Lateralized representation of affect, affect cognizance and the coronary-prone personality

Biological Psychologv 15 ( 1982) 17 1 - 189

North-Holland Publishing Company

171

LATERALIZED REPRESENTATION OF AFFECT, AFFECT COGNIZANCE AND THE CORONARY-PRONE PERSONALITY

Mark W. KETTERER *

Center for Behavroral Medicine, Tulsa, OK 74101, U,S.A.

Accepted for publication 1 July 1982

Forty-eight right-handed subjects equally divided among four cells defined by sex (male versus

female) and familial handedness (at least one member of the immediate family who is left-handed

or ambidextrous versus none) were asked to recall times they were angry, anxious and content

while tonic SC and bilateral parietal alpha-band EEG power was recorded. Subjects also com-

pleted the Jenkins Activity Survey (JAS) and scales assessing their subjective success (SS) at

achieving each affective state and the cognitive mode (verbal/visuospatial) they used to do so.

Contrary to previous research, greater left parietal activity occurred during affective arousal.

Subjects reporting no experienced arousal during the anger and anxious conditions were higher on

the overall type A and speed and impatience scales of the JAS. ‘Repression,’ in the sense of greater

autonomic arousal (as measured by increases in tonic SC above baseline) despite no distinction in

SS, was observed in type A relative to non-type A subjects. For males this effect was most

pronounced during self-stimulation of anxiety. For females, the contentment condition produced

the effect. Type A subjects tended to produce greater relative left parietal activity than non-type A

subjects. Results are discussed in terms of automatistic nonawareness of affective arousal as an

overlearned, achievement-facilitating coping mechanism in type As.

1. Introduction

The coronary-prone behavior pattern (type A), characterized by speed and impatience, job involvement and hard-driving competitiveness (Friedman and Rosenman, 1974), has been implicated as an independent risk factor in the pathogenesis of clinical heart disease (Brand, 1978; Zyzanski, 1978). However, the mechanisms linking this behavioral syndrome to the biochemical and physiological processes which may mediate coronary heart disease (Sokolow. 1980) have only begun to be illuminated.

For the coronary-prone behavior pattern, one such pathway may have begun to be revealed by the observation of greater relative autonomic response (e.g. increased systolic blood pressure and plasma norepinephrine) by type A’s to situations involving competition with and/or aggressive behavior in others

* Address requests for reprints to: Mark W. Ketterer, Center for Behavioral Medicine, OCOMS, P.O. Box 2280, Tulsa, Oklahoma 74101, U.S.A.

0301-05 1 l/82/0000-0000/$02.75 0 1982 North-Holland

(Glass. Krakoff, Contrada, Hilton, Kehoe, Manucci, Collins, Snow and Elting, 1980; Lovallo and Pishkin, 1980; MacDougalI, Dembroski and Krantz, 1981). It may be that type A individuals chronically expose themselves to such situations because they have learned to ignore attendant subjective distress. For example. type A people are reported to suppress the experience of fatigue when it would interfere with task performance (Carver, Coleman and Glass, 1976) and to selectively ignore or suppress non-task relevant environmental and somatic cues (Matthews and Brunson, 1979; Weidner and Matthews, 1978). Type A individuals also often display behavior indicating the presence of anger and anxiety {Friedman and Rosenman, 1974). Such displays seem to occur as a result of self-imposed time pressure (performance-oriented behavior) and achievement frustration.

These individuals may be largely unaware of some negative affective states while in the presence of certain types of stimuli because it is adaptive for them to maintail attentional focus elsewhere (Rosenn~al~, 1978). Suggestive is the observation that certain behaviors (e.g. tics, nervous mannerisms, impatience) typically noted in type A individuals by interviewers are frequently denied on questionnaires (Jenkins, 1978). The implication is that nonawareness of these behaviors and/or the somatosensory experience of affective states they are driven by does not allow the individual to question or work at changing his/her behavior or the environment which elicits it. Such a lack of awareness could lead to chronic sympathetic arousal because the person does not strongly experience the discomfort of these states and thus cannot focus adaptive behavior and cognition on changing the behavior or its cues. This chronic arousal could lead to the biochemical abnormalities observed in the type A person that predispose to atherosclerosis (Seiye, 1956).

