This article was downloaded by: [Trini Closa Leon]On: 17 March 2015, At: 15:32Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Psychology & HealthPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/gpsh20

Social support and individual variabilityin patterns of haemodynamic reactivityand recoveryTrini Closa León a , Arie Nouwen a & David Sheffield ba School of Psychology , The University of Birmingham ,Edgbaston, Birmingham, B15 2TTb Faculty of Health and Sciences , Staffordshire University , MellorBuilding, College Road, Stoke-on-Trent, ST4 2DE, UKPublished online: 08 May 2007.

To cite this article: Trini Closa León , Arie Nouwen & David Sheffield (2007) Social support andindividual variability in patterns of haemodynamic reactivity and recovery, Psychology & Health,22:4, 473-492, DOI: 10.1080/14768320600941806

To link to this article: http://dx.doi.org/10.1080/14768320600941806

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to orarising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Psychology and HealthMay 2007; 22(4): 473–492

Social support and individual variability in patternsof haemodynamic reactivity and recovery

TRINI CLOSA LEON1, ARIE NOUWEN1, & DAVID SHEFFIELD2

1School of Psychology, The University of Birmingham, Edgbaston, Birmingham,

B15 2TT and 2Faculty of Health and Sciences, Staffordshire University,

Mellor Building, College Road, Stoke-on-Trent, ST4 2DE, UK

(Received 10 November 2005; in final form 13 July 2006)

AbstractAlthough it is generally accepted that laboratory manipulations of social support canmoderate cardiovascular reactivity to psychosocial stress, the findings are highly variableand the mechanisms of influence remain to be fully elucidated. We used thoracicimpedance cardiography to assess patterns of parasympathetic activation and examinewhether social support buffers stress reactivity and/or prevents prolonged activationfollowing a stressor. Sixty-one female undergraduates completed an anger recall task witheither a neutral or a supportive experimenter. Supported participants evidence increasedcardiac output reactivity and delayed systolic blood pressure recovery compared tounsupported participants. However, perceived support from the experimenter wasassociated with reduced stroke volume reactivity. Highly cynically hostile participantsevidenced delayed cardiovascular recovery compared to low cynicism participants.Counter-intuitive findings are explained in terms of individual variations in haemo-dynamic patterns of response. Perceived support may be determined by individualdifferences or response bias, rather than by support manipulation.

Keywords: Social support, cardiovascular reactivity, cardiovascular recovery, hostility,psychosocial stress, impedance cardiography

Introduction

It is now generally accepted that social isolation represents a potent risk factor forpremature death from cardiovascular disease (CVD;House, Landis, &Umberson,1988; Mookadam & Arthur, 2004; Orth-Gomer, 1994). The reactivity hypothesisassumes that recurrent pressor episodes of high magnitude represent an important

Correspondence: Arie Nouwen, School of Psychology, The University of Birmingham, Edgbaston,Birmingham, B15 2TT, UK. E-mail: a.nouwen@bham.ac.uk

ISSN 0887-0446 print/ISSN 1476-8321 online � 2007 Taylor & FrancisDOI: 10.1080/14768320600941806

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

pathogenic mechanism in the development and progression of CVD (Krantz &Manuck, 1984; Manuck, 1994). Accordingly, social support may influencecardiovascular health by dampening cardiovascular responses to stressfulsituations. A meta-analytic review of the effects of laboratory analogues of socialsupport has indicated an overall attenuation of cardiovascular reactivity (CVR)to behavioural challenge (Thorsteinsson & James, 1999). However, the resultshave been mixed; some studies found a moderating effect of social support onheart rate (HR) and blood pressure (BP) reactivity to laboratory stressors (Gerin &Pickering, 1995; Gerin, Pieper, Levy, & Pickering, 1992; Kamarck, Manuck,& Jennings, 1990; Kamarck, Annunziato, & Amateau, 1995; Kiecolt-Glaser &Greenberg, 1984; Lepore, Allen, & Evans, 1993), while others failed tofind any dampening effects (Allen, Blascovich, Tomaka, & Kelsey, 1991;Sheffield & Carroll, 1994, 1996) or even reported a detrimental effect of thesupport manipulation on CVR (Edens, Larkin, & Abel, 1992). This variabilityin outcomes has been attributed to heterogeneity in the conceptualizationand manipulation of key constructs, such as the type of stressor, thecharacteristics of the support provider and the kinds of behaviours deemedto be supportive (Kamarck et al., 1995; Lepore, 1998; Thorsteinsson &James, 1999).To date, most support-reactivity experiments have measured only HR and BP,

although thoracic impedance cardiography (TIC) can be used to explore thehaemodynamic mechanisms underlying the stress response, revealing importantindividual variability that would be obscured by traditional BP measurementsalone (Thorsteinsson & James, 1999). Recent research shows that individualsvary in their cardiovascular responses to challenge along two dimensions,‘‘cardiac’’ or ‘‘vascular’’ change (Kasprowicz, Manuck, Malkoff, & Krantz, 1990;Manuck, 1994), suggesting individual ‘‘response specificity’’. For cardiacreactors, increases in BP are characterised by increased cardiac output (CO),while vascular reactors experience greater increases in the peripheral resistanceof the vasculature (stroke volume, SV).The traditional laboratory (BP and HR) reactivity paradigm may also be

neglecting important facets of real-life patterns of cardiovascular response, suchas the frequency and duration of episodes of heightened arousal (Christenfeld,Glynn, & Gerin, 2000). The return to resting BP levels, known as cardiovascularrecovery, has long been implicated in the development of hypertension (Hines &Brown, 1936; Hocking-Schuler & O’Brien, 1997). Delayed recovery isconsistently observed in protocols involving anger provocation (Lai & Linden,1992). Rumination has been found to sustain anger after provocation (Rusting &Nolen-Hoeksema, 1998) and may prolong pressor episodes by delaying recoveryor triggering repeated episodes of arousal (Glynn, Christenfeld, & Gerin, 2002;Schwartz et al., 2000). Recalling a stressful event is associated with significantelevations in BP and HR (Carels, Szczepanski, Blumenthal, & Sherwood, 1998)and delayed recovery (Earle, Linden, & Weinberg, 1999; Glynn et al., 2002).Supported participants may ruminate less, or their rumination may consistof less negative affect, than non-supported participants. Although some

