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ANGINA AND STRESSFUL PERSONAL STYLES: HOSTILITY
A study of 255 male medical students, followed up 25 yea afterwards found those who had hostile personalities were more
likely to develop angina. At Duke University in Durham, USA, 307 men and 117 women underwent angiography to investigate angina. They found that the amount of blockage (atherosclerosis) in the coronary arteries was less likely to predict who was most disabled by angina than how hostile they were. So, modifying how hostile you are may reduce your symptoms.
Being hostile can mean you are easily provoked to become angry. Anger is an emotion, like anxiety, which is justified in some circumstances but not others. It is healthy to express anger if you are thwarted in achieving your legitimate goals or meeting your everyday needs. But a person who has a hostile personality is not simply anger-prone: they have a view of the world which can lead to chronic stress due to frequent angry outbursts and to brittle relationships which are distrustful and emotionally shallow.
Do you believe such things as:
‘If I don’t stand up for myself, someone else will get what I want’
‘You just can’t trust people’
‘People today are just not as moral as they should be’
‘Other people just don’t care as much as I do, and they should!’
‘If I don’t watch my back, someone will be getting one over on me’ or
‘I feel others are out to get me, or put me down? Do you generally feel:
like hitting someone?
that you get into arguments easily?
you have problems controlling your temper?
Do you tend to shout, swear, throw things, clench your fists, hit out, slam doors?
Do you drive impatiently or aggressively, hooting your horn if you can’t pass a slow driver, or signalling your displeasure at bad drivers?
Do you get into races or ‘cut up’ other drivers?
If so, you have a tendency to express your anger. But there are also hostile people who do get angry, but bottle up their anger. Do you generally:
have angry thoughts about people? Feel easily annoyed and frustrated?
sit and fume about what has annoyed you?
turn over and over in your mind how you would like to get revenge?
How does hostility affect you?
We may all feel strongly about some issues and many people have strong moral, religious or political views. But if you hang on to beliefs in the face of evidence that your beliefs are incorrect in the present situation, or let other people provoke you for the fun of seeing you rise to bait, or you generally feel people are out to do you harm, you may well have a hostility problem.
You may develop problems of anger control because you are easily provoked by situations that do not provoke other people.
If you are often angry, and express it in aggressive language and acts, you will experience strong physiological arousal since anger expression is often accompanied by very sudden increases in heart rate and blood pressure – anger is the emotion most likely to trigger angina. Not only will it affect you physically, but aggressive language and behaviour will threaten other people who may retaliate, or withdraw from you, or in other ways seek to do you down, and so proving to you that the world is against you!
If you sit on your anger, you may not threaten others directly, but if you harbour aggressive thoughts about others this will harm your relationship with them and make you distrustful and emotionally cold. This in turn can lead others to be less open with you, and add to your cynical and distrustful view of the world.
What can you do about hostility and anger?
You were not born with a short fuse. You have learned a habit of seeing the world in a hostile way and you have learned to produce an angry response.
Understanding what makes you angry
Personal insult, particularly being sworn at by other people, is a common anger trigger.
Thwarting your goals: stopping you doing things that are important to you, such as a car mechanic not fixing your car so you are unable to go away on holiday on time.
Frustration with others who do not let you achieve your goals. Children are often an enormous source of frustration to parents who cannot see why they are disobedient.
Threat or insult to people or values important to you: for example, party political broadcasts of a party you do not vote for which presents ideas and values opposite to your own, may be a source of annoyance.
Using the Anger Provocation Exercise Sheet record over the next week the type of provoking events you faced. In the first column, describe the situation. In the second, put which of the four reasons outlined above (personal insult, thwarting your goals, frustration with others, threat to your values) seems to explain why you got provoked. In the final column, rate how angry you became.
Over a period of days or weeks you can determine which situations regularly make you angry. This knowledge can be useful in helping you to understand how your views of the world lead you to become more easily provoked to anger than other people. Asking others whom you respect as being better able to control their emotions than yourself how they would have reacted, can also help you to understand your anger reaction and learn to change your thoughts about anger-provoking events.
