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More than 50 years ago, two cardiologists described the type A versus type B personality styles: Type A individuals were ambitious, aggressive and impatient, whereas people with type B personalities were more easygoing, patient and calm. Early studies found that type A personalities had a higher risk of developing heart disease, but over time it appeared that only the group’s negative emotions -- aggressiveness and anger -- were associated with the condition. Although the expression “type A” is still used from time to time, physicians and health psychologists now view it as dated. More recently, researchers have identified a type D personality style that is linked with negative health outcomes, including heart disease.
In 1998, psychologist Johan Denollet and other researchers in the Netherlands named type D for a distressed personality style. Type Ds experience many negative emotions and are extremely socially inhibited. They feel a lot of anxiety, anger, sadness and pessimism, but do not express these feelings for fear of disapproval. Unsurprisingly, a growing body of research has associated the type D personality with overall poor health and quality of life, slower recovery from heart attacks and a greater risk of burnout. Although women are underrepresented in many of the studies, it does appear that the harmful effects of the type D personality apply to women and men alike.
Type D is not clinical depression or general anxiety disorder. Although those conditions are associated with poor physical health, they are acute conditions that dramatically interfere with daily life. The type D personality is a more general personality style that is consistent over time. A type D person may live in a state of pessimism but will not have the other symptoms of major depression, like changes in weight, sleep, concentration and activity level. Similarly, type Ds avoid expressing their emotions but do not suffer from panic attacks or an overall sense of fear.
So does type D actually cause heart disease? The answer is not totally clear. It’s possible that the distress type Ds experience causes the body to release stress hormones that, over a long period of time, have negative effects on cardiovascular functioning. Another possibility is that the bodies of type Ds react more intensely to any stress, resulting in increased blood pressure and heart rate. In addition, some type Ds manage their unexpressed negative emotions by engaging in unhealthy habits, like smoking, substance abuse and eating a high-fat, high-carbohydrate diet. Not a pretty picture.
So, for women (and men) of all ages, it is important to alter the type D personality style. But can a long-term, consistent set of traits be altered? The answer is yes, and the time to start is now. Personality styles can be flexible, and people are resilient. Several studies have successfully employed stress-management strategies to help type Ds feel better and cope more effectively. All that is needed is the motivation to change and a good plan.
Increased self-awareness is always the first step in any behavior change. Do you find yourself becoming easily angered, sad or anxious? Is your outlook usually gloomy or pessimistic? Do you avoid expressing your emotions because you feel that other people will reject you? Do you tend to be a reticent person? If so, you may well be type D.
You probably have a type D personality style for a number of reasons. First, there is a genetic component to personality. Family styles and values also shape the way we express ourselves. In some families, expressing emotions -- especially negative ones -- is seen as unacceptable. In more serious situations, children who have been physically or sexually abused or come from families with alcohol or drug problems learn a culture of secrecy. It is also possible that you did not have serious family problems, but came from a culture that values a stoic approach to life.
The next step is to develop strategies that have two goals. The first goal is to decrease or manage your negative emotions and attitudes. The second goal is to increase social interactions and self-expression. Negative emotions, like sadness, anxiety and anger, are part of life, but if they are pervasive, they are harmful to your health. If you feel an undercurrent of irritability and anxiety, physically relaxing can help you to better manage, express and even identify your emotional state.
This can be accomplished by a number of techniques, such as progressive muscle relaxation, slow and deep breathing or progressive relaxation exercises. Cutting back on your caffeine consumption and getting enough sleep will also help. By calming your body, you will be better able to experience your emotions.
Mindfulness-based stress reduction (MBSR) can help you become more aware of your feelings and attitudes. Jon Kabat-Zinn, a molecular biologist who studied mind-body interactions, developed MBSR as a stress-reduction program for patients at the University of Massachusetts Medical School. MBSR has been quite effective in helping patients suffering from a variety of medical problems. The principles of mindfulness are extremely beneficial. These include adopting a nonjudgmental attitude toward yourself and others, being patient and compassionate, practicing acceptance and focusing on the present. In addition, a large part of MBSR is the development of skills for relaxation and focused concentration. MSBR has been shown to reduce anxiety and increase positive emotions. Other forms of meditation are also valuable.
While it is important to identify and manage your emotional states, increasing your ability to express those emotions is another challenge. Awareness of the health risks should increase your motivation to share your feelings. Remember, carrying around a suitcase of sadness and anxiety is bad for both your physical and emotional health. After you identify someone you trust, try to be more open. It is especially important to take small steps. You might start by writing down what you’d like to say. It may take a while to find the words, but there is no rush. Many type Ds have relationships built on shared activities rather than shared emotions, yet most people will not rebuff your attempt at sharing. If it feels too difficult to talk to a friend or family member, then psychotherapy is a safe setting where your feelings will be private and confidential, and you can develop the skills for self-expression.
Anger is one of the most frightening emotions for type Ds to express. In addition to calming and meditative practices, when you feel angry, take a minute to reflect. Is whatever you experienced that harmful? Was your life affected in a negative way? Did the person mean to hurt you? Often the answer to these questions is no. If the issue is important you, try to use the following formula to begin to express yourself: First, describe what happened in a factual manner. Next, express how the interaction made you feel or its impact on you. Finally, ask for change in the future. This is an assertive -- not aggressive – strategy.
In addition to small steps and long-term strategies to alter your type D personality, you may benefit from a formal stress-management program. These involve groups of people, have an educational approach and teach new coping skills for managing stress. Individual psychotherapy also provides a safe place to examine your personality style and plan for behavior change. It took time to develop your personality style, so it will take time to modify it. But it’s worth it to protect your heart and overall health.
Check out this slideshow for more tools that can help you adjust your outlook.
Carol Landau is a clinical professor of psychiatry and medicine at Brown University’s Alpert Medical School.
Do you have a question about personality and heart health? Dr. Landau will be answering your questions on our Heart Health message board on Monday through Friday, 8/15 to 8/19.