Defensiveness and essential hypertension

Running away from phonological ambiguity, we stumble upon our words: Laboratory induced slips show differences between highly and lowly defensive people

Introduction

Freud proposed that slips of the tongue, including apparently simple ones, always have a sense and constitute « a half-success and a half-failure » compromise resulting from defensive mechanisms.

Material and methods

A total of 55 subjects participated in a French adaptation of the Spoonerisms of Laboratory Induced Predisposition or SLIP-technique including 32 “neutral” and 32 taboo spoonerisms and measures of defensiveness. In accordance with a psychoanalytical and empirically supported distinction, we considered two kinds of defenses: elaborative or primary process and inhibitory or secondary process defenses, which were operationalized with the GeoCat and the Phonological-Nothing (PN) WordList, respectively. The GeoCat is a validated measure of primary process mentation and the PN WordList was shown to measure the defensive avoidance of language ambiguity.

Results

Participants produced 37 slips, with no significant difference in the number of “neutral” and taboo slips. The GeoCat and the N/PN parameters explained 30% of the variance in the production of parapraxes, confirming the defensive logics of slips. When dividing the population into lowly and highly defensive participants (with the Marlowe Crowne Social Desirability scale), primary process mentation appears as a baseline default defense, but only highly defensive participants mobilize an additional inhibitory secondary process type of defense. Taking into account the a priori difference between taboo and “neutral” parapraxes, highly defensive participants made 2.7 times more taboo parapraxes than lowly defensive participants. However, if “neutral” parapraxes in both subgroups followed the same logic as the total group of parapraxes (significant contribution of primary process mentation in lowly defensives and of primary and secondary process mentation in highly defensives), these measures had no contribution to explain the occurrence of taboo parapraxes.

Conclusion

We propose that Motley et al.’s prearticulatory editor, ensuring the censorship over taboo parapraxes, is an external instance of inhibition, proximal to uttering, equivalent to the censorship between the systems Preconscious and Conscious in Freud’s metapsychology. By contrast, the defenses measured in this research are internal, intimate control systems, probing for the censorship between the systems Unconscious and Preconscious, this is, for repression. This study contributes to support a psychodynamic explanatory model for the production of parapraxes.

Antihypertensive and cardioprotective effects of three generations of beta-adrenergic blockers: an historical perspective

There are currently, 3 generations of beta-adrenergic blockers for the treatment of hypertension and cardiovascular diseases. The 1^st generation caused vasoconstriction and bronchoconstriction due to β₁ + β₂ receptor blockade and unopposed α₁ receptors. The 2^nd generation of beta-blockers has lesser adverse effects than the 1^st generation with the 3^rd generation beta-blockers having much lesser effects than the other two generations. Current US and International guideline do not recommend beta-blockers as first line therapy of hypertension, but only in the presence of coronary artery disease or heart failure due to their lesser antihypertensive effect. These recommendations are disputed by several older and recent studies which have shown that the beta-blockers are effective and safe for the treatment of hypertension and could be used as first line therapy. To clarify this issue a Medline search of the English language literature was conducted between 2012 and 2021 and 30 pertinent papers were selected. The data from these studies show that the beta-blockers have inferior antihypertensive and stroke protective effect compared with the other classes of antihypertensive drugs and should be used as first line therapy only in patients with hypertension associated with coronary artery disease or heart failure. The information from these papers and collateral literature will be discussed in this perspective.

Psychological Profiles in the Prediction of Leukocyte Telomere Length in Healthy Individuals

BACKGROUND

Shorter telomere length (TL) may signal premature cellular aging and increased risk for disease. While depression and psychosocial stress have been associated with shorter telomeres, other psychological risk factors for cardiovascular disease have received less attention.

PURPOSE

To evaluate the association between TL and psychological risk factors (symptoms of anxiety and depression, hostility and defensiveness traits) for heart disease, and to examine whether chronological age and sex moderate the associations observed.

