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Theory and research ( Helgeson, 1994 ) suggest that women are particularly responsive to communion stressors (i.e., social relationship concerns) as opposed to agency (i.e., achievement and dominance concerns) and that women low in the trait of agency are vulnerable to stress. To test these hypotheses, 60 undergraduate women interacted with a pre-recorded partner; one-third provided support to an interaction partner (i.e., communion stressor), debated current events (i.e., agency stressor), or described a typical day (i.e., control task). Compared to controls, the debate task evoked greater systolic blood pressure and heart rate reactivity and related autonomic changes. Compared to controls, providing support evoked larger increases in cardiac sympathetic activation and reduced vascular resistance. Low levels of trait agency were associated with greater CVR overall. Hence, agency and communion stressors had distinct psychophysiologic effects. Although both tasks heightened reactivity, the agency task evoked cognitive and physiological responses consistent with threat, whereas the communion task evoked a pattern consistent with challenge.

The effect of personality characteristics on physical health continues to be an important topic in personality psychology, behavioral medicine, and health psychology. A more definitive methodological approach to the topic has evolved in recent years, emphasizing prospective designs, well-validated measures of personality, and unambiguous health outcomes. Further, this research is increasingly based on more detailed, physiologically plausible models of the possible mechanisms linking personality and health. Yet, one valuable perspective, life span development, has been relatively absent. As a guide to the next generation of studies on personality and health, we review conceptual and methodological issues, emphasizing the potential role of the life span perspective. We also illustrate these issues by reviewing recent reach on three personality characteristics studied as risk factors for physical disease—hostility, neuroticism, and optimism. The strengths of current personality and health research, recent developments in personality psychology, and the concepts and methods of life span approaches can be combined to construct a more complete and useful account of personality's effects on health and disease.

Lower socioeconomic position is associated with increased risk of coronary heart disease. This robust gradient is found across levels of socioeconomic position and after controlling access to health care and traditional biological and behavioral risk factors. Thus, previous theory and research has examined the role of other, relatively static psychosocial factors (e.g., social isolation and negative emotional traits) that may account for this association. Utilizing an interpersonal perspective on psychosocial risk (Smith & Cundiff, 2011; Smith, Gallo, & Ruiz, 2003; Smith, Glazer, Ruiz, & Gallo, 2004), this review examines the role of recurring interpersonal experiences and their physiological effects as a pathway linking socioeconomic position and coronary heart disease. Specifically, we focus on proximal interpersonal experiences that may not only explain the increased prevalence of more chronic psychosocial vulnerabilities in lower socioeconomic environments and individuals but may also link those psychosocial vulnerabilities to the momentary physiological mechanisms (i.e., stress responses) that directly contribute to coronary heart disease. Recurring experiences of reduced support and increased conflict in important personal relationships, work stress, multiple aspects of interactions with higher-status others, the effects of negative stereotypes about lower socioeconomic groups and individuals, greater use of suppressive strategies for emotion regulation and greater negative consequences for more direct and expressive social behavior, and greater engagement in perseverative cognition all plausibly combine to perpetuate psychosocial risk and produce overall greater physiological burden at lower levels of socioeconomic position.

The principle of complementarity in interpersonal theory states that an actor’s behavior tends to “pull, elicit, invite, or evoke” responses from interaction partners who are similar in affiliation (i.e., warmth vs. hostility) and opposite in control (i.e., dominance vs. submissiveness). Furthermore, complementary interactions are proposed to evoke less negative affect and promote greater relationship satisfaction. These predictions were examined in two studies of married couples. Results suggest that complementarity in affiliation describes a robust general pattern of marital interaction, but complementarity in control varies across contexts. Consistent with behavioral models of marital interaction, greater levels of affiliation and lower control by partners—not complementarity in affiliation or control—were associated with less anger and anxiety and greater relationship quality. Partners’ levels of affiliation and control combined in ways other than complementarity—mostly additively, but sometimes synergistically—to predict negative affect and relationship satisfaction.

