Hardiness Revisited

Why a chapter on hardiness? After all, hardiness, or stress resistance, is what we have been discussing throughout this book. The purpose of this chapter, however, is to pull together the interventions presented thus far and to put them in the context of your personal stress cycle. Perception, a person's outlook on life and his or her place in it, is really the heart of hardiness, and so we have saved our stress resistance wrap-up for this unit on perception.

You encountered the term hardiness back in Chapter 4 when we discussed research by Suzanne Kobasa and her colleagues. They found several personality traits that discriminated between people who were stress resistant and those who were more vulnerable to the negative effects of stress. People who coped successfully with stress were described as having "hardy" personalities (Kobasa, 1979). Other researchers have also found evidence that certain qualities are associated with better stress resistance (Funk, 1992; Nowack, 1991).

    Perhaps you have thought about the relationship between personality and stress resistance as well. Do you know people who never smile and always complain? No matter what happens, things are never right. In the face of stress, they blame others and feel helpless and hopeless. You have probably met other people who are usually cheerful and try to make the best of life, even when things aren't going their way. Did you ever wonder why some people are stubborn, aggressive, and even angry with life while others seem to be flexible, friendly, and optimistic? In this chapter, we explore further the relationship between personality traits and stress response, and we look at what can be done to develop those traits that increase stress resistance.

PERSONALITY AND ARTERY DISEASE: TYPE A BEHAVIOR

One of the most interesting research areas in the field of personality, stress, and health deals with Type A behavior. Type A behavior was mentioned briefly in Chapter 3 in the context of stress and health. You may remember that the concept grew out of work by two cardiologists, Meyer Friedman and Ray Rosenman. Their work began in the 1950s, when heart disease had reached epidemic proportions in North America and many researchers were attempting to learn why the incidence of atherosclerosis was so high. During this period scientists began exploring the link between artery disease and lifestyle behaviors such as diet, exercise, and smoking. Although common sense dictated a relationship between emotional health and heart disease, Friedman and Rosenman were the first medical researchers to document this relationship and explore it in a scientific manner (Rosenman et al., 1964).

    Friedman and Rosenman had observed that their heart disease patients tended to be hard- driving, impatient, competitive, and aggressive overachievers. They usually did everything, including walking, eating, and talking, in a hurry. They seemed more intent on acquiring objects than enjoying them. During a period of several years, Friedman, Rosenman, and their colleagues interviewed over 3,500 people and found evidence that this collection of traits, which they called Type A behavior, predisposed people to greater stress reactivity (larger sympathetic nervous system (SNS) response to stress), higher blood cholesterol levels, increased risk of hypertension, and higher rates of coronary artery disease (Friedman & Rosenman, 1974).

Research on Type A behavior and irrational beliefs suggests that irrational beliefs underlie Type A behavior. An interesting study by Westra and Kuiper (1992) highlights three fundamental beliefs that seem to color a Type A person's outlook on life:

1. Self-worth is largely a function of personal achievements and excessive personal standards. The hardcore Type A lives in perpetual fear of being judged worthless.

2. No universal moral principle exists. Type A people fear that justice will not prevail, and they must therefore ensure justice for themselves.

3. Resources are in scarce supply. Type A's fear they will not get their fair share (although their definition of "fair share" is often vague) and therefore they must fight for it.

    Type A individuals with these irrational beliefs look for (and perceive) evidence that supports these beliefs. The result is anger and anxiety, a state of mind dominated by fear rather than openness. As we discuss later, this anger is responsible for a majority of the negative health effects associated with Type A behavior.

One study (Hart, Turner, Hittner, Cardozo, & Paras, 1991) found that Type A subjects who scored high on a measure of irrational beliefs experienced significantly more anger in the face of stress, as measured by negative life events, than Type A subjects scoring low on irrational beliefs.

