Type D personality and cardiovascular reactivity in active performance situations: Gender and task-specific influences

Personality and Individual Differences 132 (2018) 74–78

Contents lists available at ScienceDirect

Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid

Type D personality and cardiovascular reactivity in active performance situations: Gender and task-specific influences☆

T

⁎

Margit Gramer , Julia Haar, Marleen Mitteregger Department of Psychology, University of Graz, Austria

A R T I C LE I N FO

A B S T R A C T

Keywords: Type D Cardiovascular reactivity Active coping Recovery Gender differences

The present study evaluated the moderating influence of gender and type of stressor on cardiovascular effects of Type D personality. Seventy-two normotensive students (36 women) characterized as either Type D or non-Type D performed two evaluative active coping tasks: mental arithmetic and a speech task requiring persuasive behavior. Type D compared to non-Type D men exhibited intensified task engagement indicated by greater elevations in systolic blood pressure (SBP) and heart rate (HR), whereas Type D women responded with withdrawal of effort. This gender-specific effect was primarily evident during mental arithmetic. Furthermore, Type D men, but not women, showed impaired HR recovery. These findings seem to suggest that dysfunctional cardiovascular response patterns might be more likely in Type D men.

The Type D (distressed) personality construct, introduced by Denollet et al. (1996), refers to the joint occurrence of high negative affectivity (NA) and social inhibition (SI). Type D has drawn sustained research interest as potential predictor of adverse cardiac outcomes in patients with coronary heart disease (CHD). Meanwhile, substantial prospective evidence connects this construct to cardiac prognosis, the effect seems to be stronger for coronary artery disease (CAD) than chronic heart failure (CHF; Grande, Romppel, & Barth, 2012), though. Type D is not a mere epiphenomenon of cardiovascular disease but a stable personality trait (Denollet, 2005) that predicts increased CAD risk also in healthy populations (Mols & Denollet, 2010). Research on potential biological mechanisms linking Type D to CAD has emphasized the cardiovascular system and the so-called “reactivity hypothesis” (Obrist, 1981). This perspective assumes that exaggerated and/or prolonged cardiovascular reactivity (CVR) to psychological demands may constitute a marker or causal factor in the etiology of hypertension and CAD (e.g., Kamarck & Lovallo, 2003). Research on the reactivity hypothesis has focused on tasks eliciting effortful “active coping” (Obrist, 1981) as major determinants of enhanced CVR. These performance situations tend to provoke large betaadrenergically mediated increases in cardiac activity with systolic blood pressure (SBP) and/or heart rate (HR) being most reliably affected (Wright & Kirby, 2001). The myocardial effects of active coping seem to reflect psychological effort and task engagement rather than metabolic demand (Obrist, 1981). Research by Wright and coworkers (for a

review see Wright & Kirby, 2001) on determinants of effort expenditure indicates that effort in active performance situations corresponds to experienced task difficulty so long as success seems possible and worthwhile. In situations exceeding perceived coping ability, attenuated cardiac activity or reduced task engagement might result. Individuals with Type D are characterized by lower self-efficacy (Wiencierz & Williams, 2016) and higher perceived background stress (e.g., Kelly-Hughes, Wetherell, & Smith, 2014), factors which might function as distal mediators of perceived coping resources. Thus, they should display greater cardiac reactivity as long as both groups view success as possible (due to higher perceived demand). However, they might withdraw effort more readily in highly demanding situations resulting in reduced reactivity compared to non-Type D individuals. The majority of available research (Howard, Hughes, & James, 2011; Kelly-Hughes et al., 2014; Kupper, Denollet, Widdershoven, Willem, & Kop, 2013; O'Leary, Howard, Hughes, & James, 2013) observed reduced cardiac reactivity in Type D individuals. Two studies (Bibbey, Carroll, Ginty, & Phillips, 2015; Williams, O'Carroll, & O'Connor, 2009) noted heightened responses. In one of these (Bibbey et al., 2015), increased cardiac activity was accompanied by greater cortisol responses. This joint activation of sympathetic (beta-adrenergic) and hypothalamic-pituitary-adrenocortical axes in Type D individuals may indicate effort despite low perceived control (Dienstbier, 1989), possibly induced by high evaluative threat. The other study (Williams et al., 2009) systematically evaluated gender differences and