Biventricular (BiV) pacing for cardiac resynchronization therapy (CRT) is intended to improve left ventricular function by coordinating systolic activity of the septum and free walls. Optimal resynchronization should be manifested by 12-lead electrocardiogram (ECG) patterns consistent with resynchronized activation, a tall (≥4 mm) R wave in V1, and predominant negative deflection in lead I (RV1SI). We investigated whether the presence or absence of RV1SI predicts heart failure outcomes within 1 year of CRT implant.Two independent physicians reviewed the paced ECG of 213 patients post-CRT device implantation with disputes resolved by a third reviewer. The primary end points of all-cause death, unplanned hospitalization, left ventricular assist device implant, or transplant within a 1-year follow-up were blindly adjudicated according to standard definitions. Groups were compared via Kaplan-Meier estimates and Cox proportional hazards models to determine association with event-free survival.Among CRT patients postimplantation, 56 (26.3%) exhibited the RV1SI pattern on ECG. Patients with the RV1SI pattern were significantly less likely to achieve the primary end point as compared to patients without the RV1SI pattern (33.9% vs 52.2%; Log Rank P = 0.022). This difference was driven by a significantly lower risk for unplanned hospitalization among patients with the RV1SI pattern (hazard ratio = 0.510; confidence interval [0.298, 0.876]). The predictive value remained after adjustment for potential confounders (P = 0.004).The 12-lead ECG postimplantation predicts clinical outcomes of BiV pacing. Such prediction may be useful in predicting the need for alternative or advanced heart failure therapies. Further study into ECG patterns may help to prospectively guide CRT.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is associated with increased risk of coronary heart disease (CHD) and difficulties in intimate relationships. Greater frequency and severity of couple conflict and greater cardiovascular reactivity to such conflict might contribute to CHD risk in those with PTSD, but affective and physiological responses to couple conflict have not been examined previously in this population. METHOD: In a preliminary test of this hypothesis, 32 male veterans of the Iraq and Afghanistan Wars with PTSD and their female partners, and 33 control male veterans without PTSD and their female partners completed relationship quality assessments and a conflict discussion task. PTSD diagnosis was confirmed through diagnostic interviews and questionnaires. State anger, state anxiety, and cardiovascular measures (i.e., blood pressure, heart rate) were recorded during baseline and the conflict discussion. RESULTS: Compared with controls, PTSD couples reported greater couple conflict and less warmth, and displayed pronounced increases in anger and greater increases in systolic blood pressure in response to the conflict task (all ps < .05; range η2: .05-.24). Partners in the PTSD group exhibited similar, if not greater, responses as veterans. CONCLUSIONS: This was the first investigation to document emotional and cardiovascular responses to couple conflict in veterans with PTSD and their partners. PTSD was associated with greater frequency and severity of couple conflict, and greater anger and cardiovascular reactivity to conflict discussions. Anger and physiological responses to couple discord might contribute to CHD risk in veterans with PTSD, and perhaps their partners, as well.

The quality of spousal relationships has been related to physical-health outcomes. However, most studies have focused on relationship positivity or negativity in isolation, despite the fact that many close relationships are characterized by both positive and negative aspects (i.e., ambivalence). In addition, most work has not accounted for the reciprocal nature of close-relationship processes that can have an impact on health. Using a sample of 136 older married couples, we tested whether actor-partner models of relationships that were either primarily positive or ambivalent (i.e., perceived as having both helpful and upsetting aspects) predicted measures of coronary-artery calcification. Results revealed an Actor × Partner interaction whereby coronary-artery calcification scores were highest for individuals who both viewed and were viewed by their spouse as ambivalent. These data are discussed in light of the importance of considering both positive and negative aspects of relationship quality and modeling the interdependence of close relationships.

Social-evaluative threat evokes increases in salivary cortisol and heightened cardiovascular reactivity. However, the types or content of social threats underlying these physiological responses are not clearly delineated in direct comparisons. Based in interpersonal theory, the present study manipulated high and low levels of acceptance threat (i.e., evaluation of likability, potential for inclusion) and status threat (i.e., evaluation of competence, leadership potential) during a modified Trier Social Stress Test, using a sample of 137 undergraduates (73 women). Both acceptance threat and status threat heightened salivary cortisol, heart rate, and blood pressure responses to the task. Hence, concerns about social inclusion or connection with others and concerns about social standing or status can contribute independently to physiological stress responses.