474 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

support-reactivity protocols have included a recovery period, many authors donot report any analysis of recovery data (Christenfeld et al., 2000).There is significant individual variability in patterns of physiological response to

environmental demands, and it is possible that the hypothesized mechanisms bywhich support moderates reactivity to stressors are only relevant to individualswho exhibit behavioural responses to stress that potentiate heightened reactivity.For example, Thorsteinsson and James (1999) suggested that participantswho benefit from high habitual social support levels may benefit more fromlaboratory manipulations of social support than participants with low levels ofnaturalistic support, and there is some evidence to support this view (Fontana,Diegnan, Villeneuve, & Lepore, 1999). Similarly, participants who score highly inhostility would be expected to exhibit exaggerated reactivity (Suarez & Williams,1990) and delayed recovery from stressors (Ganster, Schaubroeck, Sime, &Mayes, 1991).Christenfeld and Gerin (2000) suggest that men benefit more from marriage,

and suffer more from its loss, because women are better at providing effectivesocial support than men. This suggests that support from women will be moresuccessful at moderating CVR in the laboratory than support from men. Indeed,Glynn, Christenfeld and Gerin (1999) found that support from a man did notattenuate CVR in either men or women, but support from a woman reduced CVRin both sexes. Conversely, Fritz, Nagurney and Helgeson (2003) reported that thegender of the participant was most salient, with women benefiting more fromemotional support than men, regardless of the gender of the partner. On balance,evidence reviewed by Uchino, Cacioppo and Kiecolt-Glaser (1996) suggestedthat the clearest support effects upon CVR are observed when women supportwomen (Edens et al., 1992; Snydersmith & Cacioppo, 1992); thus we chose tofocus on support in women.The aims of this study were to test the potential moderating effect of a

laboratory analogue of social support upon CVR to an anger-recall task andsubsequent cardiovascular recovery. We manipulated the perceived availabilityof support, given Uchino and Garvey’s (1997) finding that the availability ofsupport, in the absence of enacted support, was sufficient to moderate BPresponses to a speech stressor. The potential interactive effects of hostility andanger rumination were measured, and TIC was used to delineate the patterns ofhaemodynamic response involved.

Method

Participants

Previous meta-analyses have indicated a standardized effect size for social supporton CVR of r¼ 0.28 (see Uchino et al., 1996). Using this estimated effect size,and the formula recommended by Daly and Bourke (2000, p. 282), we calculateda required sample size of at least N¼ 49.

Support reactivity and recovery 475

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

Sixty-one female undergraduate students, with a mean age of 21.3 years(SD¼ 2.9), received course credit or payment of £5 in exchange for theirparticipation. All participants met the eligibility criteria; they were in good health,and none reported a personal history of heart disease, hypertension or diabetes,or the use of medications with cardiovascular effects. Two participants wereexcluded from the data analysis due to a failure to obtain physiological dataresulting from equipment malfunction, and one as a multivariate outlier (see datareduction and analysis), leaving a total of 58 participants. Participants were askedto refrain from consuming alcohol, nicotine, caffeine or other stimulant drugs,and to avoid vigorous exercise on the day of the experiment.

Procedure

Prior to arrival, participants were assigned randomly to one of the three supportconditions: support-reactivity, support-recovery and neutral. Upon arrival,participants were seated facing a video camera linked to the adjoining controlroom. The electrodes and BP cuff were then attached and adjusted if necessary.The experimenter then left the room; all further communication was via an audioand video link. Participants were asked to rest for a 10min baseline period, andreadings were taken for the last 5min of this period. During this time they wereasked to sit reasonably still, relax and keep the non-dominant arm (attached tothe BP cuff) still and resting on the armrest of the chair. Participants were giventhe choice to either read magazines or sit back and relax for the duration of therest period. After the baseline period was completed, the experimenter explainedthe exact nature of the anger-recall task and delivered instructions accordingto support condition. The stressor component of the procedure lastedapproximately 5min (2min preparation, 3min talking). Cardiovascular indiceswere measured at 1min intervals during the preparation and task periods.Immediately after the completion of the task, the second set of instructions wasgiven according to support condition, and the participant asked to rest for afurther 10min. Participants were again asked to sit as still as possible, but wereasked not to read any of the magazines during this period so as to avoiddistraction during the recovery period, which might prevent rumination.Readings were taken for 8min and the recovery period terminated. Theexperimenter then asked the participant to complete the manipulation checks,and to seal the questionnaire in an envelope. Finally, participants were asked tocomplete the questionnaire items assessing health and medication status,demographic information and individual differences.

Stress manipulation. Participants were asked to recall and talk about a recentanger-inducing encounter, such as an argument with a spouse or friend. In thepreparation period, they were asked to spend 2min mentally recreating theincident and recalling it in as much detail as possible. Then they were asked tospeak continuously about the incident for 3min, forming the stress period.During this time the experimenter only spoke to prompt the participant when

476 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

necessary to facilitate the recall process. To standardize evaluation apprehensionacross all conditions, participants were told that their speech would be taped andevaluated by another experimenter, and their attention was drawn to a videocamera in the corner of the room (in reality, the speeches were not recorded).Participants spoke into a small, unobtrusive microphone attached by a clip totheir clothing.

Support manipulation. The perceived availability of social support from theexperimenter was manipulated via task instructions and positive feedback,immediately prior to the speech or the recovery phase, depending on supportcondition. Experimenters were female, as social support has been found tohave differential effects during opposite-sex interactions (Glynn et al., 1999).Task instructions were based partly on those used by Uchino and Garvey (1997)to influence the perceived availability of support, and supportive comments werescripted and delivered at fixed intervals during the experiment. To control fordistraction effects, in the neutral condition the experimenter made a similarnumber of comments of neutral content. There were three experimentalconditions, manipulated between subjects.

