The effects of Neuroticism and Extraversion on cardiovascular reactivity during a mental and an emotional stress task

International Journal of Psychophysiology 74 (2009) 274–279

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International Journal of Psychophysiology j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / i j p s yc h o

The effects of Neuroticism and Extraversion on cardiovascular reactivity during a mental and an emotional stress task C.R. Jonassaint a, Y.P. Why b, G.D. Bishop b,⁎, E.M. Tong b, S.M. Diong b, H.C. Enkelmann b, M. Khader c, J. Ang c a b c

Duke University, United States National University of Singapore, Singapore Police Psychological Services Division, Singapore Police Force, Singapore

a r t i c l e

i n f o

Article history: Received 25 May 2009 Received in revised form 27 August 2009 Accepted 29 September 2009 Available online 7 October 2009 Keywords: Neuroticism Extraversion Emotion Cardiovascular reactivity Stress

a b s t r a c t Evidence suggests that physiological reactivity to mental and emotional stress may be influenced by personality traits. Objectives: This study aimed to examine the relationship between, emotionally based personality traits, Neuroticism (N) and Extraversion (E), and cardiovascular reactivity (CVR) during mental arithmetic (MA) and anger recall (AR). Methods: Heart rate, blood pressure, cardiac output and total peripheral resistance were measured in 114 Singaporean male patrol officers from the Singapore Police Force while they performed MA and AR tasks. N and E were assessed using the NEO PI-R. Results: Higher N was associated with lower DBP and TPRI reactivity during MA as compared to lower N, but higher TPRI reactivity during AR. Lower E scores were associated with heightened CVR while higher E scores were associated with lower CVR. For SBP and HR, E was associated with a reduction in reactivity across tasks; whereas, for DBP and TPRI this reduction was found only during AR. Conclusion: In this population, N had differential effects on CVR depending upon the nature of the stress task, cognitive or emotional. However, higher E was consistently linked to lower CVR during stress tasks and appeared to influence how individuals express and cope with anger. © 2009 Elsevier B.V. All rights reserved.

1. Introduction The magnitude or pattern of an individual's hemodynamic response to psychological stress may be an important marker of CHD risk (Sherwood and Turner, 1995). Cardiovascular reactivity (CVR) is thought to be involved in the pathogenesis of coronary atherosclerosis (Everson et al., 1997) and a predictor of essential hypertension (Kasagi et al., 1995), increases in left ventricular mass (Murdison et al., 1998), and new cardiac events in CHD patients (Krantz et al., 1999). Various personality dimensions are thought to have an influence on cardiovascular reactivity. Because the experience and regulation of emotions have been associated with cardiovascular responses (Gross, 1998, Herrald and Tomaka, 2002), personality dimensions closely associated with emotion have received the most attention in the cardiovascular literature. Further, the link between personality and CVR is likely not an independent process but one operating through emotion (Houston, 1989). Thus, personality dimensions that are associated with or modulate an individual's emotional experience should

⁎ Corresponding author. Department of Psychology, National University of Singapore, 9 Arts Link, Singapore 117570, Singapore. Tel.: +65 6874 6415; fax: +65 6778 1213. E-mail address: [email protected] (G.D. Bishop). 0167-8760/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.ijpsycho.2009.09.012

have more influence on reactivity during a stimulus event than dimensions not related to emotion. Neuroticism, an indicator of proneness to negative affectivity, is the best-established personality risk factor for poor health (Smith and MacKenzie, 2006). Several studies have examined N as a potential CHD risk factor; however, the literature has been mixed showing N to increase risk (Christensen et al., 2002), be protective (Korten et al., 1999; Weiss and Costa, 2005) and have no association (Almada et al., 1991a; Nakaya et al., 2005) with CHD and mortality. Sample population differences in age, gender, socioeconomics and ethnicity between studies may be factors contributing to the incongruent findings. However, despite these inconsistencies, well-designed prospective studies consistently suggest that a disposition to negative affectivity is a CHD risk factor (Suls and Bunde, 2005). Further, research examining the effects of personality on CVR has shown greater reactivity to stress to be associated with components of N, anger (Siegman et al., 1990) and hostility (Harralson et al., 1997). Therefore, it is likely that high N is associated increased reactivity to emotionally relevant stress. A personality dimension that has received less attention as a CHD risk factor, Extraversion (E), has been positively correlated with the experience (Schimmack et al., 2002; Lucas and Fujita, 2000) and expression of positive emotions (Pavot et al., 1990; Ruch, 1993), as well as emotional reactivity (Lucas and Baird, 2004). Further, level of E

