.

Using unit weights, therefore, I reprocessed the data from Study I of Ray & Bozek (1980) to score both the 21 items prescribed by the Jenkins group for measuring 'A-B' and the 18 items used by Ray & Simons (1982) to score 'A-B'. After attenuation correction, the two forms of the scale correlated + 1.00. Operationally, therefore, the concepts of 'A-B' used by me and by the Jenkins group are identical.

References

Jenkins, C. D. & Zyzanski, S. J. (1982). The type A behaviour pattern is alive and well - when not dissected: A reply. British Journal of Medical Psychology, 55, 219.

Ray, J.J. & Bozek, R.S. (1980) Dissecting the A-B personality type. British Journal of Medical Psychology 53, 181-186.

Ray, J.J. & Simons, L. (1982) Is authoritarianism the main element of the coronary-prone personality? British J. Medical Psychology
55, 215-218.



FINIS

Sunday, August 14, 2005

Personality Study and Group Behaviour, 1986, 6 (2), 1-7.

ALTERNATIVES TO THE A-B PERSONALITY CONCEPT IN PREDICTING CORONARY HEART DISEASE




J. J. Ray

University of N. S. W., Australia

Abstract

"A-type" personality is said to lead to coronary heart disease (CHD) yet even the authors of the concept admit that "A type" comprises several independent components. Generally, these components seem to be well-known psychological constructs (such as achievement motivation and aggression) but a fairly new construct which might be called "Freneticism" is also included. Freneticism (as measured by factors "S" of the Jenkins Activity Survey (JAS), does not however in fact seem to predict CHD. A reanalysis of the data from an Australian study by Ray & Simons was therefore carried out to see if something could be saved from the one genuine conceptual innovation falling under the "A-B" umbrella. After appropriate partial correlations were carried out to allow for correlations among the predictor variables, it was found that a new measure of freneticism independent of "A-B" (the Ray & Bozek scale) did provide a significant prediction of CHD. "A-B" score (derived from the JAS), however, was found to be a significant predictor of CHD only insofar as it measured an element of authoritarianism. There are thus two quite independent predictors of CHD -- authoritarianism and Freneticism. The A-B concept and the scale used to measure it (the JAS), however, have no useful role in either of them.


In 1979 Jenkins, Zyzanski & Rosenman (1979) published their manual for the ` "Jenkins Activity Survey" (or JAS) as the culmination of a research program that stretched back to at least 2O years earlier. The JAS was intended primarily as a measure of "A-B" -- a personality type (or, as they call it, a "behaviour pattern'') that has been claimed to be particularly common among sufferers from coronary heart disease (CHD). Since this commercial publication of the JAS in 1979, interest in the "A-B" concept appears to have become widespread among psychologists -- even among social psychologists (e, g. Mathews, 1982 and Strube, Turner, Patrick & Perillo, 1983). The interest of the concept now seems, in other words, to extend well beyond its original cardiological applications. Close attention to what the concept of "A-B" means and whether the JAS measures it is then well-warranted.

The term "A-B" seems to be used by its authors in two different ways (See Ray, 1984b). It can mean either whatever personality predisposes to CHD or a particular set of personality traits. In the first usage the theory "A-type personality leads to CHD" is no theory at all but merely a proposal for a definition. Usually, however, the term is used for a set of specifiable traits including achievement motivation, aggressiveness and hyperactivity. The theory "A-type personality leads to CHD" thus could be expanded to: "Aggressiveness, achievement motivation, hyperactivity (etc) lead to CHD''. Talk about "A-B" is thus in a sense superfluous. Should we not be examining whether individual traits within the set of A-B lead to CHD? Could It not be that measures that mix up achievement motivation, aggression and hyperactivity all in the one index might be providing a prediction of CHD solely because of one component in that index? Might it not be that aggression alone could account for the relationships observed ? A recent literature review (Diamond, 1981) suggests that it might.

If, then, aggression/hostility could alone account for much of the relationship between CHD and personality, where lies the usefulness of the "A-B" concept? Aggression and hostility are familiar concepts to psychologists and well-known measures of them have long been available. Why do we need either the concept of "A-B" or the inventory (the JAS) needed to measure it? One possible answer is that the definition of "A-B" includes one concept that is in fact relatively new to users of personality tests -- a concept that has to do with the way time is handled. Note the following descriptions of the "A-type" from Jenkins, Rosenman Et Zyzanski (1974) : "Time-urgency, acceleration of common activities, restlessness, feelings of struggle against the limitations of time". The Jenkins group do of course avoid providing a name for this component of "A-B" but for ease of reference we might perhaps call this component of the "A-type" personality "Freneticism". This then is one of the traits that is said to lead to CHD. This is obviously an hypothesis well worth examining. Unfortunately, it cannot be tested simply by using "A-8" scores from the JAS. "A-B" scores might predict CHD because of the other elements (such as aggression) that they contain. To test the freneticism hypothesis we need a separate freneticism measure. Such a measure is available. Jenkins, Zyzanski & Rosenman (1979) obtain from the JAS a factor-score labelled "S" (for "speed and Impatience") that should be adequate for the purpose. Unfortunately, in the studies they themselves list on p. 14 of their manual, factor "S" does not seem to predict CHD! The most original aspect of their theory appears therefore to be false.

Clearly, then, the days have passed when a single "A-B" score can be regarded as informative. What it measures is too multi-dimensional and some at least of the things it measures seem to be quite unrelated to CHD. Obviously, then, any relationship between "A-B" and other variables would be of uncertain implication. What is needed are studies which take the various proposed "components" of "A-B" separately and use different instruments to measure them. Two studies which did this were by Ray & Bozek (1980) and by Ray & Simons (1982). The first showed that what the JAS measured could be reduced to the familiar psychological constructs of dominance and achievement motivation plus a minor element of "Freneticism". The second study showed that of the three only aggressive dominance or "authoritarianism" (measured by the Ray (1976) "Directiveness" scale) predicted CHD. Thus most of what the Jenkins group have been measuring was found to be irrelevant to CHD. The finding with the "Directiveness" scale, it should be noted, does confirm Diamond's (1982) hypothesis that aggression is the central personality element in CHD prediction. As Heaven (1986) has shown, scales of dominance generally seem to measure a strong component of aggression as well as dominance per se.