METHODS

132 healthy men and women (Mage = 45.34 years) completed the Marlowe-Crowne Social Desirability Scale, the Beck Depression Inventory II, The Beck Anxiety Inventory and the Cook-Medley Hostility Scale. Relative TL was measured by quantitative polymerase chain reaction (PCR) of total genomic DNA samples. A series of hierarchical linear regressions were performed controlling for pertinent covariates.

RESULTS

Shorter TL was observed among individuals high in defensiveness (β = -.221) and depressive symptoms (β = -.213), as well as in those with less hostility (β =.256) and anxiety (β =.220)(all Ps<.05). Psychological variables explained 19% of the variance over and above that explained by covariates (age, sex, exercise, alcohol consumption, systemic inflammation, and 24-hr mean arterial pressure). Age moderated the relation between TL and defensiveness (β =.179, p =.03). Sex did not influence any of the relations.

CONCLUSIONS

Telomere length is associated with psychological burden though the direction of effect differs depending on the psychological variables under study. Further research is needed to determine the reasons for and implications of these seemingly contradictory findings.

High Prevalence of Insecure Attachment in Patients with Primary Hypertension

Hypertension is a major cardiovascular (CV) risk factor and is predicted by heightened CV reactivity to stress in healthy individuals. Patients with hypertension also show an altered stress response, while insecure attachment is linked to a heightened stress reactivity as well. This is the first study aiming to assess attachment representations in patients with primary hypertension and to investigate their CV responses when their attachment system is activated. We studied 50 patients (38 men, 12 women) with primary hypertension. The Adult Attachment Projective Picture System (AAP), a widely used and validated interview, was performed to measure the patients' attachment representations, and to activate their attachment system. Blood pressure and heart rate were measured after 10 min at rest prior to and directly after the AAP interview. Mood and state anxiety were assessed using the Multidimensional Mood State Questionnaire (MDBF) and the State Trait Anxiety Inventory-State (STAI-S) before and after the experiment. The prevalence of insecure attachment (dismissing, preoccupied, unresolved) in hypertensive patients was predominant (88%), while in non-clinical populations, only about 50% of individuals had insecure attachment patterns. Blood pressure (p < 0.001), heart rate (p = 0.016), and rate pressure product (p < 0.001) significantly increased in response to the attachment interview. Secure attached patients showed the highest rise in systolic blood pressure (p = 0.020) and the lowest heart rate compared to the other attachment groups (p = 0.043). However, attachment representation showed no significant group or interaction effects on diastolic blood pressure (DBP) and rate pressure product. Insecure attachment was highly over-represented in our sample of patients with primary hypertension. Additionally, a robust CV response to the attachment-activating stimulus was observed. Our data suggest that insecure attachment is significantly linked to primary hypertension, which implies the need for further investigations to evaluate attachment insecurity as a possible risk factor for hypertension.

Impact of anger expression on blood pressure levels in white-color workers with low-coping behavior

To examine the relationships between anger expression and blood pressure (BP) levels and their effect modification by stress coping behaviors, the authors analyzed data from a cross-sectional study of 790 Japanese male workers aged 20-60 years. We used the Spielberger anger expression scales to measure anger-out, anger-in, and anger-control. Relationships between anger expression scales and mean systolic and diastolic BP levels were examined in the total sample and in two subgroups of high and low stress coping behaviors (low coping behavior group: having none, one, or two coping behaviors; and high coping behavior group: having three or more coping behaviors). Anger expression scales were not associated with BP levels in the total sample. Among men who reported only two or fewer coping behaviors, however, the anger-out score was significandy associated with systolic blood pressure (SBP) levels while no association was found among men who reported the larger number of coping behaviors. Anger-in and anger-control were not associated with BP levels in either low or high coping behavior groups. This study suggests that male workers who do not express their anger have a higher probability of developing high BP when they have no or few stress coping behaviors.