C.R. Jonassaint et al. / International Journal of Psychophysiology 74 (2009) 274–279

may influence one's emotional coping style. Individuals high on E are more likely to use reappraisal and less likely to use suppression as an emotion regulation technique (John and Gross, 2004). Emotional suppression has been associated with greater sympathetic activation of the cardiovascular system than non-suppression (Gross and Levenson, 1997). Because individuals low on E are less effective in regulating their emotions than those high on E (John and Gross, 2004), it is likely that E is negatively associated with CVR to stress— particularly during emotion-related challenges. Although E is a good candidate in the examination of factors influencing CVR, few studies have documented the effects of E on CVR and the findings that do exist have been inconsistent. One study showed that Extraversion had an effect on heart rate reactivity during a mental arithmetic (Pearson and Freeman, 1991); however, a recent study found no extraversion effects for MAP or HR during cognitive tasks (Vassend and Knardahl, 2005). Similarly, in earlier work, one study showed low E to be associated with greater HR reactivity in response to an aversive noise stimulus (Geen, 1984), while another study found no E differences in CVR to a mental arithmetic or a Stroop task (Glass et al., 1983). However, none of these studies included an emotional stress task; therefore, the effect of E on CVR during emotional stress is still unknown. Cardiovascular reactivity to stressful stimuli has been shown to be a marker for CHD risk (Kamarck, 1992; Treiber et al., 2003). Further, it is suggested that elevated CVR may mediate the relationship between ‘at risk’ personality variables and CHD (Williams et al., 1985). The current study hypothesis was, therefore, that higher N and lower E would be associated with elevated reactivity to stress. Due to the emotional nature of these personality traits, it was also predicted that N would have a larger positive and E a larger negative association with CVR during the emotional stress task than the mental stress task. A majority of the studies on personality and CVR have been restricted to Western populations. For this reason, this exploratory study investigated a male police officer Singaporean sample composed of three diverse ethnic groups: Indians, Malays, and Chinese.

2. Methods

Participants were 119 male police officers who volunteered from a larger sample of 254 male patrol officers (Why et al., 2003). History of heart problems or hypertension was an exclusion from the study. Ethnicity was determined by the classification on their national identification cards (33 Chinese, 39 Indians and 37 Malays). Mean age of the officers was 27.31 years (range: 19–51). Five participants with incomplete NEO PI-R data were excluded from the study. The final sample did not differ from the larger sample on measures of BMI or ethnicity. Table 1 shows the sample characteristics by ethnic group. Table 1 Demographic characteristics of participants.

