Annals of Behavioral Medicine

, Volume 20, Issue 4, pp 326–332 | Cite as

Anger inhibition, cardiovascular recovery, and vagal function: A model of the link between hostility and cardiovascular disease

  • Jos F. Brosschot
  • Julian F. Thayer
Article

Abstract

A model of the association between hostility and cardiovascular disease (CVD) is proposed based upon anger inhibition, slow cardiovascular recovery, and low parasympathetic activity (vagal tone). This model is opposed to the more conventional model that emphasizes anger expression, cardiovascular reactivity, and high sympathetic tone. We argue that in social reality, incidences of anger inhibition outnumber incidences of anger expression to a great extent, irrespective of preferred expression style. Moreover, slow cardiovascular recovery, rather than high reactivity, may be the mechanism underlying the CVD risk associated with anger inhibition. Both anger inhibition and slow cardiovascular recovery are associated with a persistently low vagal tone. Thus, the anger inhibition/vagal inhibition model seems more consistent with the actual nature of anger in daily life and with the known cardiovascular control mechanisms. The model may better account for the chronic pathophysiological state that is believed to lead to CVD. Importantly, an experimental inhibition/recovery paradigm might also allow to test potential behavioral and cognitive accelerators of cardiovascular recovery. As an example of an important socially-mediated health risk that may be elucidated using the anger inhibition/vagal inhibition model, we discuss Black-White differences that have been found in CVD.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. (1).
    Hokanson JE, Shelter S: The effect of overt aggression on physiological arousal.Journal of Abnormal and Social Psychology. 1961,63: 446–448.CrossRefPubMedGoogle Scholar
  2. (2).
    Hokanson JE, Burgess M: The effect of three types of aggression on vascular processes.Journal of Abnormal Psychology. 1962,64: 446–449.CrossRefGoogle Scholar
  3. (3).
    Baker JW, Schaie KW: Effects of aggression “alone” or “with another” on physiological and psychological arousal.Journal of Personality and Social Psychology. 1969,12: 80–86.CrossRefPubMedGoogle Scholar
  4. (4).
    Harburg E, Erfurt J, Hauenstein L, et al: Socioecological stress, suppressed hostility, skin colour, and Black-White male blood pressure.Psychosomatic Medicine. 1973,35: 276–296.CrossRefPubMedGoogle Scholar
  5. (5).
    Julius M, Harburg E, Cottington E, Johnson E: Anger coping types, blood pressure, and all-cause mortality: A follow-up in Tecumseh, Michigan.American Journal of Epidemiology. 1986,124: 220–233.PubMedGoogle Scholar
  6. (6).
    Schneider RH, Egan BM, Johnson EH, Drabny H, Julius S: Anger and anxiety in borderline hypertension.Psychosomatic Medicine. 1986,48: 242–248.CrossRefPubMedGoogle Scholar
  7. (7).
    Lai JY, Linden W: Gender, anger expression style, and opportunity for anger release determine cardiovascular reaction to and recovery from anger provocation.Psychosomatic Medicine. 1992,54: 297–310.CrossRefPubMedGoogle Scholar
  8. (8).
    Linden W, Chambers L, Maurice J, Lenz JW: Sex differences in social support, self-deception, hostility, and ambulatory cardiovascular activity.Health Psychology. 1993,12: 376–380.CrossRefPubMedGoogle Scholar
  9. (9).
    Mills PJ, Dimsdale JE: Anger suppression: Its relationship to beta-adrenergic receptor sensitivity and stress-induced changes in blood pressure.Psychological Medicine. 1993,23: 673–678.CrossRefPubMedGoogle Scholar
  10. (10).
    Friedman HS, Booth-Kewley S: The “disease prone personality”.American Psychologist. 1987,42: 539–555.CrossRefPubMedGoogle Scholar
  11. (11).
