ABSTRACT
During the 1980s, many studies examined the association of chronic anger and hostility with cardiovascular morbidity and mortality (Helmers & Krantz, this volume; Smith, 1992). In fact, more empirical support for this psychosomatic hypothesis accrued during this period than had appeared in its entire previous history, despite the fact that the health consequences of anger and hostility have been discussed for centuries (Siegman, this volume). This empirical support came from cross-sectional studies of coronary artery disease (CAD; e.g., Dembroski, MacDougall, Williams, Haney, & Blumenthal, 1985) and prospective studies of initially healthy persons (e.g., Barefoot, Dahlstrom, & Williams, 1983; Hecker, Chesney, Black, & Frautschi, 1988). There is also converging evidence from animal studies implicating aggressive behavior and angerlike states in the development of CAD (Kaplan, Botchin, & Manuck, this volume; Manuck, Kaplan, Muldoon, Adams, & Clarkson, 1991) and the occurrence of acute manifestations of coronary heart disease (CHD), such as myocardial ischemia (Verrier, Hagestad, & Lown, 1987). The possible clinical relevance of these findings was suggested in the Recurrent Coronary Prevention Project (RCPP), in which group therapy for coronary-prone behavior significantly reduced recurrent cardiac events (Friedman et al., 1986). Although this intervention focused on the globally defined Type A pattern, chronic anger and hostility was a central issue in the treatment program (Thoresen & Powell, 1992).
