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Self-regulation and mortality Table 13. Self-regulation and genetic determinances in cancer of the breast (degl'¢¢ of self-regulation) Cancer of the breast Healthy and living Group N S-R N % S-.R N % S-R 0 544 3.6 1 0.2 3.1 316 58.1 4.6 I 349 3.5 9 2.5 3.0 205 58.7 4.7 2 138 3.6 9 6.5 2.9 64 46.4 4.9 3 54 3.9 14 25.9 3.1 21 38.9 5.0 1085 33 3.0 606 55.6 791 between S-R and physical risk factors, Spearman p = - 0.24, which is significant statistically, but only accounts for less than 5% of common variance. It is possible to pursue the search for physical risk factors a little further by looking more closely at genetic factors, implied by the first item in Table 11. This can be done by looking directly at parents and grandparents who died of the same disease as the proband. Of course this is only possible in large groups with high mortality, e.g. wo .men with breast cancer. Table 13 shows the results for four groups of women who died of cancer of the breast. One group had no first-degree relatives who also died of cancer of the breast, one group had one such relative, one group had two such relatives, and one group had three. There is a clear-cut regre~siort: cancer of the breast increases with an increase in the number of relatives who died of such cancer, but there is no change in S-R, which clearly does not correlate with the genetic predisposition. Kruskal-Wallis ANOVA by rank gives H = 58.5, d.f. = 2 and P < 0.00001 .for mortality and genetic predisposition. Breast cancer patients are clearly separated from healthy probands in respect to genetic predisposition. Looking at S-R by itself, this gives a P < 0.130001 for the comparison with still living probands. Clearly sufferers from cancer of the breast are strongly predisposed to develop this type of cancer by both genetic factors and 'by low self-regulation. The causal nexus--an intervention study Although clearly there are important correlations between S-R and mortality, correlations largely independent of and larger than those observed between mortality and physical risk factors, it would be dangerous to interpret these correlations as necessarily involving causalitymarguing from correlation to causality is only too frequently done in epistemiology, particularly in relation to smoking (Eysenck, 1991). However, the hypothesis of a causal nexus can be given greater plausibility by intervention studies, i.e. by demonstrating that changing degree of S-R can change the risk of mortality. Previous studies have shown that autonomy training can change mortality risk very markedly (Grossarth-Maticek & Eysenck, 1991; Eysenek & Grossarth-Maticek, 1991), and an attempt to apply these methods in connection with the present study seemed worth-while. The experimental and control groups used in this study are of course not included in the group that formed the samples discussed thus far. We chose 700 persons in 1974 who showed high physical risk factors (e.g. high blood pressure, high cholesterol, high cigarette and alcohol consumption, lack of exercise, etc.), as well as low degree of self-regulation (below 3, average 2.5 points). These 350 probands were divided into two groups on a chance basis, and one group was administered autonomy training, the other was left alone. The principles of autonomy training have been discussed elsewhere (Grossarth-Maticek & Eysenck, 1991a). Beginning with the use of individual and bibliographic therapy, we followed up with a course of group therapy, involving altogether about 30 hr per person. ili Six months after completion of the therapeutic intervention probands were again administered the SRI. (The first occasion of administration was one month before the beginning of therapy.) As a result of the changes from first to second administration, probands were divided into four groups. Group I ,- showed an improvement in SRI scores, but with an average score still below 3.5. Group II showed "~" a " " " ~: markedly better degree of improvement, with values well below 3.5 the first tame, but a score above ~ 3.5 the second tame. (On the basxs of the results shown m Figs I and 2, 3.5 seems to have been a good ~. choice for making this diagnosis.) ,-, t Group III includes those probands whose scores were worse on the second occasion, and ~roup