Physiological stress responses in defensive individuals: age and sex matter

The association between defensiveness and physiological responses to stress were evaluated in 81 healthy working men and 118 women, aged 20 to 64 years (M=41; SD=11.45). Participants underwent laboratory testing during which they were exposed to interpersonal stressors. Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and salivary cortisol were measured. Defensiveness was evaluated using the Marlowe-Crowne Social Desirability Scale. In women, higher defensiveness was associated with greater BP and HR reactivity to stress (p<.05). In older men, lower defensiveness was associated with increased systolic BP reactivity to stress (p<.02), delayed HRV recovery (p<.02), and greater salivary cortisol levels (p<.02). In conclusion, greater defensiveness was associated with increased reactivity to stress in women whereas in older men, lower defensiveness was associated with elevated cardiovascular, autonomic, and endocrine responses to stress.

Preliminary Study of a Chinese Language Short Form of the Marlowe–Crowne Social Desirability Scale

To evaluate the internal consistency reliability and discriminant validity of a Chinese language short form (14-item) of the Marlowe–Crowne Social Desirability Scale, data from 197 Chinese medical students were analyzed. Half (48 men, M age = 23.0 yr.; 51 women, M age = 22.0 yr.) were randomly assigned to receive standard instructions, and half (46 men, M age = 21.7 yr.; 52 women, M age = 21.5 yr.) were given mock job-selection instructions. The later had a higher mean Social Desirability score, which demonstrates discriminant validity. Split-half reliability was .71. Five factors were identified, but confirmatory factor analysis indicated adequate fit with a 1- or 2-factor model. Despite the challenge of translation into Chinese (in this case, involving translation into Mandarin and back-translation by native speakers for examination by a native speaker of English), this short form appears to have adequate internal consistency reliability and discriminant validity.

Psychometric properties of the Marlowe-Crowne social desirability scale with adult male sexual offenders

This research project investigates the factor structure, reliability, and validity of the Marlowe-Crowne Social Desirability Scale (MCSDS) when used with a sample of convicted, adult male sexual offenders. Results confirm the two-factor structure (Denial and Attribution) originally proposed by the authors (Study 1, n = 247). Results also reveal that the full-scale MCSDS has strong internal consistency estimates (Study 1), discriminant and convergent validity (Study 2, n = 91), and test-retest reliability over a 3-week period (Study 3, n = 74). Information is provided to aid evaluators' interpretation of MCSDS full-scale and factor scores when used with male adult sexual offenders.

Defensiveness and metabolic syndrome: impact of sex and age

The association between defensiveness and metabolic burden, as well as the moderating effects of sex and age were evaluated in 199 healthy working men (N=81) and women (N=118), aged 20-64 years (M=41; S.D.=11.45). Defensiveness (Marlowe-Crowne Social Desirability Scale) and parameters of metabolic syndrome (MS; waist circumference, HDL, triglycerides, glucose, 24h ambulatory blood pressure) were obtained. In men, defensiveness was inversely related to MS burden (Beta=-.288; p=.001), as well as to individual measures of SBP, DBP, glucose and waist circumference (p<.05). In older women, high defensiveness was associated with a greater MS burden (p=.050) and glucose level (p=.005) while the reverse was true in younger women (p=.012). In conclusion, defensiveness was associated with a worse metabolic profile in older women but may be protective for men and younger women. Understanding the pathophysiological processes underlying these associations could elucidate sex and age differences and inform prevention efforts.

