Some time ago, Parade magazine showed a cover with a heart complete with its coronary arteries, and the headline “Does Anger Kill?” The associated article went on to explain much medical data showing that yes, indeed, anger along with cynicism and hostility are significantly potent risk factors for heart attacks and strokes. This has been known for many years, since the 1960’s excitement about “Type A” behavior. But more recent analyses have shown that some of the other components of Type A, such as the busy-ness, are not nearly so toxic as are the cynical hostility.
Tom was relatively young (51) when he had his heart attack. The usual coronary risk factors were fairly minimal- cholesterol upper normal, normal blood pressure, no smoking, CRP negative, homocysteine normal. What was going on? Tom had several in his family with both heart attacks and a history of anxiety or depression. He didn’t meet full criteria for clinical depression himself, however. (Clinical depression is a significant coronary risk factor, comparable in severity to smoking.) When asked if he felt hostile to those around him, he angrily replied, “No! What do you take me for, anyway?!” Over time, it became clear that Tom was indeed an angry and hostile man, and his non-verbal behaviors showed this, but he didn’t like the idea of his being that way, because his values spoke of a gentle kindness that he found difficult. His angry, controlling ways had alienated some of those close to him – and lack of close, intimate relationships also puts one at higher risk for myocardial infarction. After we had established some trust and talked of some of these issues, he said, “What am I to do? I hate being this way, but it’s just the way I am.- And it gets things done! You should see the way people hop when I get angry! I can’t imagine being one of those uninvolved, ‘don’t care’ Type Bs.” Yet inside, Tom felt very unsettled by the effects of his behavior.
We seem so often to want to identify the things that cause disease -in this case anger and cynicism-and then tell people not to do them. But that seldom works. The brain has a way of being unable to do what it’s told not to do. To form a new behavior, we need to be able to form a picture doing that new desired behavior, and we can’t picture not doing something. To change, we need to picture what to do instead. And the “instead behavior” needs to be in full compliance with our deeply held values.
Many of us are familiar with the descriptions of Type A behavior that was proven to be cardiotoxic, but what exactly is the Type B pattern that protects from heart attacks? Is it really the usual image: laid back, not caring, uninvolved, nonproductive? That style doesn’t really appeal to the often highly productive Type A like Tom. But, in fact, when one looks at the details of what the cardioprotective pattern really is, it becomes quite appealing indeed to most people, and certainly was attractive to Tom.
In fact, a large, well controlled study of over 780 heart attack patients over five years, showed an intervention to create a change from hostile Type A to cardioprotected Type B behavior was well received by the participants. In comparison to those receiving usual cardiac care without the intervention, creating Type B behavior reduced second infarctions by nearly 50%, a result better than anything else we do for prevention of myocardial infarction.
The Effective Type B Personality
Here is the outline of the misunderstood effective Type B in those original studies. These people are often peak performers and hold many top positions (40% of studied large company CEOs fit this profile.) They are effective because people like working for them. See if you don’t find the pattern appealing indeed:
Cardioprotected Behavior
No excessive time urgency
- More mindful in giving attention to the central task a hand
- Not easily bored or eager to move on to something else
- Usually keeps on time, but without frenzy or rage
- Patience (not habitual haste)
- Contemplative: enjoy beauty and metaphor.
- Tend to see the whole more than the parts
- Able to value and enjoy the things already done, or being now done, as much as those things to be done in the future
Able to relinquish control
- Good at delegation, team players-inspire creative involvement of others
- Tolerant of differences-even enjoy them
An internal locus of high self value
- Appreciates self for what he/she is as much as what he/she does
- Accepts and values self as is
- Feel valued and of worth regardless of achievement and numbers (often derived from parents)
- Often work as hard at something as Type A’s, but failure does not collapse self esteem
- Love growth, getting better (often through mistakes)
- Compete with self, not with others
No free floating hostility
- No need to find fault to bolster own ego
- Are forgiving: Can accept with equanimity the errors of others (“They practice the art of being wise by knowing what to disregard.”)
- Enjoy empowering and lifting others
- Uncommonly feel tense or induce tension in others
- Their self confidence allows objectivity, and ability to see through another’s eyes.
- Capable of both feeling and expressing affection – enjoy intimate relationships