☆ Declarations of interest: none. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. ⁎ Corresponding author at: Department of Psychology, University of Graz, Universitätsplatz 2, A-8010 Graz, Austria. E-mail address: [email protected] (M. Gramer).

https://doi.org/10.1016/j.paid.2018.05.027 Received 12 December 2017; Received in revised form 17 May 2018; Accepted 21 May 2018 Available online 25 May 2018 0191-8869/ © 2018 Elsevier Ltd. All rights reserved.

Personality and Individual Differences 132 (2018) 74–78

M. Gramer et al.

evaluated whether perceived stress might explain eventual Type D recovery effects. The ethics committee of the university approved the procedures.

observed heightened reactivity in Type D men but not Type D women. It is of note that two of the studies observing reduced reactivity in Type D individuals utilized female-only samples (Howard et al., 2011; O'Leary et al., 2013). Overall, these findings seem to suggest that Type D individuals tend to show attenuated rather than heightened reactivity in demanding performance situations. Furthermore, this tendency might be stronger in women. In this respect, it might be of importance that the noted studies on gender differences and Type D effects in female-only samples have utilized mental arithmetic as sole stressor. As women tend to have lower performance expectations in math - but not public speaking tasks - (Hughes & Callinan, 2007; Skaalvik & Skaalvik, 2004), the observed effect might be task-specific. A major aim of the present study therefore was to evaluate the cross-task consistency of gender-specific Type D effects by directly comparing two types of evaluative active performance situations: mental arithmetic and a speech task requiring persuasive behavior. Drawing from evidence on impaired self-efficacy (Wiencierz & Williams, 2016) in Type D individuals and theoretical concepts on determinants of cardiovascular activity (Wright & Kirby, 2001), Type D compared to non-Type D individuals were expected to display enhanced task engagement (i.e., elevations in SBP and/or HR) as long as they perceived success as possible. Withdrawal of effort due to low success expectations was primarily expected for Type D women exposed to mental arithmetic. Theoretical contributions on prolonged cardiovascular activation have identified stressor-related negative affect and subsequent post-task rumination as major determinants of impaired recovery (Brosschot, Pieper, & Thayer, 2005). Thus, Type D individuals, who tend to experience greater negative affect (e.g., Howard et al., 2011) - rumination has not been attended to - might be at risk via impaired recovery from stressors. Available research on Type D has found no evidence for sustained post-task reactivity, though. Considering eventual task-specific effects (i.e., mental arithmetic and speech might be differentially prone to post-task rumination), the present study evaluated effects of Type D also for post-stress recovery. Additionally, the potential mediating influence of post-task rumination was assessed. As stressor recovery and rumination tend to elicit an essentially vascular response pattern, i.e., increases in blood pressure (BP) - in particular diastolic blood pressure (DBP) - but not HR (Gregg, James, Matyas, & Thorsteinsson, 1999; Radstaak et al., 2011), BP was expected more likely to show differential effects.