Personality and electrodermal response lability: an interpretation

Electrodermal response (EDR) lability is a psychophysiological trait reflecting stable individual differences in electrodermal activation as indexed by frequency measures of phasic EDR activity. There is no consistent evidence that EDR lability reflects dispositional or clinical anxiety. However, EDR lability appears to be related to individual differences in the overt expression of emotional and antagonistic impulses. Greater EDR lability is associated with a relatively undemonstrative and agreeable disposition, whereas greater EDR stability is associated with a relatively expressive and antagonistic disposition. The inverse relationship between EDR lability and the expression of emotional and antagonistic impulses suggests that EDR lability may reflect individual differences in the effortful control of such expression. This hypothesis is consistent with cognitive effort interpretations of phasic EDR activity, with evidence of the sensitivity of phasic EDR activity to capacity-demanding tasks, and with evidence of reduced spare capacity among EDR labile individuals under cognitive challenge. Individual differences in effortful self-control may explain the association of greater EDR lability with essential hypertension and greater EDR stability with forms of antisocial behavior.

Repressive/defensive coping, blood pressure, and cardiovascular rehabilitation

The emotional style of repressive coping in relation to blood pressure and cardiovascular disease has received increasing attention during the past 25 years. Repressive coping describes the capacity to render events and feelings inaccessible to consciousness. Intrapsychic conflicts involving unacceptable wishes, fantasies, and impulses can be hidden from conscious awareness. Repressive (or defensive) coping has been associated with elevated blood pressure levels, essential hypertension, and paroxysmal hypertension. Cardiovascular patients who use a repressive style have shown mixed results during recuperation. The repressive coping style is easily assessed with two pencil-and-paper measures, which clinicians could administer. Knowledge that a patient uses repressive emotional coping could help physicians better treat this unique group. For patients recovering from cardiovascular events, intervention styles can be adopted that fit the repressive personality. More research in this area will be a challenge to psychologists and internal medicine specialists.

Suppressed hostility predicted hypertension incidence among middle-aged men: the normative aging study

This study tested whether suppressed hostility predicted incident hypertension (HTN) in initially nonhypertensive men, using prospective data from the Normative Aging Study. Six hundred twenty-seven men who completed the MMPI and participated in a subsequent laboratory assessment were included in the study. The Cook-Medley Hostility scale (Ho), a suppression factor, and other risk factors were used to predict incident HTN over a 3-year period. Logistic regression showed a significant three-way interaction among Ho, suppression, and age in predicting incident HTN. Among middle-aged men (<or=60 years) with higher suppression, a 1-point decrease in the Ho score was associated with an 18% increase in HTN risk. This relationship remained significant after controlling for relevant risk factors. Among older participants, the HoxSuppression interaction was not predictive of HTN incidence. These results provide support for the Suppressed Hostility hypothesis in middle-aged men.

Interactive effects of avoidant coping and parental hypertension on Rate Pressure Product reactivity in women

BACKGROUND

Previous research suggests that personality, situational context variables, and genes might interact to potentiate cardiovascular stress responses.

PURPOSE

Our purpose is to examine interactive effects of dispositional avoidant coping and parental hypertension on cardiovascular reactivity to three different laboratory stressors.

METHOD

Participants were 63 healthy female students. Stressors were an evaluated videotaped speech, the cold pressor, and viewing of the speech video. Heart rate and blood pressure were continuously recorded during baselines and tasks.

RESULTS

After controlling for age, body mass index, smoking status, reported exercise, alcohol consumption, oral contraceptive use, parental hypertension, and avoidant coping, the interaction term of parental hypertension and avoidant coping was the best predictor of rate pressure product (RPP) reactivity to the speech task and to the video-viewing task. In contrast, reactivity to the cold pressor was not significantly predicted by this interaction term. Furthermore, there were no significant main effects of parental hypertension and avoidant coping on RPP reactivity in any of the tasks. There were no significant interactive effects for diastolic blood pressure.

CONCLUSIONS

Consistent with an interactive model of cardiovascular reactivity, parental hypertension plus avoidant coping led to enhanced RPP reactivity. This effect, however, was only evident during self-threatening stressors. The results suggest that the coincidence of genetic and personality factors might enhance risk for cardiovascular diseases.