The purpose of the present study was to examine the possibility that one cognitive/behavioral mechanism contributing to the type A syndrome is nonawareness of affective arousal. This process might be conceptualized as repression (Holmes, 1974). The study of nonawareness of a mental event, such as affective arousal, is an inherently difficult undertaking (Shevrin and Dick- man, 1980; Lieberman, 1979; Nisbett and Wilson, 1977; Smith and Miller, 1978). The nonawareness to be considered here would represent the occurrence of affective arousal without the concurrent phenomenological experience. The occurrence of such a mental event must, of course, be inferred by the co-occurence of some physiological or behavioral event assumed to be a correlate. Autonomic arousal is generally accepted as a reliable correlate of affective arousal (Stern and Janes, 1973). And individuals are known to vary in their accuracy of autonomic perception (Katkin, Morell, Goldband, Bernstein and Wise, 1982; Pennebacker, Gonder-Frederik, Stewart, Elfman and Skelton,

1982). Two possible correlates of affective arousal are an increase in tonic skin

conductance (Stern and Janes, 1973) and increased desynchronization of

M. W. Ketterer / Affect cognizance and the coronary -prone personulit~ 173

frequency-domain right parietal EEG (Davidson Schwartz, Pugash and Brom- field, 1976; Davidson and Schwartz, 1976; Bennett, Davidson and Saron, 1980; Davidson, Schwartz, Saron, Bennet and Goleman, 1979). The latter is a particularly interesting index of affective arousal in the present context (Flor- Henry, 1979; Tucker, 1981) since inhibition of cross-callosal transmission of affective activity has been offered as a mechanism for repression (Galin, 1974; 1976; 1977).

Several expectations were held at the beginning of this investigation. First, it was expected that greater right-hemispheric activity would be observed in subjects across all conditions (Davidson et al., 1976; Davidson and Schwartz, 1976; Bennett et al., 1980; Davidson et al., 1979). Type As were expected to show a greater right-left differentiation, in response to self-stimulation (voli- tionally remembering events) of anger and anxiety but not contentment, than non-type As in accord with Galin’s theory of cross-callosal inhibition of affective activity as the mechanism in repression (Galin, 1974; 1976: 1977). Third, it was expected that subjects reporting an inability to experience any affective arousal during anger and anxiety would score higher on a measure of type A behavior. And finally. it was expected that type A subjects would demonstrate greater sympathetic arousal than non-type A subjects during anger and anxiety, but not contentment. while reporting the same degree of subjectively experienced arousal.

2. Methods

2. I. Subjects

Subjects were recruited from a large course in Abnormal Psychology in the Department of Psychology. Prescreening was done with a handedness screening form. Left-handed and ambidextrous subjects were eliminated. The remaining subjects were divided into four cells defined by sex (male versus female) and familial handedness (at least one member of the immediate family who is left-handed or ambidextrous versus none). Each subject in the final analyses: (a) used the right hand in filling out forms at the start of the experimental session, (b) indicated on a questionnaire given prior to the recording session no recent drug usage, loss of sleep or neurological disorders, (c) produced a usable polygraph record, (d) did not indicate having fallen asleep during the recording session, (e) indicated at least ‘somewhat,’ on a five-point scale running from ‘not’ to ‘ very’ when self-rating success at achieving each affective state, and (f) scored at least 15 on a handedness behavior questionnaire (Oldfield, 1969). Subjects meeting these criteria were randomly selected from within each cell for participation in the experimental session. Twelve subjects per sex X familial handedness cell - a total of 48 in all - successfully completed the recording session.

2.2. Appurutus

A Grass Il~struments Model 7 polygraph. equipped with a 7PIB lowlevel DC preamplifier to record electrodermal activity and 7P5B AC preamplifiers to record electroencephalographic activity, was used for physiological monitor- ing. The low-level DC preamplifier was modified to output 8 PA to the skin. Current density was 9.66 PA/cm’. Electroencephalographic data was filtered for 8- 13 Hz activity on-tine (50% signal passage at 7.0 and 14.7 Hz, maximum signal passage at 10.4 Hz, maximum signal attenuation 27%) and amplitude summated across each condition for each lead by a Grass Instruments In- tegrater Model 7PlOB. Electrodermal data was hand-scored. Tonic SC levels were recorded 10 set after the onset of each affective arousal condition and 10 set prior to the onset of the first set of instructions. Instructions for the three emotional memory conditions were recorded on tapes (six of them to permute condition order) and played back on a Sony tape deck and amplifier through matched, calibrated earphones. Throughout the recording session. subjects were seated in an Audio-Suttle Mode1 AS-109, Type 4Oc sound-attenuating chamber.