A surprising and previously little-remarked feature of the Ray & Simons (1982) data, however, is that "A-B" was shown to be negligibly related to scores on the Ray & Bozek (1980) Freneticism scale. This suggests that either the JAS or the Ray & Bozek scale may be lacking in validity as measures of freneticism. Obviously, both cannot be measuring the same thing. See Ray (1984a). If we assume that it is the JAS that is providing a poor measure of "A-B", we are left with the interesting possibility that the theory put forward by the Jenkins group (concerning the involvement of freneticism in CHD) may simply not so far have been adequately tested. The consistent failures to confirm the theory may have been due to an inadequate measuring instrument. Clearly, alternative measures of freneticism should be tested tor their relationship with CHD.

The Jenkins group would no doubt wish to say again that the relationships with "A-B" reported in Ray & Simons (1982) and Ray (1984a) cannot be accepted because the selection of JAS items used by Ray & Simons (1982) to measure "A-B" is not exactly coterminous with any of the various selections of items that have been used by the Jenkins group from time to time. Ray (1984b) has however shown that the selection of items used in Ray & Simons (082) in fact correlates to the point of virtual identity with the selection currently favoured by Jenkins, Zyzanski & Rosenman (1979). This objection cannot therefore be used to deflect us from looking at the potential use of alternative measures of freneticism in CHD prediction.

METHOD

Following in the tradition of the many reanalyses of the "Framingham" and other data-bodies on CHD incidence, the simplest method of testing the possibility mentioned above seemed to be to carry out further analyses of the data described in Ray & Simons (1982) and Ray (1984a). These papers report a comparison of CHD sufferers and controls on a variety of personality tests and the Ray & Bozek (1980) Freneticism scale is one of those tests. The raw correlations between CHD incidence and personality variables reported in Ray (1984a) do not however tell us much by themselves because many of the predictor variables for CHD are themselves correlated. This must be allowed for in some way if fully informed conclusions are to be drawn.

The obvious confounding variable is age. Age is of course a strong independent predictor of CHD and also has effects on personality. It makes you slow down and thus get lower scores on measures of freneticism and "A-B". When therefore the influence of age is removed by partial correlation, the correlation of the JAS "A-B" score with CHD rises to .148. The correlation between CHD and the Ray & Bozek (1980) Freneticisrn scale also rises -- to .174. The Directiveness scale is not significantly correlated with age so there is no point in partial correlations for that variable. Since the level of the correlation required for significance (p <. 05) with the given N (313) is .113, it may be seen that the new analyses reported so far show in fact three scales which significantly predict CHD -- the JAS, the Ray & Bozek Freneticism scale and the Ray (1976) Directiveness scale. The claim by the Jenkins group that the JAS "A-B" score predicts "CHD" does therefore stand replicated and two new scales have been added to the predictor set. As the "A-B" score was however highly correlated with Directiveness and as the Directiveness scale is the better predictor of CHD (p < .05), it is appropriate to partial out Directiveness from the correlation between CHD and "A-B". When this is done; the correlation drops again to non-significance -- .076. Partialling out Directiveness from the correlation between CHD and Freneticism, however, leaves the correlation still significant -- at .147. Clearly, then it is the aggressive dominance component (the Directiveness component) of "A-B" which is providing the prediction of CHD. The Freneticism scale, however, is a separate predictor in its own right.

DISCUSSION

The new analyses of the Ray & Simons (1982) data have confirmed the disutility of using a single "A-B" score to predict CHD or, presumably, anything else. When separate scales are used to measure the main "components" of "A-B", it is found that there is not one personality type leading to CHD but rather two quite independent personality types -- freneticism and authoritarianism (the latter being here defined and measured as aggressive dominance). Nor can further use of the JAS be justified. The measures it provides (of "A-B" and "S") appear related to authoritarianism and freneticism but in neither case do they predict CHD as well. Even insofar as "A-B" does predict CHD, it is here shown that it does so only insofar as "A-B" contains an element of authoritarianism. "A-B" and the JAS fail, then, not only on grounds of conceptual clarity but also as empirical CHD predictors.

Paradoxically, rejection of the JAS as an adequate measure of coronary-prone personality leads to resurrection of one of the more dubious aspects of the Jenkins group theory -- the relationship between freneticism (their factor "S") and CHD. When a better measure of freneticism than the JAS can provide is used, support is found for the theory. Their theory is found to be better than their measuring instrument.

Perhaps the most revealing aspect of the Ray & Simons data, however, is traceable to the way relationships in it were analysed. The use of correlation coefficients reveals that even the highly significant relationships were of very low absolute magnitude. There are personality correlates of CHD but personality as a whole is a factor of negligible importance in CHD prediction.

REFERENCES

Diamond, E. L. (1982) The role of anger and hostility in essential hypertension and coronary heart disease. Psychological Bulletin 92, 410-433.

Heaven, P. C. L. (1986) Directiveness and dominance. Journal of Social Psychology 126 (2), 271-272.

Jenkins, C. D., Rosenman, R. H. & Zyzanski, S. J. (1974) Prediction of clinical coronary heart disease by a test for the coronary-prone behavior pattern. New England Journal of Medicine 290 (23), 1271-1275.

Jenkins, C. D., Zyzanski, S. J. & Rosenman, R. H. (1979) Jenkins activity survey form C. N.Y.: Psychological Corporation.

Matthews, K.A. (1982) Psychological perspectives on the Type A behavior pattern. Psychological Bulletin, 91, 293-323

Ray, J.J. (1976) Do authoritarians hold authoritarian attitudes? Human Relations, 29, 307-325.

