In recent years, behavioral scientists have become a rich source of clues and  answers to many questions plaguing the medical community. They have provided  directions to further research and better understanding of diseases that defy neat  diagnoses and treatments. In this regard behavioral sciences deserve as much  credit as physiological and pharmaceutical sciences in solving the mystery of human  ailments.

Type A Traits  
      One of the most prominent terms to emerge and become part of our lexicon in the  past two decades from the works of behavioral scientists is Type A Behavior .

      The term was coined by two cardiologists, Meyer Friedman and Ray H.  Rosenman, who had studied coronary heart disease in the consultation room,  at the hospital bedside, and in the laboratory. Their studies led to a startling  conclusion: Although the coronary heart disease has been a leading cause  of death in this country and average American is deluged with information about  high cholesterol, elevated blood pressure, dangers of cigarette smoking and  benefits of exercise, he is denied the most important piece of information that  may actually help him avert the risk of a heart attack. 

      They were referring to specific behavior pattern that they designated Type A.  They concluded that in the absence of Type A behavior pattern, coronary heart  disease almost never occurs before 70 years of age, regardless of the fatty foods  eaten, the cigarettes smoked, or the lack of exercise, but when this behavior pattern  is present, coronary heart disease can readily strike in one's thirties or forties. They  became convinced that Type A behavior was the actual culprit for death by heart  attack among young people.        

      The so-called conventional risk factors, such as smoking, diet, exercise, family  history, and so forth, explained only about half the heart attacks leaving a vast majority  of cases where there was no suitable explanation. To explain the occurrence of heart  disease among these individuals, Friedman and Rosenman pointed to Type A behavior  pattern which is a complex of personality traits characterized by obsessive competitive  drive, aggressiveness, impatience and a compulsive sense of time urgency. Individuals  displaying this pattern seem to be engaged in a chronic, ceaseless and often fruitless  struggle - with themselves, with others, with circumstances, with time, sometimes with  life itself. Above all, these individuals exhibited a deep-rooted sense of insecurity and  hostility. 

       Drs. Friedman and Rosenman initiated the studies on the link between emotional  stress and coronary heart disease in the mid 1950s. In the book, Type A Behavior  and Your Heart, they recalled a particular incident that took place about that time.  They had called in an upholsterer to fix the seats of the chairs in their reception room.  After inspecting the chairs, he asked what sort of medical practice they had. When  informed they were cardiologists, he replied, "I was just wondering, because it's so  peculiar that only the front edge of your chair seats are worn out." This was a telling  remark.  

      One of the early conclusions drawn by the researchers was that whenever a person  felt within himself a chronic sense of time urgency and also exhibited excessive  competitive drive, he invariably possessed Type A behavior pattern. Further, they  were able to link the serum cholesterol level directly with the intensity of Type A  behavior. For example, when they followed the serum cholesterol level of a group of  accountants from January to June, they found that as the April 15 tax deadline  approached, and with it the sense of time urgency, so did the level of serum cholesterol.  Conversely, in May and early  June when sense of time urgency almost disappeared, their serum cholesterol fell.  The inescapable conclusion here was that the level of cholesterol was directly linked to  the emotional stress experienced by the accountants as there was no change in their  dietary exercise or smoking habits. 

What Is Type A Behavior?  
      In their book, Type A Behavior and Your Heart, Friedman and Rosenman, define  Type A behavior as follows: 

       The person with Type B behavior is the exact opposite of the Type A individual.  Type B individual may be just as intelligent or even more so than Type A subject. He  may be equally ambitious and possessive of drive, but "his character is such that it  seems to steady him, give confidence and security to him, rather than to goad, irritate  and infuriate, as with the Type A man."

      The researchers found a stark contrast in the degree of susceptibility to heart disease  between individuals exhibiting Type A behavior as opposed to Type B behavior. Person  with Type A behavior between the ages of 35 and 60, was almost 3 times more likely than  a Type B person to get coronary heart disease in the subsequent decade. Type B  individual, on the other hand, regardless of cholesterol or fat level in his food, or smoking  habits, or history of coronary disease in the family appeared to be immune to early attack  of heart disease. 
      Type A individual is characterized by 5 behavioral traits. 