This study examined the association between attachment style and marital functioning, focusing on cognition as a key explanatory link. Married spouses completed measures of anxious and avoidant attachment, negative attributions, and perceived marital support and conflict. Attachment style was related to marital adjustment and to attribution style, with anxious attachment being a stronger predictor than avoidant attachment. The interaction of husbands' and wives' attachment styles also predicted marital functioning. In some cases, the tendency to make negative attributions for spouse behavior mediated the effects of attachment style on marital adjustment. Couples also participated in a marital interaction task involving two social situation manipulations - an agency threat (i.e., evaluation) and a communion threat (i.e., disagreement with one's spouse). Following the task, participants completed a measure assessing their appraisals of their spouses' behavior. Attachment style interacted with the social situation manipulations to affect spouse appraisals. The results support the general hypothesis that adult attachment style predicts functioning in intimate relationships, and suggest that cognitive processes may form part of the path explaining this association.

This study examined the joint and independent effects of experimentally manipulated social contexts and individual differences in hostility and perceived social support on physiological responses to a social stressor, while illustrating the use of the interpersonal circumplex for integrative social psychophysiological research. Undergraduate women completed a speech task in a supportive, neutral, or provoking context and completed measures of hostility and perceived social support. The provoking context evoked the largest blood pressure and heart rate (HR) responses, followed by the neutral and the supportive context. Social context also influenced HR and electrodermal reactivity during task preparation. Hostility elicited higher systolic blood pressure (SBP) reactivity during preparation, speech, and recovery. Perceived social support interacted with context to affect SBP and HR during speech and preparation. The roles of interpersonal characteristics and contexts in the physiological stress response and the utility of interpersonal methods in studying these associations are discussed.

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Although hostility and social support are closely related, these risk factors for cardiovascular disease and premature death are typically considered separately. Interpersonal approaches to personality and social relations (Kiesler, 1996) provide models and methods for examining the interrelation of these constructs. The current study used the interpersonal approach to identify and describe groups of individuals varying on hostility and social support. In two samples of undergraduate men and women, replicated cluster analyses revealed three distinct patterns of psychosocial risk. An affiliative (i.e., “low-risk”) group was characterized by low hostility and high social support. This group displayed a friendly interpersonal style on a measure of the five-factor model that incorporates the interpersonal circumplex. On a related measure of parental representations, the low-risk group reported pervasively affiliative interactions with their mothers and fathers as well as a secure adult attachment style. A hostile group was characterized by higher levels of hostility and high social support. These individuals presented a more hostile interpersonal style and higher levels of neuroticism, but reported typically affiliative interactions with parents and a secure attachment style. Finally, a hostile-isolated group was distinguished by elevated hostility and low social support. These subjects displayed a hostile-submissive interpersonal style as well as higher levels of neuroticism. They also reported more hostile and fewer friendly interactions with their parents and an insecure adult attachment style. These findings illustrate the potential value of examining naturally occurring patterns of psychosocial risk. Because the interpersonal approach allows the description of personality traits and interpersonal processes in a common conceptual language, it may be a particularly useful methodology in this regard.

Objective Prior studies demonstrate that hostile persons respond to social stressors with heightened cardiovascular responses. This study examined the effects of individual differences in hostility and two experimentally manipulated social stressors on cardiovascular reactivity during marital interaction. Methods Sixty couples participated in a discussion task under conditions of high or low evaluative threat and while either agreeing or disagreeing with each other. Individual differences in hostility were assessed with the Buss-Perry Aggression Questionnaire. Participants' appraisal of their spouses' behavior during the interaction task was assessed with a standardized measure. Systolic and diastolic blood pressure and heart rate responses were recorded. Results Among husbands, hostility was associated with greater systolic blood pressure reactivity under high, but not low, threat. Appraisals suggested that this might be due to husbands' efforts to assert dominance in the interaction. Wives' hostility scores were unrelated to cardiovascular reactivity, but wives disagreeing with hostile husbands showed greater heart rate reactivity. Conclusions Heightened cardiovascular reactivity to stressful marital interactions among hostile men provides additional evidence of the viability of this psychophysiologic mechanism as a link between hostility and health. The lack of effects among wives suggests sex differences in the social psychophysiology of hostility. Interpersonal concepts and methods are useful in the study of psychosocial risk factors and mechanisms.