It is well known that thinking angry thoughts can provoke strong physiological arousal. The bodily sensations of the adrenalin response can become a cue to remind you that you are aroused and that this arousal is associated with fighting and attacking behaviour. It can become almost automatic for a person in this situation to respond to the bodily cues of arousal by bracing themselves. Their behaviour and posture can indicate aggression, by for example, ‘squaring up’ to the other person and getting close to them with threatening gestures and a loud tone of voice. This behaviour itself can be a cue for the thoughts to become more aggressive. The vicious circle is complete, with the thoughts, bodily arousal, and behaviour interacting to produce an angry outburst.
Stage 1: Preparing for provocation Your thoughts: Using the information you have gleaned from the anger provocation exercise, identify in advance the situations and people who tend to provoke you. Try to think of the thoughts you have which make you feel angry. See if you can substitute more calming thoughts:
‘This could be a rough situation, but I know how to deal with it.’
‘I can work out a plan to handle this. Easy does it.’
‘Remember, stick to the issues and don’t take it personally’
‘There is no need for an argument, I shall just state my case.’
Your bodily arousal and behaviour: It is important to remain calm and physically relaxed, breathing slowly and evenly, and maintaining a non-threatening posture and a low and calm tone of voice.
Stage 2: Confronting the situation
Your thoughts: Learn to distance yourself from the provocation
so you will not overreact:
‘OK, so you seem to be rather rude but it’s not worth taking it personally’
‘He’s entitled to his views, so what?’
‘If I stay calm, I’ll handle it better.’
‘I don’t need to prove myself. Don’t make more out of this than I have to.’
‘There is no point getting angry, think of what I have to do to get out of this.’
‘Look for the positive side and don’t jump to conclusions.’
Bodily arousal and behaviour: It is particularly important to maintain a relaxed calm stance, low and unthreatening voice and to maintain your distance in order to prevent the other person from feeling threatened and retaliating.
Stage 3: Coping with your physical tension Your thoughts:
‘My muscles are tight, I feel sick. I can counteract this by relaxing and slowing down.’
‘Take this problem point by point. There must be a better way to react than getting angry.’
‘My muscles are getting tight. Relax and slow things down.’
‘My anger is a sign of what I need to do. Time for problem solving.’
‘He probably wants me to get angry but I’m going to deal with it my own way’
Bodily arousal and behaviour: A positive effort to back off and remain calm will be a cue to yourself, as well as to other people involved, that you are not getting worked up.
Stage 4: Reviewing your performance A. If a conflict is unresolved:
Thoughts:
‘Forget about the aggravation. Thinking about it only makes me upset.’
‘Try to shake it off. Don’t let it interfere with what I’m going to do.’
‘Relaxation is better than anger.’
‘Don’t take it personally. It’s probably not so serious.’
It is important to try to put the situation behind you and do not let your anger or frustration eat you up.
Bodily arousal and behaviour:
Try to do something that will help release the tension constructively such as taking brisk physical exercise or doing a relaxation exercise.
B. If the conflict is resolved:
Thoughts:
Congratulate yourself!
‘My pride can get me into trouble, but I’m learning to overcome it.’
‘I’m so pleased I got through that without blowing up.’
‘I handled that one pretty well. That’s doing a good job.’
Bodily tension and behaviour:
You may still feel somewhat tense even though you have succeeded in controlling yourself. Again, it is worth taking some brief physical exercise or doing a relaxation response to get rid of this tension.
In order to practise these techniques it can help to go over recent events in your mind. Use the situations you have listed using the Anger Provocation Exercise sheet:
List the situations which regularly provoke you.
Put them into an order from LEAST to MOST provoking.
Identify which type of provocation this is (threat to others, threat to your values, threat to your possessions, personal insult, frustration with others, thwarting your goals).
Starting with the least provoking event take yourself through the situations using the four-step ‘anger inoculation method’.
You can also use the anger inoculation method next time you feel you are being unnecessarily aggressive or becoming wound up. This technique was used by a psychologist, Raymond Novaco, from the USA. It has been used with people who have particularly short fuses, such as people who have been violent offenders, as well as people who develop health problems when l hey are in acute stress, including people who develop angina pain when angry.
The anger inoculation technique can be used to help you plan for situations which you know are often likely to provoke you to anger. When you have been through such a situation using the anger control techniques, it can be helpful to look back over the situation and try to find out how you responded and see if there are better solutions to your response.
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