Neutral condition. In the neutral condition, the experimenter greeted theparticipants in an efficient manner. Task instructions were kept to a minimumand delivered in a cold, disinterested tone.

Support-reactivity condition. In the support-reactivity condition, the experi-menter was warm and friendly, reassured the participant and informed her thatshe was available to give any help or advice if needed. This was intended toinfluence the perceived availability of support. Explicitly supportive commentswere made prior to the speech task, for example, ‘‘. . . remember that I’m just nextdoor if you need me for any reason or if you have any questions. Obviously I wantto be helpful if I can because I appreciate you taking part.’’

Support-recovery condition. In the support-recovery condition, no explicitlysupportive comments were made prior to the speech task so that any differencesin recovery would not be due to significant differences in reactivity. Thus, untilthe end of the speech task all instructions were identical to those in the neutralcondition. After the speech task and immediately prior to the recovery period, theexperimenter provided positive/empathic feedback with the participant concern-ing her performance as follows: ‘‘I can see why you got annoyed about it! I hope itwasn’t too difficult, I really do appreciate you volunteering to do it . . . Remember,I’m just next door, so if you need me for any reason just let me know’’.

Measures

Cardiovascular reactivity and recovery. Systolic BP, diastolic BP and HR weremeasured at 1min intervals with a Dinamap automated BP monitor using anappropriate sized occluding cuff attached to the non-dominant arm above the

Support reactivity and recovery 477

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

brachial artery. A Bio-Impedance Inc. HIC-300 Impedance Cardiograph wasused to measure stroke volume (SV), cardiac output (CO), total peripheralresistance (TPR), and the systolic time intervals pre-ejection period (PEP) andleft-ventricular ejection time (LVET). Four self-adhesive aluminised bandelectrodes (Instrumentation For Medicine Inc., Greenwich, CT) were appliedto the participant; two were placed around the base and upper neck, one aroundthe thorax at the level of the xiphisternal joint and one below the rib cage justabove the waist. The pairs of band electrodes were spaced at least 3 cm apart.In addition, three paediatric self-adhesive gel spot ECG electrodes (ConMed,Utica, NY) were applied, one above the right collarbone, one on the left ribcageand one on the right abdomen, to record ECG measurements. A number ofstudies have presented evidence supportive of satisfactory reliability forimpedance measures (Sherwood, 1991), and Papillo and Shapiro (1990) believethat the existing empirical evidence justifies the use of impedance cardiographyfor comparing relative changes in SV and CO.

Manipulation checks.

Perceived stress. The stress manipulation check consisted of four items scoredon a 1 (not at all) to 7 (extremely) scale, asking participants to rate how calm,distressed, tense and relaxed they had felt during the speech task. The four itemswere combined to form an average perceived stress score; Cronbach’s alphaindicated that this scale had adequate internal consistency (�¼ 0.81).

Task engagement. Differences in effort or engagement with the task may affectcardiovascular responses during rumination and recovery (Glynn et al., 2002), soparticipants were asked how emotionally involving they found the task, how angrythey felt during the task, how difficult and challenging they found the task andhow vividly they were able to recall the anger episode. Participants also rated theextent to which they felt that the incident they had spoken about had ever beensatisfactorily resolved, in case there were any differences between supportconditions that might affect the degree to which participants became emotionallyaroused by talking about the incident. All items were rated on a six-point scalefrom 1 (not at all) to 6 (extremely). The internal consistency of the scale wasless than adequate (�¼ 0.50); thus the items were compared individually andnot averaged.

Perceived social support. Four items assessing the perceived supportiveness ofthe experimenter were included to measure the effectiveness of the supportmanipulation. Items included friendly, supportive, warm and helpful, and werescored on a seven-point scale from 1 (very unfriendly) to 7 (very friendly),averaged to form a mean perceived support score (�¼ 0.94). Participants alsocompleted three items measuring evaluation apprehension; evaluative, pryingand judgmental, scored in the same way as the support scales. However, theinternal consistency of the three evaluation items was less than adequate(�¼ 0.59), so the items were analysed separately.

478 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

State rumination. A state measure of rumination, consisting of four items basedupon Sukhodolsky, Golub and Cromwell’s (2001) trait rumination scale, wasused to assess any differences between support groups in the extent ofspontaneous rumination during the recovery period. For example, participantswere asked whether, during the rest period following the main anger recall task,they had ‘‘continued to re-enact the anger episode’’. Internal consistency of thescale was adequate (�¼ 0.85).

Individual differences.

Support network and satisfaction. Based upon the full version Social SupportQuestionnaire (SSQ; Sarason, Sarason, Shearin, & Pierce, 1987), the six-itemSSQ assesses both the size of the support network and the participants’satisfaction with the support that they receive. Participants were asked to indicatethe initials of a number of target persons they can count on for support, andthen indicate how satisfied they are with this support on a six-point scale from 1(very dissatisfied) to 6 (very satisfied). The six-item SSQ has high internal validityand is highly correlated with the full SSQ (Sarason et al., 1987).

Anger rumination. The anger rumination scale (Sukhodolsky et al., 2001)comprises 19 items designed to measure the tendency to focus attention on angrymoods, recall past anger episodes and focus upon the possible causes andconsequences of such experiences. The scale has a four-factor structure,comprising items measuring ‘‘angry afterthoughts’’, ‘‘thoughts of revenge’’,‘‘angry memories’’ and ‘‘understanding of causes’’, and has good psychometricproperties (Sukhodolsky et al., 2001). Items consist of statements such as ‘‘I keepthinking about events that have angered me for a long time’’, and are scored ona four-point Likert-type scale from 1 (almost never) to 4 (almost always), so thata higher score corresponds to a higher level of anger rumination.