Attributions have been found to influence theimpact of stressful life events. This study examined therole of attributions in emotional adjustment toend-stage renal disease (ESRD). The Illness Attributions Inventory (IAI) was developed to access threeattributions for problems created by ESRD and itstreatment -- self-blame, acceptance of responsibility,and other blame. Factor analyses and associations with measures of adjustment and personalitygenerally support the distinctiveness of these threedimensions, but suggested that self-blame and acceptanceof responsibility can also be seen as inversely related components of a single dimension. Inprospective analyses, high acceptance ofresponsibility/low self-blame was associated with betteremotional adjustment.The effects of other blame onadjustmentwere context-specific. Among patients reliant on dialysis staff, otherblame was associated with better adjustment over time.Among patients responsible for their own dialysistreatments, other blame was associated with worse adjustment over time.

INTRODUCTION The construct of cardiovascular reactivity (CVR) occupies a central place in both the history and current state of behavioral medicine research. Early theories identified transitory, stressinduced increases in heart rate, blood pressure, and other parameters as pathophysiologic mechanisms through which negative emotions, stressful life circumstances, and maladaptive social relations caused cardiovascular disease (1,2). Since that time, well-developed models of the potential role of CVR in the development of essential hypertension (EH) and coronary heart disease (CHD) have been proposed (e.g. 3,4). A large body of research has accumulated (5,6), and the methodology for examining the issue continues to be refined (7,8). Although some studies have not supported the hypothesized role of CVR (9,10), a variety of recent studies are consistent with this general model (1 I). For example, CVR to laboratory stressors has been found to predict later EH (12). Also, in both crosssectional and prospective designs, CVR in response to laboratory stressors has been found to predict more severe atherosclerosis (13,14). Similarly, exaggerated CVR to mental stress has been found to be associated with coronary artery disease among asymptomatic persons at high familial risk of CHD (15). Among patients with CHD, those who display the most pronounced CVR in response to laboratory mental stressors also display the greatest amount of myocardial ischemia during daily activities (16). Finally, some evidence suggests that heightened CVR predicts recurrent cardiovascular morbidity among survivors of myocardial infarction (17). Thus, CVR has been found to have predicted associations with the development, manifestations, and course of cardiovascular disease (CVD). Social processes have long been recognized as potentially important influences on CVR (18,19). Yet, until recently, social factors have not been a major focus of research on the construct. A largely non-social psychophysiology of CVR has been accumulated during much of the recent history of research on the topic (20). Although this work produced important advances in our understanding of the nature and consequences of CVR (21), the construct was, for the most part, studied without explicit attention to the social determinants of cardiovascular response. The collection of papers in this special issue reflect the range of work currently underway on the social psychophysiology of CVR. They illustrate the promise, unique challenges, and products of recent

Cardiovascular reactivity (CVR) has been identified as a potential mechanism linking a variety of psychosocial processes to the development of cardiovascular disease. Although the effects of hostile and supportive social stimuli on CVR have been studied extensively, less is known about the effects of a second major dimension of social relations--dominance versus submissiveness. In the present study, 45 married couples participated in an interaction task involving the assertion of differing opinions. Subjects also provided ratings of their typical level of dominance versus submissiveness in relation to their spouse. Consistent with predictions derived from related conceptual models of psychological determinants of CVR, blood pressure reactivity was positively associated with perceptions of the spouse as dominant. At the highest level of perceived spouse dominance, CVR was attenuated, again consistent with prediction. Results are discussed in terms of the usefulness of conceptual models of interpersonal relations and motivation as guides in studying the social determinants of CVR, as well as the value of marital interactions as a context for understanding CVR.