Ray, J.J. (1984a) Authoritarianism, A-B personality and coronary heart disease: A correction. British Journal of Medical Psychology 57, 386.

Ray, J.J. (1984) Confusions in defining A-B personality type: A rejoinder to Jenkins & Zyzanski. British Journal of Medical Psychology 57, 385

Ray, J.J. & Bozek, R.S. (1980) Dissecting the A-B personality type. British Journal of Medical Psychology 53, 181-186.

Ray, J.J. & Simons, L. (1982) Is authoritarianism the main element of the coronary-prone personality? British J. Medical Psychology
55, 215-218.


Strube, M, J., Turner, C.W., Patrick, S. & Perillo, R. (1983) Type A and type B attentional responses to aesthetic stimuli: effects on mood and performance. Journal of Personality & Social Psychology 45, 1369-1379.


FINIS

Friday, August 12, 2005

"A-B" MAY NOT PREDICT HEART DISEASE BUT MANY OTHER SCALES DO: IS IT TIME TO ABANDON "A-B"?






J.J. Ray

University of N.S.W., Australia




Abstract

Although the various measures of "A-B" have now been shown to be seriously problematical and as generally not predicting coronary heart disease (CHD) this matters little as there are a large number of scales measuring other constructs which do predict CHD. Future research should therefore abandon the failed "A-B" concept and investigate more fully the alternative measures.




JAS or SI or neither?

Yarnold & Bryant (1988) are just one example of many authors who have recently commented on the now widely acknowledged failure (See e.g. Appels, Mulder & Van Houtem, 1985; Emara, El-Islam, Abu Dagga & Moussa, 1986; Ray, 1986; Jenkins, Rosenman & Zyzanski, 1974; Katz & Toben, 1986; Lelouch & Kornitzer, 1982; Linden, 1987; Matthews, 1982; Myrtek & Greenlee, 1984; Nanjundappa, Friis & Taladrid, 1987; Rosenman, 1978; Ruberman, Weinblatt, Goldberg & Chandbury, 1984; Shekelle, Hulley, Neaton et al, 1985; Young, Barboriak, Hoffman & Anderson, 1984) of the Jenkins Activity Survey or "JAS" (Jenkins, Zyzanski & Rosenman, 1979) to predict coronary heart disease (CHD) but who still, for all that, seem unable to let go of the "A-B" concept that the JAS claims to measure. Eysenck (1990) has a slightly different approach. He still uses "A-B" terminology to denote coronary-prone and non-coronary-prone personalities but gives a description of what those personalities are that is more in accord with the evidence than is the description offered by the Jenkins group.

The JAS is not, of course the only measure of "A-B" in the sense intended by the Jenkins group. The other main measure of "A-B" is the structured interview (or "SI"). The SI appears in some studies to have some correlation with CHD incidence but, as Yarnold & Bryant rightly point out, has other problems: notably difficulty of training raters, subjectivity of scoring and poor score reliability in various senses of that term. Yarnold & Bryant are particularly persuasive in noting that the SI can reasonably be administered only once to each subject because subjects tend to "wise up" after the first administration. This means that the reliability of the measure in what is arguably the most important sense of that term is in principle unknowable. From a psychometrician's point of view, therefore, it would be hard to imagine a worse measure of anything. Additionally, in view of its weak relationship with the JAS, the small predictive success of the SI could even be due its measuring things outside the "A-B" concept. In the circumstances, Yarnold & Bryant urge us not to "throw out the baby with the bathwater" and urge us to continue using the JAS but with extra precautions. It is my submission that there is no baby in the bathwater but that there are lots of interesting babies elsewhere.

The other "babies"

The measures that Yarnold & Bryant suggest to enable continued use of the JAS (such as using only extreme scores) are very limiting and, as such, have something of an air of the counsel of despair. Their comment that we need to develop better alternative measures to the JAS is also somewhat strange. The crucial fact that Yarnold & Bryant and many others seem oblivious of is that there are already many self- report personality scales in the literature which do predict CHD. The JAS is in fact unusual in not predicting CHD. This can perhaps most clearly be seen in Krug & Sherman (1977) -- who show that in two large studies ten out of the 16 scales in the 16PF differentiated CHD sufferers from non-sufferers. There is, therefore, no reason at all to persevere with any form of the failed "A-B" concept. As reviews of the literature made plain as long ago as 1982 (e.g. Diamond, 1982) various measures of aggression or hostility in particular are good predictors of CHD. Being aggressive or hostile takes its toll on the body in various ways and CHD is one of those ways. It may therefore be useful here to mention at least a small sample of the more recent findings to this effect. A brief look at predictive scales outside the aggression/hostility area will also be attempted.

Scales of aggression and hostility

Katz & Toben (1986) found that the JAS did not predict CHD symptomatology but the Novacco (1975) Anger scale did.

Eysenck (1990) reported a large prospective study in which it was found that an apparently unpublished scale of anger and excitement predicted a variety of adverse cardiac events.

Ray (1984b & 1986) found that the Ray (1976) Directiveness scale (measuring aggressive dominance) was the strongest of several predictors of CHD and that partialling out Directiveness from the small correlation between the JAS and CHD reduced that correlation to non-significance. Ray (1984b) used a simplified scoring system to get A-B score but Ray (1984a) showed that this scoring system and the standard scoring system give results that are essentially identical.

Smith, Follick & Korr, 1984) found that the frequency of anginal pains was predicted only by trait anger.

Rime & Bonami (1979) used mainly scales constructed by themselves for the occasion and reported five different personality predictors of CHD including their own scales measuring self-assertiveness and ego-defensiveness.

Van Dijl (1982) lists a 9-item scale of aggressiveness/ hostility which was found on several occasions to predict CHD.

Scales of other constructs: Eysenck's variables

Eysenck's two major personality variables (neuroticism and introversion. See e.g. Eysenck & Eysenck, 1969) have been implicated with CHD in a number of studies. Lelouch & Kornitzer (1982) found anomalous results with the Bortner (1969) scale of A-B but also found that the Eysenck N scale was the best predictor of CHD. More anxious persons suffered more CHD.