Age BSA, m2 BMI, kg Neuroticism Extraversion

2.2. Apparatus Experimental tasks and questionnaires, with the exception of the NEO, were presented on a 15-inch CRT display, which an experimenter manipulated with a laptop computer. SBP and diastolic blood pressure (DBP) were obtained using an automated auscultatory blood pressure monitor (Model SD-700A: Industrial & Biomedical Sensors Corporation, Waltham, MA). Heart rate (HR), and cardiac output were obtained using the Minnesota Impedance Cardiograph Model 304B (Instrumentation for Medicine Inc., Greenwich, CT) with the standard four mylar band electrode configuration. 2.3. Questionnaires 2.3.1. Personality Personality was assessed using the NEO PI-R, a 240-item measure of the five factor model (FFM) of personality, with retest reliability ranging from 0.75 to 0.83 (Costa and McCrea, 1992). The FFM has been shown to have universal applicability as a personality structure in cross-cultural studies (McCrae et al., 1996; Leung et al., 1997; Huang et al., 1997; Almada et al., 1991b). In the current sample, the internal consistency for the Neuroticism and Extraversion domain was high (Cronbach's alpha = 0.84 and 0.73, respectively). Mean scores for each ethnic group are shown in Table 1. Ethnic groups did not differ on N or E. A 15-item Mood Adjective Checklist, derived from the UWIST Mood Adjective Checklist (Matthews et al., 1990), a measure of Hedonic tone, Tense arousal, Energetic arousal and Angry mood, was administered at three points in the protocol: baseline, post NR and post AR. The items were randomly ordered each time and displayed on the computer monitor in front of the participant. Angry mood scores were determined by averaging five angry mood items (‘Impatient’, ‘Annoyed’, ‘Angry’, ‘Irritated’, and ‘Grouchy’) at each period. Mood response was calculated using the change score from baseline to post stressor. All items were rated on a 4-point scale: ‘1’ for ‘Definitely Not’, ‘2’ for ‘Slightly not’, ‘3’ for ‘Slightly’ and ‘4’ for ‘Definitely’. 2.4. Experimental tasks

2.1. Participants

Ethnic group

275

Chinese (33)

Malays (39)

Indians (37)

Total (109)

Mean

Mean

Mean

Mean

SD

SD

SD

Freq.

%

Freq.

24.24 17b

%

Freq.

43.59 20b

%

Freq.

54.05 45.00

Means sharing a common subscript are not significantly different at p < 0.05.

2.4.2. Anger recall The anger recall (AR) task was used as an emotion arousing stressor. Participants were told to think of a time that had occurred within the last 6 months when someone made them really angry. Participants were allowed 1 min to think of an incident and then were asked to talk about the incident for 5 min.

SD

5.59 27.31 6.17 25.36a 5.19 28.23a 7.16 28.08a 1.79a 0.13 1.90b 0.19 1.89b 0.16 1.86 0.17 3.33 24.53 3.58 22.93a 2.65 24.93b 4.07 25.55b 84.29 19.52 88.11a 17.65 86.05a 17.35 79.03a 22.43 107.49a 16.92 112.23a 16.34 113.69a 15.19 111.29 16.20

Positive family 8a history of hypertension

2.4.1. Mental arithmetic The mental arithmetic (MA) task was included as a mild cognitive stressor that is emotionally neutral. The MA task consisted of mathematical problems, displayed on a computer screen, ranging from subtracting or adding one digit numbers to subtracting or adding three digit numbers. The participant responded by tapping either of two keys on the keyboard using his dominant hand to indicate whether the given answer was correct or incorrect.

% 41.25

2.5. Procedure The five physiological measures analyzed were SBP, DBP, HR, cardiac output index (CI) and total peripheral resistance index (TPRI). Body surface area (BSA) was calculated from the formula of Mosteller (1987). To control for body size, CI was calculated by dividing cardiac output by BSA and TPRI was obtained by multiplying total peripheral resistance by BSA. SBP, DPB and HR represent general cardiovascular indices that are most commonly measured in other studies, while CI and TPRI represent the hemodynamic factors affecting blood pressure.

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Table 2 Means and standard deviations of cardiovascular measures baseline and stress periods. Task Baseline

SBP DBP HR TPRI CI

Mental Arithmetic

Anger-recall

Mean

SD

Mean

SD

t (108)

p value

Mean

SD

t (108)

p value

114.54 74.52 74.07 2884.91 2.57

7.48 8.38 10.58 786.22 0.51

123.42 79.06 77.81 2970.32 2.68

11.19 9.32 10.41 864.47 0.63

11.97 7.14 7.31 2.74 3.9

<0.001 <0.001 <0.001 0.007 0.001

127.88 83.73 78.46 3039.98 2.70

12.49 10.50 10.70 756.68 0.54

14.45 11.00 10.33 3.89 4.61

<0.001 <0.001 <0.001 <0.001 <0.001

All participants were asked to abstain from smoking, caffeine, and exercise for 2 h prior to the experiment. Upon arrival, participants were briefed about the experimental study. After the electrodes and blood pressure cuff were attached, participants were asked to relax for approximately 8 min. Baseline measurements of physiological data were collected during this time. Following this baseline, the participants were told to proceed with either the MA or AR task. The presentation order of the two tasks was counterbalanced within each ethnic group. Baseline measurements were taken before and after the two task sessions. All baselines lasted 8 min. A full description of the experimental tasks and procedures is presented elsewhere (Why et al., 2003).