Friedman and Rosenman (1974) felt that Type A traits were part of the American model for success, especially in an urban environment. Type A traits tend to be more prevalent in higher than lower socioeconomic groups and seem to typify "life in the fast lane." Type A behavior is probably engendered by many of our cultural values, including the following (Schafer, 1987; Seaward, 1994; Wright, 1991):

     1. Emphasis on acquiring material wealth. We value our possessions, sometimes more than we value relationships with others. Our financial worth becomes a measure of how successful or important we are.

     2. Expectation of immediate gratification. We expect things to come easily and immediately. We want easy answers and quick solutions. We find it difficult to live with ambiguity and shades of gray.

     3. Competition. We are ranked and compared to others beginning at a very young age. Our schooling tends to encourage competition rather than cooperation.

     4. Secularization. Spiritual involvement in our public lives is discouraged. Our solution to religious disagreement has been a moratorium on discussion. A decline in spiritual involvement has led to feelings of spiritual emptiness and a lack of connectedness for many. Lack of spiritual values has been replaced with an emphasis on material wealth.

     5. Emphasis on left-brain thinking. We value logical, linear thought and the scientific method more than creative, emotional, intuitive ways of knowing. We have overdeveloped certain aspects of our personality and neglected our need for wholeness and holistic development.

 

     6. Television. Statistics show that the average American watches between 20 and 40 hours of television each week. Life is becoming a spectator sport. Many of the traits associated with Type A behavior are illustrated by television characters. Television reality is portrayed as intense and often violent. Who wants to watch something boring? We enjoy action, intrigue, and romance. But too much of this, especially for young viewers, colors our perception of reality and shapes too strongly our expectations of life and ourselves: what we should look like, what our relationships should be like, and how we should treat others.

    In the section on values clarification in Chapter 6, we encouraged some introspection and evaluation of personal values. How do yours fit with the Type A cultural values presented above? Many people, young and old, are forming values that require cultivation of a more meaningful life. Many are deemphasizing acquisition, turning off their TVs, and living a more creative, spiritual, and holistic lifestyle (Pearce, 1992).

Many researchers have explored the notion that not all Type A characteristics are created equal. Scientists trying to pin down exactly what it is about Type A behavior that leads to illness have found that feelings of hostility, anger, and cynicism are strongly associated with cardiovascular disease, including hypertension (Hafner & Miller, 1991) and heart disease (Barefoot, Dahlstrom, & Williams, 1983; Blumenthal, Barefoot, Burg, & Williams, 1987; Williams, 1989; Williams & Williams, 1993). They also often accompany risk factors for cardiovascular disease, such as a risky blood lipid profile (Knox et al., 1996), cardiovascular reactivity (Powch & Houston, 1996), and platelet reactivity (Markovitz, Matthews, Kiss, & Smitherman, 1996). In one study, researchers looked at the incidence of heart disease in 255 physicians by using a scale designed to measure hostility; those who scored high on the scale experienced five times the number of heart attacks and were six times as likely to die as those with low hostility (Barefoot et al., 1983). These researchers concluded that the components of Type A such as competitiveness, hurrying, and achievement orientation were harmful only to the extent that they cause a person to become hostile and angry.

    Several studies have evaluated a variety of interventions for modifying hostility and anger. Treatments that have been most successful so far have been those that focus on cognitive intervention techniques (Deffenbacher et al., 1996; Gidron & Davidson, 1996; Williams & Williams, 1993).

    The hostility scale on the facing page will tell you if you have a problem with hostility.

Is TYPE A OKAY?

If you scored fairly low on the hostility scale, does that mean you can ignore your other Type A characteristics? Type A types are inclined to think "Whew! Maybe my rushing, nervous, anxious approach to life is OK." But is it? Maybe you shouldn't let Type A behavior off the hook so easily. If you are fairly hardy and not very hostile, your Type A traits may not send you to an early grave, but let's look at how these qualities contribute to your stress response. Does impatience feel good? Tune in to your physical and mental sensations next time you are rushing to do too many things in too little time. Researchers Kuiper and Martin (1989) believe that Type A behavior results in a lowered quality of life. Before you accept your Type A traits as harmless, tune in to their effects not only on your health but on your stress response and quality of life as well. You must be the judge of whether Type A traits fit your personality and lifestyle.