Drummond (1982) found that introversion predicted CHD symptomatology.

Siltanen, Lauroma, Nirrko, Punsar, Pyorala, Tuominen & Vanhala (1975) reported a study done in Finland wherein the scales used were especially constructed in Finnish. Their two best predictors of CHD, however, were "inhibition" followed by Neuroticism. If we identify "inhibition" with "introversion", we again have an indication of the relevance of Eysenck's variables.

Eysenck himself (Eysenck, 1990) has also discussed the relationship between adverse cardiac events and extraversion/neuroticism.

Freneticism

Although most of the content of the JAS can be traced to familiar personality variables such as dominance and achievement motivation (Ray & Bozek, 1980; Hansson, Hogan, Johnson & Schroeder, 1983), there is a small residue of reasonably unique items which load on what Jenkins, Zyzanski & Rosenman (1979) call the "Speed and Impatience" or SI factor. It is, in fact, this aspect of "A-B" that seems to be most stressed in discussions of what constitutes "A-B". Regrettably, even the JAS test manual (Jenkins et al, 1979) shows that this factor does not predict CHD. There is, however, another measure of SI which was in fact partly derived from the JAS. This scale (the Ray & Bozek, 1980, Freneticism scale) does predict CHD (Ray, 1986) when appropriate controls are applied. This tends to suggest that the Jenkins and Rosenman group had better clinical insights than scale -constructing skills. Their theory was partly right even if their measuring instruments were inadequate.

Conclusion

It is hoped that sufficient has been said to indicate that there are far more promising lines of enquiry to follow in investigating the personality correlates of CHD than anything offered by the various measures of A-B. Other readings that would give extra context to what has been said here are: Linden (1987); Dembroski, MacDougal, Herd & Shields (1979); Haynes & Matthews (1988); Wright (1985) and Booth- Kewley & Friedman (1987).


REFERENCES

Appels, A., Mulder, P. & Van Houtem, J. (1985) De validteit van de Jenkins Activity Survey, een vragenlijst ter meting van het type A gedrag. Nederlands Tijdschrift voor de Psychologie en haar Grensgebieden 40, 474-487.

Booth-Kewley, S. & Friedman, H.S. (1987) Psychological predictors of heart disease: A quantitative review. Psychological Bulletin 101, 343-362.

Dembroski, T.M., MacDougall, J.M., Herd, J.A. & Shields, J.L (1979) Effect of level of challenge on pressor and heart rate responses in Type A and B subjects. J. Applied Social Psychology 9, 209- 228.

Diamond, E.L. (1982) The role of anger and hostility in essential hypertension and coronary heart disease. Psychological Bulletin 92, 410-433.

Drummond, P.D. (1982) Personality traits in young males at risk for hypertension J. Psychosomatic Research 26, 585-589.

Emara, M.K., El-Islam, M.F, Abu Dagga, S.I. & Moussa, M.A. (1986) Type A behaviour in Arab patients with myocardial infarction. J. Psychosomatic Res. 30, 553-558.

Eysenck, H.J. & Eysenck, S.B.G. (1969) Personality structure and measurement. London: Routledge.

Hansson, R.O., Hogan, R., Johnson, J.A. & Schroeder, D. (1983) Disentangling Type A behavior: The roles of ambition, insensitivity and anxiety. J. Res. Personality 17, 186-197.

Haynes, S.G. & Matthews, K.A. (1988) Area review: Coronary prone behavior: Continuing evaluation of the concept. Annals of Behavioral Medicine 10, 47-59.

Jenkins, C.D., Rosenman, R.H. & Zyzanski, S.J. (1974) Prediction of clinical coronary heart disease by a test for the coronary prone behavior pattern. New England J. Medicine 290, 1271-1275

Jenkins, C.D., Zyzanski, S.J. & Rosenman, R.H. (1979) Jenkins Activity Survey manual N.Y.: Psychological Corp.

Katz, R.C. & Toben, T. (1986) The Novacco anger scale and Jenkins Activity Survey as predictors of cardiovascular reactivity. J. Psychopathology & Behavioral Assessment 8, 149-155

Krug, S.E. & Sherman, J.L. (1977) Psychological trait analysis in preventive medicine. Journal of IAPM Winter, 48-56.

Lelouch, M. & Kornitzer, M. (1982) Ischemic heart disease and psychological patterns. In: H. Denolin (Ed.) Psychological problems before and after myocardial infarction Basel: S. Karger

Linden, W. (1987) On the impending death of the type A construct: Or is there a phoenix rising from the ashes? Canadian J. Behavioural Science 19, 177-190.

Matthews, K.A. (1982) Psychological perspectives on the Type A behavior pattern. Psychological Bulletin 91, 293-323

Myrtek, M. & Greenlee, M.W. (1984) Psychophysiology of Type A behavior pattern: A critical analysis. J. Psychosomatic Res., 28, 455-466.

Nanjundappa, G., Friis, R. & Taladrid, B. (1987) Type A personality: Hispanic and Anglo diabetes and cardiovascular disease. International Migration Rev. 21, 643-655.

Ray, J.J. (1976) Do authoritarians hold authoritarian attitudes? Human Relations, 29, 307-325.

Ray, J.J. (1984a) Confusions in defining A-B personality type: A rejoinder to Jenkins & Zyzanski. British Journal of Medical Psychology 57, 385

Ray, J.J. (1984b) Authoritarianism, A-B personality and coronary heart disease: A correction. British Journal of Medical Psychology 57, 386.

Ray, J.J. (1986) Alternatives to the A-B personality concept in predicting coronary heart disease. Personality Study & Group Behaviour 6(2), 1-8.

Ray, J.J. & Bozek, R.S. (1980) Dissecting the A-B personality type. British Journal of Medical Psychology 53, 181-186.