of these analyses showed a significant ethnic main effects for SBP (F(2,103) = 4.86, p = 0.01) and a significant ethnicity by task interaction effect for CI reactivity (F(2,106) = 3.34, p = 0.04) during stress tasks. Malays showed lower SBP reactivity during MA (M = 6.41, SE = 1.2) and AR (M = 11.02, SE = 1.53) than either Chinese (M = 11.38, SE = 1.31 and M = 14.78, SE = 1.66, respectively) or Indians (M = 9.24, SE = 1.24 and M = 14.47, SE = 1.57, respectively). For CI reactivity Chinese showed greater CI reactivity during MA (M = 0.23, SE = 0.05) than both Malays (M = 0.05, SE = 0.05) and Indians (M = 0.09, SE = 0.05); whereas, during AR, there were no significant differences between any of the three ethnic groups. Although significant effects were found with ethnicity, ethnicity did not moderate the effect of N or E on CVR as all such interactions were non-significant (ps > 0.10). As such ethnicity was not included in the analyses reported below.

2.6. Data reduction and analyses Mean values of physiological measures were computed for each experimental period. Two delta (reactivity) scores were created for each cardiovascular variable (SBP, DBP, HR, TPRI, and CI) by subtracting the first baseline from the mean of the MA and the mean of the AR period. Only the last two measurements of the baseline were used to ensure that a true resting baseline was obtained. Data were analyzed using repeated measures moderated regression using SAS Proc Mixed with each DV analyzed separately. For these analyses task was the repeated measure with N and E entered as centered between subjects continuous variables in separate analyses. Baseline hemodynamic measures, family history of hypertension, age, BMI and their interaction with Task were included as covariates. All interactions were computed as the product of the variables representing the main effects. A compound symmetry covariance model using a maximum likelihood estimator demonstrated the best fit to the data. In addition, t-tests were conducted comparing baselines to each task value to assess the effects of the stressors on cardiovascular parameters.

3.2. Neuroticism Neuroticism was not associated with baseline measures on any cardiovascular index. Further, Table 3 shows that no significant main effects were obtained for N on CVR. However, a significant Task × N interaction effect on DBP reactivity (p = 0.01) showed that N was negatively associated with reactivity during MA (β = − 0.16), but had a much smaller positive effect on reactivity during AR (β = 0.06). A similar Task × N effect was found for TPRI reactivity (p = 0.02). N was negatively associated with TPRI reactivity during MA (β = −0.08), but was positively associated with TPRI reactivity during AR (β = 0.15). Thus, higher N was associated with lower DBP and TPRI reactivity during MA than lower N, but higher TPRI reactivity during AR (Fig. 1). 3.3. Extraversion Extraversion was not associated with baseline measures on any cardiovascular index. However, mixed effects models showed significant main effects of E on SBP (p < 0.01) and HR reactivity (p = 0.01; Table 3). These effects indicate that higher scores on E were associated with decreased changes in SBP (β = − 0.58) and HR (β = − 0.43) across stress tasks. As shown in Table 3, significant Task × E interaction effects were obtained for DBP (p < 0.01) and TPRI (p = 0.02). Introverts exhibited greater DBP (β = − 0.25) and TPRI (β = − 0.22) reactivity but only during AR, whereas during MA, E had little effect on DBP (β = 0.02) and TRPI reactivity (β = 0.02). Therefore, as shown in Fig. 2, higher E was associated with decreased CVR but only during AR.