1.2. Experimental tasks and procedure After obtaining informed consent, the experimental session started with a 10-min rest period. Then, Mental Arithmetic and the task combination Speech Preparation/Speech Performance followed in a counterbalanced order. The five-min Mental Arithmetic task was composed of 22 items from a concentration test developed by Düker and Lienert (2001). The items consisted of two triplets of one-digit numbers and were presented at constant time intervals by means of a personal computer. Participants were first required to calculate the triplet totals and then to subtract the smaller from the bigger triplet total. Final answers were given orally to control for verbalization during speech. Participants were told that their performance was protocolled by the experimenter and examined for correctness (differential Type D effects are more likely in evaluative contexts, Bibbey et al., 2015). To give the impression of intermediate difficulty, participants further got the information that in previous studies 50% of participants had made less than six mistakes. The task combination Speech Preparation/Speech Performance required participants to prepare and deliver a speech in which they applied for a position in their academic field. A 5-min preparation period led directly into a 5-min talking period. Participants were told that their video-recorded speeches would be evaluated according to quality and effectiveness of arguments, poise and self-confidence of presentation on rating scales ranging from 0 to 10. Furthermore, they got the information that in prior studies 50% of the participants had received a rating of six or more (Gramer & Saria, 2007). After task instructions, but prior to task onset, participants gave cognitive appraisal ratings of the upcoming stressors. Each stressor/ stressor combination was followed by a 10-min recovery period. On completion of baseline, stressor, and recovery periods, participants provided retrospective ratings of experienced affect. Additionally, they rated frequency of post-task rumination after each recovery phase. 1.3. Measures 1.3.1. Cardiovascular assessments SBP, DBP, and HR were recorded with the TM-2430 (BOSCH & SOHN GmbH & Co. KG, Germany) oscillometric ambulatory monitoring system. This device is equipped to detect artifact caused by movement or poor cuff placement and fulfills the criteria of the British Hypertension Society (BHS) protocol. Readings of BP and HR were taken at 5 min intervals during rest and recovery periods (that is, immediately at rest or recovery onset, 5 min later, and at the end of these periods). During Mental arithmetic, Speech preparation/Speech performance readings were taken 1 and 4 min after task onset.

1. Method 1.1. Participants Seventy-two normotensive students (36 women) were recruited using the University's Web-based experiment scheduling system. They had an average age of 23.28 (SD = 3.54) years and a BMI of 22.90 (SD = 2.91). Exclusion criteria were a BMI > 29, hypertensive status, use of medication that may influence CVR, and clinically relevant depression scores. The German version of the 14-item Type D scale, the DS14 (Grande et al., 2004) was utilized to identify Type D personality. Following Denollet (2005), participants with a score ≥ 10 on both the NA and SI subscales were classified as Type D (M = 28.50, SD = 7.23 for total DS14 score), the others as non-Type D (M = 12.42, SD = 4.58 for total DS14 score; p < 0.0001). The sample comprised 36 individuals identified as Type D (18 men and 18 women) and 36 nonType D individuals (18 men and 18 women). There were no Gender or Gender × Type D effects for the DS14 (p's > 0.47). Groups were comparable in age and life-style variables (see supplementary Table for details). BMI was higher in men (23.85 vs. 21.96 kg/m2; p = 0.005; ηp2 = 0.11). Furthermore, type D individuals indicated higher depression scores (24.06 vs. 14.22; p < 0.0001, ηp2 = 0.28) and higher perceived stress (26.69 vs. 22.53, p = 0.003, ηp2 = 0.12). Depression and perceived stress were unrelated to CVR during task exposure, but perceived stress predicted impaired HR recovery (p = 0.02). Therefore, we

1.3.2. Psychological assessments Type D personality was assessed with the German version of the DS14, an instrument with sound psychometric properties (Grande et al., 2004). Two seven-item subscales (NA, SI) were rated on five-point scales (0 = false, 4 = true). According to Denollet (2005), a cutoff ≥ 10 on both subscales indicates Type D personality (Chronbach's α was 0.82 for NA and 0.90 for SI). Clinically relevant depression was identified with the simplified Beck Depression Inventory (BDI-V, Schmitt et al., 2003), an economic instrument equivalent to the original BDI (α was 0.82). A cut-off ≥ 35 was used. It shows the best compromise between sensitivity (0.92) and specificity (0.91). The German version of the Perceived Stress Scale (PSS-10; Reis, Lehr, Heber, & Ebert, 2017) was used as a measure of background stress (α was 0.82). To measure state affect, the German version of the Positive and Negative Affect Schedule (PANAS, Krohne, Egloff, Kohlmann, & Tausch, 75

Personality and Individual Differences 132 (2018) 74–78

M. Gramer et al.

1996) was applied (α was 0.84 for NA and 0.88 for PA). Two sevenpoint scales (1 = not at all, 7 = very) assessed the threatening quality of upcoming tasks (demand appraisal) and perceived coping ability (resource appraisal). Cognitive appraisals were operationalized as ratio of demand appraisal to resource appraisal (Blascovich & Tomaka, 1996). A third seven-point scale assessed perceived difficulty. Finally, participants indicated on a five-point scale (1 = almost never, 5 = very often) how often they had thought about the preceding stressor during the recovery phase (Radstaak et al., 2011). See supplementary references for further information on psychometric quality of instruments.

