Anger, hostility, and cardiovascular disease in the context of interpersonal relationships

Abstract

Anger and hostility are described with special attention to their cognitivemotivational properties. Varying operational definitions related to anger selfreport and behavioral observation are presented. The idea that anger can be maladaptive is now widely accepted as in DSM and alternative classifications of dysfunctional anger. The idea that maladaptive anger raises risks for hypertension and coronary heart disease is reviewed with reference to empirical findings on mediators such as atherosclerosis, cardiovascular reactivity, immune system changes, and unhealthy lifestyles. Given that anger is a relational emotion, it is not surprising that it befalls many interpersonal relations including close/intimate relationships. Dimensions of affiliation and control in relationships are presented as a framework for understanding how anger and hostility can develop and persist in these contexts. The further connection between such anger and cardiovascular function is illustrated. Fortunately, maladaptive anger is treatable, as explained with meta-analytic evidence on cognitive behavioral therapy (CBT). Also available are recent enhancements like CBAT that involve sequencing multiple cognitive, behavioral, and affective strategies appropriate to the process of anger from onset, through progression, to offset. Finally, traditional interpersonal therapies and newer therapeutic formulations such as acceptance and commitment therapy may address major themes in interpersonal conflict underlying the onset and maintenance of cardiovascular disease. Yet, many of these potential applications still await research and implementation in the field of psychocardiology.