Background —Recently, attempts have been made to cure atrial fibrillation by creating multiple linear atrial lesions with radiofrequency energy. Intracardiac echocardiography (ICE) offers imaging of endocardial anatomy and the ablation electrode–tissue interface not available with standard fluoroscopy. This study sought to prospectively compare fluoroscopic with ICE guidance for the creation of linear atrial lesions in a canine model. Methods and Results —The creation of 3 linear atrial lesions was attempted in each of 10 dogs, half guided by fluoroscopy alone and half by ICE. Coil-tissue contact was prospectively graded. After ablation, animals were euthanized, and the location and continuity of lesions were evaluated. ICE guidance led to a higher percentage of successful applications ( P =0.02) and mean achieved temperature ( P =0.004). The contact scores of excellent, fair, and poor correlated well with successful energy delivery, mean temperature, and efficiency of heating ( P Conclusions —Compared with fluoroscopy, ICE guidance improved targeting, energy delivery, and lesion formation in this canine model. This study suggests that ICE guidance improves lesion formation and prevents energy delivery to potentially dangerous sites.

The general literature on personality traits as risk factors for physical illness--as well as the specific literature on health consequences of anger, hostility, and aggressive behavior--often suffers from incomplete or inconsistent construct validation of personality measures. This study illustrates the utility of two conceptual tools in this regard--the five-factor model and the interpersonal circumplex. The similarities and differences among anger, hostility, verbal aggressiveness, and physical aggressiveness as measured by the Buss and Perry (1992) Aggression Questionnaire were identified. Results support the interpretation of anger and hostility as primarily reflecting neurotic hostility and antagonistic hostility to a lesser extent. In contrast, verbal and physical aggressiveness can he seen as primarily reflecting antagonistic hostility, and to a lesser extent neurotic hostility. Further, verbal aggressiveness was associated with hostile dominance, whereas hostility was associated with hostile submissiveness. These findings identify potentially important distinctions among these related constructs and illustrate the potential integrative value of standard validation procedures.

Chronic hostility is associated with increased vulnerability to serious physical illness, making developmental influences on this trait important. We used the Structural Analysis of Social Behavior (SASB) model to examine retrospective descriptions of twin interactions during childhood in a sample of 48 adult male twin pairs. Consistent with previous research on parental behavior correlates, self-reported hostility as measured by the Cook and Medley Ho scale was associated with descriptions of the twin's behavior as hostile, controlling, and neglecting. Consistent with the SASB principle of introjection, hostility was also associated with self directed hostility and neglect. Thus, a developmental perspective not only describes possible social contexts involved in the emergence of this trait, but also suggests possible psychological underpinnings. Implications for models of hostility and health are discussed.

The effects on cardiovascular reactivity of incentive to influence the judgements of the experimenter and the threat of social evaluation were examined in a sample of 60 male and 60 female undergraduates. Participants either were guaranteed $5.00 to prepare and deliver a brief speech or were told that the money was contingent on an evaluation by the experimenter. Participants believed that their speech would be rated for either simple clarity or verbal intelligence. The contingent incentive increased systolic blood pressure reactivity by 6.5 mmHg (32%). Evaluative threat increased systolic reactivity by 7.1 mmHg (36%). These interpersonal processes could increase the risk of cardiovascular disease and are likely to affect the degree of cardiovascular reactivity in laboratory studies.

This study examined the proportion and magnitude of dose escalation nationally and regionally among rheumatoid arthritis (RA) patients treated with TNF-blockers and estimated the costs of TNF-blocker therapy.This retrospective cohort study used claims data from US commercially-insured adult RA patients who initiated adalimumab, etanercept, or infliximab therapy between 2005-2009. Biologic-naïve patients enrolled in the health plan for ≥6 months before and ≥12 months after therapy initiation were followed for 12 months. Dose escalation was assessed using three methods: (1) average weekly dose recommended label dose, (2) average ending dispensed dose maintenance dose, and (3) average dose after maintenance dose maintenance dose. Annual cost of therapy included costs for mean dose and drug administration fees.Overall, 1420 etanercept, 874 adalimumab, and 454 infliximab patients were included. A significantly lower proportion of etanercept-treated patients had dose escalation using the average weekly dose (3.9% vs 21.4% adalimumab and 69.6% infliximab; p 0.0001), average ending dispensed dose (1.1% vs 10.6% adalimumab and 63.0% infliximab; p 0.0001), and average dose after maintenance dose methods (2.8% vs 15.7% adalimumab and 69.6% infliximab; p 0.0001). Regional dose escalation rates and magnitudes of escalation were directionally consistent with national rates. Etanercept had the lowest cost per treated RA patient ($19,690) compared to adalimumab ($23,020) and infliximab ($24,030).Exclusion of patients not on continuous TNF-blocker therapy limits the generalizability; however, ∼50% of patients were persistent on therapy for 12 months. The study population comprised RA patients in commercial health plans, thus the results may not be generalizable to Medicare or uninsured populations.In this retrospective study, etanercept patients had the lowest proportions and magnitudes of dose escalation across all methods compared to adalimumab and infliximab patients nationally and regionally. Mean annual cost was lowest for etanercept-treated patients.