792 R. Grossarth-Maticek and H. J. Eysenck IV showed a marked deterioration. Thus Group I showed an improvement of 2 points or less, and a final score below 3.5. Group II showed an improvement of 2-5 points, and a final score above 3.5. Group III showed a deterioration of 1 point or less, and Group IV one of more than 1 point. There was also a small Group V where there was no change. The average age of the treatment group was 54.6 yr, of the control group 54.8 yr, an insignificant difference. Mortality was ascertained in 1993, giving a follow-up period of 19 yr. Nine probands in each group could not be located on follow-up, thus reducing the total number analysed to 2 × 341 = 682. Table 14 shows the results. Results show the following major findings. (1) Regardless of therapy or control, mortality in the five groups is similar, being highest in Group IV, lowest in Group II (markedly worse and markedly better), with Group III and Group I showing intermediate degree of mortality. (The numbers in group 5 are too small to be very meaningful.) In other words, improvement in S-R, whether achieved spontaneously or as the result of autonomy training, is significantly related (negatively) to mortality; those who improved are less likely to die than those who got worse in degree of S-R. (2) Overall, the group with autonomy training shows a significantly reduced mortality compared with the control group as regards mortality from all causes, as well as a higher percentage of probands who are healthy and live without any chronic disease---61.7% compared with 37.6% in the therapy and control group, respectively. This effect is clearly due to the fact that markedly improved probands are nearly eight times as frequent in the therapy group as in the control group. In the other, groups the advantage of the proband who underwent therapy is small, although present even in those where S-R scores get worse. It is interesting to note the changes in physical function which accompany any changes in S-R (Table 15). Measures are reported for blood pressure, cholesterol (total), cigarettes per diem, alcohol g/day, bodyweight, lack of exercise, and unhealthy nutrition. In each case, thefirst measure was taken before beginning therapy, the second after one year, i.e. six months after the second measurement of S-R. The results show that in the group with improved S-R, all the physical risk factors improve, while in the group with worsening S-R scores there is also a worsening of all the physical variables. The conclusion suggested by these data must be that (1) improvement in S-R is a systematic process which results not only in improvement in the physical sphere. (2) When looking for an improvement in the physical risk factors it would be advisable to try and improve the psychological risk factors, through improvement in S-R. 206363~606 I SUMMARY AND CONCLUSIONS The results of this large-scale prospective study suggest that psychological factors incorporated in the concept of the healthy personality have a profound influence on disease and mortality. Mens sana in corpore sano was the health slogan of the ancients; ~ seems that this combination constitutes a strong correlation between body and mind, and that changes in the psychological sphere produce changes in the physical sphere also. That of course is the main assertion of psychosomatic theory, and this study adds to the large literature supporting it. Psychological risk factors exert a largely independent influence on mortality, and can be influenced, modulated and changed decisively by autonomy training, a kind of behaviour therapy stressing management technique. The personality of probands incorporates their sensitivity to stress, their coping behaviours, and their general outlook on life; self-regulation is in many ways the opposite to neuroticism, constituting a flexible autonomous, functional way of solving problems and getting over difficulties, while neuroticism is linked with inappropriate emotional responses, rigidity, and inability to cope with stress, leading to feelings of helplessness, hopelessness and finally depression. [In the case of cancer, we are dealing with a tendency to suppression of emotion and denial; hence for the cancer-prone person low neuroticism scores may be predictive of cancer (Kissen & Eysenck, 1962). This denial factor may cause confusion; thus Kreitler and Kreitler (1991) found health oriented people scoring low on negative emotions, like anxiety and fear, but high on neuroticism.] It would seem that preventive medicine should pay attention to psychological factors that have been shown to be vitally important to survival, as well as modifiable by autonomy training which, particularly when administered in the

