Chapter 1



Chapter 18

Stress, Coping, Adjustment, and Health

Chapter Outline

Models of the Personality-Illness Connection

• Interactional model

• Objective events happen to a person, but personality determines the impact of events by influencing a person’s ability to copy

• Personality moderates the relation between stress and illness

• Coping response influences degree, duration, and the frequency of a stressful event

• Problem: Researchers are unable to identify stable coping responses that are consistently adaptive or maladaptive

• Transactional model

• Personality has three potential effects

• Can influence coping

• Can influence how a person appraises events

• Can influence events themselves

• Appraisal suggests that it is not the event itself that causes stress, but how the event is interpreted by a person

• People don’t just respond to situations, they also create situations through choices and actions

• Health behavior model

• Personality does not directly influence the relation between stress and illness

• Instead, personality affects health indirectly, through health promoting or health degrading behaviors

• Predisposition model

• Associations may exist between personality and illness because of a third variable that is causing them both

• Association found between illness and personality because of some predisposition that underlies them both

• Illness behavior model

• Personality influences the degree to which a person perceives and attends to bodily sensations, and the degree to which a person interprets and labels sensations as illness

• Most models of personality and illness include a key variable of stress

• Stress is not “out there” in our lives, representing something that happens to us

• Instead, stress lies in part in how we interpret and respond to those events

• Thus, stress lies “in between” the event and the person

The Concept of Stress

• Stress is a subjective feeling produced by events perceived as uncontrollable and threatening

• Stressors: Events that lead to stress and have several common attributes

• Extreme in some manner, in that stressors produce a state of feeling overwhelmed

• Produce opposing tendencies in us, such as wanting and not wanting some activity or object

• Perceive as uncontrollable

Stress Response

• Startle, heart beats fast, blood pressure increases, sweaty palms and soles of feet—fight-or-flight response, increase in sympathetic nervous system activity

• General Adaptation Syndrome (GAS)

• Alarm stage: Fight-or-flight response

• If stressor continues, stage of resistance: Body uses resources at above average rate, even though fight-or-flight response subsided

• Stress is being resisted, but takes a lot of person’s energy

• If stressor is constant, the person enters the stage of exhaustion: More susceptible to illness, because physiological resources are depleted

Major Life Events (Holmes & Rahe, 1967)

• Identified both positive and negative events that are stressors

• People who experienced most stress also are more likely to have a serious illness over the next year

• Subsequent experimental work suggests that people under chronic stress deplete bodily resources and become vulnerable to infections

• Current thinking is that stress lowers the functioning of immune system, leading to lowered immunity to infection and resulting in illness

Daily Hassles

• Major events stress, but infrequent

• Daily hassles provide most stress in most people’s lives

• Research indicates that people with a lot of minor stress suffer more from psychological and physical symptoms

Varieties of Stress

• Acute stress

• Episodic acute stress

• Traumatic stress

• Post-traumatic stress disorder (PTSD)

• Chronic stress

• Stress has additive effects, cumulating in a person over time

Primary and Secondary Appraisal

• Stress is the subjective reaction of a person to potential stressors

• According to Lazarus (1991), in order for stress to be evoked, two cognitive events must occur

• Primary appraisal: Person perceives an event as a threat to goals

• Secondary appraisal: Person concludes they do not have resources to cope with demands of threatening event

Coping Strategies and Styles

Attributional Style

• Answer to question, “Where does the person typically place the blame when things go wrong?”

• Three dimensions of attribution: External versus internal, unstable versus stable, specific versus global

• Different measures: Attributional Style Questionnaire, Content Analysis of Verbatim Explanations (CAVE)

Refinements to the Attributional Style Construct

• Optimism-pessimism (Peterson, 2000): People who make stable, global, and internal explanations for bad events termed “pessimists,” whereas people who make unstable, specific, external explanations for bad events termed “optimists”

• Dispositional optimism (Scheier & Carver, 2000): Expectation that good events will be plentiful and bad events rare in future

• Self-efficacy (Bandura, 1986): Belief that one can do behaviors necessary to achieve desired outcome

• Optimistic bias: People generally underestimate their risks, with the average person rating risks as below true average

Optimism and Physical Well-Being

• Optimism predicts good health and health promoting behaviors

• The typical correlations between optimism and health or health behaviors tend to run between .20 and .30

