My recent review of the research on personality, mental health, and heart disease showed that research continues to support and extend knowledge in this area (Contrada, 2025). Yet the idea that emotional personality traits are associated with physical diseases is ancient, going back at least to the time of Hippocrates (Contrada & Goyal, 2004). In the scientific era, this thinking first garnered systematic empirical support in work on the Type A Coronary-Prone Behavior Pattern. Type A refers to a constellation of attributes including achievement-striving, competitiveness, impatience, anger, and hostility, and was shown to be a predictor of coronary heart disease. Later, anger and hostility were identified as the chief bases for this association.
Negative Affectivity
The focus on anger and hostility soon broadened to encompass other negative emotional factors, including sadness and anxiety, which, along with anger, form a pattern sometimes referred to as negative affectivity. The fact that these emotional tendencies tend to co-occur has made it difficult to determine which of them may be most responsible for increased cardiovascular risk. Adding to the complexity, high levels of pessimism and low levels of optimism, which are correlated with negative emotional attributes, also appear to predict risk of heart disease (Bajaj et al., 2019).
Mental Health Problems
Whereas emotional personality traits generally refer to normal individual differences, recent work has focused more on mental health disorders. First, clinical depression was identified as a cardiovascular risk factor, and, subsequently, anxiety disorders and post-traumatic stress disorder (PTSD) have received considerable attention in this regard. As with emotional personality attributes, these conditions often co-occur, making it difficult to tease apart their independent effects on heart health.
Mechanisms
It is important to note that a predictive association with cardiovascular conditions is a correlation and therefore does not by itself constitute evidence of causality. The case for a cause-and-effect relationship is bolstered by evidence regarding mechanisms that might explain how personality and mental health can be causal determinants of physical disease. This work draws on research showing that the physiology of psychological stress and negative emotions appears to lie in causal pathways that can initiate and promote the progression of atherosclerosis, hypertension, and other cardiovascular disorders. The same kind of physiological activity has been linked to emotional traits and mental health disorders, strengthening the case for their causal role in heart disease (Betensky & Contrada, 2010).
Surprising Results of Intervention Studies: The Missing Piece of the Puzzle
This brings us to practical implications. Here, the picture becomes complicated and a bit puzzling. There is some evidence that psychological interventions specifically aimed at modifying emotional traits and ameliorating clinical depression, anxiety, and PTSD reduce the risk of disease progression in heart patients. But this work is inconsistent, at best. It is unclear why this is, which forms of intervention work, and if so, why that might be.
A Broader Approach
It is now more generally suspected by scientists and clinicians that the relationships of personality and mental health problems to disorders of the heart involve not only the direct physiological effects of stress but also stress-related behaviors.
In the healthy individual, stress may be related to cardiovascular disease through emotional eating and its impact on weight regulation, as well as interactions between adipose tissue and stress hormones among overweight and obese individuals.
Negative emotions may influence cardiovascular risk in part by promoting a sedentary lifestyle. And the regulation of stress and emotion may promote heart disease by contributing to the use of substances such as tobacco, alcohol, and cannabis.
In patients with cardiovascular disorders, negative affect, especially depression, is associated with medication noncompliance, allowing these conditions to progress. This is especially unfortunate given the availability of medications and other treatments that are demonstrably quite effective.
The Takeaways
Stress almost certainly contributes to heart disease. And there is good reason to suspect that this explains relationships linking anger/hostility, depression, anxiety, and PTSD to cardiovascular risk.
It follows that the maintenance of heart health provides an additional incentive for us all to work on managing stress levels beyond the inherent benefits this has for quality of life.
It also follows that healthcare providers whose patients have problems in the domain of stress, emotion, and stress-related mental disorders should be cognizant of the risks these problems pose for heart health. And that physicians caring for heart patients should address stress, emotion, and mental health.
Moreover, while the mind-body connection may be at play, stress and negative emotions should also be addressed with regard to their relationships with unhealthy lifestyle behaviors and medication noncompliance. Stress reduction in the context of behavior change is effective, as has been seen in the results of cardiac rehabilitation.
Hopefully, by striving to understand the inconsistent results of efforts to address heart disease by modifying negative affectivity and mental health problems, we may gain a clearer insight into which approaches are most successful.
Copyright 2025 Richard J. Contrada, Ph.D.
