Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 157-169). Also available on the Internet.

Thesis (Ph. D.)--University of Adelaide, 1985. / Includes bibliographical references (leaves 476-502).

Thesis--University of Helsinki, 1990. / Added t.p. with thesis statement inserted.

Ph.D. / It has become an accepted fact that Coronary Heart Disease is an epidemic of modern civilisation. Coronary Heart Disease is responsible for approximately a third of all deaths in the Western world (Fullard, 1990) and South Africa is no exception. Several risk factors contributing to the development of heart disease have been identified but the extent and exact nature of their contribution is not fully understood. Traditionally accepted risk factors that play a role in the development of Coronary Heart Disease include diet, hypertension, hypercholestrolaemia, smoking, physical inactivity, age, sex and genetic disposition. However the strongest combination of these factors has been unable to predict the majority of heart disease cases. In this regard psychological factors are steadily gaining acceptance as risk factors, one of the most important of these being the Type A behaviour pattern. The far reaching consequences of Coronary Heart Disease have necessitated investigations into methods of decreasing contact with risk factors, particularly psychological ones. The substantial success of the Recurrent Coronary Prevention Project (Friedman et al), coupled with the promising results from other intervention studies, suggests that behaviour change is a viable goal in the prevention of heart disease. Following on from the Recurrent Coronary Prevention Project, Venter (1993) and Viljoen (1993) adapted it for the South African population. Although relatively successful, it did have its flaws. Thus the motivation for redesigning this intervention addressing its shortcomings The revised intervention was administered to a group of 25 Coronary Heart Disease patients. A second group of 22 patients were subjected to the intervention utilised in the original South African Recurrent Coronary Prevention Project. A third group of 18 patients served as a waiting list control group. The results indicated that although the revised intervention produced larger changes in Type A behaviour than the original South African Recurrent Prevention Project intervention, these differences were not significant. Possible reasons for this were the measures utilised, the sample sizes and the nature of the groups themselves. However, the revised version of the SARCPP was found to be more effective in the reduction of the hostility and anger components of the behaviour pattern than the original version. In conclusion it was found that before any further research in this area be conducted, the measures utilised should be modified and the mechanisms of treatment effect be examined.

M.Sc. (Psychology) / Please refer to full text to view abstract

D.Litt. et Phil. (Psychology) / Over the past four decades we have witnessed the emergence of amazingly sophisticated means of cardiovascular diagnosis and therapy. For the first time in many years, some Western countries could report a decline in cardiovascular deaths. During this same span of years we have witnessed the remarkable development of an array of technological achievements that include the means for invasive diagnostic procedure such as cardiac catherization, and non-invasive methods of echocardiography, magnetic, radio-isotopic and positron imagery which provide detailed diagnostic and prognostic information. This innovations along with synthetic grafts have permitted surgical interventions that would not have been conceivable at the outset of this cardiovascular odyssey. Another major advance has been the appearance of new pharmacological modalities; the diuretics, the beta-adrenergic receptors and angiotension converting enzyme inhibitors, the calcium antagonists and other anti-hypersensitive agents, a spectrum of antiarrhythmic compounds, anticoagulants and fibrinolytic therapy, and the promise of still more innovative and novel modes of therapy which will appear via genetic engineering. Over the past years there has been equally significant development in the area of cardiovascular epidemiology. These advances include the demonstration of validity and the efficacy of various therapeutic programmes by the unique development of complex multi-center trials, as well as long-term population-based studies. Through this endeavours specific risk factors that impart independent risk ofpremature cardiovascular morbidity and mortality has been identified. Some of these risk factors are clearly not modifiable such as advancing years, male gender and race. Others are at least partly modifiable: predisposition to diabetes myelitis and increased body mass. By virtue of multi-center trials we have clear evidence that cigarette smoking, rising systolic and diastolic arterial pressures, serum cholesterol levels, and diabetes are modifiable. It is a known fact that not all individuals with coronary artery disease are cured by medication or by means of a surgical intervention. In addition to this, the reduction of traditional biomedical risk factors have been shown to be insufficient in averting the reocclusion and the further occlusion of coronary arteries in patient populations.

D.Litt.et Phil. (Psychology) / Cardiovascular disease, and specific disorders associated with this complex disease pattern, has been the subject of numerous investigations to determine the nature and cause of this disturbance in both white and Black population groups in various countries around the world. Although the findings of research into this matter has been directed mainly towards more effective drugs and more advanced surgical techniques, there are numerous indications in literature and current research that certain social and psychological factors might indeed play an important part in the aetiology and nature of cardiovascular diseases. In a developing Third World country such as the Republic of South Africa, with its complex and heterogenous population, evidence derived from past and current research indicates that cardiovascular disease and the consequences of cardiovascular disease are assuming epidemiological proportions among both White and Black South Africans. Against this background, it appeared necessary to establish whether Black patients with cardiovascular disease also showed the type A behaviour pattern which is closely associated with diseases of the cardiovascular system among Whites. The present study was therefore performed to test the hypothesis firstly that cardiovascular disease and the type A behaviour pattern are closely associated in Blacks, and secondly whether factors such as stress, caused by social readjustment and urbanization, as well as anxiety and diet, plays significant role in cardiovascular disease amongst Blacks. Four groups of patients were selected on the basis of the presence or absence of cardiovascular disorders, and the presence or absence of the type A behaviour pattern. All four groups were then subjected to assessment by the Structured Interview, Jenkins Activity Survey, Taylor Manifest Anxiety Scale, Grant's Urban-Rural Scale" the Social Readjustment Rating Scale and a Health Scale to test the hypothesis that basic differences, regarding cardiovascular diseases, existed among people who differ in respect of personality type, social readjustment, the experiencing of anxiety and changing lifestyle due to urbanization and dietary patterns. A prior validation procedure for the assessment devices indicated that the tests demonstrated adequate construct validity and factorial validity. After examining the data of the four groups of patients obtained from the scales, the results were statistically analysed.