Management of Emotions

• Some theorists suggest that emotional inhibition leads to undesirable consequences

• Other theorists see emotional inhibition more positively

• Chronically inhibited emotion seems to come with certain “costs” to the nervous system

• Someone who characteristically inhibits emotional expression may suffer effects of chronic sympathetic nervous system arousal

• Also, emotions serve the function of communicating to others how we are feeling

• Research indicates that emotional expressiveness may be good for our psychological health and general adjustment

Disclosure

• Pennebaker argues that not discussing traumatic, negative, upsetting events can lead to problems

• Telling a secret can relieve stress, increase health

Type A Behavior and Cardiovascular Disease

• Type A behavior pattern

• Achievement motivation and competitiveness

• Time urgency

• Hostility and aggressiveness

• Early studies of Type A found it was an independent risk factor for developing cardiovascular disease

• Early studies conducted by physicians using structured interview

• Later research used self-report surveys

• Studies using surveys less likely to find relationships between Type A and heart disease than studies using structured interview

• Structured interview gets at the lethal component

Hostility: The Lethal Component of the Type A Behavior Pattern

• Trait of hostility: reacting disagreeably to disappointments, frustrations, and inconveniences; also a subjective feeling that comes when one is blocked from an important goal

• Hostility is the lethal component of heart disease for Type A people

How the Arteries Are Damaged by Hostile Type A Behavior

• Strong feelings of hostility and aggression produce the fight-or-flight response

• Part of this response is an increase in blood pressure, accompanied by a constriction of the arteries, plus an increase in heart rate and in the amount of blood pumped out with each heartbeat

• These changes can produce wear and tear on the inside lining of the arteries, causing microscopic tears and abrasions. These abrasions then become sites at which cholesterol and fat can become attached

SUMMARY AND EVALUATION

• Some psychologists study the link between personality and health

• Personality influences health in many ways

• Understanding why some personalities are more resistant to stress, better able to cope, and better able to adjust is an important goal with a practical application

KEY TERMS

Health Psychology Secondary Appraisal

Stress Positive Reappraisal

Interactional Model Problem-Focused Coping

Transactional Model Creating Positive Events

Health Behavior Model Dispositional Optimism

Predisposition Model Self-Efficacy

Illness Behavior Model Optimistic Bias

Stressors Emotional Inhibition

General Adaptation Syndrome Disclosure

Alarm Stage Type A Personality

Resistance Stage Competitive Achievement Motivation

Exhaustion Stage Time Urgency

Major Life Events Hostility

Daily Hassles Frustration

Acute Stress Leukocyte

Episodic Acute Stress Type D Personality

Traumatic Stress Arteriosclerosis

Post Traumatic Stress Disorder

Chronic Stress

Additive Effects

Primary Appraisal

Chapter Overview

This chapter provides an introduction to the historical and current work on the interrelationships between stress, coping, adjustment, health, and personality. The authors begin by presenting five models of the links between personality and health: The interactional model, the transactional model, the health behavior model, the predisposition model, and the illness behavior model. Although the models present different perspectives on the relationships between personality and health, each model highlights the important role of stress. The authors next review the concept of stress, including a discussion of the stress response and general adaptation syndrome. The authors then review work on major life events and daily hassles as stressors that can lead to illness. The authors review the concepts of primary appraisal and secondary appraisal, noting that it is the interpretation of events and not the events themselves that produce stress. The authors review theory and research on the role of positive emotions in helping people cope with stress, highlight the coping strategies of positive reappraisal, problem-focused coping, and creating positive events. Next the authors review coping style, including discussions of attributional style, optimism-pessimism, and self-efficacy. The authors then turn to a review of the relationships between optimism and health. The authors next review theory and research on managing emotions and emotional inhibition, including discussions of the health benefits of disclosure and revealing secrets. In the final section of the chapter, the authors review theory and research on the relationships between personality and cardiovascular disease, highlighting the hostility component of Type A behavior pattern.

Learning Objectives

1. Define the features of the field of health psychology.

2. Discuss the concept of a model and how it might help theorists and researchers understand the relationships between personality and health.