2.3. Protedure

On arrival at the laboratory, subjects were given pre-experimental instructions to read, asked to sign a consent form, fill out a physiological states questionnaire (assessing drug usage, recent sleep loss and neurological disorders) and write three short descriptions of times they were very angry, very anxious and very content. Having subjects write down these events before the recording session served to minimize time lost to memory search during recording. The use of idiosyncratic memories as the stimulus for affective arousal was done’ to enhance the likelihood of detectable arousal (Harmon and Ray, 1977). When these preliminary activities were completed, subjects were seated in the sound-attenuating chamber. The volar surfaces of the first and middle fingers of the left hand were prepared by brisk rubbing with isopropyl alcohol. Two points located over the parietal lobes (P3 and Pa), both earlobes and an inactive common ground (Jasper, 1958) were prepared in a like manner. These sites were then checked for a contact resistance of less than 5 K&J (Kooi, Tucker and Marshall, 1978). Grass Ag/AgCl cup electrodes were used at all sites except the linked ear.lobe reference sites where Grass flat gold electrodes were used. Attachment was accomplished with masking tape. PX and P4 electrodes were also securely anchored by pressure from an Ace bandage. Care was taken that paste did not exceed cup surface contact area at all sites. The paste used was a 0.05 M NaCl commercial electrolyte (Hewlett-Packard Re- dux). Electrode attachments were tested by having the subject take a deep breath. Earphones were then placed on the subjects’s head with care being

M. W. Ketterer / Affect cognizance and the coronq -prone personaliry 175

taken not to disturb head leads. The subject’s eyes were covered to control for occipital artifacts and reduce oculomotor activity in EEG data. The experimenter then left and closed the chamber door. Equipment calibration took place at this time.

Recording began and the taped instructions started. The tapes contained instructions to self-induce emotional states by remembering previously selected affect-laden memories and began with a 5 min quiet period to allow the subject to adapt to his/her surroundings. This was followed by requests in a quiet voice speaking slowly to focus on external (sounds, tactile pressure) and then somatic (breathing, muscle tension) sensations in an effort to induce a mild trance-like receptive state. Three affective recall periods followed. Each con- sisted of: (a) requesting the subject to recall a particular affect-laden memory (anger, anxiety or contentment), (b) a 2.5 min memory period, and (c) a 2 min return-to-baseline period with a request to remember an emotionally neutral scene (sitting on the steps of the campus library on a spring day). All six possible sequences of the three affect conditions were employed. Each subject was randomly assigned to one sequence such that two of the. twelve subjects in each sex X familial handedness cell went through each sequence. Of these two, one had a given electrode/preamplifier system recording from the right side and the other from the left to allow for lateral counter-balancing of the recording systems.

A 30 set epoch, starting immediately after condition onset, recorded summated amplitude of alpha frequency power. Increased power implies decreased synchronization of underlying cortex and thus increased psychoneural ‘processing’ (Andersen and Andersson, 1968). A 30 set baseline sample recorded prior to condition onset was subtracted from the condition sample to produce the EEG dependent measure. A sample of tonic SC was taken 10 set after the onset of each condition and 10 set prior to the start of the first set of instructions. The latter sample served as a baseline against which to measure condition-induced changes. Tonic change from baseline served as a measure of condition-induced arousal.

Upon completion of the physiological recording session, subjects were given their credit slips and then asked to fill out a post-session questionnaire assessing their subjective sense of success at achieving the affective states (from 4 = ‘ very’ to 0 = ‘not’) and the cognitive mode (Vera1 and visuospatial) utilized (from 0 = ‘none’ to 4 =‘a lot’) for each condition. This ordering of events served to encourage candor on the part of the subject. A handedness behavior questionnaire (Oldfield, 1969) and the Jenkins Activity Survey (Jenkins, Zyzanski and Rosenman, 1979) were also given at this time.

2.4. Data anulyses

The analyses run served one of two tasks. The first of these was to assess differences among the subgroups in the arousal measures (subjective success

ratings and change from baseline in tonic skin conductance) that might confound or illuminate later interpretations of EEG data. Additionally, dis- crepancies between the subjective (SS) and objective (SC) measures might indicate ‘repressed’ cognizance of affective arousal by a type A subgroup relative to its non-type A counterpart. The A-group distinction was made by splitting subjects at the mean on the overall A scale of the Jenkins Activity Survey into high-A (N = 22) and low-A (N = 26) subgroups. Three-between (sex, familial handedness and A-group), one-within (condition) sub.ject ANOVAs which treated the arousal measures as dependent variables and correlations with the Jenkins Activity Survey scores served this purpose.