3. Results Both tasks elicited a significant increase in all cardiovascular measures. Means, standard deviations, t and p values of all dependent measures are shown in Table 2. 3.1. Ethnicity Preliminary tests were performed to determine whether the relationships between E and CVR were moderated by ethnicity. Results

Table 3 Results of moderated regressions of cardiovascular reactivity variables on neuroticism and extraversion controlling for baseline hemodynamic measures, family history of hypertension, age, BMI and their interaction with Task.

Between subjects Within Subjects

N E Task × N Task × E

num df

den df

1 1 1 1

100 100 100 100

SBP

DBP

HR

TPR

CI

F

p

F

p

F

p

F

p

F

p

0.33 8.74 0.01 1.23

0.566 0.004 0.927 0.269

0.35 1.9 6.41 9.22

0.555 0.171 0.013 0.003

0.01 6.81 0.27 1.07

0.936 0.010 0.607 0.303

0.17 1.85 5.74 5.92

0.677 0.177 0.018 0.017

1.15 0.27 2.19 1.69

0.286 0.605 0.142 0.196

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277

3.4. Mood anger scores To evaluate mood as a possible mediator of the personality effects on CVR, we examined whether N and E were associated with angry mood at baseline or change in angry mood in response to the AR task. Pearson product moment correlations showed that neither N nor E were associated with baseline mood scores but both N and E were significantly associated with change in angry mood response to the AR task, r = −0.30, p < 0.01 and r = 0.30, p < 0.01, respectively. However, despite the significant association between anger response and our personality variables, anger response was not correlated with any index of CVR and thus did not account for the observed effects of personality on CVR during AR. 4. Conclusion

Fig. 1. Neuroticism and cardiovascular change scores during anger recall and mental arithmetic.

Fig. 2. Extraversion and cardiovascular change scores during anger recall and mental arithmetic.

The findings from the present study suggest that emotionally based personality traits Neuroticism (N) and Extraversion (E) are related to reactivity to stressful stimuli. Higher N scores were associated with heightened CVR but only during the AR task. During the MA task, a different pattern emerged with higher N being associated with decreased CVR. Findings for E were more consistent showing that lower E scores were associated with heightened CVR while higher E scores were protective. Ethnicity also had an effect on CVR. However, these ethnic differences did not influence the effect of N or E on CVR, despite ethnic differences in baseline hemodynamic measures. The current sample was composed of all males of the same profession—police officers— and thus, relatively similar daily routines, incomes, and lifestyles. The homogeneity of the sample eliminated potential sociocultural confounds that may have been present in a demographically diverse sample. Future studies using larger, more demographically representative, male and female samples may be required to determine the influence of ethnicity on CVR in Asian populations. This study does show a robust effect of E on CVR, independent of ethnicity. Previous reports of E effects on CVR in response to stress have been weak and inconsistent, potentially due to the lack of an emotionally relevant stress task. This has been a gap in the literature considering the strong interconnection between E and emotion. The link between E and the physiological stress response involves a person by situation interaction; the nature of the stressor determines whether E may influence affective arousal and therefore, physiological reactivity (Houston, 1989). Previous studies may have failed to show an association between E and CVR in relation to mental stressors because E plays more of a role in emotion regulation than cognitive processes. Extraversion may only exert a robust effect on CVR during emotion provoking tasks. Theory on the biological dimensions of E posits that introverts have relatively higher levels of arousal than extroverts (Eysenck, 1967). Further, the social-avoidance hypothesis posits that introversion is a temperamental precursor to emotional suppression (John and Gross, 2004). Introverts may not only experience more anger but they may have less effective ways of coping with their anger— suppressing rather than controlling or effectively expressing—and thus experience greater physiological reactivity when recounting emotionally relevant material than extroverts. Our results showing a larger anger response among the low E group is consistent with this hypothesis of poor emotion regulation among introverts. We did not find, however, a link between mood and CVR. Research showing that introverts have difficulty describing their feelings (De Gucht et al., 2004) suggests that our subjective measures may not have been adequate to capture true mood responses in low E individuals, and would help explain the low correlation between our subjective measure of mood and objective measure of stress response (i.e. CVR). Introversion and emotional suppression may also contribute to social isolation, which is associated with higher rates of cardiac

