Spielberger Anger Expression Scale Research Articles

Modifying effect of outdoor recreational activity on the association between anger expression and cardiovascular disease risk: the Circulatory Risk in Communities Study.

Outdoor recreational activity (ORA) has been suggested as a practical strategy for anger management to moderate the risk of cardiovascular disease (CVD). However, there is a lack of evidence pertaining to this topic. Our aim was to examine whether ORA modified the association between anger expression and the risk of CVD. A community-based cohort study was conducted among 1877 Japanese individuals aged 40-79 years at baseline in 1997. The anger expression was measured using the Spielberger Anger Expression Scale. Stratified into low and high ORA (0 and ≥ 1 of the four behaviors), a Cox proportional hazards model was used to assess the anger expression-related risk of incident CVD (ischemic heart disease and stroke). We identified 76 incident CVDs during a median follow-up of 18.8 years. Among participants with low ORA, anger expression was associated with an increased risk of CVD, whereas no association was identified among those with high ORA. The standardized hazard ratios were 1.53 (95% CI, 1.23-1.91) and 0.77 (0.51-1.15) among those with low and high ORA, respectively: p for interaction = .004. Similar associations were observed regarding the risk of total and ischemic stroke, and ischemic CVD. We found an elevated risk of CVD associated with anger expression among participants with low ORA but not among those with high ORA, suggesting that ORA use may mitigate the association between anger expression and CVD risk.

Mentalization and empathy as predictors of violence in schizophrenic patients: Comparison with nonviolent schizophrenic patients, violent controls and nonviolent controls

There are conflicting results concerning risk of violence in schizophrenia. Empathy and mentalization deficits are associated both with schizophrenia and violence, however, there are only a few studies with equivocal results concerning their relationship. 88 violent and nonviolent paranoid schizophrenic and violent and nonviolent control males in psychiatric, forensic psychiatric and correctional institutions completed the Ekman 60 Faces test, Faux Pas Recognition Test, Eysenck IVE test, Interpersonal Reactivity Index, and the Spielberger Anger Expression Scale. Data were analysed with ANOVA and logistic regression models. Significant group differences with a characteristic pattern were detected in mentalization, facial affect recognition, fear and anger recognition, interpersonal distress, and frequency of direction of anger expression. Predictors of violent behaviour were different in the schizophrenic and non-schizophrenic groups. Lack of major differences in empathy and mentalization between violent and nonviolent schizophrenia patients suggests that such deficits are core features of schizophrenia but do not determine emerging violence in this illness. Our results emphasise the importance of distinguishing between violence related to core positive symptoms of schizophrenia and that emerging from independent comorbid antisocial personality traits in order to identify targets for screening, detection, prevention and management of violence risk in different subpopulations of schizophrenia patients.

Abstract P306: Negative Emotional States and Atherosclerosis in African American Adults: The Jackson Heart Study

Background: Atherosclerotic cardiovascular disease is prevalent among African Americans (AAs). Findings are mixed regarding the relationship between anger expression and peripheral atherosclerosis, as well as coronary atherosclerosis, as measured by coronary artery calcification (CAC). In addition, this relationship is unknown among AAs. Hypothesis: Higher anger levels are positively associated with CAC and abdominal-iliac artery calcification (AAC) among AAs. Methods: Using the Jackson Heart Study cohort (N=5301), we stratified 1809 participants who completed the Spielberger Anger Expression scale at baseline into four quartiles. The scale consists of 16 items, measuring anger-in and anger-out, with higher scores representing higher frequencies of anger expression. Total anger (anger-in and anger-out) quartiles were measured against CAC and AAC using ordinal logistic regression. CAC and AAC were categorized as: 0, 1-10, 11-100, 101-300, and greater than 300. Models were adjusted for potential confounding variables (age, sex, smoking, alcohol, diabetes mellitus, hypertension, and coronary heart disease). Results: The final study sample consisted of 34% (615 of 1809) male with a mean age of 54.0 (SD 10.79). Higher total anger was inversely associated with age and hypertension, but positively related to alcohol use and smoking status. Unadjusted analysis showed that total anger quartiles and anger-in quartiles were inversely related to CAC and AAC. The association of anger with CAC and AAC was non-significant after adjustment for confounders (Table). Conclusion: Before adjustment, higher anger levels showed a protective effect against coronary and aortic atherosclerosis. However, this relationship was no longer significant after adjustment for confounders suggesting that age and hypertension played a major role in the presence of atherosclerosis in this AA population. Future studies should investigate whether other negative emotional expressions are associated with atherosclerosis in AAs

Abstract P291: Anger Expression and Risk of Stroke Subtypes: The Circulatory Risk in Communities Study (CIRCS)

Background: Previous studies have reported that anger expression style is associated with cardiovascular disease and its risk factors. Epidemiologic data regarding the association between anger expression and risk of stroke have been inconsistent, and few studies have reported the association of anger expression with stroke subtypes. Hypothesis: We assessed the hypothesis that suppressed anger is associated with increased risk of stroke, and the associations vary by stroke subtype. Methods: A prospective study of Japanese subjects aged 30–74 years was undertaken using data collected from 6,276 participants (2,285 men and 3,991 women) in cardiovascular risk surveys conducted in four communities between 1995 and 1998. We used the Spielberger Anger Expression Scale to measure self-reported levels of anger expression style; anger expressed outwardly is regarded as “anger-out” and anger held in or suppressed is classified as “anger-in.” The incidence of stroke was ascertained by systematic surveillance. The hazard ratios (HRs) of incidence of stroke and its subtypes and 95% confidence intervals (CI) relative to the lowest tertile of anger expression were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazards model. Results: During an average follow up of 9.1-years, 129 incident strokes (50 hemorrhagic, 77 ischemic, and 2 unclassified strokes) occurred. Men with “anger-in” scores in the highest tertile had a 1.7-fold multivariable-adjusted relative risk of stroke as compared with those in the lowest tertile, but it did not reach statistical significance (HR; 1.73, 95% CI; 0.94–3.19, p=0.08). When stratifying for stroke subtypes, the associations between “anger-in” and stroke tended to be stronger for hemorrhagic stroke than ischemic stroke; HRs (95% CI) were 3.82 (1.03–14.1) for hemorrhagic stroke and 1.32 (0.64–2.71) for ischemic stroke. Anger-in score was not associated with incidence of either hemorrhagic or ischemic stroke in women. In men and women, there were no significant associations between “anger-out” and incidence of stroke. As compared with the lowest tertile of “anger-out” scores, the multivariable-adjusted HRs of stroke for the highest tertile of “anger-out” scores were 1.39 (0.74–2.59) for men and 1.48 (0.78–2.78) for women, respectively. Conclusions: Suppressed anger may be associated with increased risk of hemorrhagic stroke among middle-aged Japanese men, but not women.

Anger Types: Heritability and Relation to Blood Pressure, Body Mass Index, and Left Ventricular Mass

The relationship between anger and cardiovascular morbidity has not been investigated among Mexican Americans. This exploratory study examined the heritability of anger types and their relationship to cardiovascular variables in samples of unrelated and related Mexican Americans residing near Chicago, Illinois. All of the anger variables of the Spielberger Anger Expression Scale (in, out, control, total expression) had significant heritabilities. Using the total sample of related individuals, higher female anger-out scores were associated with greater left ventricular mass after correction for height to the 2.7 power (LVM/HT2.7), systolic blood pressure, and diastolic blood pressure. Females had positive, significant associations for body mass index with LVM/HT2.7, systolic blood pressure, and diastolic blood pressure; among males, these variables were similarly but less strongly related. Anger (coraje in Spanish) is discussed in the context of folk medicine as a risk factor for cardiovascular morbidity.

