WASHINGTON -- Nearly everyone has heard of the 'Type A' personality, the competitive, argumentative, often unpleasant kind of person who is considered a prime candidate for heart disease.
A Nebraska cardiologist and pioneer in stress research now says one in five Americans belongs to another group that may be just as much at risk for heart disease -- or even more so.
These simmering pots are 'hot reactors,' said Dr. Robert S. Eliot. They expend a mountain's worth of energy to get over a mole hill. Their blood pressure goes up, they get tense, they are ready for top-speed performance no matter what the task. Things really get to them, but they may not show it.
What's worse, they probably aren't even aware of their reactions, he said.
'These are people whose bodies are in all-out mortal combat, fighting sabre-tooth tigers, 30 to 40 times a day,' he said in an interview.
Their extreme reaction may be triggered by anything from writing an office memo to seeing a colleague scowl at them to dealing with a 'Type A' boss.
They may be able to take it for a while, but as the years go by their bodies pay the price for this extreme physical arousal in the form of disease and disability.
But they don't have to.
Eliot is director of preventive and rehabilitative cardiology at the Hearth-Lung Center, St. Luke's Hospital, Phoenix, Ariz., and a cardiology professor at the Universityof Nebraska Medical Center. He is the author of 'Is It Worth Dying For?' -- a book about how to tell if you're a hot reactor and deal with the stresses of career and private life.
In other words, how to become 'thick-skinned.'
Eliot knows whereof he speaks, on a personal as well as professional level. Eleven years ago, he suffered a heart attack he believes was brought on by a an overloaded life and a habit of reacting emotionally to stress.
He defined stress as the result of a mismatch between what someone wants and what the world has to offer.
Eliot's work has won recognition in medical circles. He was a founder and is now director of the International Stress Foundation in Phoenix, Ariz., which he said is dedicated to supporting research and finding ways to help keep people from destroying themselves. The foundation will get the profits from the book.
In person, he is low-key, wryly witty, irreverant, and full of practical advice about how to stop letting the world get so much of a rise out of you.
Eliot said there is sound evidence now that stress contributes significantly to disease. Besides the obvious connection between stress-caused tension and accidents, there are biochemical relations.
For instance, stress causes an elevation of a neurochemical transmitter called cortisol. Cortisol is an element of the 'fight or flight' reaction we inherited from hunting and gathering days.
However, elevated blood cortisol can also increase the stickiness of platelets, cells in the blood that help in clotting. Platelets can stick to blood vessel walls, contributing to the build-up of plaque which is at the root of cardiovascular disease. The result can be high blood pressure, heart attack and stroke.
Eliot said 55 percent of all disease could be prevented, if people only learned how to handle stress and heed the body's warning signals it is undergoing too much in too short a time.
'Type A' behavior was described publicly in 1974 and has since become a recognized risk factor for heart disease. 'Type A's' typically fidget, show signs of hostility, irritation or impatience when things are not going according to plan. They schedule more and more activities into less and less time and fail to smell the roses along the way.
However, someone can be a 'Type A' -- hot on the surface -- and still be cool underneath, Eliot said. Another person can be an apparently calmer 'Type B,' typically considered at less risk for heart disease, and underneath be full of hot reactor steam.
Among hot reactors, blood pressure goes up dramatically under everyday stress, Eliot said. Hot reactors may suffer little aches and pains of unexplained origin, insomnia, loss of appetite or any of a number of physical symptoms.
If you want to find out your own type at home rather than at a doctor's office, he suggests buying a blood pressure cuff and testing yourself at rest and under moderate stress.
There are also questions you can ask yourself, such as whether you feel in control of your life or whether your life is controlling you; whether you generally feel tense and knotty after work; whether you are anxious, nervous, slightly nauseous, tired all the time, whether you are having trouble sleeping or you're not very hungry any more.
If your blood pressure and tension analysis indicate you are reacting too hotly to stress, there are many things you can do. Even if you're not a hot reactor, they wouldn't hurt.
The chapter headings of Eliot's book provide a list: change the way you talk to yourself, clarify your values, relax your body, increase your fitness, make the most of support and leisure, eat right, manage alcohol, cigarettes, caffeine and pills, relieve stress on the job and maintain a healthy heart.
Most of these speak for themselves. Others need a little explanation. For instance, self-talks can be considered 'having the mind write healthy prescriptions for the body.'
'Much of our stress is due to conversations we have with ourselves,' Eliot wrote.
People often believe they can't change the way they react to things when actually their emotions have been trained into long-standing habits. If they have been trained, they can be retrained, Eliot said.
Controlling the response does not mean stifling the response -- it means limiting the duration and intensity.
For instance, the next time something goes wrong, instead of telling yourself, 'He should have known better' or 'If she's late one more time I'll kill her,' say, 'It would be great if things go the way I want, but I'm prepared to deal with whatever happens.'
A corollary to this involves learning how to deal with people who upset you. You might not be able to change their behavior -- but you can change yours, Eliot said.
'You can say to yourself, 'I can decide how upset I'm going to be about this person. I can choose how much I dislike him.' Why pay the price of hatred, when a little dislike will do?'
To distance yourself from an annoying or hurtful person, you can use what Eliot calls the 'brain tumor' approach. That is, pretend the Godzilla in your life has a brain tumor that causes him or her to behave in strange irrational ways and say to yourself, 'That's just the way he is. He can't help it.'
Eliot said he doesn't wish to offend anyone with the use of 'brain tumor.' He meant the term to describe destructive behavior sometimes characteristic of brain tumor victims.
When your tormenter's offensive behavior seems personally directed at you, there are other tactics -- realizing, for instance, that these people are mainly concerned with themselves. Another thing you can do:
'Try to teach yourself to smile when someone is coming at you with anger,' he said. 'This is Japanese Phase I.'
'Phase II is smiling and bowing. While you're bowing, take a deep breath and exhale as if you were about to whistle' -- a stress reduction technique.
'The heavy artillery is Japanese Phase III: Say, 'So sorry, but not understand the meaning of four-letter words,' Eliot said.
Another important way to reduce the effects of stress is to allow yourself to play -- that is, do something for the heck of it, with freedom, spontaneity and laughter.
'Play is not a luxury -- it's a necessity,' Eliot said.
You should take a short 'vacation' several times a day, he said.
'At the absolute worst, you can go into the bathroom, sit down and take a trip,' he said. 'The great thing about the mind is you can take a trip at low cost. The thing about the body is it will respond as if you were there.'
If you're angry enough to make a fist, instead of telling yourself to relax immediately, try tightening the fist to the maximum, then slowly relaxing.
Also: 'Teach yourself the value of humor. You need a laugh as much as a junkie needs a fix.'
More advice: Realize there are only so many hours in the day and so many things that have to be accomplished. Don't fret if some of the things you schedule don't get done.
Don't spend so much time fretting over the 'shoulds' and 'shouldn't haves.' Or, as the popular psychologists remind us in self-help books, 'Don't 'should' on yourself,' Eliot said.
'Mymotto is this basic rule,' wrote Eliot in his book. 'Don't sweat the small stuff. And the corollary: It's all small stuff. I have learned that most of the time you can't fight and you can't flee, but you can learn to flow.'
