Chapter 12 PERSONALITY AND HEALTH

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Chapter 12 PERSONALITY AND HEALTH

• .

D.F.Marks, M.Murray, B.Evans, C.Willig,
C.Woodall C.M. Sykes (2005) Health Psychology
Theory, Research and Practice (2nd edition).
London Sage
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PERSONALITY AND HEALTH

• Introduction
• Psychoanalysis and psychosomatic medicine
• Explaining links between personality and disease
• The Type A/B personality, hostility and coronary
  heart disease
• Further studies
• Summary

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INTRODUCTION

• The view that psychological disorders are best
  explained by psychological causes, and that
  physical disorders are attributable to physical
  causes, is an oversimplification.
• Since the fifth century BC, an influential
  doctrine presupposed that there is a physical
  basis for all disorders - whether physical or
  psychological. This model is more commonly known
  as the
• THE HIPPOCRATIC TRADITION

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The Hippocratic Tradition

• This assumes that psychological and physical
  disorders are both attributable to an imbalance
  of the four bodily humours
• Blood
• Phlegm
• Black bile
• Yellow bile
• For further discussion, see Chapters 1 and 4

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The Hippocratic Tradition

• One feature of the doctrine of the four humours
  that even today finds its echo in psychological
  theory is Galens description of the four
  classical temperaments
• The sanguine has an excess of blood
• The choleric of yellow bile
• The phlegmatic of phlegm
• The melancholic of black bile
• In Eysencks (1970) theory of the two basic
  dimensions of personality, extravert-introvert
  and stable-unstable, he pointed out that the
  classical temperaments do correspond quite
  closely with four extremes using his personality
  test
• The stable extravert (sanguine)
• The unstable extravert (choleric)
• The stable introvert (phlegmatic)
• The unstable introvert (melancholic)

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The fall of the humoral theory

• The humoral theory was eventually abandoned
  following the founding of the modem science of
  cellular pathology in the 1850s.
• This was the key that opened the door to our
  contemporary understanding of physical diseases.
• In recent years, advances in our understanding of
  neurotransmitters and the development of DNA
  research, together with criticism of the cost and
  efficacy of psychotherapy, has led to an
  increased enthusiasm for physiological
  explanations of psychological disorders.

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PSYCHOANALYSIS AND PSYCHOSOMATIC MEDICINE

• The psychosomatic approach has its roots in
  Freuds theories of HYSTERIA
• conditions where the patient appears to have a
  neurological or other physical disorder but where
  there is no obvious physical basis for it
• Freuds theories were extended to provide
  psychological explanations for the causation of
  real organic disorders such as heart disease and
  cancer.

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PSYCHOANALYSIS AND PSYCHOSOMATIC MEDICINE

• The term hysteria is not very often used
  nowadays, having been largely replaced by
  psychosomatic disorder or somatoform disorder.
• This idea provoked controversy between those who
  believe that they are modern forms of hysteria
  and those who believe that they are new organic
  disorders whose physical basis is not yet fully
  understood.
• Examples of such conditions are myalgic
  encephalomyelitis (ME) and chronic fatigue
  syndrome (CFS).

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Research on the Psychosomatic Traditions within
Psychoanalysis (Brown, 2004)

• According to George Groddeck, all illness is
  unconsciously motivated and has a meaning for the
  sufferer. For example
• An hysterical pregnancy might be motivated by an
  unconscious wish to have a baby
• A case of laryngitis be motivated by a desire not
  to speak
• A heart attack might be viewed as an unconscious
  attempt to commit suicide
• An alternative approach was that of Wilhelm
  Reich. He believed that, among many other
  things, repressed sexual feelings could lead to a
  blocking of mysterious forms of organic energy
  leading to the development of cancer.

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Franz Alexanders Theory of Psychosomatic
Disorders (1950)

• Franz Alexanders theory combines psychoanalytic
  theory with hypotheses about physiological
  mechanisms, principally those involving the
  autonomic nervous system (ANS).
• He emphasizes the distinction between
• Sympathetic division of the ANS that controls
  emotional arousal and the fight-or-flight
  emergency reactions of the organism.
• Parasympathetic division that controls relaxation
  and the slowing down of functions activated by
  the sympathetic division.

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Franz Alexanders Theory of Psychosomatic
Disorders (1950)

• Sustained activity in either branch of the ANS
  without the counterbalancing effect of the other
  can have disease consequences. For example
• Excessive sympathetic activity contributes to
  cardiovascular disease, diabetes and rheumatoid
  arthritis
• Excessive parasympathetic activity contributes to
  gastrointestinal disorders including dyspepsia,
  ulcers and colitis
• Alexanders theories also led to the development
  in contemporary Health Psychology of the
  distinction between the Type A and Type B
  personalities and their differential
  susceptibility to cardiovascular disease, and to
  recent related work on hostility and
  cardiovascular disease.