The second task was to detect consistent differences between the hemispheres in EEG data that reflect affective arousal. The extension of this task was to detect such right-left differences in particular sub-groups. Three-between (sex, familial handedness and A-group), two-within (condition and side), two-covariate (verbal and visuospatial ratings) ANCOVAs were used for this purpose. The use of the covariates served to remove the effects of lateralized cognitive activity that might confound interpretations of EEG activity (Ehrlichman and Wiener, 1980).

Since subjects spontaneously expressed difficulties with maintaining affective states, most studies of this kind examine shorter time periods (Harmon and Ray, 1977; Davidson and Schwartz, 1976) and the first 30 set epoch showed the most consistent shifts from baseline in EEG data. the first epoch was the only one used in hypothesis testing.

Post-hoc Scheffes (Hays, 1973) were run on certain contrasts within some of the significant effects resulting from ANOVA/ANCOVA analyses to assess theoretically relevant contrasts. The 0.05 level of significance was used in testing ANOVA/ANCOVA significance. The 0.10 level of significance was used for post-hoc Scheffe testing because of the inherent conservatism of this

test (Hays, 1973).

3. Results

3.1. Type A score comparisons

Comparison of the Jenkins Activity Survey scores of the sample with subjects eliminated for failing to meet various criteria (e.g. fell asleep during session, equipment failure, etc.) and published norms (Jenkins et al., 1979) revealed no significant differences with either group.

JAS scores of the used sample were compared with those of subjects eliminated because of reporting no experienced affect during the anger and/or anxiety conditions (table 1). Two of the four t-tests applied were significant. These significant contrasts were for the overall type A score and the speed and

M. W. Kelterer / Affect cognizance and the coronary-prone personaliry 117

Table 1

Jenkins Activity Survey scores of the ‘repression’ sample

A score Used sample a

mean

(S.D.)

Unused sample b

mean

(S.D.)

r-observed,

df= 49

Type A

Hard-driving

competitiveness

Job involvement

Speed and impatience

49.292

(10.273)

49.661

(9.720)

50.083

(10.135)

49.417

(10.283)

62.333 2.148’

(8.505)

55.000 0.890

(16.093) (N.S.)

54.000 0.652

(9.539) (N.S.)

61.667 1.9lOC

(19.035)

’ Sample on whom psychophysiological data are reported (N = 48).

b Sample eliminated because of reporting no experienced anger and/or anxiety (N = 3).

c p 6 0.05.

impatience subscale of the JAS. Both differences in means were in the direction indicating greater coronary-prone behavior in those subjects reporting no experienced arousal during anger and anxiety.

Two-between (sex and familial handedness) ANOVAs for each of the four type A scores revealed no significant effects.

3.2. Subjective success rutings

None of the correlations between type A scores and subjective success ratings reached significance (table 2). Apparently any differences that exist between type A and non-type A individuals in experienced arousal are not large.

The three-between (sex, familial handedness and A-group), one-within

Table 2

Jenkins Activity Scores and subjective success correlations

Type A Hard-driving competitiveness Job involvement Speed and impatience

Subjective success

Anger Anxiety

0.069 - 0.142 0.065 -0.111

0.204 -0.188 0.044 -0.221

Contentment

0.088 0.089

- 0.256

- 0.070

178 M. W. Ketterer / Affect cognmmce md the coronary -prone persondit~

(condition) ANOVA treating subjective success ratings as a dependent measure revealed one significant main effect. This was for condition (F(2,SO) = 6.957. MS, = 0.534). Post-hoc Scheffes (anger: psi = 0.521, N = 48, J = 2; anxiety: psi = 0.500, N = 48, J = 2) demonstrated that subjects, as a group, felt they were more successful at achieving the affective state of contentment than either anger of anxiety. Means for the conditions were: anger = 2.354, anxiety = 2.375 and contentment = 2.875.

3.3. Chunge in tonic skin conductunce

The three-between (sex, familial handedness and A-group), one-within (condition) ANOVA treating change from baseline skin conductance as a dependent measure revealed two significant effects. The first was a condition X A-group interaction (F(2,80) = 5.341, MS, = 0.011) shown in fig. 1. Post-hoc Scheffes demonstrated significant contrasts between the high-A and low-A groups for anxiety (psi = 0.086, N = 48, J = 2) and contentment ( psi = 0.13 1, N = 48, J = 2). In both cases, the high-A individuals showed an increase in skin conductance from baseline while the low-A individuals showed no substantial change from baseline.

CONDITION - anger anxiety contentment anger anxiety tontentmenf

A-GROUP - high low

Fig. 1. The condition X A-group interaction in change from baseline tonic skin conductance data. Significant high-A/low-A Scheffe contrasts occurred for the anxiety and contentment conditions.