Sense of time urgency   Type A man feels he never has enough time to do all the things  he wishes to do. He is always trying to compress more and more activities in the allotted  time. In an attempt to save time the Type A man often creates artificial deadlines, creating a continuous time pressure! for himself He convinces himself that by setting earlier and earlier deadlines I for himself he will somehow complete the task sooner. Of course, the unfortunate result is that as Type A man constantly struggles with ever-dwindling supply of time that he feels is available to him he loses the creative and imaginative powers and the sense of  balance, and very frequently succumbs to early demise from coronary heart disease. 

Obsession with numbers   For Type A man, even the most mundane I activity of life is  translated into a game of numbers where the outcome I is measured in quantitative rather  than qualitative terms. Type Al businessman drives himself to make more money, not for what it will I do for him, but for what it represents to him as achievement of a goal. I Life  becomes a game of Monopoly or a game of marbles, where the! ultimate success is defined by the quantity of houses or marbles collected. 

Insecurity of status  Type A man exudes confidence and oozes I success. So  how could he be insecure of his status? The truth is such I an individual typically suffers  from a hidden lack of self esteem, which I in turn results in "insecurity of status." This  individual is so absorbed I in his never-ending quest for trophies that he never feels  he has accomplished enough, so no amount of encomium from his peers or superiors  is sufficient to please him. He constantly  feels inadequate in his tasks. 

Aggression and hostility   This is the hallmark of Type A personality. Most Type A individuals possess so much aggressive drive that it frequently evolves into free- floating hostility. Hyperaggressivenessasso-1 ciated with Type A behavior involves  "not merely a desire to win but to dominate, with indifference to the feelings or  fundamental rights of one's j competitors or opponents" (Friedman and Ulmer, 1984).

      This trait was expressed quite accurately by author Jess Lair when | he wrote:  "Before I had my heart attack I didn't have any friends; when I played poker I played  to win from the bastards."

       Hyperaggressive pattern often develops very early in life, and can be detected  early in infancy. Type A children, as a rule, are more active and exhibit more aggression.

      The Type A person generally sees the darker side of other people, displaying  suspiciousness and distrust. The hostility in such individuals is lurking only slightly  below the surface and it takes mere trivial annoyances for it to burst out in the open.  Loud conversation at the next table at a restaurant, a barking dog, blaring radio,  slow motorists, some idiot in the line who is taking too much time, politicians and  bureaucrats— anyone of these seemingly innocuous happenings will be sufficient to  make him fly off the handle.

      Friedman and Ulmer describe one of their hostile, Type A patients who had  stopped for a red light, lit a cigarette just as the signal had turned green when the  female motorist behind him honked several times. Reacting, he slowly got out of  his car, sneeringly smiled at her and then sauntered to the front of his car, opened  the engine hood and pretended to look for some mechanical breakdown. "I think  the bitch got the message," he later remarked to a friend.

      Hostility of Type A individuals is not merely confined to certain actions; it often  spills over into their conversations, which are punctuated by such pejoratives as  "stupid," "ridiculous," "idiotic," or "nonsensical" to belittle the comments of others.  It is this hostility which makes it difficult for Type A person to come to peace with  himself or those around him. 

Polyphasic thinking and performance   Friedman and Ulmer have pointed out that  Type A person can be seen constantly trying to do 2 or 3 activities at the same time  as he races to finish all the tasks he has set for himself within the self-imposed time  limits. We all know or have met such people who are thinking or doing something else  while ostensibly listening to another person. While carrying on a conversation on the  phone this person is simultaneously signing his correspondence, or reading a  magazine, or charting some notes for himself for later. Another favorite activity of such  a person is driving on the freeway while dictating a memo or talking on the car phone.  Some Type As may be found attempting to watch television, read a newspaper and  eat dinner, all at the same time. 

