According to the modern transactional theories of stress and coping, psychobiological stress responses emerge through an imbalance between demands (i.e., stressor) and psychosocial coping resources, and many factors relevant to this transaction have been identified including the opportunities for control, chronically and predictability of stressor, the availability for expression of anger and for completion of consummately behavior. This review provides some support for the findings that different coping strategies are associated with different patterns of psychobiological stress responses such as the development of gastric lesions, increased release brain noradrenaline and plasma corticosterone as well as deficit of avoidance-escape behavior, and that there is no completely effective coping from the psychobiological perspective. The classification of these patterns named as problem-focused and emotional-focused coping strategies helps us to identify the most appropriate coping behaviors for adaptation to different situations.

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The Type A behavior pattern is recognized to be one of the risk factors for coronary heart disease. This article discusses the relationships between the Type A behavior pattern and those psychological and physiological responses to stress which contribute to the occurrence of coronary heart disease. Type A persons suffer from lower self-esteem and fears about the loss of self-esteem that result from the belief that their values can be easily changed by various kinds of external factors. Further, a lack of confidence in social relationships, along with parental attitudes that emphasize achievement striving, may contribute to this pattern. Type A persons tend to overestimate the stressfulness of difficult situations and to perceive them more critically than do Type B persons. Type A's bring a more active coping style to stressful situations than do Type B's. Compared with Type B persons, Type A's showed higher sympathetic activities on physiological measures, higher neuroendocrinological responses and greater psychological stress reactions. Continuous excitation in the sympathetic nervous system contributes to disorders of the circulatory and neuroendocrinological systems which, then, contribute to the occurrence of coronary heart disease.
Based on the relationships between the decrease of peripheral beta adrenergic activity and decrease of the intensity of Type A behavior pattern, it is suggested that peripheral physiological activity may play a role in maintaining the Type A behavior pattern. The relationship between central dopaminergic functioning and answers on the Jenkins Activity Survey suggest the existence of alexithymic features in the Type A behavior pattern.
The relationship between peoples' separation experiences from their parent(s) and dysfunction of central dopaminergic function is also described. This article indicates that both psychoneuroendocrinological and psychosocial studies are necessary to fully understand the nature of the Type A behavior pattern.

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Recently, it has been reported that various stressors affect immune system. Both reduction and enhancement of immune functions have been found in animals exposed to different stressors.
The triadic design has been widely used to examine whether controllability against physical stressors modify immune responses. Maier et al. found the reduction of lymphocyte mitogen response in rats exposed to uncontrollable footshock using the triadic design. However, the reliability of the result failed to be confirmed.
To apply the findings on stress and immunity obtained by animal studies to human, controllability against stressors should be taken into consideration. Further studies to clarify the mechanism of the effects of psychosocial factors on immune system are encouraged.

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The research group of the Type A Behavior Pattern Conference, Japan has developed a 122-item questionnaire called Japanese Coronary-prone Behavior Scale (JCBS) which assesses Japanese mentality, habits and daily behaviors as well as type A behavior pattern (TABP). In a previous study of the responses to the JCBS in 292 patients undergoing coronary angiography (CAG), we have proposed a 26-item subscale of the JCBS (Scale A) which discriminated patients with significant (≥75%) coronary stenosis from those without such stenosis with a total error count of 22%. In the present study, we examined if the Scale A predicts the presence of coronary stenosis among an independent group of patients.
The JCBS was administered to newly collected 158 male patients undergoing CAG (age, 57±9 years); 54 (35%) of them were patients with acute myocardial infarction (MI), 31 (20%) had a history of MI, and 20 (13%) had a history of percutaneous transluminal coronary angioplasty (PTCA). According to the CAG, 106 patients (67%) had significant (≥75%) coronary stenosis in at least one major coronary artery or branch (group CS+) and 52 had no such stenosis (group CS−). According to the discriminant score calculated by applying the previously defined canonical discriminant function on the responses to Scale A items, the patients were classified into two groups by the likelihood to have coronary stenosis.
The discriminant score of the Scale A predicted correctly the absence of coronary stenosis in 65% of group CS− patients and the presence of coronary stenosis in 71% of groups CS+ patients (total error count = 32% and χ²=18.8, P<0.001). Among 54 patients with acute MI, 10 patients belonged to group CS−. These patients showed a tendency to have a greater discriminant score than the rest of the patients in group CS- (P=0.082), while no such difference was observed between patients with and without acute MI in group CS+. None of the patients in group CS- had a history of MI or PTCA. In group CS+, there was no difference in the discriminant score between patients with and without previous MI or between those with and without a history of PTCA.
The results of this study indicate the validity of the JCBS Scale A as a predictor of significant coronary stenosis among male patients undergone CAG. Although several questionnaires have been reported in earlier studies to predict coronary artery disease, most of them have aimed to assess TABP. The Scale A is unique from these scales in that it assesses the behavioral characteristics which are not restricted in the concept of TABP. In this aspect, the Scale A seems to be a valuable measure of the characteristics of coronary-prone behavior among Japanese. Additionally, the discriminant score of the Scale A tended to be higher in patients with acute MI but having no significant coronary stenosis, suggesting that this scale may be also associated with the process of coronary artery obstruction by thrombus formation or vasospasm. To clarify the potential values of the JCBS Scale A, further studies are necessary on its associations with various features of coronary artery disease in wider ranges of population.