HARDINESS: THE ANSWER FOR HIGH-STRESS TIMES?

While you continue to work for a lower-stress lifestyle-accepting the things you can't change, changing the things you can change, and learning to know the difference-periods of stress inevitably arise. Kobasa and her colleagues found that personality traits they defined as control, commitment, and challenge helped protect people undergoing high levels of stress from stress-related illness. Let's take a look at the hardiness concept and what it offers in terms of increasing stress resistance.

    Control is the hardiness variable that has received the most research attention and substantiation concerning its relationship to stress response and health. Control is the opposite of helplessness and hopelessness, which greatly increase one's susceptibility to stress-related illness. Hardy people feel that they are in control of their lives. While they certainly cannot control everything, when faced with a stressor they feel as though they have resources and options and can at least influence what is going on around them.

    Commitment is another strong card in the hardiness player's hand. Commitment means feeling that what you do is important and valuable. Stressors are viewed as meaningful and interesting in some way. Commitment is the opposite of alienation, isolation, and loneliness. People with commitment are involved in life: in work, family, friendships, community, and their own growth and development (Mansfield & McAdams, 1996; Peterson & Stewart, 1996).

    Challenge refers to the stress-resistant person's perception of stressors, to the ability to see demands as opportunities and learning experiences rather than obstacles. Less research has been done on this component of hardiness than on the others, and what has been done is not always supportive of the link between challenge and health (Hull, Van Treuren, & Virnelli, 1987). But the challenge concept supports the idea that hardy people have an optimistic outlook. Perhaps future research will clarify the role that perception of stressors plays in the stress-illness relationship.

DOES HARDINESS KEEP You HEALTHY?

While many researchers have challenged the particulars of the hardiness concept, most agree that hardiness (or a similar construct) does protect against the negative health effects of stress. Several studies have found an association between high hardiness scores and less physical illness not only in white-collar male executives but in women in various occupations (Rhodewalt & Zone, 1989), college students (Roth et al., 1989), adolescents (Shepperd & Kashani, 1991), blue-collar workers (Manning, Williams, & Wolfe, 1988), and other groups (Nowack, 1989, 199 1; Westman, 1990).

    Hardiness traits also appear to protect you psychologically as well. Hardiness is associated with better job satisfaction, less tension at work, less depression and anxiety, and in general, a better quality of life (Manning et al., 1988). However, while hardiness is protective, it does not confer unconditional immunity to the negative effects of stress. When stress levels are very high, stress can still get under your skin and upset your hardiness homeostasis.

How DOES HARDINESS WORK?

Hardiness probably keeps us healthy in several ways. We examine several of them here.

We have said that perception is the heart of hardiness. Stress resistance is associated with an optimistic point of view. Remember that it is one's perception that turns an event into a stressor and determines the degree and significance of that stress. Hardy people are less likely than others to appraise life experiences as undesirable or requiring a great deal of adjustment (Allred & Smith, 1989; Pagana, 1990; Rhodewalt & Zone, 1989; Wiebe, 1991). They are optimistic and tend to play up the positive and downplay the negative (Hull et al., 1987).

Hardiness May Decrease the Physical Strain of Stress

The physiological arousal associated with negative stress differs from the arousal associated with eustress. When you feel that you have some control over a stressor and tend to expect positive outcomes, your stress response is not so harmful to your health (Ekman, Levenson, & Friesen, 1983).

    Several researchers have found that hardy subjects have a better physical stress tolerance than others. When faced with stressors, hardy subjects have been found to have a lower increase in diastolic blood pressure (Contrada, 1989) and a smaller increase in heart rate (Lawler & Schmied, 1987; Wiebe, 1991).