3. Identify and discuss the five models of the personality-health link presented by Larsen and Buss.

4. Define the key components of stress.

5. Identify and discuss the key features of stressors.

6. Discuss the key features of the stress response.

7. Identify and discuss each of the three stages of the general adaptation syndrome.

8. Discuss the relationships between major life events, stress, and illness.

9. Discuss the relationships between daily hassles, stress, and health.

10. Define and differentiate primary appraisal and secondary appraisal.

11. Discuss the role of positive emotions in coping with stress.

12. Discuss and distinguish attributional style, optimism, dispositional optimism, self-efficacy, and optimistic bias as coping strategies, including a review of how each concept is related to health.

13. Briefly review work on the relationships between optimism and physical well-being, including a discussion of how optimism promotes health.

14. Discuss the health risks of chronic emotional inhibition.

15. Discuss the health benefits of self-disclosure and the revelation of secrets.

16. Discuss the findings of research on the relationships between Type A behavior pattern and cardiovascular disease.

17. Discuss hostility as the lethal component of the Type A behavior pattern.

18. Review the application of each of the five models of the personality-health link to Type A behavior pattern and cardiovascular disease.

Lecture Topics and Lecture Suggestions

1. Effects of Future Writing and Optimism on Health Behaviors in HIV-Infected Women (Mann, 2001). This lecture presents students with an example of current research on the link between optimism and health. The research attempts to alter the participants’ levels of optimism, and thereby health behaviors, by having them write about a positive future. Interestingly, the strategy of writing about a positive future increased the health-promoting behaviors of pessimists, but not of optimists. Challenge students to consider what might account for this intriguing pattern of results. Use this lecture as a springboard for discussing the links between optimism and health.

• Optimists (people who have positive expectations about the future) have been shown to perform more health promoting behaviors than pessimists

• This study attempts to alter individuals’ levels of optimism, and thereby their health behaviors, by having them write about a positive future

• 40 HIV-infected women on combination therapies were randomly assigned to write about a positive future or assigned to a no-writing control group

• Among participants who were low in optimism, the writing intervention led to

• Increased optimism

• A trend toward increased self-reported adherence to medications, and

• Decreased distress from medication side effects, compared to controls who did not write

• Participants who were high in optimism showed the opposite effects after writing about the future

• Results suggest that a future-oriented writing intervention may be a promising technique to increase medication adherence and decrease symptom distress in pessimistic individuals

Reference:

Mann, T. (2001). Effects of future writing and optimism on health behaviors in HIV-infected women. Annals of Behavioral Medicine, 23, 26–33.

2. Personality as Predictor of Mortality Among Patients with Congestive Heart Failure: A Two-Year Follow-Up Study (Murberg, Bru, & Aarsland, 2001). This lecture provides students with an example of a recent study investigating the relationship between personality and cardiovascular illness. This study specifically investigated neuroticism as a predictor of congestive heart failure. Use this lecture as a springboard for discussing the causes of the links between neuroticism and heart failure. In addition, challenge students to think about the features of neuroticism that are common to Type A behavior.

• Murberg, et al. (2001) evaluated the effects of neuroticism upon mortality risk among patients with congestive heart failure (CHF)

• Proportional hazard models were used to evaluate the effect of the enduring personality factor, neuroticism, on mortality among 119 clinically stable patients (71.4 percent men, mean age 65.7 years) with symptomatic heart failure

• Participants were recruited from an outpatient cardiology practice

• Twenty deaths were registered during the 24-month period of data collection, all from cardiac causes

• Results indicated that neuroticism was an independent, significant predictor of mortality

• According to the researchers, health care professionals should identify CHF patients with a tendency to express high levels of neuroticism and should try to provide appropriate treatment if possible

Reference:

Murberg, T. A., Bru, E., & Aarsland, T. (2001). Personality as a predictor of mortality among patients with congestive heart failure: A two-year follow-up study. Personality and Individual Differences, 30, 749–757.

Classroom Activities and Demonstrations

1. Larsen and Buss review the classic research by Holmes and Rahe (1967), which identified the stressful events in people’s lives that can result in illness if not coped with properly. This activity is deigned to get students actively involved in thinking about the relationship between stressful life events and health, and to apply to their own experience the idea of the link between stressful life events and health. Distribute Activity Handout 18–1 (“Stressful Life Events”). Give student about five minutes to complete the handout. Note for students that this is an abbreviated and modified version of the actual Holmes and Rahe measure. Nevertheless, students who indicate experiencing fewer of these stressful life events are likely to be at lesser risk for illness in the next year. Use this activity as a springboard for discussing the links between stress and health, in general, and the links between stressful life events and health, in particular.