There is extensive evidence that the rehabilitation of individuals with coronary heart disease needs to include psychological components to complement the exercise and dietary recommendations that are normally provided. However, psychological aspects have not been integrated into medical care in South Africa to any significant degree. Psychological interventions overseas have included the modification of the Type A behaviour pattern, stress management, cognitive restructuring, relaxation techniques, improved communication skills, the identification and expression of emotions, and emotional support. The aim of the present study was to design a short-term group intervention which incorporated these aspects and which included an exploration of the mind-body experience post infarct. In addition, the intervention aimed to increase participants' awareness of the compensatory dynamics of the Type A behaviour pattern. The intervention was tailored to South African conditions and was evaluated by means of a multiple case study design. The intervention was delivered to a group of nine coronary heart disease patients which included six survivors of myocardial infarction, the remaining participants having undergone a by-pass operation. Data included weekly feedback sheets evaluating each session, repeated measures on the Profile of Mood States, the Jenkins Activity Survey, a Spouse Rating Scale and extensive qualitative data on each participant including tape recordings of each session and data collected from a series of interviews before, during and after the programme. The feedback sheets and recordings of the sessions were used as a basis for recommendations for revising the content and structure of the programme for future use. Case narratives were written for three of the participants and provided an in-depth look at how and why individual changes did or did not occur in response to the intervention. In addition, the case narratives revealed the role played by the compensatory dynamics of the Type A behaviour pattern in complicating rehabilitation for survivors of myocardial infarction. Two participants were offered a series of individual sessions at 18-month follow-up and the material from these sessions was also used to aid in the interpretation of the data. The content of the 18-month follow-up sessions provided evidence for the importance of conducting a developmental analysis of the origins of low self-esteem and insecurity that maintain and drive the Type A behaviour pattern. In these sessions, this analysis provided the basis for a brief focused psychodynamic psychotherapy that facilitated marked changes that had not been achieved in the 12-week structured group intervention. It is recommended that future research investigate the use of brief psychodynamic psychotherapy on an individual basis as a complement to a group intervention focusing on psycho-education, building social support and management of problematic emotions in everyday situations.

M.A. / Research on Type A behaviour has produced many contradictory results. Some studies, for example, have found that Type A individuals experience less work satisfaction, and others that they experience more work satisfaction. In the light of these contradictions, some researchers are of the opinion that Type A behaviour has to be explored as a multidimensional instead of a global construct. Some components of Type A behaviour have been proved to have healthy consequences, while others have been proved to be "toxic" and therefore have different correlations with personality factors. This study explored the differential relationships of I wo components of Type A behaviour, namely -achievement-striving and impatience-irritability, with academic achievement, self concept and preference Ibr sensation, a Jungian personality factor. Two groups of students, in Accounting and Psychology respectively, served as research subjects. Data for 25 men and 24 women taking Accountancy 1, and 19 men and 68 women taking Psychology 1, was gathered with regard to achievement-striving, impatienceirritability, academic aptitude, scholastic achievement, self-concept and preference for sensation. As predicted, achievement-striving correlated positively with academic achievement for - most groups. Impatience-irritability correlated negatively with academic achievement for some groups. Achievement-striving showed a positive relationship and impatienceirritatability a negative relationship with self-concept, also as predicted. Achievementstriving showed a positive relationship with preference for sensation and impatienceirritability correlated negatively with preference for sensation. No prediction was made with regard to the direction of the relationship for preference for sensation, yet the negative correlation found between preference for sensation and impatience-irritability came as a surprise. Attempts have been made to explain this finding. Subject groups were small and the abovementioned relationships were not statistically significant for all groups

There currently exists a large body of research associating the Type A behavior pattern with an increased risk of coronary heart disease. Further, studies in the area of social support and health suggest that an absence of supportive relationships may result in a decreased resistance to disease in general, both physical and psychological. The present study sought to integrate the Type A research and social support literature through a correlational investigation of the relationship between Type A behavior and perceived quality of social support in 46 male subjects undergoing out-patient treatment for symptomatic coronary disease. It was hypothesized that the Type A pattern would show a significant inverse relationship with perceived quality of social support.