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The present studies investigated the relationship between Type A characteristics and living habits centering on sleeping habits of female college students. In Study 1, 342 female students completed KG's Daily Life Questionnaire to measure their Type A characteristics and Tokyo Metropolitan Institute for Neurosciences Living Habits Inventory to measure their living habits concerning sleeping, eating, exercise and others. Results showed that Type A students (defined as the students above the median of Type A scores) had stronger “evening” characteristics, more variable bedtimes, higher level of post-sleep negative emotion, more dreams and nightmares, more skippings of breakfast and dinner, more frequent late-night meal taking, higher alcohol intake, and more frequent all-night activities than did Type B students. These results altogether showed unhealthy habits in Type A individuals.
Study 2 investigated whether these characteristics of living habits in Type A individuals depend on conditions, by comparing living habits during usual working days with those during a long summer vacation. 247 female college students completed Type A questionnaires and Living Habits Inventories before a summer vacation began, and answered the same Living Habits Inventories just after their vacation was over. In this study, the Type A questionnaire was the same as in Study 1, but the living habits inventory was the short version made of the original inventory used in Study 1. Results showed that in addition to the results obtained in Study 1, Type A students had later bedtimes, more variable waking times and sleep duration, longer sleep duration, more satisfaction with sleep duration, more trouble falling asleep, and more frequent lunch-skipping than did Type B students. Moreover, significant interactions between groups (Type A or B) and periods (usual working days or a vacation) were found in three items: time falling asleep after going to bed, alcohol intake, and late-night meal taking. These interactions indicated that Type A students showed the same unhealthy habits independent of the periods, whereas Type B students showed more unhealthy habits during their vacation than during their usual working days, suggesting that Type B individuals changed their living habits according to lifestyle conditions.
Those two studies clearly show that worse living habits in Japanese Type A individuals range over not only sleeping habits but also eating habits. Moreover, judging from the results that unhealthiness of living habits in Type A individuals is valid also during long vacations, this persistent disturbance of habits might be seen as a mediative factor in Type A characteristics and mental or physical disorders this group exhibits.

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Karasek (1979) noted that task demand and decision latitude had affected induction and reduction of work stress. Especially, high decision latitude had an important role in reducing stress responses. The present study was designed to examine the effect of decision latitude on stress responses, which was administered task intervals by oneself. Twenty undergraduates were served as subjects, who divided into two latitude conditions randomly. All subjects received both a mental arithmetic and an error detection tasks. In high latitude condition, subjects could control intervals between task presentations. While tasks were randomly presented at intervals of 1 to 3 s (2 s in average) in low latitude condition. To make task demands equal in both conditions, duration of task was restricted by mean response time in the practice session. Measures of stress responses were five subjective sub-scales (tension, boredom, depression, perceived control, and fatigue), correct response rate and reaction time, and autonomic responses (heart rate, respiratory rate, systolic blood pressure, and diastolic blood pressure).
Intervals between tasks in high latitude condition were 2.2 s at a mental arithmetic task and 1.8 s at an error detection task, which were nearly similar to 2.0 s interval set in low latitude condition. Task difference was observed in correct response rate, reaction time, and three of subjective responses (boredom, depression, and perceived control). On the other hand, respiratory rate was faster in low latitude condition than in high. Though systolic and diastolic blood pressures tended to increase in low latitude condition, there were statistically marginal differences and not significant. These results indicated that low decision latitude made increment of cardiovascular response reactivity which was becoming to a risk-factor of coronary heart disease.

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It is well known that the Okinawan people have the longest average life span in all of Japan and the rate per 100,000 of centenarians in Okinawa is about five times higher than the average for the whole of Japan. In this study, the author attempts to elucidate characteristics of Okinawan centenarians in terms of the Type A behavior pattern in their prime of life.
The survey was done for the subjects of sixty Okinawan centenarians and sixty-eight middle-aged and aged Okinawan controls using a brief questionnaire developed by Maeda based on Jenkins Activity Survey by recall method. In comparison of frequency of Type A, statistically no significant difference was found between centenarians and controls. Contents of the questionnaire and distributions of mean scores for each item demonstrated that profiles of the centenarians' Type A behavior pattern were different from those of controls, especially centenarians showed low scores in “time urgency” and “tension”, but high scores in “self-confidence” and “unyieldingness”.
Okinawan centenarians may be judged as Type A outwardly, but when considering their detailed profiles of behavior pattern they are different from the control group and in these profile differences it might be possible to find psychological or psychosocial clues for their longevity.

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From the previous trial for type A behavior modification by educational counselling, the author proved some effects in reduction of type A behavior. But in patients who were administrators with high scored type A, the type A modification was remarkably difficult. Many type A patients have workaholic tendency and malcognitions about their behavior and life-style caused by hidden excessive anxiety, irritability and hostility.
The author reported 2 successful cases (one postinfarction angina, another vasospastic angina) in cognitive-behavioral therapy. Cognitive therapy was performed, at first step, by the detection of patient's hidden feelings (anxiety, irritability and hostility) and malcognition about behavior and life-style, then, by the investigation how to diminish them. For cognitive therapy, it was beneficial to repeat behavioral counselling and to make social support in job environmental surroundings and in family.
This cognitive-behavioral intervention can improve the quality of life of patients and may become more reasonable, more useful method for type A modification.

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