M. W. Ketterer / Affect cognm~nce and the coronnry - prone personalrty 179

This effect was articulated in a condition X sex X A-group interaction

(F(2,80) = 3.754, MS, = 0.011). High-A versus low-A post-hoc Scheffe contrasts revealed that males followed the pattern of greater increases from baseline in skin conductance only for the anxiety condition (psi = 0.102, N = 24, J = 2). Females followed the pattern of greater increases in skin conductance only for contentment (psi = 0.217, N = 24, .I = 2). This interaction is shown in fig. 2.

Thus the assumption of equivalent autonomic arousal across subgroups cannot be made. Any results in EEG data must be interpreted in light of the fact that substantial differences occurred across subgroups and conditions in autonomic arousal.

3.4. EEG data

A three-between (sex, familial handedness and A-group), two within (condition and side), two-covariate (verbal and visuospatial ratings) ANCOVA treating the first 30 set epoch as a dependent measure yielded two significant effects. The first was as a within-subject factor. This was for the first covariate (F( 1,78) = 4.579, MS, = 4836.367). M ore parietal alpha-band power was ob-

served during the first epoch under those conditions when subjects reported

using little verbal mode cognition to achieve affective arousal.

-

.14-

- .lO- -

- -

s 5 .06 - - =I

- s

.02 -

o-

-.02 -

P

-

l-l CONDITION - ang anx cant ang anx cant ang anx cant ang anx cant

A-GROUP - high low high low

SIX - M F

Fig. 2. The condition X A-group X sex interaction in change from baseline tonic skin conductance data. Significant high-A/low-A Scheffe contrasts occurred for males during anxiety and for females during contentment.

180 M. W. Kettrrer / Affect cogntzunce md the coronary -prone personalr~~v

The second effect involved the interaction of sex X familial handedness X A-group X condition X side (F(2,80) = 3.213, MS, = 435.6 16). This complex interaction (fig. 3) was tested for all possible right versus left subgroup contrasts. The sole significant right versus left contrast was for genetically-pure. high-A females under the contentment condition (psi = 39.500, N = 12, J = 2). Greater relative right parietal alpha-band power was observed in this group. Collapsing across familial handedness and conditions, high-A females demonstrated a significant contrast between right and left parietal power (psi =

15.500, N = 12, J = 2) during affective arousal generally. Low-A females showed a significant contrast in the opposite direction (psi = 9.917. N = 12, J = 2). Comparable right versus left contrasts for males were also significant (high-A, males: psi = 11.576, N = 10, J = 2; low-A, males: psi = 8.143. N = 14,

0 -right q -left

CONDITION - WJ OIIX cant ang ll”X tont

A-GROUP- high low

M, 100%

40.

-40. =QzFJ - -

M,l l00% 40.

-‘ -40.

F,lOOQllJ

40.

m L rFTLd-EI

-40. --El

F, 1100 9,

40.

-40. w w

Fig. 3. The sex X familial handedness X A-group X condition X side interaction in EEG data. The only significant right/left Scheffe contrast occurred for high-A, genetically-pure females during

contentment.

M. W. Ketterer / Affect cognmznce and the coronaq~ -prone personality 181

n-right

A-GROUP - high

rzl -left

IOW high IOW

six - M F

Fig. 4. Significant right/left Scheffe contrasts for sex X A-group combinations of the sex X

familial handedness X A-group X condition X side interaction in EEG data.

J = 2). However, both contrasts were in the direction indicating greater left hemisphere activity. These sex X A-group X side contrasts are shown in fig. 4.

4. Discussion

4. I. Luteralization of affect

The first major question raised by this study concerned the lateralized representation of affect. That is, did one side of the scalp consistently evidence greater activity during affective arousal or during one type of arousal?

Of the 24 group (sex X familial handedness X A-group) by condition combinations shown graphically in fig. 3, eighteen (75%) show greater activity detected over left parietal cortex than over right parietal cortex relative to resting state. Of the remaining six combinations, four show a strong tendency for greater right-sided activity. While suggestive, this overall tendency towards greater left-sided activity is signifiant (according to post-hoc Scheffe) only for the genetically-pure, high-A female subgroup during contentment. Indeed females, as a whole, show greater variation from baseline and across leads as a function of affective arousal. This is supportive of previous findings suggesting greater focal organization of affective cortical arousal in females (Davidson et al., 1976; Davidson and Schwartz, 1976). Of course, we do not know whether such effects would generalize to other regions.