Table 1 Cell means (standard deviations) for cardiovascular reactivity (changes from baseline) by group and task condition. Type D

1.3.3. Data reduction and statistical analyses As participants did not return to initial resting values during the inter-task recovery period, the initial resting phase constituted the baseline for both stressors. For further analyses, cardiovascular indices were averaged over the last 5 min of the initial resting period (measurements 2 and 3), the measurements within each stressor (mental arithmetic, speech preparation, speech performance), and the recovery phases. To evaluate cardiovascular responses to experimental tasks, change (Δ) scores computed as differences between task levels and initial resting levels (baseline) were subjected to 2 (Gender) × 2 (Type D) × 3 (Tasks) ANOVAs (there were no significant correlations between change scores and baseline values: p's 0.11–0.93). Results involving repeated measures with more than two levels were corrected by the Greenhouse-Geisser procedure. Post-task recovery was assessed by subjecting change (Δ) scores between mean post-task values and initial resting levels to 2 (Gender) × 2 (Type D) × 2 (Tasks) AN(C)OVAs with repeated measures. Reactivity during stressor exposure was included as covariate to control for carry-over effects. Analogue analyses were performed for changes (Δ) in emotional states. Tukey's HSD test was utilized for a posteriori comparisons among means. Simple effects analyses and least square contrasts were performed on significant interactions involving a priori hypotheses. Partial eta-square (ηp2) is reported as measure of effect size. To confirm effects obtained with categorical Type D, ANOVAS were followed by ANCOVAs substituting the categorical variable with the continuous NA × SI interaction term as a covariate (e.g., O'Leary et al., 2013).

non-Type D

Women

Men

Women

Men

Arithmetic ΔSBP (mmHg) ΔDBP (mmHg) ΔHR (bpm)

9.28 (10.65) 6.94 (6.50) 5.11 (6.54)

22.97 (10.59) 12.78 (9.76) 14.06 (12.23)

15.61 (11.68) 10.36 (10.45) 9.39 (8.79)

11.94 (6.51) 8.64 (4.48) 6.69 (7.95)

Preparation ΔSBP (mmHg) ΔDBP (mmHg) ΔHR (bpm)

10.83 (11.54) 8.97 (7.04) 9.81 (12.94)

16.64 (14.77) 3.00 (10.64) 10.80 (6.56)

12.53 (9.70) 10.78 (7.68) 11.00 (8.66)

12.67 (10.69) 7.56 (6.94) 6.17 (7.81)

Speech ΔSBP (mmHg) ΔDBP (mmHg) ΔHR (bpm)

31.25 (13.76) 22.67 (17.89) 25.50 (13.69)

37.14 (12.27) 16.47 (11.12) 28.03 (9.57)

36.97 (14.86) 24.72 (19.20) 23.06 (9.04)

28.92 (14.50) 21.75 (14.11) 18.83 (13.05)

Note: SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; n = 18 in each cell.