Hostility. One of the most frequently used instruments for measuring hostility(Ho) in CVD research is the Cook–Medley Hostility Questionnaire (Cook &Medley, 1954). Five subscales were used, based upon the Barefoot, Dodge,Peterson, Dahlstrom and Williams (1989) method of scoring: ‘‘cynicism’’,‘‘hostile affect’’, ‘‘aggressive responding’’, ‘‘hostile attribution’’ and ‘‘socialavoidance’’. Participants indicated a true/false response to statements, dependingon how they believed they applied to them. Scores on the scale have been foundto be reliable predictors of CVR (Suls & Wan, 1993).

Data reduction and analysis

Cardiovascular indices were averaged over each experimental period to improvereliability (Kamarck et al., 1992). Residual recovery (total carry over of arousal)was used as an index of recovery (Christenfeld et al., 2000) and was calculated byaveraging the eight readings taken during the recovery period and subtracting themean baseline score for each cardiovascular index, thus providing a measure ofthe amount of arousal carried over from the task to the recovery period.

Support reactivity and recovery 479

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

The raw data were screened for outliers. Anomalous readings, such as a noisyECG signal, were deleted. If any outlier fell beyond three standard deviationsfrom the mean, but was not considered anomalous, the reading was adjusted inthe manner described by Dancey and Reidy (2004). Briefly, outliers at the upper(or lower) extreme of the scale are re-coded as one digit higher (or lower) than thehighest (or lowest) non-outlier, so that case remains the highest (or lowest) score,but is no longer extreme. Outliers less than 3 SD from the mean were notadjusted. The same process was applied to the subjective data. The averaged(baseline, preparation and task) scores for each physiological variable were thenexamined for multivariate outliers. A linear regression was performed toinvestigate collinearity and casewise diagnostics (Tabachnik & Fidell, 2001).One participant was found to be a multivariate outlier and excluded from allfurther analyses.To examine the effects of social support on CVR, mean scores for baseline

and task were compared using a 3 (neutral, support reactivity and supportrecovery)� 2 (baseline and task) repeated-measures analysis of variance(ANOVA). As recommended by Anthony and O’Brien (1999), a series ofindividual ANOVA’s for each cardiovascular measure were used instead of amultivariate analysis, because inter-correlations between cardiovascular indicesare typically inconsistent. Post hoc tests with Bonferroni adjustment were used toexplore significant main or interaction effects.

Results

Baseline comparisons

A series of one-way ANOVAs revealed no significant main effects of socialsupport condition on resting HR, F(2, 55)¼ 0.00, ns; SBP, F(2, 55)¼ 1.74, ns;DBP, F(2, 55)¼ 0.62, ns; SV, F(2, 55)¼ 0.70, ns; CO, F(2, 54)¼ 1.27, ns; PEP,F(2, 55)¼ 0.27, ns; LVET, F(2, 55)¼ 0.74, ns; or TPR, F(2, 55)¼ 1.27, ns.A further series of ANOVAs indicated that participants in each of the threesupport conditions did not differ in terms of age, F(2, 55)¼ 0.22, ns; ethnicity,F(2, 55)¼ 0.30, ns; support network, F(2, 55)¼ 0.23, ns; support satisfaction,F(2, 55)¼ 0.17, ns; trait rumination, F(2, 55)¼ 1.59, ns; or hostility, F(2, 55)¼1.53, ns.

Manipulation checks

Stress manipulation. The mean perceived stress score, with SD in parentheses,was 4.4 (1.17), with M¼ 4.1 (0.99), 3.9 (1.14), 3.26 (1.48) and 4.43 (1.3) forinvolvement, anger, challenge and vividness of recall, respectively. None of theparticipants reported that the event they chose to speak about had been fullyresolved satisfactorily, with a mean score of 2.31 (SD¼ 1.64). The anger recalltask evoked an average increase (collapsed across support conditions) in HR of18.8 b.p.m. (SD¼ 10.35), while SBP and DBP increased by an average of 22.5(SD¼ 11.03) and 15.5mmHg (SD¼ 7.59) respectively. SV, PEP and LVET

480 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

decreased by an average of 13.0ml/beat (SD¼ 14.55), 8.9 s (SD¼ 11.84) and17.9 s/beat (SD¼ 21.27), respectively, while CO and TPR increased by anaverage of 0.69 L/min (SD¼ 1.46) and 144.3 ds (SD¼ 188.03) from baseline totask. A set of 3 (neutral, support reactivity and support recovery)� 2 (baseline,task) repeated-measures ANOVAs were conducted to compare mean scoresduring each period, for each physiological variable. Within-subjects analysisrevealed that stress exerted a highly significant main effect (p<0.001) upon everymeasure of cardiovascular response except for CO, which was significant at thep<0.005 level. Stepwise multiple regression revealed that perceived stress was thestrongest predictor of task HR, F(1, 55)¼ 4.29, p<0.05; SBP, F(1, 55)¼ 7.77,p<0.01; and DBP reactivity, F(1, 55)¼ 6.92, p<0.05.

Support manipulation. A set of one-way (neutral, support reactivity and supportrecovery) between-subjects ANOVAs comparing scores on the manipulationcheck items indicated a significant difference in perceived support,F(2, 55)¼ 7.73, p¼ 0.001, �2p ¼ 0.23. Post hoc analysis with Bonferroni adjust-ment revealed that the overall perceived support score was significantly higher inboth the support-reactivity (M¼ 6.21, SD¼ 0.95) and the support-recovery(M¼ 6.38, SD¼ 0.71) conditions than the neutral (M¼ 5.10, SD¼ 1.37)condition (both p<0.05), but did not differ between the two support conditions.ANOVA indicated that the judgmental scale differed significantly across

support conditions, F(2, 54)¼ 4.51, p<0.05, �2p ¼ 0.14, and post hoc analysisindicated that participants in the neutral condition perceived the experimenterto be more judgmental than those in the support-recovery condition (p<0.05),while the neutral and support-reactivity conditions did not differ significantly.The other evaluation apprehension items did not differ across support conditions.ANOVA further indicated a significant difference between support conditionsin the amount of self-reported rumination, F(2, 54)¼ 4.16, p<0.05, �2p ¼ 0.13.Post hoc analysis with Bonferroni adjustment indicated that participants in thesupport-reactivity condition (M¼ 4.65, SD¼ 1.55) ruminated more than thosein the neutral condition (M¼ 3.49, SD¼ 1.58, p<0.05); the support-recoverycondition did not differ from the other two conditions. ANOVA revealed nosignificant differences in perceived stress between support conditions, F(2, 54)¼1.39, ns, �2p ¼ 0.05, and no differences in self-reported involvementF(2, 54)¼ 0.86, ns, �2p ¼ 0.03; anger F(2, 54)¼ 2.68, ns, �2p ¼ 0.09; challengeF(2, 54)¼ 0.24, ns, �2p ¼ 0.01; or vividness F(2, 54)¼ 2.04, ns, �2p ¼ 0.14.