Perhaps the most puzzling thing about this finding is that present results are in the opposite direction of those reported previously. Davidson reports greater right parietal activity during affective arousal (Davidson et al., 1976; Davidson and Schwartz, 1976; Davidson et al., 1979; Bennett et al., 1980). Collapsed across familial handedness and condition, the Scheffe testing of right-left differences in parietal activity revealed that the pattern reported by Davidson’s group is seen only in low-A females (fig. 4). The other three groups show a tendency to produce greater left parietal activity during affective arousal. It seems appropriate to search for methodological differences which might account for such discrepant findings.

Davidson’s group have at least four common methodological differences with the present study. First, most of Davidson’s work does not report whether subjects’s eyes were consistently kept closed during recording (Davidson et al., 1979; Bennett et al., 1980; Davidson and Schwartz, 1976). This is a surprising omission given the powerful effect of this state on posterior frequency-domain

activity and its presumed artifactual (i.e. non-parietal) nature (Butler and Glass, 1976). The present study included blindfolding the subjects. Interest- ingly, in the one study (Davidson et al., 1976) where subjects were blindfolded, only females showed greater right parietal activation in response to self-genera- tion of angry and relaxing memories. This is, of course, consistent with present results for low-A females (fig. 4).

The second distinction to be made between Davidson’s work and that presented here is in the affective states evoked. Davidson has used as affective stimuli; the self-induction of anger and relaxation using visual or verbal cognition (Davidson et al., 1976; Davidson and Schwartz, 1976, ‘linguistic stimulation’ of positive, negative or neutral scenes (Bennett et al., 1980) and positive versus negative response to a television program (Davidson et al., 1979). Thus Davidson does not report the explicit use of anxiety and contentment in his work. ‘Relaxation,’ as conventionally conceived, would not be the same as contentment in the present study given that contentment produced overall increases in autonomic arousal rather than decreases. Additionally, the stimuli used by Davidson and his colleagues seem, on the whole, unlikely to have generated anxiety.

Third, Davidson has attempted to manipulate hemisphere/cognitive strategy in at least one of his self-stimulation experiments (Davidson et al., 1976; Davidson and Schwartz, 1976). While this procedure may produce useful data, it is unlikely that subjects are able to totally stop using one type of cognition or the other. Rather, they may be able to use one or the other to a greater degree. Post-hoc assessment of degree of usage of each strategy has been absent in Davidson’s work. At least some of the tendency towards greater right hemispheric activity during affective arousal in Davidson’s subjects may be due to cortical/cognitive strategy rather than reflective of affect per se (Ehrlichman

and Wiener, 1980).

Fourth, Davidson has usually not reported much detail on his subjects or the selection/recruitment procedures used to obtain them. He has generally not controlled for familial handedness (Davidson et al., 1979; Bennett et al.. 1980; Davidson and Schwartz, 1976) and sometimes not even sex (Davidson et

al., 1979) despite their known relevance to lateralized phenomena of a cognitive nature (McGlone, 1980; Bradshaw and Nettleton, 1981). In several reports of mixed sex samples, he has neglected to report numbers of males and females (Davidson and Schwartz, 1976; Davidson et al., 1979). The present study was fairly non-demanding of, and aggressive in pursuing, subjects during recruitment procedures (having screening forms filled out in class) and may have culled a different sample. For example, one might speculate that high-achieving (and thus in no need of extra course credit) and time-pressured type A individuaIs would be more likely to appear in the present sample than one

dependent on volunteers taking the initative to call an experimenter after seeing a posted notice.

4.2. Laterality, affect and coronary-prone behavior

The arousal measures (subjective success and change in tonic skin conductance) provide an intriguing paradox. Subjects experienced the intensity of anger and anxiety as approximately equivalent. For contentment. a much greater degree of success was experienced. Interestingly, this was the pattern initially assumed to exist only (or in greater measure) in the type A group.

On the other hand, substantial variation occurred across conditions and groups in the tonic skin conductance measure that was not reflected in the subjective success rating (figs. 1 and 2). High-A subjects showed a substantial increase from baseline in tonic skin conductance levels for anxiety and contentment not seen in low-A subjects (fig. 1). The possibility must be considered that the selection of contentment as a neutral affective state for the type A/non-type A dichotomy was in error. As Friedman and Rosenman ( 1974) note, coronary-prone individuals often report feeling ‘ vaguely guilty’ when trying to relax and are often preoccupied with obsessional work-related cognition. For whatever reasons. current results indicate greater autononic arousal during affective memory-based self-stimulation in the type A person when the affective state is anxiety and contentment. Anger produces an approximately equivalent degree of autonomic arousal in both high-A and low-A individuals. Given the failure to find a high-A/low-A distinction in subjective success data, this pattern indicates that despite greater autonomic arousal during anxiety and contentment, the type A person does not report (and thus presumably does not experience) greater affect. This might be conceptualized as ‘repression’ of the intensity of an affective state.

