Almost two decades ago, Drs. Meyer Friedman and Ray Rosenman de veloped the concept of the Type A coronary-prone behavior pattern and pioneered research in the area. Since then, much effort has been devoted to investigating both medical and psychosocial implications of this phenomenon by an impressive array of biomedical and behavioral scientists. On the basis of the National Heart, Lung, and Blood Institute's (NHLBI) recent Congressional mandate concerning disease prevention and control, the Division of Heart and Vascular Diseases undertook an intensive review of the existing literature in this area. The review underscored that the very nature of the concept of coronary-prone behavior requires examination by researchers from a variety of disciplines. Publication of findings in both the medical and behavioral literature, however, has created difficulties in gaining a truly com prehensive understanding of the total effort in this area. It became obvious that there was no coherent integration of information regarding the strength of the association between behaviors and disease processes (or outcomes), how be havioral factors associated with coronary heart disease were measured, the possible physiological mechanisms mediating the relationship between be havior and disease, whether intervention could be effective, and what forms of intervention appeared most promising. In short, a clear need existed to or ganize this information in a more coherent fashion so that it could be subjected to critical review by members of both the medical and behavioral scientific communities.

Cardiovascular disease continues to be the number ioral medicine" was developed and shaped into the one source of morbidity and mortality in our coun­ following definition: try. Despite a 35% reduction since 1964, these Behavioral medicine is the interdisciplinary field con­ diseases, particularly coronary heart disease cerned with the development and integration of behav­ (CHD), claim nearly 1,000,000 lives each year in ioral and biomedical science knowledge and techniques the United States (Havlik & Feinleib, 1979). relevant to the understanding of health and illness and The Framingham study, among others, has iden­ the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation. tified three major risk factors implicated in the de­ (Schwartz & Weiss, 1978) velopment of CHD: smoking, elevated serum cho­ lesterol, and high blood pressure (Castelli et at., This concept of "biobehavioral" collaboration 1986). Given that these factors account for less challenged scientists and clinicians of many disci­ than 50% of the variance associated with CHD plines to consider how they might more effectively (Jenkins, 1976), it has become obvious that addi­ develop diagnostic, treatment, and prevention tional risk factors must be identified if further pro­ strategies by merging their perspectives to address gress is to be made in disease prevention and simultaneously, among others, behavioral, psy­ control.

Provides a comprehensive overview of epidemiologic, experimental, and clinical data evidencing the emergence of cardiac psychology as a specialty. It offers a thorough and up-to-date review of the scientific research supporting the relationship between cardiac disease and psychological condition, practical suggestions for developing a clinical practice and directions for future research in this new field of "cardiac psychology". The first part provides an overview of the psychological risk factors for cardiac disease. Emphasis is placed on physiological basis of mind-heart link, depression and anxiety, personality and relational aspects, and on advanced statistical tools for the study of personalities at risk. The second part offers a systematic overview of literature on psychological treatments in cardiac rehabilitation.

Despite medical technological advances, the major killers with which we must currently contend have remained essentially the same for the past few decades. Stroke, cancer, and heart disease together account for the vast majority of deaths in the United States. In addition, due to improved medical care, many Americans who would previously have died now survive these disorders, necessitating that they receive appropriate rehabilitation efforts. One result of our own medical advances is that we must now accept the high costs associated with providing quality care to individuals who develop one of these problems, and we must avail ourselves to assist of afflicted individuals. families Despite the relative stability of causes of death and disability, the health-care field is currently experiencing tremendous pressures, both from professionals with in the field, who desire more and better technology than is currently available, and from the public and other payers of health care (e.g., insurance companies), who seek an end to increasing health-care costs. These pressures, along with an increased emphasis on providing evidence of cost-effectiveness and quality assurance, are substantially changing the way that health-care professionals perform their jobs.

The original and creative analyses presented in this work represent a new understanding of the exciting field of personality and disease. Contributors offer current research findings and their experienced opinions on the relationship that exists between personality and disease in a clear, comprehensive fashion. Among the topics covered are models of linkages between personality and disease, stress and illness, individual differences and health--gender, coping and stress. Personality and social factors or and how they affect the outcome of cancer, are also discussed. The exploration and examination of the issues presented here are extremely valuable and will have a major impact on future research and practice.

In recent years ideas about the influence of psychological status on physical health have been elevated from intuition and clinical lore to a legitimate area of scientific study. Mechanisms of influence are, indubitably, diverse. Some of this influence is indirect, accounted for simply by the instrumental help that social engagement, associated with good mental health, affords people; for example, psychologically "healthy" people are probably more likely to comply with medication regimens and engage in other healthful behaviors to a greater extent than those who are socially withdrawn or psychologically unstable. But recent studies suggest that while the importance of these more obvious factors cannot be denied, the complete picture includes factors that are much more subtle and complex. A body of research is beginning to accumulate that suggests that all three major regulatory systems -- the central nervous system, the endocrine system, and the immune system -- are affected by cognitions, emotions and behavior. There is no doubt that a relationship between mental and physical health exists, but very little is known about the specific mechanisms by which such influence occurs. At least in part, empirical research in this area has been limited by the inherent need for an interdisciplinary approach and synthesis of collected data. Recently, a few researchers in a number of different disciplines have begun to study directly the linkage between psychological and emotional well being and health.

Fundamental and challenging questions about the origin and sustenance of Type A behaviour - such as whether environmental or genetic factors play a role in its development, and whether Type A parents raise Type A children - are explored in this volume. Leading scholars also present current research on such topics as whether gender affects the development of Type A behaviour, and methods of developing and evaluating programmes aimed at altering such behaviour.