    While stress reactivity gives some information on how individuals respond to stress, it does not tell the whole story. In the right amount, SNS arousal increases your performance and helps you cope with stress. The key is to have the right amount of arousal at the right time. An interesting study of male college students found that subjects scoring low on hardiness experienced high SNS arousal waiting for the lab stress simulation test to begin, while those scoring high on hardiness had higher systolic blood pressure during the laboratory stress simulation (Allred & Smith, 1989). The parallel to real life is that hardiness is characterized by active coping, getting aroused at the right time to confront a stressor effectively but not getting aroused (worrying) before the stressor is at hand.

    Some researchers believe that as people become accustomed to handling stress in a positive way, they may also get "tough" and physically better able to cope with sympathetic arousal (Dienstbier, 1991). Good coping skills encourage you to seek out greater challenges and get more practice handling stress. As one researcher has written, "As the rich get richer, so the tough should get tougher" (Dienstbier, 1991).

Hardy People Cope More Effectively with Stress

Stress-resistant people are more likely to use problem-focused coping measures, positive thinking, and support-seeking strategies when faced with stress (Cohen & Edwards, 1989; Holt, Fine, & Tollefson, 1987; Nowack, 1989; Williams, 1989). These measures reduce feelings of stress and are associated with positive emotions (Lazarus & Folkman, 1984). People scoring low on hardiness are more likely to deal passively with stress, avoiding the situation and indulging in maladaptive palliative strategies.

Could it be that hardy people stay healthier in the face of stress because they take better care of themselves? Evidence suggests that this is so (Nagy & Nix, 1989), at least for hardy people concerned about their health (Hannah, 1988). Researchers Nagy and Nix have hypothesized that hardy people have better health practices partly because they tend to use more effective coping measures. They are less likely to indulge in maladaptive palliative strategies that are harmful to their health, such as abusing alcohol and drugs or acting aggressively, when under stress. In addition, a sense of personal control over one's health behavior has been associated with better health habits, such as exercise, diet, and smoking behaviors. Since hardy people score higher on control, this may help explain why they are healthier than others.

Environmental demands vary. We must all find work environments and communities that feel right to us and provide the best match between our abilities and environmental demands. Some people enjoy life in the fast lane. So do not despair, readers with a Type A streak. Some Type A qualities may be adaptive for the American way of life (even the American way that has strong spiritual values and limits television viewing). In fact, Kobasa and her colleagues found that Type A types who scored high on measures of hardiness were the healthiest group of subjects in their study of stressed executives (Kobasa 1983)!

    But Kobasa's study also found that the Type A's without hardiness were the most prone to illness in the face of stress. Like hardiness, Type A is a conglomeration of traits, and some, especially anger and hostility, seem to have a stronger relationship than others with stress-related illness. In other words, there are many manifestations of Type A behavior; some of these are dangerous to your health and well-being but some may be relatively benign.

    The components of hardiness, commitment, control, and challenge are quite compatible with Type A behavior and appear to buffer Type A people from the negative effects of stress. Take commitment, for example. Type A's with a strong job involvement value their work, perform well, and often reap personal and financial rewards without falling prey to stress-related illness. job commitment fits the cultural and personal expectations for many people, and the Type A focus on striving for high achievement works in this environment.

    We have said that Type A behavior is generally more typical of city dwellers than their country cousins. One New Yorker told us of weekend ski trips to a backwoods location. Impatient at the grocery checkout counter, one of his friends said to the clerk, "Can't you hurry?" The clerk looked the young city slicker in the eye and said, "Son, one thing we never do is hurry." Type A qualities that help us thrive in a fast- paced, urban environment may not translate into success in a culture that does not value speed and getting everything done in a hurry.

Exercise

As discussed in Chapter 10, many studies have found that regular physical activity makes a strong contribution to stress resistance. The body-mind effects of exercise are wonderfully therapeutic (Wilcox & Storandt, 1996).

Without adequate self-regard, stress resistance is impossible. Self-esteem is the cornerstone of control, commitment, and challenge. When self-esteem is low, people feel out of control, alienated, and overwhelmed (DeLongis, Folkman, & Lazarus, 1988).