CI Table 14. The preventive effects of autonomy training on mm~lity Therapy group (with autonomy training) causes Alive, CHD of death Alive ill N N Ca Control group Other causes CHD of death Alive 5 10 10 44 12 6.1% 12.3% 12.3% 54.3% 14.8% 8 9 10 157 15 4.0% 4.5% 5.0% 78.8% 7.5% 3 7 11 6 8 8.5% 20.0% 31A% 17.1% 22.8% 3 5 9 1 1 15.7% 26.3% 47.3% 5.2% 5.2% 1 ! 2 +2 I 14.2% 14.2%. 28.5% 28.5% 14.2% 20 32 42 210 37 5.8% 9A% 12.3% 61.7% 10.8% 81 Improving 196 17 29 8.6% 14.7% 199 Markedly Improved 25 I 1 4.0% 4.0% 35 Worse 80 7 16 8.7% 20.0% 19 Markedly worse 21 4 8 19.0% 38.0% 7 No change 19 2 3 10.5% 15.7% 341 Total 341 31 57 9.1% 16.7% 9 Not investigated 9 54.6 Mean age (yr) 54.8 15,3% 2 8.0% 21 26.3% 7 33.3% 4 21.0% 64 18.8% 88 44.8% 19 76.0% 15 18.7% ! 4.7% 5 26.3% 128 37.6% Table 15. Physiological and behavioural effects of autonomy training Alive, ill 32 16.3% 2 8.0% 21 26.3% ! 4.7% 5 26.3% 61 17.9% Therapy group Blood Cigarettes Alcohol Body Lack of Healthy pressure Cholesterol per day per g weight exercise nutrition n(= 341) n(= 341) Control group Blood Cigarettes Alcohol Body Lack of Heai~hy pressure Cholesterol per day per g weight exercise nutrition 163/I 19 276 28.9 86.3 + 17 49 49 152/96 259 26.3 70.1 + 13 13 49 162/120 291 31.6 90.6 + 15 102 17 148/90 255 23.6 42.3 + 7 ! i ! 13 163/117 165/118 161/112 169/115 164/99 163/I I0 287 24.6 90.4 + 14 20 17 289 27.7 95.3 + 15 26 18 288 20.8 85.3 + 13 10 13 305 30.6 97.2 + 16 11 14 273 25.3 70.7 + 12 2 3 273 26.1 69.4 + 9 2 3 Group I 81 196 Group 2 199 25 Group 3 35 80 169/123 Group 4 19 21 Group 5 '7 19 162/120 281 30.1 82.6 + 20 88 18 159/! I0 264 25.9 75.3 + 16 59 39 2 163/120 290 28.6 88.3 + 14 13 3 I 149/90 278 25. ! 50.2 + 8 6 16 2 168/i19 276 23.6 86.2 + 13 35 42 285 28.1 89.2 + 12 50 39 2 170/114 267 25.3 84.6 + !0 12 15 170/114 267 25.3 84.6 + 10 12 .15 162/98 276 26.7 68.5 + 13 6 5 I 162/99 278 26.2 68.7 + 14 5 4 2 L09~89890~

Self-regulation and mortality 795 Kn¢ier, A. W. & Temoshok, L. (1984). Repressive coping reactions in patients with malignant mechanisms as compared with cardiovascular disease patients. Journal of Psychosomatic Medicine, 28, 145-155. Kobasa, S. C. (I 979). Stressful life events; personality, and health: An inquiry into hardiness. Journal of Personality and Social Psychology, 37, 1-17. Kowal, S. J. (I 955). Emotions as a cause of cancer: Eighteenth and nineteenth century contributions. Psychoanalytic Review, 42, 217-227. Kz~itler, S. & Kreitler, H. (1990). Repression and the anxiety-defensiveness factor: Psychological correlates and manifestations. Personality and Individual Differences, II, 559-570. Kreitler, S. & Kreitler, H. (1991 ). The psychological profile of the bealth-odented individual. European Journal of Personality, 5, 35-60. Langer, E. (1983). The Psychology of control. Beverley Hill, CA: Sage. Lesser, I. M. (198l). A review of the Alexithymia concept. Psychosomatic Medicine, 43, 531-543. Leventhal, H., Nerenz, D. & Strauss, A. (1980). Self-regulation and the mechanism for symptom appraisal. In D. Mechanic (Ed.), Psychosocial epidemiology. New York: Academic Publications. Mettler, C. C. & Mettler, F. A. (1947). History of Medicine. Philadelphia, PA: L. Biakston. Mithaug, D. (1993). Self-regulation theory: How optimal adjustment maximises gain. Westport, CT.: Praeger/Greenwood. Mullen, B. & Suls, J. (1982)."'Know Thyself': Stressful life events and the ameliorative effects of private-self-consciousness. Journal of Experimental Social Psychology, 18, 43-55. Osier, W. (1906). Aequanimitas. New York: McGraw-Hill. Peterson, C. & Seligman, M. (1987). Explanatory style and illness. Journal of Personality, 55, 237-265. Roseh, P. J. (1979). Stress and cancer: A disease of adaptation? In J. Tacke,'H. Selyer & S. B. Day (Eds), Stress and cancer (pp. 187-212). New York: Plenum Press. Roseh, P. J. (1980). Some thoughts on the endemiology of cancer. In S. B. Day, E. V. Sugarbeker & P. J. Rosch (Eds): Readings in ontology (pp. I-6). New York: The International Foundation for Biosocial Development and Human Health. Rueseh, J. (1948). The Infantile