Rime, B. & Bonami, M. (1979) Overt and covert personality traits associated with coronary heart disease. British J. Medical Psychology 52, 77-84

Rosenman, R.H. (1978) The interview method of assessment of the coronary-prone behavior pattern. In T.M. Dembroski, S.M. Weiss, J.L. Shields, S.G. Haynes & M. Feinleib (Eds.) Coronary-prone behavior N.Y.: Springer.

Ruberman, W., Weinblatt, E., Goldberg, D.D. & Chandbury, B. (1984) Psychosocial influence on mortality after myocardial infarction. New England J. Medicine 311, 552-559.

Shekelle, R.B., Hulley, S.B., Neaton, J.D. et al (1985) The MRFIT behavior pattern study III: Type A behavior and incidence of coronary heart disease. American J. Epidemiology 122, 559-570.

Smith, T.W., Follick, M.J. & Korr, K.S. (1984) Anger, neuroticism, Type A behaviour and the experience of angina. British J. Medical Psychol. 57, 249-252.

Van Dijl, H. (1982) Myocardial infarction patients and heightened aggressiveness/hostility. J. Psychosomatic Res. 26, 203-208.

Wright, L. (1985) The Type A behavior pattern and coronary artery disease. American Psychologist 43, 1-12.

Yarnold, P.R. & Bryant, F.B. (1988) A note on measurement issues in Type A research: Let's not throw out the baby with the bath water J. Personality Assessment 52, 410-419.

Young, L.D., Barboriak, J.J., Hoffman, R.G. & Anderson, A.J. (1984) Coronary-prone behavior attitudes in moderate to severe coronary artery occlusion J. Behavioral Medicine 7, 205-215


FINIS

Wednesday, August 10, 2005

British Journal of Medical Psychology 1990, 63, 287-288.
AUTHORITARIANISM AS A CAUSE OF HEART DISEASE: REPLY TO BYRNE, REINHART & HEAVEN



J.J. Ray

University of N.S.W., Australia



Abstract

Byrne, Reinhart & Heaven (1989) report a study which replicates many findings of the present author. They interpret their findings, however, to create the impression that they somehow undermine a theory advanced by the present author. Reasons for this are explored and important omissions are noted.




Byrne, Reinhart & Heaven (1989) have recently in this journal briefly surveyed my articles on the psychological precursors of coronary heart disease (CHD) with particular reference to my claim that the authoritarian personality (as I define it) is a major precursor of CHD. They sound a rather skeptical note about my (admittedly unusual) claim. As I have written a very large number of papers on authoritarianism, they could perhaps be forgiven the impression that I have something of a "bee in my bonnet" about the subject and tend to see authoritarianism "under every bed", as it were. To their credit, however, they do not confine themselves to skepticism but report a large new empirical study that replicates very well a large number of relationships that I have previously reported.

Their interpretation of their results is, however, a curious one. Instead of seeing their results as excellent confirmation for my various contentions, they somehow seem to think that they have shown something new or cast my theories into doubt. This seems to be traceable to a rather hasty reading of my work. They purport to test my theory but what they test is in fact their own transmogrified version of my theory. As an admittedly rather trivial instance of this, I have long argued (e.g. Ray, 1976, 1983 & 1984a) that the different senses of the term "authoritarian" must be distinguished and that authoritarianism of attitude, behaviour and personality may not necessarily be correlated or have similar correlates. These authors make much the same point but seem to think there is some originality in their doing so.

More importantly, however, where I claim a relationship between the authoritarian personality and CHD, what they test (in ostensibly testing my theories) is the relationship between authoritarianism of various types and the well-known A-B personality construct of Jenkins, Zyzanski & Rosenman (1979). It is almost as if they equate this dubious construct with proneness to CHD.

It is also curious that they seem to see their finding that authoritarian attitudes (as distinct from authoritarian personalities) do not predict CHD as somehow limiting my theory. They cite my paper (Ray, 1976) in which I claim that authoritarian attitudes are unrelated to the authoritarian personality but show remarkably little sign of having read it. Their findings, incidentally, confirm the said lack of
relationship.

They report a relationship between various measures of authoritarian personality and the A-B construct of generally around .4, which is very much what I had previously reported (Ray, 1984b) and note that, although this is suggestive, it still leaves most of the variance in A-B unexplained. They conclude that authoritarianism is not what underlies the A-B construct. Since I have never claimed that it did (I claimed that authoritarianism in the sense of "aggressive dominance" was the major psychological predictor of CHD), the importance of this
conclusion rather escapes me.

Most of what has been said so far, however, concerns really rather minor matters by comparison with their major omission: They failed to cite my paper (Ray, 1986) in which I show that it is precisely the overlap between A-B and the authoritarian personality (in the sense of aggressive dominance) that predicts CHD and that A-B must therefore hence be seen as only an early approximation to what predicts CHD. They omit to say that I have given precise empirical confirmation to my theory. They may not have succeeded in testing my theory but I have and what I found was that the relationship between CHD and A-B vanishes when controls for authoritarianism are applied. It is the "authoritarian" part of A-B which does the predicting of CHD. They could have discovered the same thing for themselves by doing a simple partial correlation from the matrix provided in Ray (1984b) but they did not.

It seems important that readers be alerted to the peculiarities of this paper.

REFERENCES

Byrne, D.G., Reinhart, M.I. & Heaven, P.C.L. (1989) Type A behaviour and the authoritarian personality. British J. Medical Psychology 62, 163-172.

Jenkins, C.D., Zyzanski, S.J. & Rosenman, R.H. (1979) Jenkins Activity Survey manual N.Y.: Psychological Corp.

Ray, J.J. (1976) Do authoritarians hold authoritarian attitudes? Human Relations, 29, 307-325.

Ray, J.J. (1984) Alternatives to the F scale in the measurement of authoritarianism: A catalog. Journal of Social Psychology, 122, 105-119.

