Type a behaviour: Recent developments

Abstract

This paper discusses: (1) the difficulties associated with description and assessment of Type A behaviour (TAB); (2) the association between measures of TAB and psychopathology; (3) new approaches to the measurement of TAB; and (4) the results of recent studies that have attempted to modify the behaviour pattern, using (a) psychological treatment, (b) exercise, and (c) drug treatment. The psychological dimensions underlying Type A behavioral characteristics have not been identified, and attention is drawn to the very small overlap between the main instruments used to measure the behaviour pattern. An examination of the association between the different measures of TAB and psychopathology suggests that both the Framingham Type A scale and the Bortner scale show high correlations with neurotic manifistations of personality. A case is made for exploring the relationship between the behavior pattern and other psychosocial variables that have been shown in both retrospective and prospective studies to be associated with CHD risk. The paper describes a new methods of conceptualising and describing TAB, derived from cognitive social learning theory. This model asserts that assessment of the individual's personal beliefs and fears is essential if the observable behaviours associated with pattern A are to be modified. In the Recurrent Coronary Prevention Project, attempts to modify TAB using techniques derived from cognitive behaviour therapy have produced encouraging results. Future large scale studies of CHD prevention should take account of psychosocial and personality variables as well as more traditional risk factors.