preparation (MΔ 13.17 mmHg) and mental arithmetic (MΔ 14.95 mmHg), F (2, 136) = 102.06, p < 0.0001, ηp2 = 0.60. Analyses with the NA × SI predictor confirmed the Gender × Type D interaction [F (1, 68) = 4.22, p = 0.04, ηp2 = 0.06]. Task-specific analyses found the interaction valid for mental arithmetic, only (p = 0.001, ηp2 = 0.14; men: r = 0.40, p = 0.02, women: r = −0.36, p = 0.03). For DBP a Task main effect [F (2, 136) = 35.68, p < 0.0001, ε = 0.770334, corrected p < 0.0001, ηp2 = 0.34] indicated greater elevations during speech performance (MΔ 21.40 mmHg) compared to speech preparation (MΔ 7.58 mmHg) and mental arithmetic (MΔ 9.68 mmHg). For HR a Gender × Type D interaction [F (1, 68) = 4.37, p = 0.04, ηp2 = 0.06] indicates greater reactivity in Type D compared to nonType D men (MsΔ 17.63 vs. 10.57 bpm respectively; p = 0.01), women showed no Type D effect (MsΔ 13.47 bpm vs. 14.48 bpm, respectively; p = 0.71). The interaction was valid for mental arithmetic (p = 0.009, ηp2 = 0.10), only (Table 1). For speech performance a Type D main effect indicated higher reactivity in Type D individuals (MsΔ 26.76 vs. 20.94 bpm; p = 0.04, ηp2 = 0.06). Overall, HR elevations were greater during speech performance (MΔ 23.85 bpm) compared to speech preparation (MΔ 9.44 mmHg), and mental arithmetic (MΔ 8.81 mmHg), F (2, 136) = 102.95, p < 0.0001, ε = 0.911612, corrected p < 0.0001, ηp2 = 0.60. The NA × SI predictor showed a Type D main effect [F (1, 68) = 5.80, p = 0.02, ηp2 = 0.08] that was specified by a Tasks × Type D interaction [F (2, 136) = 3.61, p = 0.03, ε = 0.914576, adjusted p = 0.03, ηp2 = 0.05]. The Gender by Type D interaction for mental arithmetic (p = 0.04, ηp2 = 0.06; men: r = 0.34, p = 0.04; women: r = −0.10, p = 0.57) and the Type D main effect (p = 0.003, ηp2 = 0.12) for speech performance were confirmed.

2. Results 2.1. Group comparisons at baseline Men had higher SBP baseline levels compared to women (122.44 vs. 109.44 mmHg), F (1, 68) = 34.17, p < 0.0001, ηp2 = 0.33. Baseline levels in DBP (70.74 vs. 68.01 mmHg, p = 0.11) and HR (70.47 vs. 75.24 bpm, p = 0.08) showed no gender differences. Furthermore, nonType D compared to Type D individuals displayed higher DBP (71.64 mmHg) baseline levels (67.11 mmHg), [F (1, 68) = 7.26, p = 0.01, ηp2 = 0.10]. The ANCOVA with the NA × SI composite score did not confirm this finding (p = 0.13, ηp2 = 0.03), though. 2.2. Gender, Type D and cardiovascular reactivity during task exposure

2.3. Gender, Type D and cardiovascular recovery

For SBP a Gender × Type D interaction [F (1, 68) = 8.09, p = 0.006, ηp2 = 0.11] was obtained. Analyses within each gender group found Type D compared to non-Type D men to display higher SBP reactivity (MsΔ 25.58 vs. 17.84 mmHg, respectively; p = 0.02). In women an opposite, albeit not significant, pattern was observed (MsΔ 17.12 vs. 21.70 mmHg, respectively; p = 0.14). This resulted in a significant gender difference in Type D individuals (p = 0.007). Exploratory task-specific analyses found the interaction valid for mental arithmetic (p = 0.0005, ηp2 = 0.16) and speech performance (p = 0.04, ηp2 = 0.06), see Table 1. Contrasts for speech performance were not significant, though. Furthermore, SBP increases were greater during speech performance (MΔ 33.57 mmHg) compared to speech

ANCOVAs revealed a Gender × Type D interaction for HR [F (1, 67) = 6.95, p = 0.01, ηp2 = 0.09]. The effect proved robust when controlling for perceived stress (p = 0.01; ηp2 = 0.10). Type D compared to non-Type D men showed marginally less complete HR recovery (MsΔ 2.12 vs. −2.82 bpm, respectively; p = 0.09), whereas women showed the opposite effect (MsΔ − 3.09 vs. 0.64 bpm; p = 0.04). This resulted in a gender difference in Type D individuals (p = 0.02). The interaction was valid for mental arithmetic (p = 0.01) and speech (p = 0.03) and was confirmed utilizing the NA × SI score [(F (1, 67) = 5.08, p = 0.03, ηp2 = 0.07; semipartial r men: 0.27, p = 0.06; women: r = −0.21, p = 0.18)].