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Criticisms of the Psychosomatic Tradition

• Proponents of the psychosomatic approach have
  been criticized for much the same reasons that
  psychoanalysis has been criticized more generally
  (Webster, 1996)
• Their theories were highly speculative and relied
  on elaborate interpretations of clinical data
  rather than controlled statistical studies.
• They suffered from the defect of being
  retrospective, seeking to explain patients
  illnesses as caused by psychological
  characteristics already known to the clinician,
  rather than prospective, making predictions about
  future illness on the basis of present
  psychological assessments.

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Problems of explanation in research on
personality and illness

• Direction of causality
• Since cross-sectional studies are correlational,
  there is no certainty regarding which is the
  cause and which is the effect.
• Background variables
• Two variables that are associated may both be
  related to a third variable that has not been
  measured.

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Problems of explanation in research on
personality and illness

• Self-reported illness and the distress-prone
  personality
• Health psychology research often relies upon
  self-reported illness that has not been verified
  by objective medical tests.
• Dimensions of personality
• The number of personality dimensions to evaluate
  remains controversial.

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Problems of explanation in research on
personality and illness

• Physiological mechanisms versus health behaviour
• It is uncertain whether it is health behaviour or
  physiological differences that are causing
  illness.

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THE TYPE A/B PERSONALITY

• Speculation about an association between the
  Type A and B personalities and CHD has a history
  which dates back at least fifty years
  (Riska,2000).

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THE TYPE A/B PERSONALITY

• The classification of individuals as Type A or B
  was initially made on the basis of a structured
  interview, where people were not only asked
  questions about their Type A/B modes of
  behaviour, but were also provoked into directly
  manifesting such behaviour.
• For example, by being subjected to pauses and
  delays in the interview, deliberately interrupted
  and challenged about their answers to questions.
• Later studies adopted a less time consuming
  approach using standardized self-report
  questionnaires such as the Jenkins Activity
  Survey (JAS).

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Research on Type A/B Personality and CHD The
Western Collaborative Group Study

• The Western Collaborative Group Study (WCGS) is
  the key pioneering study of Type A/B personality
  and CHD
• It assessed over 3,000 Californian men, aged from
  39 to 59 at entry, using structured interviews
  and followed up initially over a period of eight
  and a half years, and later extending over 22
  years.
• The results reported that Type As were twice as
  likely as Type Bs to suffer from subsequent CHD.
• Of the sample 7 developed some signs of CHD and
  two-thirds of these were Type As.
• This increased risk was apparent even when other
  risk factors, such as blood pressure and
  cigarette smoking, were statistically controlled
  for.

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Research on Type A/B Personality and CHD The
Western Collaborative Group Study

• Similar results were subsequently published from
  another large-scale study conducted in
  Framingham, Massachusetts, this time with both
  men and women
• It was confidently asserted that Type A
  characteristics were as much a risk factor for
  heart disease as high blood pressure, high
  cholesterol levels and smoking.
• However, subsequent research failed to support
  these early findings.

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Research on Type A/B Personality and CHD The
Western Collaborative Group Study

• When Ragland and Brand (1988) conducted a 22-year
  follow-up of the WCGS, the early reports appeared
  to have exaggerated the significance of the Type
  A risk, and three subsequent follow-ups yielded
  inconsistent findings.
• Using mortality as the crucially important
  measure, they found
• Type A/B behaviour was positively but not
  significantly associated with coronary heart
  disease in the first and third intervals,
  significantly negatively associated . . . in the
  second interval and not associated in the fourth
  interval.
• The results confirm the importance of the
  traditional coronary heart disease risk factors,
  and raise a substantial question about the
  importance of Type A/B behaviour as a risk factor
  for coronary heart disease mortality. (Ragland
  and Brand, 1988, p. 462)

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Re-evaluation of Type A/B Research (Evans, 1990)

• Re-evaluation of Type A/B research showed that
  the bulk of the positive findings came from
  cross-sectional studies rather than prospective
  studies.
• Positive prospective findings also tended to come
  from population studies of initially healthy
  volunteers.
• Studies of high risk individuals either failed to
  show a relationship with the Type A/B personality
  or produced a reverse finding with Type As
  actually having better outcomes than Type Bs.