The drive to self-destruction   This element of Type A personality is probably the  most dangerous and can be seen in the most severely afflicted Type A individuals.  This was not apparent to Frieman and Rosenman when they wrote Type A Behavior and Your Heart  in 1974 because at that time no one suspected that seemingly successful,  good-humored, and even optimistic Type A subjects might be harboring a covert  instinct to destroy their careers or themselves. Many immensely successful attorneys  have made headline news when they were found not to have filed their income tax  return for several years. Or take this comment from Henry Kissinger about President  Nixon: "It was hard to avoid the impression that Nixon, who thrived on crisis, also craved disasters."

      In their research, Friedman and Ulmer found that over half of Type A people who had  a heart attack had not only expected to have a heart attack but had in fact yearned for it.  As they lay on their beds in the coronary care unit, the pain of the acute attack having  barely abated, they could be heard saying such things as:        "It may seem strange to you, but I knew I was going to get this attack and I sort of  looked forward to it."

      "I'm glad it finally came. I just couldn't seem to find any other way to get out from  under the junky stuff loading me down."

      "Now I can retire from the company and begin to live like a real human being again.  You know what? I wanted this to happen and I ! didn't care whether I lived or not.  There is  enough insurance for the wife and kids and they may have been a lot better off without me." 

Type B Behavior
       If Type A person is characterized by his constant monitoring of the watch, Type B  person can be seen as floating graciously with the passage of time. He would  explain his unhurried ways with a comment like, "Why get bothered about something  one can't do anything about?" Type B rarely feels pressured to complete tasks  within some artificial time limits. He also feels more comfortable and secure about  delegating authority.

       Type A man, on the other hand, would feel that every task needs his personal  attention and constant supervision. This is what Friedman and Ulmer had to say:  "The Type B person has learned to value and enjoy himself a s much or more for  what he has already done or experienced as for what he may accomplish in the future."

       Type B men are remarkably free from hostility which can be attributed to their high  degree of self-esteem. They are able to tolerate transgressions of motorists on the highway  or shrug off trivial errors of subordinates.

       Type B person is also more likely to make a better parent. He may punish his  wayward child in a fair and understanding way without becoming rancorous or judgmental. He is also more likely to show physical affection.

       What gives Type B this extraordinary peace of mind and relaxed way of looking  at life's bumps and grinds? It is probably his sense of security and self-esteem.  He feels no urge to become hostile and volatile, he is quite capable of giving and  receiving affection. His openness is reciprocated by those around him, evoking  a general sense of pleasantness and serenity all around. 

Distinguishing Type A from Type B
      Friedman and Rosenman in their groundbreaking book have developed a  series of questions to determine whether you are a Type A person or a Type  B person.

      You possess Type A behavior pattern: 

Can You Change Type A Behavior?
        In their book Treating Type A Behavior and Your Heart, Friedman and Ulmer support vigorously their contention that Type A behavior can indeed be  changed. First, Type A behavior not only can be modified, it can be greatly  modified; and second, such modification can and does forestall the occurrence  of another heart attack or sudden cardiac death in persons who have survived  an earlier heart attack. Of course, it goes without saying that an individual who has  never had a heart attack can also benefit greatly from this behavior modification, including averting a heart attack in the near future.

       In order to determine whether Type A behavior can be changed, Friedman and  Ulmer conducted a large scale study involving several hundred candidates over  a period of 3 to 5 years. The typical participant was a male, approximately 53 years of age, weighing between 170and 179 pounds, 69 inches tall, married, and at least a  high school graduate. His average serum cholesterol was 25 9mg/100ml; his chances  of having had a mother or father who had suffered a heart attack being 1 in 2; a one -time smoker; having a 50-50 chance of high blood pressure and/or angina pectoris;  and a l-in-4 chance of having already undergone an open heart bypass surgery.  (The researchers enrolled only one physician in this group study, not because there  was a shortage of post-infarction physicians in the San Francisco area where the  study was conducted, but most of them apparently felt they could not spare the time  the study demanded, ironically, the researchers later found the time to attend the  funerals of two of the over busy physicians). 