    Scheier MF, Bridges MW: Person variables and health: Personality and acute states as shared determinants for disease.Psychosomatic Medicine. 1995,57: 255–268.CrossRefPubMedGoogle Scholar
  12. (12).
    Miller TQ, Smith TW, Turner CW, Guijaro ML, Hallet AJ: A meta-analytic review of research on hostility and physical health.Psychological Bulletin. 1996,119: 322–348.CrossRefPubMedGoogle Scholar
  13. (13).
    Smith TW, Christensen AJ: Cardiovascular reactivity and interpersonal relations: Psychosomatic processes in social context.Journal of Social and Clinical Psychology. 1992,11: 279–301.CrossRefGoogle Scholar
  14. (14).
    Cottingham M, Matthews KA, Talbott E, Kuller LH: Occupational stress, suppressed anger, and hypertension.Psychosomatic Medicine. 1986,48: 249–260.CrossRefGoogle Scholar
  15. (15).
    Haynes SG, Levine S, Scotch N, Feinleib M, Kannel WB: The relationship of psychosocial factors to coronary heart disease in the Framingham Study. I. Methods and risk factors.American Journal of Epidemiology. 1978,107: 362–383.PubMedGoogle Scholar
  16. (16).
    Siegman AW: Cardiovascular consequences of expressing and repressing anger. In Siegman AW, Smith TW (eds),Anger, Hostility, and the Heart. Hillsdale, NJ: Erlbaum, 1994.Google Scholar
  17. (17).
    Engebretson TO, Matthews KA, Scheier MF: Relations between anger expression and cardiovascular reactivity: Reconciling inconsistent findings through a matching hypothesis.Journal of Personality and Social Psychology. 1989,57: 513–521.CrossRefPubMedGoogle Scholar
  18. (18).
    Hokanson JE, Burgess M: The effect of status, type of frustration, and aggression on vascular processes.Journal of Abnormal and Social Psychology. 1962,65: 232–237.CrossRefPubMedGoogle Scholar
  19. (19).
    Hokanson JE, Burgess M, Cohen MF: Effects of displaced aggression on systolic blood pressure.Journal of Abnormal and Social Psychology. 1963,67: 214–218.CrossRefGoogle Scholar
  20. (20).
    Holmes DS: Effects of overt aggression on level of physiological arousal.Journal of Personality and Social Psychology. 1966,4: 189–194.CrossRefPubMedGoogle Scholar
  21. (21).
    Hokanson JE, Edelman R: Effects of three social responses on vascular processes.Journal of Personality and Social Psychology. 1966,3: 442–447.CrossRefPubMedGoogle Scholar
  22. (22).
    Hokanson JE, Willers KR, Koropsak E: The modification of autonomic responses during aggressive interchange.Journal of Personality. 1968,36: 386–404.CrossRefPubMedGoogle Scholar
  23. (23).
    Gambaro S, Rabin AI: Diastolic blood pressure responses following direct and displaced aggression after anger arousal in high- and low-guilt subjects.Journal of Personality and Social Psychology. 1969,12: 87–94.CrossRefPubMedGoogle Scholar
  24. (24).
    Vantress FE, Williams CB: The effect of the presence of the provocator and the opportunity to counteraggress on systolic blood pressure.Journal of General Psychology. 1972,86: 63–68.CrossRefPubMedGoogle Scholar
  25. (25).
    Larkin KT: Evaluation of experimenter as a method of reducing vascular stress.Psychological Reports. 1982,50: 95–98.CrossRefPubMedGoogle Scholar
  26. (26).
    Linden W, Earle TL, Gerin W, Christenfeld N: Physiological stress reactivity and recovery: Conceptual siblings separated by birth?Journal of Psychosomatic Research. 1997,42: 117–135.CrossRefPubMedGoogle Scholar
  27. (27).
    Verrier RL, Mittleman MA: Life-threatening cardiovascular consequences of anger in patients with coronary heart disease.Cardiology Clinics. 1996,14: 289–307.CrossRefPubMedGoogle Scholar
  28. (28).
    Saul JP: Beat-to-beat variations of heart rate reflect modulation of cardiac autonomic outflow.News in Physiological Science. 1990.5: 32–37.Google Scholar
  29. (29).
    Thayer JF, Friedman BH, Borkovec TD: Autonomic characteristics of generalized anxiety disorder and worry.Biological Psychiatry. 1996,39: 255–266.CrossRefPubMedGoogle Scholar