Ray, J.J. (1984) Authoritarianism, A-B personality and coronary heart disease: A correction. British Journal of Medical Psychology 57, 386.

Ray, J.J. (1986) Alternatives to the A-B personality concept in predicting coronary heart disease. Personality Study & Group Behaviour 6(2), 1-8.

Saturday, August 06, 2005

British Journal of Medical Psychology 1991, 64, 85-90.


IF "A-B" DOES NOT PREDICT HEART DISEASE, WHY BOTHER WITH IT? A COMMENT ON IVANCEVICH & MATTESON



J.J. Ray

University of N.S.W., Australia


Abstract

A recent paper by Ivancevich & Matteson notes many problems with research into the "A-B" personality but recommends continued research into the construct. It is pointed out that these authors omit consideration of much of the relevant literature and that when the omitted work is included in consideration the "A-B" construct must be considered a false trail which should now be abandoned.


The "A-B" concept needs no overhaul?

A recent paper by Ivancevich & Matteson (1988) in this journal gives the appearance of assessing the current status of the findings with respect to the "Type A-B Behaviour Pattern" (TABP). The paper notes many problems with this field of research but concludes that "There is now growing acceptance of the proposition that a major overhaul in the TABP is not necessary or even feasible" (p. 37). I would like to submit that these authors were able to come to this conclusion only because they ignored a substantial part of the relevant literature. Sixteen adverse papers not cited.

I make no attempt to keep a complete file of references on "A-B". I would be photocopying a paper from almost every journal I pick up if I did. An examination of what was in even my limited files, however, turned up no less than 16 papers with conclusions adverse to the "A-B" hypothesis that Ivancevich & Matteson (1988) did not cite. Since Ivancevich & Matteson have some claim to being experts in this field (They have reviewed the "A-B" literature before. See Matteson & Ivancevich, 1980) this is rather surprising.

The "overlooked" papers that I have found are: Heilbrun, Palchanis & Friedberg (1986); Pickering (1985); Rime & Bonami (1979); Young, Barboriak, Hoffman & Anderson (1984); Katz & Toben (1986); Emara, El-Islam, Abu-Dagga & Moussa (1986); Hansson, Hogan, Johnson & Schroeder (1983); Ray & Bozek (1980); Ray & Simons (1982); Ray (1984 & 86); Lelouch & Kornitzer (1982); Davis & Cowles (1985); Appels, Mulder & Van Houtem (1985); Myrtek & Greenlee (1984) and Goldstein, Edelberg, Meier, Orzano & Blaufuss (1985).

There were also several similar papers that Ivancevich (1988) & Matteson would not have had available to them at the time they wrote: Linden (1987); Helmreich, Spence & Pred (1988); Nanjundappa, Friis & Taladrid (1987). Overall, this would suggest that a systematic review of the literature would yield many more such papers.

"A-B" a false trail

If the papers reviewed by Ivancevich & Matteson (1988) are supplemented by those listed above, I believe that we can only conclude that "A-B" was a classic false trail: There is a coronary-prone personality (i.e. aggression/hostility) but the most commonly used measure of "A-B" (the Jenkins, Zyzanski & Rosenman, 1979, "JAS") does not measure it. What it does measure is a confused mixture of traits that are best studied separately. Perhaps a brief look at what the "overlooked" references say will help substantiate this.

Goldstein, Edelberg, Meier, Orzano & Blaufuss (1985) studied two precursors of coronary heart disease (CHD) and found that one went with a high score on "A-B" while the other went with a low score. Myrtek & Greenlee (1984 p. 455) concluded: "No consistent differences on physiological measures could be found in our subjects based on behaviour type (according to SI or JAS criteria)". Appels, Mulder & Van Houtem (1985) reported that a 9.5 year prospective study of 2,750 older males found no association between JAS scores and CHD. Davis & Cowles (1985 p. 39) concluded: "A brief examination of methods of Type A personality assessment concludes that the use of the most popular technique (the student version of the Jenkins Activity Survey) and the majority of studies found in the recent literature will add little to our understanding of the aetiology of coronary heart disease". Lelouch & Kornitzer (1982) found a high prevalence of "A" types as measured by the Bortner scale in one population of CHD sufferers but a low proportion of them in two other populations of CHD sufferers. Emara, El-Islam, Abu Dagga & Moussa (1986) compared CHD sufferers with controls and found no differences on A-B. Katz & Toben (1986) found that the Novacco anger scale predicted CHD precursors while the JAS did not. Young, Barboriak, Hoffman & Anderson (1984) used a short parallel form of the JAS and found that it did not predict coronary artery occlusion. Rime & Bonami (1979) compared CHD sufferers with controls and found CHD suffers to be the more passive and dependant. This is very much the opposite of the description of the "A-Type".

Hansson, Hogan, Johnson & Schroeder (1983) and Ray & Bozek (1980) both factor-analyzed the JAS and found it mostly to be resolvable into familiar psychological constructs. Ray & Bozek (1980) factor analyzed it along with items from the Achievement Motivation and Dominance scales from the Jackson (1967) "PRF". Most "A-B" items loaded on the two factors defined by the two Jackson scales.

It may also be noted that Ray & Bozek found the Bortner (1969) scale to have an internal reliability of only .53. This contrasts with the assurance by Ivancevich & Matteson (1988) to the effect that the Bortner scale is one of those that "appear to have acceptable internal reliability" (p. 49).

Ray & Simons (1982) found that "A-B" did give a tiny prediction of CHD but that a scale measuring aggressive dominance was a better predictor. Jenkins & Zyzanski (1982) criticized the Ray & Bozek (1980) study mainly on the grounds that Ray & Bozek did not use the usual complex weighting formula for scoring the JAS items. Ray (1984) replied, pointing out that Jenkins & Zyzanski and their collaborators had themselves found that a non-weighting scheme worked better.