The health benefits of optimism were presented in the previous chapter. Optimism enhances perception of personal control, deepens your involvement in life, and helps you see change as a challenge. It also helps you stay healthy and recover quickly from illness and injury when they occur (Everson et al., 1996; Jenkins, 1996; Seligman, 1991).

The perception that you have emotional support from friends and family helps protect you from the negative effects of stress (Coyne & DeLongis, 1986) and improves your quality of life (Newsom & Schulz, 1996). Social support may signify coping resources as well as healthy communication and intimacy. Many researchers believe that "a trusting heart" (Williams, 1989) and "opening our heart" to others (Ornish, 1990) are essential for stress resistance. Involvement with others is the opposite of hostility, which closes the channels of communication and forces us into isolation.

Spiritual Health

A step beyond commitment and social support, spiritual health emphasizes your larger connection to others and to your own spiritual growth. Spiritual health gives life meaning and value in the deepest sense; it is a potent stress buffer (Bellingham, et al., 1989; Kabat-Zinn, 1994; Zika & Chamberlain, 1987).

Tolerance for Ambiguity

 Some researchers have emphasized the importance of this variable for healthful adaptation to stress (Witmer et al., 1983). After all, every stressor implies some form of change. Change means a new way of doing things. Newness usually means uncertainty. If you expect always to have the right answer, to be able to feel certain that your response or performance will be perfect, you will often be disappointed. Modern times demand flexibility that allows people to live with an exploding rate of change and uncertainty.

STRESS RESISTANCE: VARIATION ON THE SELF-ACTUALIZATION THEME

A classics teacher was frequently heard to remark, "There's nothing new under the sun." Redford Williams has noted that his advice on decreasing hostility is a repack aging of the tenets of the major world religions. This discussion of hardiness characteristics is truly an echo of work by many other thinkers and writers about the qualities that make for a well-adjusted, mentally healthy person. Readers who have studied psychology may be familiar with Abraham Maslow's concept of self-actualization (1970). Maslow developed his definition of self-actualization in the 1960s from his observations of people he felt represented true fulfillment of their personal potentials (Maslow, 1970). The following description of the self-actualized (SA) person is taken from Maslow's work (de Vries, 1979; Maslow, 1970). Can you relate this description to the hardiness characteristics discussed in this chapter? 

1. SA people perceive reality, including other people, more efficiently. They are more comfortable with reality and are not threatened or frightened by the unknown.

2. SA people have an acceptance of self, others, and the world. 

3. SA people are relatively spontaneous in their behavior and even more spontaneous in their thoughts and inner life. They do not allow convention to keep them from doing something they consider important.

4. SA people are problem-centered rather than self-absorbed. They often have a mission in life, usually one that is concerned with larger philosophical or ethical issues.

5. SA people have a quality of detachment that gives them a healthy objectivity for effective problem solving. They enjoy periods of solitude and are often protective of their privacy.

6. SA people appreciate with wonder the good things about life. They enjoy healthy pleasures.

7. SA people commonly have mystic or "peak" experiences: times of strong, intense emotions in which there is a temporary transcendence of normal reality.

8. SA people have deep feelings of identification, sympathy, and affection for other people and humankind in general in spite of occasional anger or impatience with particular individuals.

9. SA people have satisfying interpersonal relationships.

10. SA people are extremely ethical and have high moral principles.

11. SA people have a philosophical, nonhostile sense of humor.

12. SA people are especially creative and inventive.

WHERE DOES STRESS RESISTANCE COME FROM?

Throughout time, people have observed personal differences in temperament and behavior and wondered where they come from. During Shakespeare's time, in the 1600s, people believed that temperament was governed by the four "humors": blood, phlegm, black bile, and yellow bile. A predominance of one humor was thought to predispose an individual to the trait associated with that humor. People dominated by blood developed a sanguine, or cheerful, disposition. A phlegmatic individual has a slow and stolid temperament. A predominance of black bile was thought to make one atrabilious (from the Latin for black bile), or melancholy. Yellow bile made one choleric, or hot tempered. Hence, one's outlook was believed to be colored by one's biochemistry, a belief we hold today, albeit on a different level.