  30. (30).
    Porges SW: Autonomic regulation and attention. In Campbell BA, Hayne H, Richardson R (eds),Attention and Information Processing in Infants and Adults. Hillside, NJ: Erlbaum, 1992, 201–223.Google Scholar
  31. (31).
    Latson TW: Principles and applications of heart rate variability analysis. In Lynch III C (ed),Clinical Cardiac Electrophysiology: Perioperative Considerations. Philadelphia, PA: Lippincott, 1994, 307–349.Google Scholar
  32. (32).
    Porges SW: Vagal tone: An autonomic mediator of affect. In Barber J, Dodge KA (eds),The Development of Emotion Regulation and Dysregulation. Cambridge: Cambridge University Press, 1991. 111–128.CrossRefGoogle Scholar
  33. (33).
    Porges SW, Doussard-Roosevelt JA, Maiti AK: Vagal tone and the physiological regulation of emotion. In Fox N (ed),Emotional Regulation: Behavioral and Biological Considerations. Monograph of the Society for Research in Child Development. 1994,59: 167–186.Google Scholar
  34. (34).
    Amerena J, Julius S: Role of the nervous system in human hypertension. In Hollenberg NK (ed),Hypertension: Mechanisms and Therapy. Philadelphia, PA: Current Medicine, 1995.Google Scholar
  35. (35).
    Houston BK: Anger, hostility, and psychophysiological reactivity. In Siegman AW, Smith TW (eds),Anger, Hostility, and the Heart. Hillsdale, NJ: Erlbaum, 1994.Google Scholar
  36. (36).
    Huber HP, Hauke D, Gramer M: Frustrationsbedinkter blutdruckanstieg und dessen abbau durch aggressive reaktionen.Zeitschrift Fur Experimentelle und Angewandte Psychologie. 1988,35:427–440.PubMedGoogle Scholar
  37. (37).
    Zarski JJ: Hassles and health: A replication.Health Psychology. 1984,3:243–251.CrossRefPubMedGoogle Scholar
  38. (38).
    Kanner A, Coyne JC, Schaefer C, Lazarus RS: Comparison of two modes of stress measurements: Daily hassles and uplifts versus major life events.Journal of Behavioral Medicine. 1981,4:1–39.CrossRefPubMedGoogle Scholar
  39. (39).
    DeLongis A, Coyne JC, Dakof G, Folkman S, Lazarus RS: Relationship of daily hassles, uplifts, and major life events to health status.Health Psychology. 1982,1:119–136.CrossRefGoogle Scholar
  40. (40).
    Monroe SM: Major and minor life events as predictors of psychological distress: Further issues and findings.Journal of Behavioral Medicine. 1983,6:189–205.CrossRefPubMedGoogle Scholar
  41. (41).
    Averill JR: Studies on anger and aggression.American Psychologist. 1983,Nov:1145–1160.CrossRefGoogle Scholar
  42. (42).
    Engebretson TO, Stoney CM: Anger expression and lipid concentrations.International Journal of Behavioral Medicine. 1996,2: 281–298.CrossRefGoogle Scholar
  43. (43).
    Suarez EC, Williams RB: The relationships between dimensions of hostility and cardiovascular reactivity as a function of task characteristics.Psychosomatic Medicine. 1990,52:558–570.CrossRefPubMedGoogle Scholar
  44. (44).
    Smith MA, Houston BK: Hostility, anger expression, cardiovascular responsitity, and social support.Biological Psychology. 1987,24:39–48.CrossRefPubMedGoogle Scholar
  45. (45).
    Frijda N:The Emotions. Cambridge: Cambridge University Press, 1986.Google Scholar
  46. (46).
    Shapiro D, Jamner LD, Goldstein IB: Ambulatory stress psychophysiology: The study of “compensatory and defensive counterforces” and conflict in a natural setting.Psychosomatic Medicine. 1993,55:309–323.CrossRefPubMedGoogle Scholar
  47. (47).
    Kagan J, Reznick JS, Snidman N, et al: Origins of panic disorder. In Ballenger JC (ed),Neurobiology of Panic Disorder. New York: Wiley-Hiss, 1990.Google Scholar
  48. (48).
    Laborit H: Inhibition of action: An interdisciplinary approach to its mechanisms and psychopathy. In Traue HC, Pennebaker JW (eds),Emotion, Inhibition and Health. Göttingen: Hogreve, Huber, 1993.Google Scholar