Anger, Hostility, and Cardiac Symptoms in Women with Suspected Coronary Artery Disease: The Women's Ischemia Syndrome Evaluation (WISE) Study

To determine the relationship of anger and hostility to angiographic coronary artery disease (CAD), symptoms, and functional status among women with suspected CAD. Data were collected from 636 women with suspected CAD referred for diagnostic angiography in the Women's Ischemia Syndrome Evaluation (WISE) Study. CAD was assessed as angiographic presence/absence of disease (> or =50% stenosis in any epicardial coronary artery). Hostility/anger, angina, symptoms, and functional status were assessed by the Cook-Medley Hostility Inventory, Spielberger Anger Expression Scale, cardiovascular symptom history, and the Duke Activity Status Index. Logistic regression revealed that anger-out (i.e., aggressive behavior in response to angry feelings) was independently associated with the presence/absence of angiographic CAD (OR = 1.09, CI 1.01-1.17). Anger and hostility were higher among women reporting increased cardiovascular symptoms. In women without angiographic CAD, those with nonanginal cardiac symptoms had the highest anger-out, anger expression, hostile affect, and aggressive responding scores, and those with typical angina reported the lowest functional status. Among women with CAD, functional status was lowest in women with atypical angina. Among women with suspected CAD, anger-out scores were associated with the presence of angiographic CAD. Anger/hostility traits were associated with increased symptoms, particularly with nonanginal chest pain in women without angiographic CAD. Relationships among psychosocial factors, cardiac symptoms, and angiographic CAD are potentially important in the management of women with suspected CAD.

Psychometric Properties of the Trauma Stages of Recovery

Of the trauma theories available, Herman's has captured the essential features common to most traumatic etiologies. Continued development of this theory has included dimensions within stages of recovery. The Trauma States of Recovery is presented here as a way of assessing stages of recovery and inherent components. Three samples of about 500 college students each and a clinical sample (n=34) were recruited. Independent principal components analyses, employing a scree plot, gave a five-component solution accounting for 40.2% of the total variance. The component solution employed Promax rotation for the correlated components. The five components were named Emotional Awareness and Control, Symptom Mastery, Coping, Memory, and Relationships. Internal consistencies, test-retest reliability, and split-half reliability were acceptable. Response bias was low. Convergent validity (with various subscales from the Beck Depression Inventory, the Self-esteem Scale, the Spielberger Anger-Expression Scale, and the Dissociative Experiences Scale) and discriminant validity (with various subscales of the AIDS Knowledge and Attitudes Survey and Jackson's Personality Research Form Dominance Scale) were promising. The Trauma Stages of Recovery also significantly discriminated between clinical and nonclinical samples on three of the five components, Symptom Mastery, Coping, and Memory.

Ambulatory blood pressure in women: Family history of hypertension and personality

The presence of certain personality traits in individuals with a strong family history of hypertension was expected to increase ambulatory blood pressure (BP) in healthy working women. Ambulatory BP was recorded on two work and two off work days during waking and sleeping hours in healthy nurses, 24-50 years of age, with varying parental history: Two hypertensive parents (n = 14); one hypertensive parent (n = 77); two normotensive parents (n = 112). BP during wake and sleep was potentiated in subjects with two hypertensive parents. Assessments were made of hostility (Cook-Medley Hostility Scale), defensiveness (Marlowe Crowne Social Desirability Scale), anxiety (Spielberger Trait Anxiety Inventory) and anger-out (Spielberger Anger Expression Scale). The offspring of two-parent hypertensive families who were hostile, defensive, anxious or did not express anger had elevated ambulatory BP, which was highest during work days. Preventive measures are particularly important for individuals with the combination of certain personality traits and a strong family history of hypertension, who may themselves be at risk for the development of hypertension.

Higher prevalence of depressive symptoms in middle-aged men with low serum cholesterol levels.

Investigators from several studies have reported a positive relationship between low cholesterol levels and death due to violent causes (eg, suicide and accidents), possibly mediated by depressive symptoms, aggression or hostility, or impulsivity. We set out to establish whether middle-aged men with chronically low cholesterol levels (< or =4.5 mmol/liter) have a higher risk of having depressive symptoms, according to scores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter. A similar comparison was also made for measures of anger, hostility, and impulsivity. Cholesterol measurements were obtained as part of a population-based cholesterol screening study in 1990-1991. These levels were remeasured in 1993-1994. Only those whose cholesterol level remained in the same range were included in the study. Depressive symptoms were assessed by using the Beck Depression Inventory; anger, by questionnaires based on the Spielberger Anger Expression Scale and State-Trait Anger Scale; hostility, by the Buss-Durkee Hostility Inventory; and impulsivity, by the Eysenck and Eysenck Impulsivity Questionnaire. Men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms (Beck Depression Inventory score > or =15 or > or =17) than the reference group, even after adjusting for age, energy intake, alcohol use, and presence of chronic diseases. No differences in anger, hostility, and impulsivity were observed between the two groups. Men with a lower cholesterol level (< or =4.5 mmol/liter) have a higher prevalence of depressive symptoms than those with a cholesterol level between 6 and 7 mmol/liter. These data may be important in the ongoing debate on the putative association between low cholesterol levels and violent death.

