Health Psychology, 2nd Edition

PERSONALITY AND HEALTH 123

analysis offers a less positive interpretation based on a smaller subset of papers (Myrtek,
2001), i.e. they suggest that while the effects are significant they are very small indeed.
Furthermore, Petticrew et al.(2012) suggest that large amounts of tobacco industry
funding also supported early research into hostility. In the main however, studies and
reviews continue to suggest that hostility plays a role in causing CHD (e.g. Gallo and
Matthews, 2003) and hypertension (Rutledge and Hogan, 2002). Most recently, Chida
and Steptoe (2009) reviewed prospective studies of the role of anger and hostility in
heart disease including a number of studies published since the previous reviews. They
conclude that both anger and hostility are associated with an increase in CHD events
in those who were initially healthy, but also poorer prognosis for CHD patients. They
suggest that interventions to reduce anger and hostility may help prevent and treat
CHD. Focus 6.2 considers one such intervention.
The possible mechanisms underlying the effects of hostility have also been discussed
in some detail. Smith et al. (2004) discuss five possible models:

Interventions to reduce hostility

There is now evidence suggesting that a hostility-reduction intervention aimed at

CHD patients with high levels of hostility may reduce risks for heart disease.

Gidron, Davidson and Bata (1999) conducted a randomized controlled trial in which

22 hostile male patients were assigned to either a treatment or control group.

Hostility was assessed by observation during a structured interview and by self-

ratings. The hostility-reduction intervention involved eight 90-minute weekly group

meetings using cognitive behaviour techniques. Participants were taught skills to

reduce antagonism, cynicism and anger. They were also asked to rate their hostility

in a daily log and to record their use of the skills they had learnt. The control group

had a one-session group meeting giving information about the risks of hostility and

about basic hostility-reduction skills. The participants were followed up immediately

after the trial and again after 2 months. Those in the intervention group were

observed to be, and rated themselves to be, less hostile at follow-up than the

controls. They also had lower diastolic blood pressure. Furthermore, reductions in

hostility were correlated with reductions in blood pressure.

In a subsequent paper, Davidson et al. (2007) conducted secondary analysis of

the data from the above study. They found that patients who received the

intervention tended to have fewer hospital admissions in the 6 months following

the intervention, and, importantly, had significantly fewer days in hospital (a mean

of 0.38 days compared with a mean of 2.15 days for the control group).

Consequently, their hospitalization costs were less. While more studies are needed

with larger and more diverse groups, these findings suggest there may be potential

to design efficacious and cost-effective hostility-reduction treatments.

FOCUS 6.2