Ray (1986) reported analyses showing that the small degree of prediction of CHD furnished by "A-B" was due solely to the degree to which "A-B" included a component of aggressive dominance. Pickering (1985) found the results of studies of the association between "A-B" and coronary artery disease to be "confusing". Heilbrun, Palchanis & Friedberg (1986) noted that the JAS is a poor predictor of CHD and proposed that only a small sub-set of the JAS items are likely to be useful predictors. Nanjundappa, Friis & Taladrid (1987) found no effect of "A-B" on CHD. Linden (1987) argued "that the Type A coronary-prone behaviour pattern when seen as a global construct has lost its usefulness". Helmreich, Spence & Pred (1988) factor analyzed the JAS and found two factors of achievement striving (AS) and impatience and irritability (II). They found that AS correlated with academic achievement but II did not.

In the light of this list of findings, does it now seem reasonable to conclude that: "There is now a growing acceptance of the proposition that a major overhaul or change in the TABP is not necessary or even feasible"? Surely not.

(What is true is that psychologists very often use scales uncritically and the JAS is no exception to this. The vast majority of studies with the JAS treat it as some sort of "black box" with no thought as to what the items actually say or whether the scale is valid or not. For instance, Yarnold and his colleagues have published a profusion of papers (e.g. Yarnold & Grimm, 1986 and Yarnold, Mueser & Grimm, 1985) which proclaim that "A-B" gives some prediction of dominance in various situations. Since so many of the JAS items measure dominance, this is not much of a discovery).

Is a non-predictor of CHD important for other reasons? Ivancevich & Matteson (1988) do of course show some awareness of the sort of conclusions that are to be found in the "overlooked" papers. Such conclusions are so common that it would be hard not to. They note, for instance, that "The three subscales and the global score of the JAS are not predictive of CHD (Jenkins, Rosenman & Zyzanski, 1974)" (p. 49) and that the "psychometric properties of Type A measures are questionable in terms of reliability, validity and concordance" (p.52).

So what is going on in the Ivancevich & Matteson (1988) paper? What they seem to be saying is: "Maybe "A-B" has got nothing much to do with heart disease but it does correlate with a lot of other things so we should go on to find out why". This is, however, remarkably uninsightful thinking. If I put together a bunch of dominance items and a bunch of achievement motivation items and threw in some other assorted items for good measure, I too would have a scale that correlated with a lot of things. But what would be the point? I would be obscuring the truth, not revealing it. Yet what I have just proposed is a reasonable description of the JAS.

The particular admixture of items in the JAS was of interest only because it was said to correspond to the "coronary-prone personality". Since it does not, it loses that interest. It is true that not everything in the JAS corresponds with already familiar psychological traits. The SI (speed and impatience) subfactor was indeed fairly original and continued study of it by itself might be of continued interest. Even here, however, it might be noted that a simple and short alternative measure of the same construct is also available (the Ray & Bozek, 1980, "Freneticism" scale). Ironically, this scale does predict CHD in its own right (Ray, 1986).

Possible criticisms of this critique

It might be objected that some of the papers which I cite as detrimental to the A-B hypothesis are themselves in various ways flawed or not decisive in the conclusions they have drawn. For example, the paper by Appels et al which I cite was acknowledged by its authors to suffer from a weak methodology so its failure to find in favour of the A-B hypothesis could simply be due to that. Further, although Pickering (1985) found the association between A-B and CHD "confusing", he does propose a rationale that would reduce this confusion.

My reply to such an objection is twofold: Firstly, similar comments could be made about papers which appear to support the A-B hypothesis. For instance, Ivancevich & Matteson (1988) cite various studies which used the Bortner (1969) scale as a measure of A-B (e.g. the Belgian-French pooling project of 1984). Yet it was reported in this journal some time ago (Ray & Bozek, 1980) that this scale had an internal reliability of only .53 even in its original English-language form.

As some context to this, Shaw & Wright (1967) evaluated a large number of scales and concluded that .75 is the minimal level of reliability required in a research instrument and even regard the lower bound for the preliminary version of a research instrument as being .60. The Bortner scale, then, is even in English too multidimensional to be said to be a measure of anything. Since translated scales generally suffer a reliability decline that can be quite severe (Balakrishnan & Ray, 1986), the nature of the Bortner scale when translated into French can surely be imagined. It seems likely that it was little more than a random number generator.

One could go on in a similar vein at much length but I am endeavouring here only to present a pointed critique, not write a book. Detailed dissection of all the studies of A-B would in fact surely require a very large book indeed.

And my second point of reply is that, whatever the flaws in the papers I cite, a review that simply ignores adverse findings is surely a perilous one in which to place our trust. My aim is simply to point out that the peril exists.

The Structured Interview?

Another query that might be raised is whether I have ignored one of the main measures of A-B, the Structured Interview (SI). The JAS may not predict heart disease but the JAS is after all in some sense a secondary instrument. Might not the SI do a better predictive job? I can do little better than Yarnold & Bryant (1988) in commenting on this possibility. Yarnold & Bryant completely reject use of the SI on a variety of grounds. They point to the difficulty of training raters up to an adequate standard, the subjectivity of scoring and poor score reliability in various senses of that term. Yarnold & Bryant are particularly persuasive in noting that the SI can reasonably be administered only once to each subject because subjects tend to "wise up" after the first administration. This means that the reliability of the measure in what is arguably the most important sense of that term is in principle unknowable. From a psychometrician's point of view, therefore, it would be hard to imagine a worse measure of anything.

Additionally, in view of its weak relationship with the JAS, the small predictive success of the SI could even be due to its measuring things outside the A-B concept. The A-B concept is not therefore in any way saved by the SI.

Ivancevich & Matteson not alone

Perhaps it is worth noting at this stage, however, that Ivancevich & Matteson are not alone is appearing perversely to cling to the A-B concept. Houston & Snyder (1988) have recently edited a book which brings together papers by many of the leading protagonists of the A-B concept. Although these authors do in various ways acknowledge the predictive problems of A-B measures -- even showing an awareness that the long term results of the once much-relied on Western Collaborative Group Study do not show A-B as a significant predictor of CHD -- they offer only vague speculations for the predictive failure and continue on as if the concept were of undiminished importance. That it has now lost its whole raison d'etre seems to have passed them by completely.