Validity and reliability of the Japanese version of the selected anger expression scale and age, sex, occupation and regional differences in anger expression among Japanese.

To examine the reliability and construct validity of the Japanese version of the Anger Expression Scale among four Japanese communities, and to examine distributions of anger expression scores according to sex, age, occupation, and community, we performed a cross-sectional study among 1,802 men and 3,229 women aged 20-70 in four geographic populations in 1995-97. We handed a self-administered questionnaire, which was selected from the Spielberger Anger Expression Scale, to the participants in the risk factor surveys and measured anger-in and anger-out as the anger expression scale. These scales had high internal consistency (Cronbach's alpha coefficient was 0.97-0.98 for anger-out and 0.77-0.86 for anger-in) and were of almost the same structure as the original. The Pearson correlation coefficients for the anger expression scale examined in 1995 and 1996 were 0.69 for anger-out and 0.57 for anger-in (both p < 0.001). The mean scores of both anger-out and anger-in were inversely associated with age. The mean anger-out score was higher for men than for women (p < 0.001), whereas the mean anger-in score did not vary significantly between the sexes. Furthermore, the mean scores of anger-out and anger-in varied among populations and occupational groups. The present study suggests that the Japanese version of the selected Anger Expression Scale is an acceptable scale for evaluating anger expression among Japanese.

Measures of hostility as predictors of facial affect during social interaction: evidence for construct validity.

We assessed the construct validity of several self-report measures and an interview-based measure of hostility (Interpersonal Hostility Assessment Technique [IHAT]) by evaluating their associations with a behavioral indicator of hostile emotions (facial expressions during social interaction). Participants in the study were 123 volunteers (44% males and 56% females) who were recruited from local community organizations. Self-report measures (Cook-Medley Hostility Scale, Rotter Interpersonal Trust Scale, Buss-Durkee Hostility Inventory, and Spielberger Anger Expression Scale) were represented by factor scores reflecting Overt Hostility, Covert Hostility, and Hostile Beliefs. A canonical correlation analysis identified significant associations between a set of facial affect scores reflecting animosity and various measures of hostility. Specifically, increases in anger and disgust expressions and decreases in happy facial expressions were associated with high IHAT scores and high scores on self-report measures of Hostile Beliefs and Covert Hostility. Women were more expressive than men, especially concerning positive affect, and women had lower scores on self-report measures of Hostile Beliefs and Overt Hostility. IHAT scores were uncorrelated with any of the self-report factors which suggests the two assessment techniques are tapping different aspects of the hostility construct.

Interactive effects of trait hostility and anger expression on cardiovascular reactivity in young men

Hostility and anger-expression style are personality traits often associated with elevated cardiovascular reactivity and potential heightened risk for cardiovascular disease. In the present study a sample of 50 young, healthy men were divided into groups low or high on the Cook–Medley Hostility scale and on anger-out from Spielberger's Anger Expression scale. Subjects worked on mental arithmetic and public speaking tasks in counterbalanced order. Heart rate, systolic and diastolic blood pressure and hemodynamic indices were measured at baseline and during the tasks. Hostility and anger-out interacted in their effects on cardiovascular responses. The High Anger-Out/Low-Hostile group displayed the greatest increases in heart rate and blood pressures, while the High Anger-Out/High-Hostile group was least reactive. Furthermore, the High Anger-Out/Low-Hostile group showed a distinct fight/flight response pattern during public speaking, indicated by increases in stroke volume and cardiac output and a decrease in systemic vascular resistance. These results suggest that a mismatch between hostile cognitions and habitual anger expression leads to greater cardiovascular reactivity to challenging tasks, potentially enhancing risk for development of cardiovascular diseases.