76

Personality and Individual Differences 132 (2018) 74–78

M. Gramer et al.

cardiovascular risk in women is less clear, though. Exaggerated reactivity to stress is in general less important for disease risk in women (Chida & Steptoe, 2010), and reduced reactivity shows no direct relationship to CVD. However, it relates to cardiovascular risk factors such as depression and obesity (Phillips, 2011). Considering that the relationship between depression and CVD is stronger in women (Vaccarino & Bremner, 2017), type D may influence CVD development in women due to its relationship with depression and other risk factors (Mols & Denollet, 2010). When talking about cardiovascular prognosis some words of caution have to be stated. The present study and prior cardiovascular research on Type D have observed rather small effect sizes. Thus, the impact of CVR on CVD development seems to be rather modest. Furthermore, it is not clear whether the effects of Type D observed in the laboratory generalize to daily life. Only one study has evaluated Type D effects in the context of ambulatory monitoring (Nyklíček, Vorselaars, & Denollet, 2011), and the authors found Type D unrelated to mean daytime and nighttime cardiovascular function, both in men and women. However, mean ambulatory values may reflect factors other than psychological demands as well (Kamarck & Lovallo, 2003). Research focusing on discrete psychological challenges in daily life might show different results. Furthermore, Nyklíček et al. (2011) utilized a somewhat older population (mean age 46 years), whereas laboratory research on Type D and CVR mainly employed student populations. As vascular influences tend to get stronger with increasing age (e.g., Hogan et al., 2012), it is not clear whether the obtained cardiac Type D effects might generalize to older populations.

2.4. Emotional responses and cognitive processes A Tasks × Gender interaction [F (1, 67) = 4.46, p = 0.04, ηp2 = 0.06] for PA indicated greater elevations for women compared to men during speech performance (7.28 vs. 1.97; p = 0.007), responses during mental arithmetic were comparable (2.14 vs. 0.14; p = 0.80). This resulted in a task effect for women (p < 0.0001). Analyses of the demand to resource ratio found men experiencing sufficient coping resources (0.80), whereas in women demand appraisals exceeded appraised coping resources (1.24), F (1, 67) = 6.82, p = 0.01, ηp2 = 0.09. The difference was substantial for mental arithmetic (1.20 vs. 0.67; p = 0.04) but not speech (1.27 vs. 0.94; p = 0.14). For difficulty, a Gender main effect [F (1, 68) = 4.19, p = 0.05, ηp2 = 0.06] was specified by a marginal Gender × Type D interaction [F (1, 68) = 3.71, p = 0.06, ηp2 = 0.05]. In non-Type D individuals, women perceived higher difficulty (4.39 vs. 3.47; p = 0.007), whereas in Type D individuals there was no gender difference (4.39 vs. 4.36, respectively) due to Type D enhancing perceived difficulty in men (p = 0.008). This increase in perceived difficulty was substantial for speech (3.44 vs. 4.72; p = 0.0006) but not mental arithmetic (3.50 vs. 4.00; p = 0.32). The NA × SI predictor revealed a Type D main effect [F (1, 68) = 6.07, p = 0.02, ηp2 = 0.08]. Exploratory analyses found the NA × SI score related to perceived difficulty (r = 0.34, p = 0.05) in men but not women (r = 0.02), though. Post-task rumination was greater after speech (2.54) compared to mental arithmetic (2.19), F (1, 68) = 5.02, p = 0.03, ηp2 = 0.07.

Appendix A. Supplementary data 3. Discussion Supplementary data to this article can be found online at https:// doi.org/10.1016/j.paid.2018.05.027.