The indirect association of marital quality with metabolic syndrome (MetS) through depressive symptoms was examined in 301 middle-aged and older couples. MetS components (i.e., waist circumference, blood pressure, blood draws to assess triglycerides, HDL cholesterol, and fasting glucose) were assessed following a 12-h fast, and were treated as a continuous latent variable for analyses. In structural equation modeling of this indirect effect, overall model fit was good, and husbands' and wives' marital quality was associated with MetS only through depressive symptoms. Joint tests of the parameters indicated that gender did not moderate this association. The best fitting, most parsimonious model, after nested model comparisons, was one in which husbands' and wives' indirect paths were equated. Overall, marital quality was related to MetS through its relationship to depressive symptoms for men and women. Associations of marital quality and depression with MetS may overlap, and couple-based approaches to psychosocial risk factors for cardiovascular disease may be useful in future research.

A variety of aspects of personality and emotional adjustment predict the development and course of coronary heart disease (CHD), as do indications of marital quality (e.g., satisfaction, conflict, strain, disruption). Importantly, the personality traits and aspects of emotional adjustment that predict CHD are also related to marital quality. In such instances of correlated risk factors, traditional epidemiological and clinical research typically either ignores the potentially overlapping effects or examines independent associations through statistical controls, approaches that can misrepresent the key components and mechanisms of psychosocial effects on CHD. The interpersonal perspective in personality and clinical psychology provides an alternative and integrative approach, through its structural and process models of interpersonal behavior. We present this perspective on psychosocial risk and review research on its application to the integration of personality, emotional adjustment, and marital processes as closely interrelated influences on health and disease.

A 63-year-old male radio announcer was admitted with a narrow complex, long RP tachycardia. While in the awake state, the patient spoke in his radio voice, initiating and maintaining the tachycardia. Three-dimensional electroanatomic mapping during electrophysiology study localized the tachycardia to the ostium of the right superior pulmonary vein. After single radiofrequency energy application, no further arrhythmias were inducible with speech. At more than 1 year of follow-up, the patient had no recurrences and continues to work as a radio announcer.

Contents: A.W. Siegman, T.W. Smith, Introduction. A.W. Siegman, From Type A to Hostility to Anger: Reflections on the History of Coronary-Prone Behavior. T.W. Smith, Concepts and Methods in the Study of Anger, Hostility, and Health. J.C. Barefoot, I.M. Lipkus, The Assessment of Anger and Hostility. K.F. Helmers, D.M. Posluszny, D.S. Krantz, Associations of Hostility and Coronary Artery Disease: A Review of Studies. B.K. Houston, Anger, Hostility, and Psychophysiological Reactivity. R.B. Williams, Jr., Basic Biological Mechanisms. J.R. Kaplan, M.B. Botchin, S.B. Manuck, Animal Models of Aggression and Cardiovascular Disease. R.J. Contrada, Personality and Anger in Cardiovascular Disease: Toward a Psychological Model. A.W. Siegman, Cardiovascular Consequences of Expressing and Repressing Anger. I.C. Siegler, Hostility and Risk: Demographic and Lifestyle Variables. C.M. Stoney, T.O. Engebretson, Anger and Hostility: Potential Mediators of the Gender Difference in Coronary Heart Disease. J.L. Deffenbacher, Anger Reduction: Issues, Assessment, and Intervention Strategies.