Effect of social support on cardiovascular reactivity

The CVR variables were placed into two sets, one for BP and HR variables andone for TIC data, to optimise control of type I and type II error. Type I error wasfixed at 0.05 for each set of variables, and Bonferroni adjusted significance levelswere used for each variable (Simes, 1986). For each set, 3 (neutral, supportreactivity, and support recovery)� 2 (baseline and task) repeated-measures ANOVAs were carried out to compare mean scores during each

Support reactivity and recovery 481

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

measurement period. For the first set of BP variables, ANOVA indicated nodifferences between the support conditions (Table I).In the second set, although there was no main effect of support on CO,

F(2, 54)¼ 1.51, ns, there was a significant stress� support interaction,F(2, 54)¼ 3.40, p<0.05, �2p ¼ 0.11. CO increased by a larger degree in thesupport-reactivity condition than the neutral condition (Table I). Differences inSV, TPR, PEP and LVET were not significant and the effect sizes were verysmall.To examine the effect of subjective experience on CVR, a series of stepwise

multiple regressions was carried out, one for each index of CVR, with reactivityas the dependent variable and inputting perceived stress, perceived support,evaluation apprehension, state and trait rumination and hostility as theindependent variables. Perceived support was the only significant predictor oftask SV reactivity, F(1, 56)¼ 4.91, p<0.05, and perceived stress did not predict

Table I. Changes in BP and TIC variables from baseline to task, and strength of stress by supportinteraction effects.

Neutral Support reactivity Support recovery

N¼ 58, df¼ 2,55 M SD M SD M SD F �2p

HR Baseline 70.39 10.33 70.30 11.30 70.65 6.55 0.27 0.01Task 90.50 14.78 88.23 13.04 88.81 9.50Reactivity 17.53 9.36 18.42 11.30 18.17 9.84

SBP Baseline 104.05 8.55 99.67 9.04 102.92 4.10 0.18 0.01Task 125.65 14.11 123.17 14.87 125.59 11.39Reactivity 20.29 9.50 23.04 10.90 22.99 11.69

DBP Baseline 61.62 6.53 60.60 5.99 59.17 7.60 0.09 0.00Task 76.95 11.21 75.73 9.03 75.29 8.91Reactivity 14.44 7.18 14.88 7.74 16.10 7.21

SV Baseline 96.90 29.17 103.93 32.90 109.06 33.73 2.31 0.08Task 80.10 25.75 96.31 32.16 94.55 25.67Reactivity �13.90 9.78 �7.91 8.58 �20.50 13.81

CO Baseline 6.85 2.08 7.18 2.02 7.92 1.89 3.40* 0.11Task 7.08 2.24 8.52 3.13 8.43 2.38Reactivity 0.33 0.95 1.33 1.84 0.24 0.73

PEP Baseline 122.59 14.54 125.73 16.22 125.10 12.02 0.04 0.00Task 114.26 16.32 116.38 20.26 116.14 9.94Reactivity �8.15 12.21 �9.14 14.02 �6.76 7.71

LVET Baseline 279.23 24.00 281.03 25.00 273.47 18.14 1.18 0.04Task 257.11 32.01 268.75 31.74 254.02 21.26Reactivity �16.96 10.75 �13.63 28.64 �20.07 14.55

TPR Baseline 961.84 299.55 885.66 258.90 816.99 274.71 1.88 0.06Task 1162.2 356.48 976.03 316.14 951.64 283.82Reactivity 162.42 171.48 89.26 181.14 165.78 87.82

HR¼ heart rate (b.p.m.), SBP¼ systolic blood pressure (mmHg), DBP¼diastolic blood pressure(mmHg), SV¼ stroke volume (ml/beat), CO¼ cardiac output (L/min), PEP¼ pre-ejectionperiod (s), LVET¼ left ventricular ejection time (s/beat), TPR¼ total peripheral resistance (dyn s).*p<0.05.

482 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

any additional variance in SVR. Higher perceived support from the experimenterwas associated with reduced SV reactivity during the task. Perceived support didnot predict any of the other CVR variables.

Effect of social support on cardiovascular recovery

The mean time to recover in the present experiment, collapsed acrosssupport conditions, was 6.09, 3.12 and 3.14min for SBP, DBP and HR,respectively. Residual recovery (or the total carry over of arousal) was 3.81 and�0.71mmHgmin�1 for SBP and DBP, respectively, and residual HR arousalaveraged at 0.42 beats.A series of between-subjects ANOVAs were carried out to compare

cardiovascular recovery across the three support conditions (Table II). Supportcondition exerted a significant main effect on SBP residual recovery,F(2, 55)¼ 5.65, p<0.01, �2p ¼ 0.19, but none of the other residual recoveryindices. Post hoc analysis with Bonferroni adjustment revealed that the amountof residual SBP arousal was greater in the support-reactivity condition than theneutral condition (p¼ 0.05). A series of stepwise multiple regressions for eachindex of residual recovery with the subjective scales as independent variables,indicated that perceived support did not predict any of the indices of residualrecovery.