Two alternative explanations are possible. First, the type A person may experience the same intensity of arousal but ‘titrate’ his/her ratings to per-

184 M. W. Ketterer / Affrct cognrrmce und the coronwy prone personul~t,

ceived peer norms. Second, non-type As may exaggerate, or ‘confabulate’, the degree of arousal they experience. On the other hand, given the strong tendency towards greater type A behavior in subjects reporting no experienced arousal for anger and anxiety (table I), the most likely interpretation appears to be that such people do not experience low levels of arousal. It may be that type A individuals have a higher threshold of somatic arousal necessary for affect to be experienced.

If one assumes that the social environment of A’s and non-A’s are equally stressful, the clinical implications are the same for all three explanations.

Chronic autonomic arousal (‘stress’) in the type A person could be caused by the failure of the type A person to experience arousal during chronic exposure to affectively arousing situations. As noted above. several of the precursors of coronary artery disease are observed in type A individuals when they are stressed by specific stimuli. In competitive and/or hostile social situations, type A people display a greater increase in systolic blood pressure and serum norepinephrine than non-type As (Glass et al., 1980; MacDougall et al., 1981; Light, 1981; Manuck, Craft and Gold, 1978; Lovallo and Pishkin, 1980).

Matthews (Weidner and Matthews, 1978; Matthews and Brunson. 1979) has argued that similar data do not suggest that type A people experience less somatic sensation than non-type A people because the effect is specific to a particular situation when attention is focused elsewhere. However, conceptu- ally and experientially it is difficult to consider ‘experience’ and ‘attentional

focus’ as orthogonal psychological processes (Kohler, 1971). They are merely different means of conceptualizing the same set of phenomena. If one’s attention is focused on an external task, one will not experience (or will experience a reduced intensity of as ‘ground’) somatic sensations which Mat- thews calls ‘physiological symptoms’.

The articulation of the above finding in the condition X sex X A-group interaction (fig. 2) allows further specificity in description concerning the cognizance of affective arousal during self-stimulation for anxiety and contentment in the type A person. High-A males showed more autonomic arousal during self-stimulation for anxiety than low-A males. High-A females showed more autonomic arousal during self-stimulation for contentment than low-A females. Other high-low contrasts are approximately equivalent. In short, the above type A constrasts are specific to one sex.

Type A behavior may tend to be expressed in males as less intensely experienced covert arousal while anxious. The autonomic arousal attendent to anxiety may contribute to coronary disease processes because it is not experienced as particularly intense and thus not responded to adaptively. Anxiety has been indicated as a left hemisphere process with other methodologies. Tucker, Antes, Stenslie and Barnhardt (1978) demonstrated that anxiety disrupted left hemisphere cognitive performance (visual half-field recognition of verbal antonyms) but not similar right hemisphere cognitive performance

M. W. Ketterer / Affect cognizance and the coronqv prone per.wnaltt.v 185

(identification of nonsense shapes). Thus, anxiety may serve the special adaptive function, if intense enough, of disrupting left hemisphere controlled cognitive activity. Such a process might serve to reorganize the cognitive and phenomenological field and focus attention on more pressing (affectively arousing) matters. If type A males are successful at suppressing/repressing anxiety, verbal processing may not be disrupted.

Females may be more likely to express type A behavior as autonomic arousal while feeling content. We can speculate that type A females are more likely to experience the ‘vaguely guilty’ feelings when relaxed; an observation made by Friedman and Rosenman (1974) in the type A patient. On the other hand, given the greater prevalence of coronary artery disease in males (Marx and Kolata, 1979)#, it is puzzling why those used here do not display increased autonomic arousal during contentment.

Thus, the subjective success ratings and change from baseline skin conductance measures appear to be at least partly independent arousal measures. Type A individuals (during anxiety for males and contentment for females) do not appear to recognize and/or report the greater increase in autonomic arousal they display in response to specific affective states. Such findings could be interpreted as ‘repressed’ awareness or reduced cognizance of the intensity of an affective state.