Marlowe-Crowne Social Desirability Scale and short Form C: forensic norms

Marlowe-Crowne Social Desirability Scale (MC) (Crowne & Marlowe, 1960) scores were collected on 1096 individuals involved in forensic evaluations. No prior publication of forensic norms was found for this instrument, which provides a measure of biased self-presentation (dissimulation). MC mean score was 19.42 for the sample. Also calculated was the score on Form C (MC-C) (Reynolds, 1982), and the mean for this 13-item scale was 7.61. The scores for the current sample generally are higher than those published for non-forensic groups, and statistical analysis indicated the difference was significant for both the MC and MC-C (d =.75 and.70, respectively, p <.001). Neither gender nor educational level proved to be significant factors in accounting for variance, and age did not appear to be correlated with scores. Group membership of subjects based on referral reason (family violence, abuse, neglect, competency, disability) was significant for both the MC and MC-C scores. Results suggest the MC or MC-C can be useful as part of a forensic-assessment battery to measure biased self-presentation.

Gender-specific association of perceived stress and inhibited breathing pattern

Stress can potentiate the development of hypertension via inhibition of renal excretory function. One potential mediating mechanism is an inhibited breathing pattern, because hypoventilation can decrease renal sodium excretion acutely via effects on pCO2 and acid-base balance. Large individual differences in resting breathing patterns have been well-documented, with some individuals maintaining slow frequency and high pCO2. Whether this breathing pattern is related to chronic stress has not been investigated. This study reports that high perceived stress over the past month was associated with significantly lower frequency breathing at rest, independently of age, race, or body mass index. This finding was more marked in women than in men. In addition, slow breathing frequency was independently associated with higher resting end tidal CO2 in both men and women. This is the first known report of an association of sustained stress with an inhibited breathing pattern in humans, and points to a pathway by which chronic stress might contribute to the development of hypertension, especially in women.

The Marlowe-Crowne affair: short forms, psychometric structure, and social desirability

The Marlowe-Crowne Social Desirability scale (Crowne & Marlowe, 1960) is widely used to assess and control for response bias in self-report research. Several abbreviated versions of the Marlowe-Crowne scale have been proposed and adopted in psychology and medicine. In this article I evaluate the adequacy of 9 short forms using confirmatory factor analysis across 2 samples (combined N = 867). There was some evidence for the adequacy of different short forms, but model adequacy was not consistent across samples. Supplementary analyses revealed a multidimensional structure to the full Marlowe-Crowne scale and indicated that the apparent adequacy of model fit for some short forms might be a statistical artifact. Using the Marlowe-Crowne scale or its various short forms as a control for response bias is discouraged on empirical and conceptual grounds.

Psychological characteristics and responses to antihypertensive drug therapy

The objective of this study was to explore the relationship between psychological characteristics and responses to antihypertensive drug therapy. Twenty-two hypertensive subjects underwent psychological evaluation and treatment with 1) a diuretic, hydrochlorothiazide (HCTZ); 2) an angiotensin-converting enzyme (ACE) inhibitor, quinapril; and 3) combined alpha + beta blockade (doxazosin + betaxolol). Anger-Out scores on the State-Trait Anger Expression Inventory were positively correlated with the HCTZ-induced fall in systolic blood pressure (p<0.01); Anger-In was negatively correlated with the quinapril-induced fall in systolic pressure (p<0.05). The target systolic blood pressure (130 mm Hg) was achieved with either HCTZ or quinapril in 79% of subjects without, vs. 25% of subjects with, childhood trauma (p=0.03). Responses to doxazosin + betaxolol were not correlated with psychological characteristics. The authors conclude that both inhibited anger expression and childhood trauma are associated with reduced response to a diuretic or ACE inhibitor. Combined alpha/beta blockade may be preferable to an ACE inhibitor or diuretic in treating selected hypertensive patients. Further studies should include examination of psychological factors in terms of the response to combined ACE inhibitor + diuretic therapy.