  49. (49).
    Friedman BH, Thayer JF: Autonomic balance revisited: Panic anxiety and heart rate variability.Journal of Psychosomatic Research. 1998,44:133–151.CrossRefPubMedGoogle Scholar
  50. (50).
    Carroll D, Cross G, Harris MG: Physiological activity during a prolonged mental stress task: Evidence for a shift in the control of pressor reactions.Journal of Psychophysiology. 1990,4:261–269.Google Scholar
  51. (51).
    Zillman D: Sequential dependencies in emotional experience and behavior. In Kavanaugh RD, Zimmerberg B, Fein S, (eds),Emotion: Interdisciplinary Perspectives. Mahwah, NJ: Lawrence Erlbaum, 1996, 243–272.Google Scholar
  52. (52).
    Drizd T, Dannenberg AL, Engel A: Blood pressure levels in persons 18–74 years of age in 1976–1980, and trends in blood pressure from 1960 to 1980 in the United States. DHHS publication (PHS) 86-1684.Vital and Health Statistics. 1986,11:234.Google Scholar
  53. (53).
    Anderson NB, McNeilly M, Myers H: Toward understanding race differences in autonomic reactivity: A proposed contextual model. In Turner JR, Sherwood A, Light KC (eds),Individual Differences in Cardiovascular Response to Stress. New York: Plenum, 1992, 125–145.CrossRefGoogle Scholar
  54. (54).
    Krieger N, Sidney S: Racial discrimination and blood pressure: The CARDIA study of young Black and White adults.American Journal of Public Health. 1996,86:1370–1378.CrossRefPubMedPubMedCentralGoogle Scholar
  55. (55).
    Anderson NB, Lane JD, Muranaka M, Williams Jr. RB, Houseworth SJ: Racial differences in blood pressure and forearm vascular responses to the cold face stimulus.Psychosomatic Medicine. 1988,50:57–63.CrossRefPubMedGoogle Scholar
  56. (56).
    Gentry WD: Relationship of anger-coping styles and blood pressure among Black Americans. In Chesney MA, Rosenman RH (eds),Anger and Hostility in Cardiovascular and Behavioral Disorders. Washington, DC: Hemisphere, 1985, 139–147.Google Scholar
  57. (57).
    Ernst FA, Francis RA, Enwonwu CO: Manifest hostility may affect habituation of cardiovascular reactivty in Blacks.Behavioral Medicine. 1990,Fall:119–124.CrossRefGoogle Scholar
  58. (58).
    Grim CE, Henry JP, Myers H: High blood pressure in Blacks: Salt, slavery, stress, and racism. In Laragh JH, Brenner BM (eds),Hypertension: Pathophysiology, Diagnosis, and Management. New York: Raven, 1995, 171–207.Google Scholar
  59. (59).
    Brownley KA, Light KC, Anderson NB: Social support and hostility interact to influence clinic, work, and home blood pressure in Black and White men and women.Psychophysiology. 1996,33:434–445.CrossRefPubMedGoogle Scholar
  60. (60).
    Miller ML, Thayer JF: On the nature of self-monitoring: Relations to adjustment and identity.Personality and Social Psychology Bulletin. 1988,14:544–553.CrossRefGoogle Scholar
  61. (61).
    Julius S: Editorial review: The blood pressure seeking properties of the central nervous system.Journal of Hypertension. 1988,6: 177–185.CrossRefPubMedGoogle Scholar
  62. (62).
    Folkow B, Grumby G, Thulesius O: Adaptive structural changes of the vascular wall in hypertension and their relationship to control of the peripheral resistance.Acta Physiologica Scandanavica. 1958.44:255.CrossRefGoogle Scholar
  63. (63).
    Kaplan JR, Adams MR, Clarkson TB, et al: Psychosocial factors, sex differences, and atherosclerosis: Lessons from animal models.Psychosomatic Medicine. 1996,58:598–611.CrossRefPubMedGoogle Scholar
  64. (64).
    Obrist P:Cardiovascular Psychophysiology: A Perspective. New York: Plenum Press, 1981.CrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 1998

Authors and Affiliations

  • Jos F. Brosschot
    • 1
  • Julian F. Thayer
    • 2
  1. 1.University of AmsterdamAmsterdamNetherlands
  2. 2.University of MissouriUSA

Personalised recommendations