Influence of individual differences

All of the rumination and Ho subscales were included in the stepwise multipleregression as independent variables, because the tolerance values for these itemswere very high, typically 0.7 to 0.9, indicating that none of the scales wereredundant in the analysis. None of the individual difference variables predictedany additional variance in CVR, beyond that predicted by perceived stress.The regression on cardiovascular recovery indicated that the cynicism component

Table II. Differences in residual cardiovascular recovery between support conditions.

Neutral Support reactivity Support recovery

N¼ 58, df¼ 2,55 M SD M SD M SD F �2p

HR 0.73 3.52 �0.18 2.93 0.75 3.92 0.46 0.02SBP 2.38 3.35 5.75 3.52 3.36 2.95 5.65* 0.19DBP �1.27 3.90 �0.45 4.39 �0.26 3.45 0.36 0.03SV 7.46 36.18 3.65 11.57 �1.24 4.95 0.64 0.02CO 0.60 3.32 0.14 0.61 �0.03 0.35 0.49 0.02PEP 4.11 20.33 0.98 11.58 �1.27 3.45 0.67 0.02LVET �1.62 28.67 5.77 15.51 3.62 8.68 0.73 0.03TPR �20.85 132.00 8.26 84.46 81.06 299.00 1.47 0.05

HR¼heart rate (b.p.m.), SBP¼ systolic blood pressure (mmHg), DBP¼diastolic blood pressure(mmHg), SV¼ stroke volume (ml/beat), CO¼ cardiac output (L/min), PEP¼pre-ejectionperiod (s), LVET¼ left ventricular ejection time (s/beat), TPR¼ total peripheral resistance (dyn s).*p<0.01.

Support reactivity and recovery 483

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

of the Ho scale was the strongest predictor of residual recovery for SV,F(1, 55)¼ 4.27, p<0.05; CO, F(1, 56)¼ 6.84, p<0.05; PEP, F(1, 55)¼ 4.65,p<0.05; and LVET, F(1, 55)¼ 5.94, p<0.05. In each case, no other subjectiveor individual difference variable was able to significantly enhance the predictivevalue of the test.To determine whether individual differences influenced subjective responses

during the experiment, a stepwise multiple regression analysis was carried out,entering support networks and satisfaction at step one, the anger ruminationsubscales at step two and the Ho scales at step three. SSQ support satisfactionwas the strongest predictor of perceived support, t¼ 2.86, p<0.01, which wasunrelated to the size of the support network.

Analysis of haemodynamic response patterns

To investigate whether the conflicting findings in the present data were due to alack of differentiation between cardiac and vascular reactors, the participants weredivided into two groups following commonly used criteria (Lawler et al., 2001;Light, Turner, Hinderliter, Girdler, & Sherwood, 1994). ‘‘Cardiac reactors’’ weredefined as having an increase in CO above the sample mean and a change in TPRbelow the sample mean, while ‘‘vascular reactors’’ exhibited an increase in TPRabove the sample mean along with a change in CO below the sample mean.A series of one-way ANOVAs comparing the cardiac and vascular reactors

indicated that there were no significant differences in BP reactivity, and therewere no differences between the two groups on any baseline cardiovascularmeasure. A 2 (cardiac and vascular)� 3 (neutral, support reactivity and supportrecovery) chi-square analysis was carried out to test whether the relativedistributions of cardiac and vascular reactor types differed between supportconditions. Individuals who could not be classified were excluded from thisanalysis. A higher proportion of cardiac reactors were found within the support-reactivity condition (n¼ 13) than the neutral or support-recovery conditions(n¼ 5 and n¼ 4 respectively), while there was a higher number of vascularreactors in the neutral condition (n¼ 13) compared to the support reactivity orrecovery conditions (n¼ 6 and n¼ 7, respectively); �2 (N¼ 48, df¼ 2)¼ 6.67,p<0.05. There were three non-reactors in both the neutral and support-recoverygroups compared with one in the support-reactivity group.

Discussion

The experiment investigated the moderating effect of the availability of socialsupport on CVR during an anger-recall task and the return of physiologicalactivation to pre-task levels. Despite using a potent stressor that increasedcardiovascular activity substantially and an adequate social support manipulation(as evidenced by differences in perceived support and the lack of differences inevaluation apprehension), the data provided no evidence of a stress-bufferingeffect of experimentally manipulated social support on CVR.

484 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

Given that our sample size was based on the effect sizes reported by Uchinoet al.’s (1996) meta-analysis, we believe that the present study was adequatelypowered to detect any support effects. The very small effect sizes of social supportin this study indicate that our social support did not exert any appreciable effectupon CVR. Unlike Uchino and Garvey’s (1997) findings, the availability ofsupport was not associated with any differences in HR and BP but only withnon-significant or contradictory differences in the TIC-derived variables. Forexample, the magnitude of CO reactivity was significantly greater in the supportreactivity than the neutral condition, an opposite effect to that predicted bythe experimental hypotheses. However, higher perceived support from theexperimenter was associated with lower SV reactivity, consistent withChristenfeld et al.’s (1997) assertion that the participant’s interpretation ofsupportive behaviours could influence reactivity, independently of the effects ofthe behaviours themselves. Indeed, as predicted by Thorsteinsson and James(1999), participants who reported high levels of support satisfaction also rated theexperimenter as more supportive than those who were dissatisfied with their usuallevels of social support, suggesting a possible positive reporting bias.Contrary to expectations, supported participants reported more rumination

during the recovery period and carried over more residual SBP arousal thanunsupported participants. Although the association between rumination anddelayed recovery is consistent with the existing literature (Glynn et al., 2002;Schwartz et al., 2000), it is unclear what aspect of the support manipulationencouraged participants to think more deeply about the issue they had spokenabout. Participants in each of the support conditions did not differ on any traitmeasure of rumination or hostility. Although data was not available to assess thisdirectly (as the speeches were not recorded), we hypothesize that participants inthe supportive experimenter condition felt able to disclose information of a morepersonal or emotive nature in their choice of speech topic. Evidence suggests thatindividuals disclose more to people they like, even in initial encounters betweenstrangers in laboratory settings (Collins & Miller, 1994). Even though CVR wasnot affected, talking about a more intimate topic may have led to increasedrumination during the recovery period (Glynn et al., 2002) and thus delayedrecovery, although further research would be needed to confirm this hypothesis.The lack of any other support effects on recovery may indicate that the measure

of recovery used lacked the sensitivity to portray the complex patterns of changingphysiological activation during the recovery period. More sensitive measurementtools, such as continuous beat-to-beat measurement of cardiovascular activationand a more sophisticated measure of recovery (Christenfeld et al., 2000), may berequired to fully elucidate the possible relationships between rumination andcardiovascular recovery.Although none of the individual difference measures predicted reactivity,

participants who scored highly on cynical hostility exhibited delayed SV, CO,PEP and LVET recovery. This is consistent with Haynes, Gannon, Orimoto,O’Brien and Brandt’s (1991) finding that 74% of variables that failed tosignificantly affect reactivity actually had a significant impact upon recovery,

Support reactivity and recovery 485

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

and suggests that recovery and reactivity may tap different psychological orphysiological mechanisms. Although there have been inconsistencies in theliterature regarding the role of hostility in elevated CVR (Thorsteinsson & James,1999) and the development of CVD (e.g. Siegman, Dembroski, & Ringel, 1987),the present data are consistent with findings implicating cynical hostility indelayed cardiovascular recovery following acute stress (Ganster et al., 1991).The present data concur with previous reactivity studies demonstrating

large variations in both the resting levels of impedance-derived indices ofcardiovascular function, particularly SV and CO (Manuck, 1994), and in TIC-derived CVR to psychological stress (Kasprowicz et al., 1990). The observeddecreases in PEP, accompanied by increases in HR and BP, would suggestincreased �-adrenergic activation in response to the stressor (Obrist, Light, James,& Strogatz, 1987). However, these mean BP changes obscured a more complexpattern of response, resulting from increases in both CO and TPR. Comparisonof haemodynamic response patterns identified two main response styles of cardiacor vascular reactors, in accordance with existing findings (Kasprowicz et al.,1990; Manuck, 1994). Such differentiation results from variability in thesympathoadrenal response: for example, the cardiac response has been attributedto primarily �-adrenergic activation (McCaffery, Muldoon, Bachen, Jennings, &Manuck, 2000). This potentially pathologically significant individual variability(Manuck, Kasprowicz, & Muldoon, 1990) has been overlooked by existingsupport-reactivity literature.Subsequent analysis revealed a greater proportion of cardiac reactors

(exhibiting higher CO reactivity) in the support-reactivity condition. However,this finding should be interpreted with caution, since the data did not permitdetermination of whether the patterns of reactivity were a stable individual trait ora result of the support manipulation. If reactor type represents a stable individualdifference (Kasprowicz et al., 1990), this could prove a source of potentialconfound in support-reactivity studies. In contrast, different types of experi-mental stress task have been found to elicit different patterns of response(Cacioppo & Hawkley, 2003), indicating some degree of haemodynamicplasticity in individuals’ cardiovascular responses ( Julius, 1988). If this is thecase, support manipulations may alter the patterning of haemodynamicresponses. Further research is needed to address this question.The present investigation differed from many previous investigations that have

found a significant effect of support on reactivity in the use of a supportiveexperimenter instead of a friend or confederate, whereas several researchers havesuggested that support is most beneficial when provided by a friend (Christenfeldet al., 1997; Edens et al., 1992). The salience of relationship quality washighlighted by Uno, Uchino and Smith’s (2002) finding that emotional supportfrom an ambivalent friend was associated with larger increases in CO than nosupport, while emotional support from a positive friend was related to lowerCO reactivity than the no support condition. Like the present study, thepattern was seen primarily in CO reactivity but not in HR or BP. However,several studies have demonstrated a buffering effect of support from a stranger

486 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

(e.g. Fontana et al., 1999; Gallo, Smith, & Kircher, 2000; Gerin et al., 1992),indicating that the source of the support cannot entirely account for the lack ofbuffering effects in the present findings.The findings of the present experiment are congruent with Anthony and

O’Brien (1999), who reported no moderating effects of support on reactivity toa speech stressor. It is notable that both of these experiments employed avideotaped speech stressor as opposed to the standard laboratory stressors such asmental arithmetic, mirror tracing, etc. The failure of social support to moderatereactivity in these speech protocols may result from the high level of cognitiveload produced by talking to a video camera and the associated threat ofperformance evaluation (Uchino & Garvey, 1997). It is possible that the mainsource of apprehension during the anger-recall stressor derived from thespeech evaluation element, rather than the recall of a past stressful incident.However, recalling, and talking about an interpersonal conflict involvinganger has been presented as primarily an anger-recall task in previous literature(Glynn et al., 2002), even when participants’ speech was taped.Consistent with most evidence from the support-reactivity literature (e.g. Gerin

et al., 1992; Lepore et al., 1993), participants’ subjective stress ratings did notdiffer between support conditions, suggesting that support did not promotecognitive reappraisal of the perceived threat (Lazarus & Folkman, 1984). Thismay explain its failure to moderate reactivity. Nonetheless, perceived stress wasthe strongest predictor of HR, SBP and DBP reactivity, an unusual finding,because many researchers have reported little congruence between self-reportedindices and physiological activation (Christenfeld et al., 1997).The low inter-correlations between the items used to measure task engagement

suggests several differing dimensions, and therefore we compared scores on eachindividual item rather than combining them as an overall scale. However,such single-item measures are psychometrically weak, and further research isneeded to develop a more appropriate multi-item measure of task engagement,that could be used in future support-reactivity studies. The same weaknessapplied to the items measuring evaluation apprehension. The primary purpose ofthis scale was to ensure that any failure of support to moderate CVR did not resultfrom a support manipulation that was perceived to be intrusive or evaluative.As the supportive experimenter was seen as less judgemental than the neutralexperimenter, we conclude that differences in evaluation apprehension were notresponsible for the lack of support effects in this study.One potential weakness in the present support manipulation relates to the

possible failure to adequately match the support to the specific needs elicitedby the experimental stressor (Cutrona & Russell, 1990). For example, whereasexperimental stressors involving a performance element allow the provision ofrelevant support that enhances performance self-efficacy, the support manipula-tion in the present experiment may not have specifically addressed any of thecoping requirements elicited by the recollection of a previous stressful encounter.However, Cutrona and Russell’s (1990) model of optimal matching identifiesemotional support as particularly beneficial in response to uncontrollable events,