Personality. Psychosomatic Medicine, 10, 134--144. Sandin, B., Chorot, P., Jimenez, M. & Santad, M. (1993a). Stress behavior types, psychosomatic complaints and disease. Presented at the 23rd European Congress of Behavioural Cognitive Therapies, London, 22-25 September 1993. Sandin, B., Chorot, P., Santad, M. & Jimenez, M. (1993b). Stress behavior types, personality, Alexithymia-coping and state-trait: Anger expression. Presented at the 23rd European Congress of Behavioural Cognitive Therapies, London, 22-25 September 1993. Sebeier, M. F. & Carver, C. S. (1985). Optimism, coping and health: Assessment and implications of generalised expectation. Health Psychology, 4, 219-247. Schmidt, G. E. (1979). The brain as a health care system. In G. Shaw, N. Adler & P. Costa (Eds), Health psychology. San Francisco, CA: Jossey-Bass. Schmitz, P. G. (1992). Personality, stress-reaction and disease. Personality and Individual Differences, 13, 683-691. Schmltz, P. (1993). Personality, stress-reactions, and psychosomatic complaints. In A. van Heck, P. Bonainto, I. Deary and W. Novak (Eds). Personality Psychology in Europe, 4, 321-343. Tilburg: Tilburg University Press. Schwartz, G. E. (1983). Disregulation theory and disease: Applications to the repression of cerebral disconnection/cardiovas- cular disorder by patterns. Review of Applied Psychology, 32, 95-118. Seligman, M. (1975). Helplessness. San Francisco: Freeman. Seltzer, C. & Jablon, S. (1977). Army ranks ~ind subsequent mortality by cause: 23-years follow-up. American Journfl of Epidemiology, 105, 559-586.. Shigehisa, T. (1994). Psychosocial determinants of physical health and disease: A theoretical analysis of the mechanisms. Journal of Tokyo Kasei Gahuiu University, No. 34. Suls, E. & Fletcher, S. (1985). Self-attention, life stress and illness: A prospective study. Psychosomatic Medicine, 47, 465-48 I. Taylor, G. (1992). Psyehosomatics and self-regulation. In J. W. Barton, M. N. Eagle & D. L. Wolizky (Eds), Interface of psychoanalysis and psychology (pp. 464-480). Washington, DC: American Psychological Association. Taylor, G. J. (1994). The alexithymia construct: Conceptualization, validation, and relationship with basic dimensions of personality. New Trends in Experimental and Clinical Psychiatry, 10, 61-77. Temoshok, L. & Dreber, H. (1992). The Type C connection: The behavioral links to cancer and your health. New York: Random House. Tennen, H. & Affleck, G. (1987). The costs of benefits of optimistic explanation and dispositional optimism. Journal of Personality, 55, 3277-393. Turner, J., Sherwood, A. & Light, K. (1992). Individual differences in cardiovascular response to stress. New York: Plenum Press. 0 O~ O~ 0

794 R. Gmssarth-Maticek and H. J. Eysenck form of group therapy, is very cost effective. Sole attention to smoking and other similar physical factors is counter-productive when it leads to the neglect of important psychological risk factors. Recognition of the psychological involvement in physical disease has been hindered by philosophical problems introduced by Descartes and the wholly erroneous notion of body and mind as totally separate substances. There is no evidence for, and much evidence against, this view, and just as physicists had to adopt the fundamental notion of a space-time continuum, so psychologists and physicians will have to return to the Hippocratic notion of a body-mind continuum. As Sir William Osier (1906), the father of English medicine, used to say: "It is very often much more important what person has the disease than what disease the person has." (pp. 258-259.) REFERENCES 206363:3809 ~ Adler, N., Boyce, T., Chesney, M., Cohen, S., Falkman, S., Kahn, R. & Syme, S. (1984). Socioeconomic status and health. American Psychologist, 49, 15-24. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behaviour change. Psychological Review, 84, 191-1215. Barrios, F. X. (1985). A comparison of global and specific estimates of self-control. Cognitive Therapy and Research, 9, 455-469. Carroll, D., Smith, G. D. & Bennett, P. (1994). Health and socio-economie status. The Psychologist, March, 122-125. Carver, C., Peterson, L., Follanbee, D. & Seheier, M. (1983). Effects of self-diverted attention in performance and persistence among persons high and low in test anxiety. Cognitive Therapy and Research, 7, 333-354. Carver, C. & Scheier, M. F. (1982). Control theory: A useful conceptual framework for personality framework for personality---social, clinical and health ~syehology. Psychological Bulletin, 92, 111-135. Cohen, S., Gwaltney, J., Doyle, W., Shoner, D., Firman, P. & Newson, J. (1955). State of trait negative affect as predictors of objective and subjective symptoms of respiratory viral infections. Journal of Personality and Social Psychology, 68, 159--169. Eyscnek, H. J. (1988). The respective importance of personality, cigarette smoking and interaction effects for the genesis of cancer and coronary heart disease. Personality and Individual Differences, 9, 453-464. Eysenek, H. J. (1990). Type 'A' behaviour and coronary heart disease. The third stage. Journal of Social Behaviour and Personality, 5, 25--44. Eysenek, H. J. (199 I). Smoking, personality and stress: Psychosocial factors in the prevention of cancer and coronary heart disease. New York: Springer. Eysenek, H. J. (1994a). Cancer, personality and stress: Prediction and prevention. Advances in Behaviour Research and Therapy, 16, 167-215. Eysenck, H. J. (1994b). Synergistic interaction between psychosocial and physical factors in the causation of lung cancer. In: C. Lewis, C. O'Sullivan & J. Burraelough (Eds), The psychoimmunology of cancer (pp. 163-178). Oxford: OUP. Eysenek, H. J. & Grossarth-Maticek, g. (1991) Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II--Effects of treatment. Behaviour Research and Therapy, 29, 17-31. Friedman, G. D., Firman, B., Petitti, D., Siegelaub, A., Ury, H. & Klatsky, A. (1983). Psychological questionnaire score, cigarette smoking, and myocardial infarction: A continuing enigma. Preventive Medicine, 12, 533-546. Friedman, H. S. (199 I). Hostility, coping attitudes. Washington, DC: American Psychological Association. Friedman, H. S. & Booth-Kewley, S. (1987). The "disease-prone personality". American Psychologist, 42, 539-595. Friedman, M. & Rosenman, R. (1974). Type-A behavior and your heart. New York: Knopf. Glover, H., Ohlde, C., Silver, S., Packard, P., Goodniek, P. & Hamlin, C. (1995). Vulnerability scale: A preliminary report of psychometric properties. Psychological Reports, 75, 1651-1668. Greet, S. (1983). Cancer and the mind. British Journal of Psychiatry, 143, 535-543. Grossarth-Madcek, R. (1976). Das Verhalten als Krebsriskfaktor. Heidelberg: Reike Sozialwissensehaftliche Onkologie. Grossarth-Maticek, R. (1989). Disposition, exposition, Verhaltens-muster,Organvorsehidigung und Stimulierung dos zentralen Nervensystems in der "A"tiologie des Bronchial-,-Magen- und LeberKarzinoma. Deutsche Zeitschri.a fur Onkologie, 21, 62-78. Grussarth-Matieek, R. & Eysenek, H. J. (1990). Personality, stress and disease: Description and validation of a new inventory. Psychological Reports, 66, 355-373. Grossarth-Maticek, R. & Eysenek, H. J. (1991a). Creative novation behaviour as a prophylactic treatment for cancer and coronary heart disease: I. Description of treatment. Behaviour Research and Therapy, 29, 1-16. Grossarth-Madeek, g. & Eysenck, H. (199 Ib). Personality stress, and motivational factors in drinking as determinants of risk for cancer and coronary heart disease. Psychological Reports, 69, 1027-1093. Grossarth-Madcek, R., Eysenck, H. J. & Barrett, P. (1993). The prediction of cancer and coronary heart disease as a function of the method of questionnaire administration. Psychological Reports, 73, 943-959. Grossarth-Matieek, R., Eysenek, H. J, & Boyle, G. J. (1995). Method of test administration as a factor in test validity: The use of a personality questionnaire in the prediction of cancer and coronary heart disease. Behaviour Research and Therapy, 33, 705-710. Grossarth-Matieek, R., Eysen~k, H. J. & Vetter, H. (1988). Personality type, smoking habit and their interaction as predictors of cancer and coronary heart disease. Personality and Individual Differences, 9, 479-495. Hinkl¢, L. & Wolff, H. (1957), TI~e nature of man's adaptation to his total environment and the relation of this to illness. Archives of lnternal Medicine, 99, 442--460. Howard, J., Cunningham, D. & Rechnitzer, P. (1985). Personality as a moderator of the effects of cigarette smoking and coronary risk. Preventive Medicine, 14, 26--33. Jonson, E. (1990). The deadly emotions. New York: Praeger. Kissen, D. M. & Eysenek, H. J. (1962). Personality in male lung cancer patients. Journal of Psychosomatic Research, 6, 123-137,