       By the end of the third year counseling, the researchers were able to see  significant decrease in the Type A behavior exhibited by the participants.       So what group of people can benefit from behavior modification treatment?  Friedman and Ulmer identified four groups of people who could definitely prolong the life span and improve the quality of life:

• Persons already suffering from clinical coronary heart disease: These would include  survivors from one or more heart attacks or people who suffer from irregularities in their  heart beat, or suffer from angina, or who have coronary artery disease as suggested by  coronary autobiography

• Persons suffering from maturity-onset diabetes: Although it is not clear whether Type  A behavior is responsible for the occurrence of maturity-onset diabetes, the  combination of diabetes and Type A behavior presents an extreme threat to the heart.

• "Triple-risk" persons: These people smoke cigarettes, suffer from hypertension,  and have a high blood cholesterol level.

• Persons with positive family history of clinical coronary heart disease or hypertension.

What To Do If You Are Type A
      The first step in curing Type A behavior is recognizing the fact that you are Type A.  According to Friedman and Ulmer, there are no "in-betweens;" there are only pure  Type Bs, who display no trace of Type A behavior and Type As who range from mild cases to severe.

      As we have seen before, particular Type A behavior emanates from various in-grown  patterns, such as extreme sense of time urgency, free-floating hostility, or self-destruct  tendency, which may all be present in some degree. The task would be to alleviate  these root causes of Type A behavior. 

Alleviating Hurry Sickness
      If you could free yourself of "hurry sickness," at least 50 percent or more of your Type  A behavior pattern would disappear. Type A person constantly finds himself battling  against time, trying to squeeze an increasing number of jobs in the ever-decreasing  amount of time. Type A person associates his sense of time urgency with social and  economic success, which in turn may be the result of inherent insecurity.

      The very first step you must take is to revise your usually busy schedule of activities  so as to eliminate as many events and activities as possible that do not contribute  directly to your social and economic well-being. This will allow you to determine  activities that you can safely dispense with. After you have eliminated the "trash"  events and activities cluttering your life, you should adopt some commonsense  practices: 

Alleviating Free-Floating Hostility
      Free-floating hostility is the second most overt characteristic of Type A behavior.  Although not all Type A persons are plagued with a sense of free-floating hostility,  a majority of Type A persons regularly exhibit deep-rooted ever-present sense  of hostility. Again, the challenge in alleviating your free-floating hostility is to first  recognize its presence in your psyche. Friedman and Ulmer report a response  from a participant to a question asking if he believed his hostility had diminished  after a year into the group study: 

      How can you tell if you have free-floating hostility in your personality makeup? 

      Here are a few telltale signs:  (1) if you become irritated or angry at relatively minor  mistakes of your family members, friends, acquaintances, or complete strangers,  or find such mistakes hard to overlook; (2) if you frequently find yourself critically  examining a situation in order to find some thing that is wrong or might go wrong;  (3) if you find yourself scowling and unwilling or unable to laugh at things your  friends laugh at; (4) if you frequently find yourself thinking or saying that most  people cannot be trusted or that every one has a selfish angle or motive;  (5) if you find yourself regarding even one person with contempt; (6) if you  frequently use obscenities in your speech; (7) if you find it difficult to complement  or congratulate other people with honest enthusiasm; (8) if you find yourself shifting blame for your woes onto your  employer, government, or large corporations or businesses. 

      If any of these applies to you, it is fairly certain that you have some degree of free-floating hostility in you.

      Many Type A persons would justify their sense of free-floating hostility by  saying, "I need a certain amount of hostility to get ahead in the world," or "I  can't do anything about my hostility," or "Other people tend to be ignorant and  inept." Not surprisingly, most Type A persons believe that giving and receiving  love is a sign of weakness. 

      To help alleviate your sense of free-floating hostility, Friedman and Ulmer  prescribe a series of drills to practice regularly: