Type A behavior: clinical significance, evaluation, and management.

Throughout recorded medical history a relationship has been postulated between the emotions and heart disease. Type A behavior is, in part, a contemporary restatement of this relationship. It is a clustering of behaviors characterized by a profound sense of time urgency, hostility, competitiveness, and a chronic struggle to obtain more and more poorly defined goals. Originally described in white urban men, it has now been shown to characterize many men and women in a variety of western industrialized societies. Type A behavior has been clearly established as a risk factor for coronary heart disease equal in magnitude to the other standard risk factors. The definitive identification of this behavior pattern is done either through a standardized interview or through one of several written tests. A simplified checklist is presented for use by the family physician in the office setting. Modification of this behavior pattern is best done using a multifaceted approach that addresses the behavioral, cognitive, physiologic, and environmental aspects. The discipline of meditation has potential as a therapeutic tool that fits in with this multifaceted approach.