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Re-evaluation of Type A/B Research (Evans, 1990)

• While healthy Type As may be more at risk than
  Type Bs, they are more likely than Type Bs to
  modify their risky health behaviours, thereby
  giving themselves a better long-term prognosis.
• Studies using the structured interviews to assess
  personality were much more likely to produce
  positive results than those using questionnaires.
• Recent reviews and meta-analyses of Type A/B
  research all conclude that there is little or no
  evidence of a relationship with CHD (Hemingway
  and Marmot, 1999 Rozanski et al. 1999 Myrtek,
  2001)

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HOSTILITY

• Research on hostility and health is divided
  between studies using structured interviews (SI)
  and those using questionnaires, usually the
  Cook-Medley Ho Scale
• Research using the SI has produced more positive
  findings than research using self-report
  questionnaires (see Miller et al., 1996).

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HOSTILITY

• Further reviews all indicate that existing
  studies are of very mixed quality, with
  inconsistent results.
• Myrtek (2001) conducted a meta-analysis and
  concluded that
• There was evidence of a statistically significant
  but very weak relationship for prospective
  studies of initially healthy individuals.
• But not for studies that have followed up
  patients already diagnosed with CHD.
• The statistical relationship between measures of
  hostility and health is, at most, a weak one.

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FURTHER STUDIES Affect, anxiety and depression

• Negative affect, anxiety and depression have been
  found to be associated with an increased risk of
  CHD.
• It should be noted, however, that these findings
  are open to a number of different
  interpretations.
• There is very little clear-cut evidence to
  support the view that personality variables are
  associated with risk of cancer or of relapse
  following treatment.

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FURTHER STUDIES Sense of coherence

• Sense of coherence is the ability to perceive
  ones world as meaningful and manageable.
• Surtees et al.s (2003) study of the relationship
  between sense of coherence and mortality from all
  causes for a very large UK sample showed that
• A strong sense of coherence was associated with a
  30 reduction in mortality from all causes, more
  specifically for cardiovascular disease.
• There was a similar reduction in mortality in
  cancer for men but not for women.

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Research on sense of coherence

• Yousfi et al. (2004) found a number of small but
  statistically significant correlations, between
  emotional lability and general disease
  vulnerability.
• Reed et al. (1994) investigated the relationship
  between realistic acceptance and survival time of
  men suffering from AIDS. They found that those
  who were assessed as showing a realistic
  acceptance of their deteriorating condition and
  eventual death had a mean survival time that was
  nine months less than those who were assessed as
  being unduly optimistic.
• Taylor and Browns (1988) literature review
  concerning mental health, concluded that overly
  positive self-evaluations, exaggerated
  perceptions of control and mastery and
  unrealistic optimism, were associated with good
  mental health.

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FURTHER STUDIES Locus of control

• Locus of control is another personality variable
  that has been of interest to health psychologists
  over the last 20 years
• This concept was applied to health beliefs by
  Wallston et al. (1978) who developed the
  Multidimensional Health Locus of Control (MHLC)
  Scale.

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MHLC Scale

• This questionnaire has three subscales.
• It measures the extent to which people attribute
  their state of health to their own behaviour
  (internal locus), and/or external factors
  including both powerful others, especially
  medical professionals, and chance or fate.
• The internal locus of control scale has much in
  common with the concept of self-efficacy
  (Bandura, 1977).

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Research on Locus of Control

• Norman and Bennetts (1996) literature review
  concluded that the relationship between locus of
  control and health behaviour is a weak one.
• Self-efficacy appears to be a rather better
  predictor of health behaviour.

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SUMMARY

• Traditional explanations based on the Galenic
  doctrine of the four humours have now been
  replaced by the medical model.
• The modern history of psychological explanations
  for physical symptoms begins with Freuds
  theories of hysteria.
• Proponents of the psychosomatic approach
  generally failed to produce convincing evidence
  in support of their hypotheses.
• However, the theories of Franz Alexander on the
  physiological mechanisms that could underlie the
  relationship between the psychology of the
  individual and organic disease have led to modern
  conceptions of the Type A personality and stress
  as contributors to cardiovascular disease.

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SUMMARY (continued)

• Early indications that the Type A personality is
  a risk factor for cardiovascular disease were not
  confirmed by later studies.
• Attention has shifted to hostility which does
  seem to be a risk factor, although much less so
  than traditional risk factors such as high blood
  pressure or cigarette smoking.
• There is some recent evidence that sense of
  coherence may be associated with coronary heart
  disease, cancer and all cause mortality.
• Internal locus of control is only very weakly
  associated with positive health behaviours.
• Self-efficacy shows an overall stronger
  relationship, yet the level of prediction is
  still relatively modest.