    Likewise, the quest for an understanding of how to develop personality traits that allow one to live in harmony with others (the ultimate form of stress resistance) is certainly not new. Folk wisdom is full of advice on the effects of various personality traits on happiness, success, and so forth.

    Personality and stress resistance characteristics probably arise from some mixture of nature and nurture. Children are certainly born with a personality all their own, which is further developed and refined as they interact with others and their environment. Meyer Friedman believes that Type A behavior is primarily learned and results from inadequate love and support in infancy and childhood (Friedman & Rosenman, 1974). Cardiologist Redford Williams believes that traits such as hostility are learned and that certain child-rearing practices can help people raise emotionally healthy children (Williams, 1989).

    Children are expert imitators, so probably the most important influence on them is their parents' behavior. If a parent models patience, love, and happiness, this is what the child absorbs. Children need plenty of love and touch: holding, hugs, and positive reinforcement when they are doing the right thing. They need safety, security, and consistency that help them feel the world is a predictable and friendly place. Williams and other writers believe that our beliefs about our children are extremely important (Williams, 1989). We must believe they are basically good and free from evil intentions. We must believe they are capable of good behavior and reward it when it appears; this is the true spirit of the child coming forth.

    If your family fit this loving ideal, and your parents raised you in the manner described above, congratulations! You are in the extreme minority. Most of us bear at least a few battle wounds from childhood. Parents are people, after all-not perfect, just doing the best they can. If you dwell upon the injustices of your upbringing, your forward progress is halted. Blaming others for your situation is detrimental to your health and wellness. Instead, move on. Get help if you need it, and do your best to increase your own wellness and stress resistance.

How CAN YOU INCREASE YOUR STRESS REsiSTANCE?

The previous chapters should have already reinforced the many ways in which you are coping effectively with stress and have given you some ideas on further increasing your stress resistance. Here are a few more.

Friedman and Rosenman (1984) followed over 500 post-heart attack patients who participated in a program designed to help them modify their Type A behavior. These patients were able to achieve a 44 percent decrease in Type A behaviors and reduced their incidence of recurring heart attacks.

    Friedman's program focused on behavior change. Participants practiced patience and slowing down: choosing the longest line at the supermarket, driving in the slowest lane of traffic. They learned to walk, talk, and eat more slowly. They practiced listening to others and taking life a little less seriously (Friedman & Rosenman, 1974).

Reducing Hostility: The Trusting Heart

In his book The Trusting Heart, Redford Williams (1989) recommends cognitive restructuring and behavior modification to reduce anger and hostility. He encourages an examination of the thought and behavior patterns that create the hostility and anger in the first place. He suggests a 12-step program:

     1. Monitor your cynical thoughts. Williams suggests keeping a hostility log, similar to the stress log you kept in Chapter 4. The goal is to assess how often and in what situations you experience feelings of hostility.

     2. Confess your hostility problem to a close other. Sharing your problem with a spouse or close friend opens your heart and increases your ability to trust.

     3. Stop hostile thoughts. Williams recommends thought stopping when you find hostile thoughts intruding. As soon as you realize you are having a hostile thought, yell silently but loudly into your mind's ear STOP!

     4. Reason with yourself. Question those irrational thoughts and beliefs. Williams suggests that when you feel anger coming, you ask yourself three questions:

Is my anger justified?

Does the situation deserve continued attention?

Do I have a constructive response?

So, for example, if someone cuts in front of you in heavy traffic, is your anger justified? Sure! Does it deserve continued attention? Well, there is nothing you can do now. Shouting obscenities, blasting your horn, or tailgating the other car is not constructive. It will only make that anger snowball and encourage negative health effects.

     5. Put yourself in the other person's shoes. Try to understand others, especially those causing you irritation. Williams also encourages altruistic activities, since helping others encourages empathy and trust and makes you feel good.