Perhaps one could see something of a silver lining in the fact that the A-B concept did have a historical role in helping to establish the medical importance of psychological traits. This may well be so but it is surely hardly reassuring that the trait concerned ended up being found as not medically important.

Psychology relevant after all

The pity is that uncritical enthusiasm for the A-B concept seems to have caused psychologists almost completely to overlook the fact that there are in fact many other psychological traits that DO predict heart disease. Quite some time ago, Krug & Sherman (1977) pointed out that, in two large studies, 10 out of 16 scales in the 16PF differentiated CHD sufferers from non-sufferers. How much more useful for all of us it would have been if the medical importance of psychological traits had come to be accepted because of research such as this.

REFERENCES

Appels, A., Mulder, P. & Van Houtem, J. (1985) De validteit van de Jenkins Activity Survey, een vragenlijst ter meting van het type A gedrag. Nederlands Tijdschrift voor de Psychologie en haar Grensgebieden 40, 474-487.

Bortner, R.W. (1969) A short rating scale as a potential measure of pattern A behavior. J. Chronic Diseases 22, 87-91.

Davis, C. & Cowles, M. (1985) Type A behaviour assessment: A critical comment. Canadian Psychology 26, 39-42.

Emara, M.K., El-Islam, M.F, Abu Dagga, S.I. & Moussa, M.A. (1986) Type A behaviour in Arab patients with myocardial infarction. J. Psychosomatic Res. 30, 553-558.

Goldstein, H.S., Edelberg, R., Meier, C.F., Orzano, J.A. & Blaufuss, L (1985) The paradoxical relation between diastolic blood pressure change under stress and the H factor of the Jenkins Activity Survey. J. Psychosomatic Research 29, 419-425.

Hansson, R.O., Hogan, R., Johnson, J.A. & Schroeder, D. (1983) Disentangling Type A behavior: The roles of ambition, insensitivity and anxiety. J. Res. Personality 17, 186-197.

Heilbrun, A.B., Palchanis, N. & Friedberg, E. (1986) Self-report measurement of Type A behavior: Toward refinement and improved prediction. J. Personality Assessment 50, 525-539.

Helmreich, R.L., Spence, J.T. & Pred, R.S. (1988) Making it without losing it: Type A, achievement motivation, and scientific attainment revisited. Personality & Social Psychology Bulletin 14, 495-504.

Ivancevich, J.M. & Matteson, M.T. (1988) Type A behaviour and the healthy individual. British J. Medical Psychology 61, 37-56

Jackson, D.N. (1967) Personality research form manual N.Y.: Research Psychologists Press.

Jenkins, C.D., Rosenman, R.H. & Zyzanski, S.J. (1974) Prediction of clinical coronary heart disease by a test for the coronary prone behavior pattern. New England J. Medicine 290, 1271-1275

Jenkins, C.D. & Zyzanski, S.J. (1982) The type A behaviour pattern is alive and well -- when not dissected: A reply. British J. Medical Psychology 55, 219.

Jenkins, C.D., Zyzanski, S.J. & Rosenman, R.H. (1979) Jenkins Activity Survey manual N.Y.: Psychological Corp.

Katz, R.C. & Toben, T. (1986) The Novacco anger scale and Jenkins Activity Survey as predictors of cardiovascular reactivity. J. Psychopathology & Behavioral Assessment 8, 149-155

Lelouch, M. & Kornitzer, M. (1982) Ischemic heart disease and psychological patterns. In: H. Denolin (Ed.) Psychological problems before and after myocardial infarction Basel: S. Karger

Linden, W. (1987) On the impending death of the type A construct: Or is there a phoenix rising from the ashes? Canadian J. Behavioural Science 19, 177-190.

Matteson, M.T. & Ivancevich, J.M. (1980) The coronary-prone behavior pattern: A review and appraisal. Social Science & Medicine 14a, 337-351

Myrtek, M. & Greenlee, M.W. (1984) Psychophysiology of Type A behavior pattern: A critical analysis. J. Psychosomatic Res., 28, 455-466.

Nanjandappa, G., Friis, R. & Taladrid, B. (1987) Type A personality: Hispanic and Anglo diabetes and cardiovascular disease. International Migration Rev. 21, 643-655.

Pickering, T.G. (1985) Should studies of patients undergoing coronary angiography be used to evaluate the role of behavioral risk factors for coronary heart disease. J. Behavioral Medicine 8,203-214

Ray, J.J. (1984) Confusions in defining A-B personality type: A rejoinder to Jenkins & Zyzanski. British Journal of Medical Psychology 57, 385

Ray, J.J. (1986) Alternatives to the A-B personality concept in predicting coronary heart disease. Personality Study & Group Behaviour 6(2), 1-8.

Ray, J.J. & Bozek, R.S. (1980) Dissecting the A-B personality type. British Journal of Medical Psychology 53, 181-186.

Ray, J.J. & Simons, L. (1982) Is authoritarianism the main element of the coronary-prone personality? British J. Medical Psychology 55, 215-218.

Rime, B. & Bonami, M. (1979) Overt and covert personality traits associated with coronary heart disease. British J. Medical Psychology 52, 77-84

Yarnold, P.R. & Grimm, L.G. (1986) Interpersonal dominance and coronary-prone behavior. J. Res. Personality 20, 420-433.

Yarnold, P.R., Mueser, K.T. & Grimm, L.G. (1985) Interpersonal dominance of Type As in group discussions. J. Abnormal Psychology 94, 233-236.

Young, L.D., Barboriak, J.J., Hoffman, R.G. & Anderson, A.J. (1984) Coronary-prone behavior attitudes in moderate to severe coronary artery occlusion J. Behavioral Medicine 7, 205-215



FINIS