Validation of the General Attitude and Belief Scale

The purpose of this study was to provide further validational information on the General Attitude and Belief Scale (e.g., DiGiuseppe, Leaf, Exner & Robin, 1988). Particular interest was in determining further the factor structure of the General Attitude and Belief Scale as confirming REBT theory concerning the nature of irrational thinking. A sample of 236 males and 490 females drawn from a variety of populations completed the General Attitude and Belief Scale as well as a number of cross-validational measures (Spielberger's Trait Anxiety, Curiosity and Anger Scales, Spielberger's Anger Expression Scale, Beck's Depression Inventory (short-form) and Diener's Life Satisfaction Scale). A second sample of 18 couples receiving on-going marriage counselling and 43 couples not receiving counselling also completed the General Attitude and Belief Scale. A principal factors analysis yielded one factor of rationality and six irrationality factors (need for achievement, need for approval, demands for fairness, need for comfort, self-downing and other-downing). Significant correlations were obtained between the seven sub-scales of the General Attitude and Belief Scale and cross-validational measures. The clinical group of distressed couples scored lower in rationality and higher on three of the six sub-scales of irrationality. The findings support the continued use of the General Attitude and Belief Scale as a research instrument and of value to practitioners.

A longitudinal study of students' depression at one medical school.

Using a standardized measure of depression at three assessment points, to examine depression in medical students during their training. Students entering the University of Massachusetts Medical School in the fall in 1987, 1988, and 1989 were mailed a recruitment letter and baseline questionnaire four weeks prior to the start of classes. Subsequent assessments took place in the middles of year 2 and year 4 and included only the students who had participated in the baseline assessment. The baseline assessment included the Center for Epidemiological Studies Depression (CES-D) scale, the Bortner Type A Behavior scale, the Spielberger Trait Anger scale, and the Spielberger Anger Expression scale. In addition, the baseline package included a rating of perceived stress, a demographics questionnaire, and a social-life survey. The follow-up assessments included the CES-D scale, the rating of perceived stress level, and the social-life survey. Analytic methods used were univariate descriptive statistics, correlation, and multiple-linear-regression analyses, two-sample t-tests, analysis of variance, and chi-square tests. Of the initial pool of 300 students, 264 responded at the baseline assessment (88% response rate; 53% men); 171 of these participated in the year-2 assessment (65% response rate; 51% men), and 126 participated in the year-4 assessment (48% response rate; 48% men); a total of 99 students participated in all three assessments. CES-D scores > or =80th percentile were obtained for 18% of the entering students. This rose to 39% at year 2 and 31% at year 4 (p = .0001). No gender difference was found at baseline; however, the women experienced higher depression levels than did the men at year 2 (p = .004) and at year 4 (p = .04). Overall, gender and increases in perceived stress (from baseline to year 2) were significant predictors of increased CES-D scores (from baseline to year 2; p = .01 and p = .0001, respectively). For the women, increased perceived stress, angerin, and frequency of social contacts outside work/school were significant predictors of the magnitude of increases in CES-D scores (baseline to year 2; p = .0001, p = .02, and p = .03, respectively). These preliminary data support the view that, upon entering medical school, students' emotional status resembles that of the general population. However, the rise in depression scores and their persistence over time suggest that emotional distress during medical school is chronic and persistent rather than episodic. Also, the women had more significant increases in depression scores than did the men.

Defensive hostility and anger expression: Relationship to additional heart rate reactivity during active coping

The main purpose of the present study was twofold: (a) to assess the relationship between defensive hostility (high hostility/high defensiveness) and additional heart rate reactivity during active coping and (b) to determine if the construct of anger-out might lend additional sensitivity to the predictive power of the defensive hostility model. Forty individuals were randomly assigned to complete a mental arithmetic task with or without the threat of shock. Participants also completed the Cook-Medley Hostility Inventory (Ho), the Marlowe-Crowne Social Desirability Scale (MC), and the Spielberger Anger Expression Scale. Defensive hostile subjects (high Ho/high MC) were significantly more reactive than any other subgroup. In addition, the combination of low Ho/high anger-out scores yielded a subgroup significantly less reactive than any other subgroup. These findings clarify the complex relationship of hostility and cardiovascular reactivity.