The present study revealed effects of Type D personality on cardiovascular reactivity that were not attributable to co-occurring psychosocial risk factors and were evident in the categorical predictor and the NA × SI interaction term. In agreement with psychophysiological models on cardiovascular adjustments in active performance situations (Obrist, 1981; Wright & Kirby, 2001), Type D primarily influenced cardiac activity (i.e., SBP; HR) indicating differences in task engagement as a potential mechanism. Furthermore, the present findings strengthen the impression that gender might be an important moderator of cardiac type D effects. Highly evaluative performance situations seemed to intensify effort mobilization in Type D men, whereas Type D women tended to respond with withdrawal of task engagement. Considering that Type D men and Type D women appraised the tasks to be of comparable - above average - difficulty, these findings seem to suggest that Type D women might abandon effort mobilization more readily in highly demanding conditions compared to Type D men. As hypothesized, abandonment of effort in Type D women was primarily evident for mental arithmetic. Cognitive appraisals provided no explanation for these task-specific effects, though. Women experienced equivalent impairment of coping resources during mental arithmetic and speech. Considering that women showed marked increases in subjectively perceived activation (PA) during speech, they might have tried to keep up task engagement despite impaired perceived coping resources. Alternatively, increased difficulty perceptions might have restrained maximal task engagement during speech in Type D men. As a cautionary point it is of note that time of day was not controlled, a factor known to influence cognitive performance (Adan, 1993). However, the relationship between effort (i.e., cardiac activity) and performance tends to be imperfect (Gramer & Saria, 2007; Wright & Kirby, 2001). There is substantial prospective evidence relating heightened CVR and impaired recovery to cardiovascular disease risk (Chida & Steptoe, 2010). Although the present sample was somewhat underpowered and replication of gender-specific effects is required, these preliminary findings seem to suggest that this biological pathway might be of relevance for Type D men. How Type D might contribute to

References Adan, A. (1993). Circadian variations in psychological measures: A new classification. Chronobiologia, 20, 145–162. Bibbey, A., Carroll, D., Ginty, A. T., & Phillips, A. C. (2015). Cardiovascular and cortisol reactions to acute psychological stress under conditions of high versus low social evaluative threat: Associations with the Type D personality construct. Psychosomatic Medicine, 77, 599–608. Blascovich, J., & Tomaka, J. (1996). The biopsychosocial model of arousal regulation. In M. P. Zanna (Vol. Ed.), Advances in experimental social psychology. vol. 28. Advances in experimental social psychology (pp. 1–51). San Diego, CA: Academic Press. Brosschot, J. F., Pieper, S., & Thayer, J. F. (2005). Expanding stress theory: Prolonged activation and perseverative cognition. Psychoneuroendocrinology, 30, 1043–1049. Chida, Y., & Steptoe, A. (2010). Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: A meta-analysis of prospective evidence. Hypertension, 55, 1026–1032. Denollet, J. (2005). DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic Medicine, 67, 89–97. Denollet, J., Sys, S. U., Stroobant, N., Rombouts, H., Gillebert, T. C., & Brutsaert, D. L. (1996). Personality as independent predictor of long-term mortality in patients with coronary heart disease. Lancet, 347, 417–421. Dienstbier, R. A. (1989). Arousal and physiological toughness: Implications for mental and physical health. Psychological Review, 96, 84–100. Düker, H., & Lienert, G. A. (2001). KLT-R Konzentrations-Leistungs-Test. Revidierte Fassung. [KLT concentration test. Revised version]. Göttingen: Hogrefe. Gramer, M., & Saria, K. (2007). Effects of social anxiety and evaluative threat on cardiovascular responses to active performance situations. Biological Psychology, 74, 67–74. Grande, G., Jordan, J., Kümmel, M., Struwe, C., Schubmann, R., Schulze, F., ... HerrmannLingen, C. (2004). Evaluation of the German Type D Scale (DS14) and prevalence of the Type D personality pattern in cardiological and psychosomatic patients and healthy subjects. Psychotherapie, Psychosomatik, Medizinische Psychologie, 54, 413–422. Grande, G., Romppel, M., & Barth, J. (2012). Association between Type D personality and prognosis in patients with cardiovascular diseases: A systematic review and metaanalysis. Annals of Behavioral Medicine, 43, 299–310. Gregg, M. E., James, J. E., Matyas, T. A., & Thorsteinsson, E. B. (1999). Hemodynamic profile of stress-induced anticipation and recovery. International Journal of Psychophysiology, 34, 147–162. Hogan, M. J., James, J. E., McCabe, T. R., Kilmartin, L., Howard, S., & Noone, C. (2012). Cardiovascular reactivity of younger and older adults to positive-, negative-, and mixed-emotion cognitive challenge. Biological Psychology, 89, 553–561. Howard, S., Hughes, B. M., & James, J. E. (2011). Type D personality and hemodynamic