2. Larsen and Buss review work on the relationships between daily hassles and health. This research indicates that people who experience a greater number of daily hassles are at greater risk for health problems than are people who experience fewer daily hassles, on average. This activity is designed to get students actively involved in thinking about the relationship between daily hassles and health, and to apply to their own experience the idea of the link between daily hassles and health. Distribute Activity Handout 18–2 (“Daily Hassles”). Give students about five minutes to complete the handout. Note for students that this list includes those hassles that the greatest percentage of participants reported represented a significant source of stress over a nine-month period. Students who indicate experiencing fewer of these daily hassles are likely to be at lesser risk for illness in the next year. Use this activity as a springboard for discussing the links between daily hassles and health. Challenge students to address how personality might moderate the link between daily hassles and health.

3. Larsen and Buss review links between Type A behavior pattern and health. This activity is designed to give students an opportunity to see how they might score on a measure of Type A behavior. The measure is not an actual measure, but is constructed from items that appear to tap the three dimensions of Type A behavior (achievement motivation and competitiveness, time urgency, and hostility and aggressiveness). Distribute Activity Handout 18–3 (“Type A Behavior Pattern”). Give students about five minutes to complete the handout. Note for students that the more items they checked, the higher their score will be on this crude measure of Type A Behavior. Use this activity as a springboard for discussing Type A behavior, and the links between this constellation of personality traits and health, including cardiovascular disease.

Questions for In-Class Discussion

1. Larsen and Buss review five models of the links between personality and health (the interactional model, the transactional model, health behavior model, predisposition model, and illness behavior model). Ask students to identify and discuss the key components of each of these models, with a special focus on the hypothesized relationships of personality to health. Challenge students to address which model seems most sensible to them and why.

2. Ask students to identify and discuss the three stages of the general adaptation syndrome, presented by Selye (1976). Guide students to the following conclusions: The General Adaptation Syndrome (GAS) includes three stages. The first stage is the alarm stage and is characterized by the fight-or-flight response. If the stressor continues, the person moves to the stage of resistance, in which the body uses its resources at an above average rate, even though the fight-or-flight response has subsided. Stress is being resisted during this stage, but this resistance takes a lot of the person’s energy. If the stressor remains constant, the person enters the stage of exhaustion, during which he or she is more susceptible to illness, because physiological resources have been depleted.

3. Larsen and Buss review five mechanisms by which optimism might promote health. First, ask students to define optimism. Next, ask students to identify and discuss the five mechanisms by which optimism might promote health—through the immune system, through an emotional mechanism, through a cognitive process, by promoting social contact, and by a direct behavioral mechanism). Challenge students to think of examples not provided by Larsen and Buss for each of the five mechanisms by which optimism might promote health.

Critical Thinking Essays

1. Review the key components of each of the five models of the personality-health link presented by Larsen and Buss. Which of these models makes the most sense to you and why? Which of these models makes the least sense to you and why?

2. Larsen and Buss review the general adaptation syndrome as presented by Selye (1976). First, identify and discuss the key components of the three stages included in the general adaptation syndrome. Next, address why you think each of these stages occurs and in the particular order in which they are proposed to occur. That is, if the general adaptation syndrome and each of the three stages of stress response produce physiological and psychological distress, why does this syndrome and its accompanying stages occur, and why in the particular order that is presented by Selye?

3. Larsen and Buss review five mechanisms by which optimism might promote health. First, review each of these five mechanisms, identifying the key features of each proposed mechanism and link. Next, identify which mechanism you think provides the most powerful explanatory link between optimism and health, and which mechanism you think provides the least powerful explanatory link between optimism and health, among those presented by Larsen and Buss. Are there other mechanisms not discussed by Larsen and Buss by which optimism might promote health?

Research Papers

1. Larsen and Buss review recent theory and research on the role of positive emotions in coping with stress. Conduct a review of the psychological literature. Identify three articles published in the past five years that address the role of positive emotions in coping with stress. Select articles that are not cited or discussed by Larsen and Buss. For each article, summarize what the researchers investigated, how they investigated it, and what they found. Discuss whether the results of these three articles are consistent with the results of research presented by Larsen and Buss.