Relationship of cardiovascular reactivity and anger expression to serum lipid concentrations in healthy young men

The relationship between behaviorally evoked cardiovascular reactivity, preferred mode of anger expression, and serum lipid concentrations was examined in 63 healthy, young adult males. Subjects derived from three studies, each evaluating cardiovascular response to laboratory stressors. All participants completed the Spielberger Anger Expression Scale and provided fasting blood samples for lipid determinations. A significant negative correlation, calculated by meta-analytic procedures, was noted between a baseline-free measure of heart rate reactivity and high density lipoprotein-cholesterol (HDL-C) concentrations ( r = -0.26, p = 0.05). However, the previously reported relationship between cardiovascular reactivity and elevated total serum cholesterol (TSC) was not found. Additionally, men scoring high on a self-report measure of the tendency to express anger outwardly had significantly higher HDL-C concentrations that men scoring low on this measure ( r = 0.30, p = 0.02); when subjects were stratified by level of cardiovascular reactivity, this relationship was apparent only among those showing the greatest magnitude of heart rate and blood pressure responses to acute mental stress.

Intervention Strategies for Victims of Sexual Abuse: A Model for Building Self-Esteem,

This article begins by explaining the devastating effects of child sexual abuse on the self-esteem of its victims. Intervention strategies are discussed with a focus on a self-esteem model — the SEAs Program — developed by psychologist James Messina. This program uses trained psychotherapists and group members to expand each survivor's support system. Cognitive and experiential techniques are implemented in a humanistic framework to help clients recover from low self-esteem. Preliminary results from an outcome study utilizing three measures of self esteem and coping strategies (the Coopersmith Self-Esteem Inventory, the Need for Harmony Scale and Spielberger's Anger Expression Scale) suggest that this model shows promise in helping women who are survivors of child sexual abuse to build healthy self-esteem and warrants further investigation.

The relation between dominance, anger, and hormones in normally aging men: results from the Massachusetts Male Aging Study.

This paper examines the relation of two personality characteristics (dominance and anger) to hormones in normally aging men. The relation of the Jackson Personality Research Form E Dominance subscale and the Spielberger Anger Expression scale to serum levels of 17 endocrine variables, including testosterone (T) and dihydrotestosterone (DHT), cortisol, and prolactin, was examined in 1709 men aged 39 to 70 years randomly sampled from the Boston Metropolitan Statistical Area. Canonical correlation analysis resulted in the identification of a personality profile characterized as dominant with some aggressive behavior that tends to correlate with a hormonal pattern labeled the "availability of androgens." These results partially support previous findings in animals, adolescents, and criminal populations that "aggressive dominance" is related to testosterone.

CORRELATES OF THE MMPI-2 ANGER CONTENT SCALE

Scores on the MMPI-2 anger-content scale were correlated with those on Spielberger's anger expression scale, Zelin, et al.'s anger self-report scale, and the Cook and Medley hostility scale. Subjects were 32 men and 33 women in college. As expected, the anger-content scale correlated significantly with measures of anger awareness, anger expression (anger out versus anger in), and negatively with anger control. There was also a significant correlation with measures of hostility (projection of anger) for men.

Blood platelet uptake of serotonin in episodic aggression

Blood platelet uptake of 3H-serotonin (5HT uptake), a potential marker of serotonergic function, was determined in male outpatients with episodic aggression ( n= 15) and in age- and sex-matched nonaggressive controls ( n= 15). Correlations with rating scales of “impulsivity” (Barratt Impulsivity Scale, 10th revision) and “anger” (Spielberger Anger Expression Scale) were performed. Mean 5HT uptake was 18% lower in patients with episodic aggression. A significant negative correlation between % difference in platelet 5HT uptake and impulsivity score was observed, but the correlation between 5HT uptake and anger was not significant. These results support the hypothesis of disturbed serotonergic function in aggression and suggest that the primary relationship is in the “control” of aggression. The blood platelet may be useful in identifying impulsive subtypes.