77

Personality and Individual Differences 132 (2018) 74–78

M. Gramer et al.

blunting using sleep-restriction as an acute stressor in Type D and Non-type D women. International Journal of Psychophysiology, 90, 37–43. Phillips, A. C. (2011). Blunted cardiovascular reactivity relates to depression, obesity, and self-reported health. Biological Psychology, 86, 106–113. Radstaak, M., Geurts, S. A. E., Brosschot, J. F., Antonius, H. N., Cillessen, A. H. N., Michiel, A. J., & Kompier, M. A. J. (2011). The role of affect and rumination in cardiovascular recovery from stress. International Journal of Psychophysiology, 81, 237–244. Reis, D., Lehr, D., Heber, E., & Ebert, D. D. (2017). The German version of the perceived stress scale (PSS-10): Evaluation of dimensionality, validity, and measurement invariance with exploratory and confirmatory bifactor modeling. Assessment (in press). Schmitt, M., Beckmann, M., Dusi, D., Maes, J., Schiller, A., & Schonauer, K. (2003). Messgüte des vereinfachten Beck-Depressions-Inventars (BDI-V). [Validity of the simplified Beck Depression Inventory]. Diagnostica, 49, 147–156. Skaalvik, S., & Skaalvik, E. M. (2004). Gender differences in math and verbal self-concept, performance expectations, and motivation. Sex Roles, 50, 241–252. Vaccarino, V., & Bremner, J. D. (2017). Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neuroscience and Biobehavioral Reviews, 74, 297–309. Wiencierz, S., & Williams, L. (2016). Type D personality and physical inactivity: The mediating effects of low self-efficacy. Journal of Health Psychology, 1–10. Williams, L., O'Carroll, R. E., & O'Connor, R. C. (2009). Type D personality and cardiac output in response to stress. Psychology & Health, 24, 489–500. Wright, R. A., & Kirby, L. D. (2001). Effort determination of cardiovascular response: An integrative analysis with applications in social psychology. In M. Zanna (Vol. Ed.), Advances in experimental social psychology. vol. 33. Advances in experimental social psychology (pp. 255–307). San Diego, CA: Academic Press.

reactivity to laboratory stress in women. International Journal of Psychophysiology, 80, 96–102. Hughes, B. M., & Callinan, S. (2007). Trait dominance and cardiovascular reactivity to social and non-social stressors: Gender-specific implications. Psychology & Health, 22, 457–472. Kamarck, T. W., & Lovallo, W. R. (2003). Cardiovascular reactivity to psychological challenge: Conceptual and measurement considerations. Psychosomatic Medicine, 65, 9–21. Kelly-Hughes, D. H., Wetherell, M. A., & Smith, M. A. (2014). Type D personality and cardiovascular reactivity to an ecologically valid multitasking stressor. Psychology & Health, 29, 1156–1175. Krohne, H. W., Egloff, B., Kohlmann, C.-W., & Tausch, A. (1996). Untersuchungen mit einer deutschen Version der “Positive And Negative Affect Schedule” (PANAS). [Investigations with a German version of the Positive And Negative Affect Schedule]. Diagnostica, 42, 139–156. Kupper, N., Denollet, J., Widdershoven, J., Willem, J., & Kop, W. J. (2013). Type D personality is associated with low cardiovascular reactivity to acute mental stress in heart failure patients. International Journal of Psychophysiology, 90, 44–49. Mols, F., & Denollet, J. (2010). Type D personality in the general population: A systematic review of health status, mechanisms of disease, and work-related problems. Health and Quality of Life Outcomes, 8, 9. Nyklíček, I., Vorselaars, A., & Denollet, J. (2011). Type D personality and cardiovascular function in daily life of people without documented cardiovascular disease. International Journal of Psychophysiology, 80, 139–142. Obrist, P. A. (1981). Cardiovascular psychophysiology: A perspective. New York: Plenum Press. O'Leary, É. D., Howard, S., Hughes, B. M., & James, J. E. (2013). An experimental test of

78