2. Larsen and Buss review recent theory and research on the links between attributional style and health. Conduct a review of the psychological literature. Identify three articles published in the past five years that address the links between attributional style and health. Select articles that are not cited or discussed by Larsen and Buss. For each article, summarize what the researchers investigated, how they investigated it, and what they found. Discuss whether the results of these three articles are consistent with the results of research presented by Larsen and Buss.

3. Larsen and Buss review recent and historical theory and research on the links between personality and cardiovascular disease, highlighting the relationships between Type A behavior and cardiovascular disease. Conduct a review of the psychological literature. Identify three articles published in the past five years that address link between Type A behavior and cardiovascular disease. Select articles that are not cited or discussed by Larsen and Buss. For each article, summarize what the researchers investigated, how they investigated it, and what they found. Discuss whether the results of these three articles are consistent with the results of research presented by Larsen and Buss.

Recent Research Articles and Other Scholarly Readings

Artistico, D., Baldassarri, F., Lauriola, M., et al. (2000). Dimensions of health-related dispositions in elderly people: Relationships with health behaviour and personality traits. European Journal of Personality, 14, 533–552.

Bermudez, J. (1999). Personality and health-protective behaviour. European Journal of Personality, 13, 83–103.

Brayne, C., Do, K.-A., Green, L., et al. (1998). Is health protective behaviour in adolescents related to personality? A study of sun protective behaviour and the Eysenck Personality Questionnaire (junior version) in Queensland. Personality and Individual Differences, 25, 889–895.

Burgess, A. P., Carretero, M., Elkington, A., et al. (2000). The role of personality, coping style and social support in health-related quality of life in HIV infection. Quality of Life Research, 9, 423–437.

Compton, W. C. (1998). Measures of mental health and a five-factor theory of personality. Psychological Reports, 83, 371–379.

Elovainio, M., Kivimaeki, M., Steen, N., et al. (2000). Organizational and individual factors affecting mental health and job satisfaction: A multilevel analysis of job control and personality. Journal of Occupational Health Psychology, 5, 269–277.

Espnes, G. A., & Opdahl, A. (1999). Associations among behavior, personality, and traditional risk factors for coronary heart disease: A study at a primary health care center in mid-Norway. Psychological Reports, 85, 505–517.

Friedman, H. S. (2000). Long-term relations of personality and health: Dynamism, mechanisms, tropisms. Journal of Personality, 68, 1089–1107.

Fritz, H. L. (2000). Gender-linked personality traits predict mental health and functional status following a first coronary event. Health Psychology, 19, 420–428.

Furnham, A., & Cheng, H. (1999). Personality as predictor of mental health and happiness in the East and West. Personality and Individual Differences, 27, 395–403.

Gallo, L. C., & Smith, T. W. (1998). Construct validation of health-relevant personality traits: Interpersonal circumplex and five-factor model analyses of the Aggression Questionnaire. International Journal of Behavioral Medicine, 5, 129–147.

George, C., & West, M. (1999). Developmental vs. social personality models of adult attachment and mental ill health. British Journal of Medical Psychology, 72, 285–303.

Ghorbani, N., Watson, P. J., & Morris, R. J. (2000). Personality, stress and mental health: Evidence of relationships in a sample of Iranian managers. Personality and Individual Differences, 28, 647–657.

Grainge, M. J., Brugha, T. S., & Spiers, N. (2000). Social support, personality and depressive symptoms over 7 years: The Health and Lifestyle cohort. Social Psychiatry and Psychiatric Epidemiology, 35, 366–374.

Hooker, K., Monahan, D. J., Bowman, S. R., et al. (1998). Personality counts for a lot: Predictors of mental and physical health of spouse caregivers in two disease groups. Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 53B, P73–P85.

Hueston, W. J., Werth, J., & Mainous, A. G. (1999). Personality disorder traits: Prevalence and effects on health status in primary care patients. International Journal of Psychiatry in Medicine, 29, 63–74.

Ingledew, D. K., & Brunning, S. (1999). Personality, preventive health behaviour and comparative optimism about health problems. Journal of Health Psychology, 4, 193–208.

Jerram, K. L., & Coleman, P. G. (1999). The big five personality traits and reporting of health problems and health behaviour in old age. British Journal of Health Psychology, 4, 181–192.

Lindeman, M., & Stark, K. (1999). Pleasure, pursuit of health or negotiation of identity? Personality correlates of food choice motives among young and middle-aged women. Appetite, 33, 141–161.

