Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


The effects of a stress management program upon the Type A behavior pattern were examined in a sample of patients with coronary heart disease who were enrolled in an on-going cardiac rehabilitation program. Based upon exhibition of Type A behavior (defined by the Structured Inverview), patients were randomly assigned to three experimental conditions: (a) behavioral stress management, (b) supportive (attention placebo control group), and (c) no treatment (waiting list control group). Patients receiving treatment attended 10 sessions of 1-1 1/2 hours duration, as well as pretreatment and posttreatment assessment sessions. Patients in the no treatment condition also completed the assessments. The evaluation of treatment outcome was based upon pre- to post-treatment change. Hypotheses that patients in the behavioral stress management condition would demonstrate greater reductions than the supportive and no treatment conditions on measures of the behavior pattern and cardiovascular reactivity during the Quiz Electrocardiogram (QE) and cold pressor were not supported. Changes during treatment were, however, significant for some of the Type A measures (Structured Interview, Framingham Scale, and Bortner Scale) and the QE but did not distinguish between experimental conditions. Cold pressor results demonstrated neither a significant time (pre- to post-treatment) by group (experimental conditions) interaction nor a significant time effect. Secondary variables (lipids, anxiety, and marital satisfaction) demonstrated a similar pattern of results. Results did offer a slight suggestion that the assessment procedures may have had a sensitizing effect which motivated patients to act more appropriately with respect to the stressors in their lives and that participation in treatment may have assisted patients' daily coping with stress. As a whole, this intervention program was not effective. The lack of positive outcome is discussed in terms of possible mitigating factors, i.e., a negative association between Type A behavior and severity of coronary artery disease, patients' ages, patients' medication, and patients' prolonged participation in an exercise oriented rehabilitation program. The present results suggest that specific Type A interventions are not necessary for all coronary patients and that the parameters of matching coronary patients with psychological interventions need refinement.