Adrenocorticotropin responses to interpersonal stress: effects of overt anger expression style and defensiveness

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Abstract

This study evaluated the influence of overt anger expression style and defensiveness on the hypothalamic–pituitary–adrenocortical (HPA) responses to acute psychological stress. These personality traits are thought to modulate the stress cardiovascular response and influence disease risk, however, little is known about their influence on HPA responses. Forty-six young, healthy male volunteers worked on counterbalanced extended public-speaking and mental arithmetic. The sample was dichotomitized into groups low vs. high in anger-out, using Spielberger's Anger-Expression Inventory, and in defensiveness, using the Marlowe–Crown Social Desirability Scale. Serum cortisol and adrenocorticotropic hormone (ACTH) concentrations were measured before and after performing each task. Heart rate (HR) and blood pressures (BP) were obtained continuously in 2-min intervals before, during and after the tasks. Public speaking produced greater adrenocortical and cardiovascular stress responses than mental arithmetic, and the greatest increases in ACTH occurred in subjects high in anger-out and defensiveness. These preliminary findings provide evidence that a mismatch between traits of preferred anger expression style and defensive style produces pronounced adrenocorticotropic responses during socially salient stress.

Introduction

Hypothalamic–pituitary–adrenocortical activity is an important mediator of stress–disease interactions (Munck et al., 1984, Henry, 1992). Biopsychological models suggest that persons displaying exaggerated physiological responses during psychological stress are at higher risk to develop a range of cardiovascular diseases and immune disorders (McEwen, 1998) than those with relatively low responses. Consequently, studies of situational antecedents, personality characteristics, and their interaction are important to our understanding of individual differences in response to stress.

Since the early days of psychosomatic medicine, an enduring hypothesis has been that suppression of anger puts individuals at a higher risk of essential hypertension, coronary heart disease and all-cause mortality (Alexander, 1939, Haynes et al., 1980). However, effects of anger coping styles have not been consistently documented in laboratory studies of stress, and the underlying mechanisms by which anger-related factors produce physiological effects are not fully understood. Some studies have shown that preventing oneself from expressing anger was associated with elevated heart rate or blood pressure (Harburg et al., 1979, Mills et al., 1989, Hodapp et al., 1992) while others have shown the opposite (Siegman et al., 1990, Siegman et al., 1992, Suarez and Williams, 1990).

To overcome these inconsistencies, it may be useful to consider anger expression style in relation to other personality dispositions that may influence the preferred style of expressing anger (Houston, 1994). It would also be important to address interactions of these dispositions with situational factors (Engebretson et al., 1989, Jorgensen et al., 1996).

Defensiveness is a personality trait that may modulate effects of anger coping. In combination with anxiety measures, subjects scoring low in trait anxiety and high in defensiveness, so called repressors, displayed exaggerated autonomic nervous system (ANS) activation during psychological stress (Weinberg et al., 1979, King et al., 1990). Defensiveness is usually measured using the Marlowe–Crowne Social Desirability Scale (MCSD; Crowne and Marlowe, 1960). High scores reflect a tendency to underreport, deny, or suppress negative emotions and to improve positive impressions in the eyes of others (Paulhus, 1984).

It has been hypothesized that conflict or ambivalence over emotional expression increases psychological distress and physiological symptoms (Pennebaker, 1985, King and Emmons, 1990). Individuals who have angry feelings but avoid expressing them for fear of negative social consequences are assumed to experience higher distress and heightened autonomic activation. In accordance with this assumption, Siegman (1994) reported that anger-repressors showed greater HR responses than persons expressing their anger. Furthermore, in an ambulatory study, paramedics scoring high in both defensiveness and hostility had exaggerated HR and diastolic blood pressure (DBP) responses to social confrontation (Jamner et al., 1991, Shapiro et al., 1993). The same authors, however, failed to replicate these results in a laboratory setting using non-social stressors (Shapiro et al., 1995). Therefore, the present study included an explicit social evaluation in the public speaking task.

There is a paucity of research investigating how overt anger expression style and defensiveness influence hypothalamic pituitary adrenocortical (HPA) responses to acute stressors. The HPA axis is activated by emotional distress, resulting in the secretion of cortisol from the adrenal cortex (Munck et al., 1984), and it can be sensitive to individual differences such as risk for hypertension (al’Absi and Lovallo, 1993) al’Absi et al., 1994), heart rate reactivity (Lovallo et al., 1990), and Type A Behavior Pattern (Williams et al., 1982). Cortisol and ACTH may be sensitive to individual differences in distress that may result from defensive avoidance of anger expression (Brown et al., 1996). As such, HPA responses may be useful indicators of potential deleterious effects of stress in persons otherwise at greater risk for developing stress-related disorders (al’Absi et al., 1997).

The goal of the present paper is to examine whether a mismatch between an outward anger expression style (i.e. anger-out) and concerns about social evaluation (i.e. defensiveness) would predict greater ACTH and cortisol responses to a social stressor. Subjects categorized as low vs. high in anger-out and defensiveness worked on a mental arithmetic and public speaking task. Based on previous work (King and Emmons, 1990, Jamner et al., 1991, Helmers et al., 1994) it was expected that subjects high in defensiveness, but who preferred an outward anger expression style, would show greater endocrine and cardiovascular responses than the other groups during the two stressors and more so during the task with greater social challenges (performing public speaking task before an audience).

Section snippets

Subjects

Forty-six healthy male volunteers were recruited by posters placed in the university community and at social clubs. Participants completed the Spielberger’s Anger-Expression Scale (Spielberger et al., 1985). This scale consists of 20 statements describing how people behave when they feel angry or furious. The questionnaire provides scores for two independent factors, Anger-In and Anger-Out. It should be mentioned that Anger-In and Anger-Out correlated positively (r=0.46, P<0.001) in this study

Sample description

Table 1 summarizes information about age, body mass index (BMI), and the pretask hormonal and cardiovascular levels for the groups resulting from the combination of Defensiveness and Anger-Out. ANOVAs for each of the variables did not reveal any differences among groups. Thus, the subgroups were considered homogenous in their distribution of age, BMI, hormonal and cardiovascular pretask values.

Cardiovascular responses

Table 2 presents cardiovascular response values. As expected, the public speaking task produced

Discussion

The present study shows that the combination of the anger-out expression style and defensiveness produced a subgroup of subjects who showed exaggerated adrenocorticotropin responses, particularly to the public speaking task. Subjects high in Anger-Out and Defensiveness had the greatest ACTH and cortisol responses to public speaking, a task that involved relatively greater interpersonal engagement than mental arithmetic. Since anger expression and defensiveness are particularly influenced by

Acknowledgements

This project was supported by the John D. and Catherine T. MacArthur Foundation and the Department of Veterans Affairs. Thanks are in order to Tony Buchanan and Karen Petersen for their assistance with data collection, management, and editorial assistance.

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