Lynch, D. J., Repka, F. J., Nagel, R., et al. (2000). Prediction of dietary adherence in cholesterol reduction: Relative contribution of personality variables and health attitudes. Psychology and Health, 15, 821–828.

Maltby, J., Macaskill, A., & Day, L. (2001). Failure to forgive self and others: A replication and extension of the relationship between forgiveness, personality, social desirability and general health. Personality and Individual Differences, 30, 881–885.

Manning, M. R., & Fusilier, M. R. (1999). The relationship between stress and health care use: An investigation of the buffering roles of personality, social support and exercise. Journal of Psychosomatic Research, 47, 159–173.

Marks, G. R., & Lutgendorf, S. K. (1999). Perceived health competence and personality factors differentially predict health behaviors in older adults. Journal of Aging and Health, 11, 221–239.

Martin, R., Wan, C. K., David, J. P., et al. (1999). Style of anger expression: Relation to expressivity, personality, and health. Personality and Social Psychology Bulletin, 25, 1196–1207.

Neeleman, J., Ormel, J., & Bijl, R. V. (2001). The distribution of psychiatric and somatic ill health: Associations with personality and socioeconomic status. Psychosomatic Medicine, 63, 239–247.

Norlander, T., Dahlin, A., & Archer, T. (2000). Health of women: Associations among life events, social support, and personality for selected patient groups. Psychological Reports, 86, 76–78.

Pufal-Struzik, I. (1999). Self-actualization and other personality dimensions as predictors of mental health of intellectually gifted students. Roeper Review, 22, 44–47.

Sansone, R. A., Wiederman, M. W., & Sansone, L. A. (1998). Borderline personality symptomatology, experience of multiple types of trauma, and health care utilization among women in a primary care setting. Journal of Clinical Psychiatry, 59, 108–111.

Snyder, C. R., Tennen, H., Affleck, G., et al. (2000). Social, personality, clinical, and health psychology tributaries: The merging of a scholarly “River of dreams.” Personality and Social Psychology Review, 4, 16–29.

Turnipseed, D. L. (1999). An exploratory study of the hardy personality at work in the health care industry. Psychological Reports, 85, 1199–1217.

Vollrath, M., Knoch, D., & Cassano, L. (1999). Personality, risky health behaviour, and perceived susceptibility to health risks. European Journal of Personality, 13, 39–50.

Yamaoka, K., Shigehisa, T., Ogoshi, K., et al. (1998). Health-related quality of life varies with personality types: A comparison among cancer patients, non-cancer patients and healthy individuals in a Japanese population. Quality of Life Research, 7, 535–544.

Zellars, K. L., Perrewe, P. L., & Hochwarter, W. A. (2000). Burnout in health care: The role of the five factors of personality. Journal of Applied Social Psychology, 30, 1570–1598.

Activity Handout 18–1:

Stressful Life Events

Instructions: Please check the events listed below that you have experienced in the past year.

___ 1. Beginning of ceasing formal schooling

___ 2. Change in residence

___ 3. Outstanding personal achievement

___ 4. Death of a close family member

___ 5. Major change in sleeping habits

___ 6. Sexual difficulties

___ 7. Major personal injury or illness

___ 8. Marriage

___ 9. Death of a close friend

___ 10. Major change in financial state

Activity Handout 18–2:

Daily Hassles

Instructions: Please check the events listed below that are significant sources of stress for you on a daily basis.

___ 1. Concerns about weight

___ 2. Health of a family member

___ 3. Rising prices of common goods

___ 4. Home maintenance

___ 5. Too many things to do

___ 6. Misplacing or losing things

___ 7. Yard work or outside home maintenance

___ 8. Property, investment, or taxes

___ 9. Crime

___ 10. Physical appearance

Activity Handout 18–3:

Type A Behavior Pattern

Instructions: Please check those items below that apply to you, in general.

___ 1. I like to work hard and achieve goals.

___ 2. I like recognition, power, and overcoming obstacles.

___ 3. I am at my best when competing with others.

___ 4. I hate wasting time.

___ 5. I am always in a hurry and feel pressure to get the most done in the least amount of time.

___ 6. I often do two things at once.

___ 7. I have to wait in line for anything.

___ 8. I get easily frustrated.

___ 9. When I get frustrated, I act unfriendly and sometimes even maliciously.

___ 10. If a vending machine took my money without giving me the product, I would yell at and

even pound the machine.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download