In view of the present findings, Galin’s (1977) theory of cross-callosal inhibition as the mechanism for repression can be evaluated. Present results demonstrate reduced cognizance of affective autonomic arousal in the coronary-prone individual as one would expect in ‘repression’. These results are in accord with psychometric, clinical and experimental observations

(Jenkins, 1978; Glass, 1977; Friedman and Rosenman, 1974; Matthews and Brunson, 1979; Weidner and Matthews, 1978). And yet the predicted decrease in relative left-to-right-hemisphere activity was not observed. Rather, present results seem to indicate an increase in left-hemispheric activity during affective arousal for the type A person relative to the non-type A person (fig. 4). This increase is most marked in females and not specific to the emotional states (anger and anxiety) initially thought to be relevant to the coronary-prone personality. Given that the influence of conscious verbal and visuospatial activity was covaried out of this data, this increase in left-sided activity in type As must be assumed to be at a nonconscious level of processing.

Of course the observed increase in left hemisphere activity does not neces- sarily preclude the possibility that affective activity was ‘confined’ to the right hemisphere. Indeed, the increase in left hemisphere activity in type A people may well have indicated that cross-callosal inhibition was taking place (Tucker et al., 1978; Shearer and Tucker, 1981). Galin’s theory does not allow us to test these mechanisms without invasive procedures.

Perhaps another thesis regarding the relationship of affective arousal to coronary artery disease needs to be developed. As noted earlier, type As not

186 M. W. Ketterer / Affect cognizance and the coroncrry -prone per.voncrlrt~~

only display frequent nonverbal behaviors taken to be indicative of negative affect states while denying such states, they also display little ability to relax and experience enjoyment of life. In the presence of an environment that would elicit relaxation in most people, type As are described as feeling ‘vaguely guilty’ about doing so while being preoccupied with other matters. While such obsessional cognition might be adaptive when measured by oc- cupational or educational success, it would probably tend to focus attention, and thus the phenomenal field, away from subtle shifts in the somatic sensations attendent to affect. One might think of this as ‘whistling past the graveyard’ so as to cope maximally with real or perceived task demands. If chronic, such a cognitive/behavioral strategy for coping with affect (of any type) might become ‘automatistic’ (Hartman, 1958) and nonconscious.

‘Any reader who has mastered typing, driving a car or playing a musical instrument can verify these arguments in an informal way. While the skill is being learned one must consciously control every activity involved, render- ing the task difficult and tiring but also making it possible to report on what is being done and why. As skill develops the fluency of the action increases and conscious control lessens. A point is reached when a typist, for example, asked where a given key is on the keyboard, is unable to answer verbally; the knowledge is said to be ‘in the fingers’. The routinized and overlearned nature of such skills seems to eliminate the necessity of their being consciously controlled at every stage and thus prevents accurate self-reports.’ (Smith and Miller, 1978, p. 357).

Analogously if, presumably at an early age, a person is consistently rein- forced for (or punished for not) focusing his/her attention on external task demands (Glass, 1977) at the expense of focusing on the somatic sensations attendent to emotion, he/she may come to automatisically prevent awareness of the affective state so that conscious cognition of the analytic/verbal type (Bradshaw and Nettleton, 1981) can be brought to bear on performance of task demands. Indeed, this is just what subjects report doing in attempting to reduce affective arousal (Shearer and Tucker, 1981). Such a strategy, used repeatedly over long periods of time, might become automatistic and non-conscious. Eventually, the person may come to accept some other (more culturally acceptable) explanation for his/her behavior and cognition (‘I’m just a go- getter’ or ‘I want to get ahead’). These new explanations may themselves be adaptive in that they help avoid cognizance and experiencing of affect or are culturally rewarded. They may also be accurate interpretations/models of actual environmental contingencies operating on the individual or not. The important point is that one important causal influence of behavior and cognition - affect ~ is excluded from, or reduced in, awareness. The net result would be a rise in the threshold for consciously detecting affect (or for detecting affect in certain types of situations) in one’s self. Greater autonomic

M. W. Ketterer / Affect cognizance und the coronary-prone personcrli~~ 187

arousal would presumably have to occur for affective states to be experienced fully. As a result, no conscious cognitive effort could be directed at changing the stimulus producing the affect or in otherwise responding to it adaptively.

Acknowledgement

This research served as a dissertation project in partial fulfillment of the requirements for the author’s Ph.D. from the University of Maryland. The author would like to acknowledge the comments of B. Smith, D. Krantz, W. Hodos, H. Whitaker, R. Dies, R. Coursey and J. Arabian. Computer support was provided by the Computer Science Center at the University of Maryland. William Cushman and Richard Frey designed and supervised construction of the filters used in this study.

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Lateralized representation of affect, affect cognizance and the coronary-prone personality