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morbidity (Orth-Gomer et al., 1998) and mortality (Eng et al., 2002). Specifically, low levels of emotional support or absence of a close confidante are associated with increased mortality (Williams et al., 1992) and greater risk of fatal and non-fatal CHD (Krumholz et al., 1998). Increased reactivity to emotional stress among introverts may be one pathway through which social isolations contributes to CHD. Future studies should examine this potential link. Neuroticism showed differential effects during AR and MA. Individuals low in N may be more likely to use reappraisal to effectively regulate their negative emotions (John and Gross, 2004). This is consistent with results showing reduced TPRI reactivity during AR among low N individuals. However, despite the link between N and negative emotional states (Watson and Clark, 1992), N had larger effects on both DBP and TPRI reactivity during the MA task suggesting that high N was associated with an attenuated cardiovascular stress response during a non-emotional stress tasks. Although increased reactivity has traditionally been considered the marker of cardiovascular disease risk (Matthews et al., 2006), the negative association between N and CVR during a cognitive stressor (i.e. the mental arithmetic task) is consistent with several recent studies showing a negative association between negative affect and CVR during acute stress (e.g. Carroll, et al., 2007; Straneva-Meuse, et al., 2004; Salomon, et al., 2009; York, et al., 2007). This literature posits that depression may confer a blunted cardiovascular response to lab induced psychological stress. Previous studies in this area, however, have lacked a personally relevant or emotionally based stressor. Our finding showing an opposite effect of N on CVR depending on the nature of the stress task suggests that the blunted CVR to stress seen among depressed individuals may be specific to non-emotional stress tasks. Further replication and extension of this study comparing depressed and non-depressed individuals on CVR during an emotionally relevant stressor, is needed to fully determine the implication of the current findings. In conclusion, E showed a consistent negative relationship with cardiovascular reactivity, an effect that was more pronounced during AR. E appears to play an important role in the experience and expression of anger, an aspect of E that has not been shown by past research. Further replication of the current findings may show that being extraverted may help individuals cope with emotional stress and reduce the risk of cardiovascular disease. In respect to N, results from the current study may shed some light on disparate findings linking depression to CVR—showing that the emotional relevance of the stressor is the critical linking factor. Acknowledgments This research was funded by grant no. R-107-000-007-012 from the National University of Singapore with supplemental funds from the Singapore Ministry of Home Affairs, Singapore Police Force. References Almada, S.J., Zonderman, A.B., Shekelle, R.B., Dyer, A.R., Daviglus, M.L., Costa Jr., P.T., Stamler, J., 1991a. Neuroticism and cynicism and risk of death in middle-aged men: the Western Electric Study. Psychosom. Med. 53, 165–175. Almada, S.J., Zonderman, A.B., Shekelle, R.B., Dyer, A.R., Daviglus, M.L., Costa Jr., P.T., Stamler, J., 1991b. Neuroticism and cynicism and risk of death in middle-aged men: the Western Electric Study. Psychosom. Med. 53, 165–175. Carroll, D., Phillips, A.C., Hunt, K., Der, G., 2007. Symptoms of depression and cardiovascular reactions to acute psychological stress: evidence from a population study. Biol. Psychiatry 75, 68–74. Christensen, A.J., Ehlers, S.L., Wiebe, J.S., Moran, P.J., Raichle, K., Femeyhough, K., Lawton, W.J., 2002. Patient personality and mortality: a 4-year prospective examination of chronic renal insufficiency. Health Psychol. 21, 315–320. Costa, P.T., Mccrea, R.R., 1992. Revised NEO Personality Inventory (NEO PI-R) and NEO Five-Factor Inventory (NEO-FFI). Psychological Assessment Resources, Odessa, Fla. 101 pp. De Gucht, V, Fontaine, J, Fischler, B., 2004. Temporal stability and differential relationships with neuroticism and extraversion of the three subscales of the 20-

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