     6. Learn to laugh at yourself. Humor is great at deflecting anger. Laugh at your hostile thoughts and they will become smaller and less significant.

     7. Learn to relax. Williams recommends meditation, which will be described in the next chapter.

     8. Practice trust. Look for opportunities to trust others. Share your feelings; expect things to work out the way they should.

     10. Learn to be assertive. Assertiveness means clear communication and a win-win attitude toward negotiation.

     11. Pretend today is your last. This enhances your ability to discern what is really important.

     12. Practice forgiving. Instead of feeling hostile, forgive those who have mistreated you. Blame leads to anger; forgiveness heals. (See also Kaplan, 1992, 1993.)

Kobasa's colleague, Salvatore Maddi, has designed short-term courses in hardiness training. In as little as 15 weeks, participants have improved their hardiness scores and job satisfaction, and they have reduced their resting blood pressure (Fischman, 1987). Maddi's hardiness training emphasizes three techniques:

     1. Situational reconstruction. Maddi encourages people to take a broader perspective on stressful events and to use cognitive restructuring techniques to get a clearer vision of the larger picture. Positive appraisal then leads to better use of problem-solving techniques, a hallmark of the hardy personality.

     2. Focusing. Maddi believes that people often cannot put their finger on what is wrong; they go around feeling down but are unable to define the cause of their unhappiness. He teaches participants to concentrate on the physical sensations of anxiety, or whatever the problem is, and to try to figure out what starts these sensations and emotions. Once they know what the problem is, they can begin looking for a solution.

     3. Compensatory self-improvement. When a situation truly cannot be changed, people often benefit from making progress in a different area altogether. Let's say Rita, from our case study, is doing what she can for her difficult English class but is stuck with this difficult situation. Perhaps she starts working out in the weight room regularly. As she improves her strength and muscle tone, she feels better about herself and her hardiness increases, even though she must still tolerate her English class until the end of the semester.

SUMMARY

1. Several personality traits discriminate between people who are resistant to the negative health effects of stress and those who are not.

2. Friedman and Rosenman coined the term Type A behavior to describe people who are hard-driving, impatient, competitive, and aggressive overachievers. They found that Type A behavior was associated with greater stress reactivity, higher blood cholesterol levels, increased risk of hypertension, and higher rates of coronary artery disease.

3. Several irrational beliefs seem to underlie Type A behavior: (1) Self-worth is largely a function of personal achievements and excessive personal standards. (2) No universal moral principle exists. (3) Resources are in scarce supply.

4. Type A behavior is at least partly learned. Many Type A traits are part of the American model for success, especially in higher socioeconomic groups and urban environments.

5. Not all Type A traits are necessarily associated with negative health effects. Hostility, cynicism, and anger are most strongly linked to stress-related illness, especially cardiovascular disease and several risk factors for cardiovascular disease, including hypertension, poor blood lipid profile, and platelet reactivity.

6. Kobasa, Maddi, and colleagues found that a cluster of variables contributed to a "hardy" personality that was relatively resistant to the negative health effects of stress. They described control, commitment, and challenge as components of the hardy personality.

7. Hardiness may have protective effects for several reasons: (1) Hardy people are optimists, and optimism itself is protective. (2) Hardy people may have a more "healthful" stress response and not experience as much physical strain when stressed. (3) Hardy people may cope more effectively with stress. (4) Hardy people may have better health habits.

8. Other variables that increase stress resistance include exercise, self-esteem, optimism, social support, spiritual health, and a tolerance for ambiguity.

9. Abraham Maslow's description of the self-actualized person illustrates many characteristics of stress resistance.

10. Personality and stress resistance characteristics probably arise from some mixture of nature (genetic or biological predisposition) and nurture (environmental influences).

11. Several interventions have been created to help people develop the personality traits associated with stress resistance. Most of these are based on cognitive intervention techniques that help people change their perceptions of stressors, themselves, and the world around them.

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