Support reactivity and recovery 487

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

which could be seen as consistent with the recollection of a past event, theoutcome of which can no longer be influenced. Although the supportmanipulation was intended to provide primarily emotional support, it remains apossibility that the support manipulation may have failed to adequately match thesupport requirements of the participants. Future studies should carefully addressthe matching of support to stressor by clarifying the coping requirements andthe proposed psychological mechanism by which the support manipulation isexpected to operate.Social support manipulations provide laboratory analogues of the processes

assumed to underlie the observed associations between support and CVD in theepidemiological literature. Although early epidemiological data indicated that thesize and satisfaction of social networks predicted mortality (House et al., 1988;Berkman & Syme, 1979), more recent data showed that it is the perceptionof support that is most strongly associated with health outcomes (Burg et al.,2005; Greenwood, Muir, Packham, & Madeley, 1996). This suggests thatlaboratory models that succeed in changing perceptions of support may parallelthe support measures used in epidemiological research. In our study the supportmanipulation check, using a robust four-item scale to assess perceived support,indicated that the experimenter in the support condition was perceived assupportive. Thus, we believe that our support manipulation provides anappropriate proxy to epidemiological measures of support.The findings of the present study, derived from a young, female sample, may

not generalize to samples used in epidemiological research. As much of theepidemiological evidence suggests that older men benefit most from socialsupport (particularly in the context of marriage) and suffer the greatestdeleterious effects from its loss (e.g. Berkman & Syme, 1979; Stroebe &Stroebe, 1983; Orth-Gomer, 1994), it is not clear that the support mechanismswe studied help to explain the epidemiological data. However, this type ofmechanistic study does help us to explore the impact of support processesupon physiology in young, healthy participants, who do not have secondarychanges in the vasculature that might complicate CVR measurement (Ewart &Kolodner, 1993).

Conclusions

The data provided little evidence to support a moderating effect of social supportavailability upon CVR to and recovery from an anger-recall stressor. This mayhave been in part due to individual variability in patterns of haemodynamicresponses or to the unfamiliarity of the support provider.For some time, impedance cardiography has been used to illuminate the

underlying mechanisms involved in the physiological stress response, butfew social support researchers have recognised its potential utility. The findingsof the present study suggest that individual differences in physiologicalresponse patterns should be considered along with behavioural predispositions.The findings also suggest that individual differences in the tendency to perceive

488 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

other’s behaviour as supportive may be more important in mediating thebeneficial effects of social support than actual enacted supportive behaviours.

Acknowledgements

This article forms part of a doctoral dissertation by Trini Closa Leon at theUniversity of Birmingham. The authors wish to thank Louise Shackleton andJoanne Lloyd for their assistance with data collection.

References

Allen, K. M., Blascovich, J., Tomaka, J., & Kelsey, R. M. (1991). Presence of human friends andpet dogs as moderators of autonomic responses to stress in women. Journal of Personality and

Social Psychology, 61, 582–589.Anthony, J. L., & O’Brien, W. H. (1999). An evaluation of the impact of social support

manipulations on cardiovascular reactivity to laboratory stressors. Behavioral Medicine, 25,78–87.

Barefoot, J. C., Dodge, K. A., Peterson, B. L., Dahlstrom, W. G., & Williams, R. B. (1989). TheCook-Medley hostility scale: Item content and ability to predict survival. Psychosomatic

Medicine, 51, 46–57.Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance and mortality: A nine year

follow up study of Alameda county residents. American Journal of Epidemiology, 109, 186–204.Burg, M. M., Barefoot, J., Berkman, L., Catellier, D. J., Czajkowski, S., Saab, P., et al. (2005).

Low perceived social support and post-myocardial infarction prognosis in the enhancingrecovery in coronary heart disease clinical trial: the effects of treatment. Psychosomatic Medicine,67, 879–888.

Cacioppo, J. T., & Hawkley, L. C. (2003). Social isolation and health, with an emphasis onunderlying mechanisms. Perspectives in Biology and Medicine, 46, S39–S52.

Carels, R. A., Szczepanski, R., Blumenthal, J. A., & Sherwood, A. (1998). Blood pressure reactivityand marital distress in employed women. Psychosomatic Medicine, 60, 639–643.

Christenfeld, N., & Gerin, W. (2000). Social support and cardiovascular reactivity. Biomedicine and

Pharmacotherapy, 54, 251–257.Christenfeld, N., Glynn, L. M., & Gerin, W. (2000). On the reliable assessment of cardiovascular

recovery: An application of curve-fitting techniques. Psychophysiology, 37, 543–550.Christenfeld, N., Gerin, W., Linden, W., Sanders, M., Mathur, J., Deich, J., et al. (1997). Social

support effects on cardiovascular reactivity: Is a stranger as effective as a friend? Psychosomatic

Medicine, 59, 388–398.Collins, N. L., & Miller, L. C. (1994). Self-disclosure and liking: A meta-analytic review.

Psychological Bulletin, 116, 457–475.Cook, W. W., & Medley, D. M. (1954). Proposed hostility and pharisaic-virtue scales for the

MMPI. The Journal of Applied Psychology, 38, 414–418.Cutrona, C. E., & Russell, D. W. (1990). Type of social support and specific stress: Toward

a theory of optimal matching. In B. R. Sarason, I. G. Sarason & G. R. Pierce (Eds),Social Support: An Interactional View (p. 319). New York: Wiley.

Daly, L. E., & Bourke, G. J. (2000). Interpretation and uses of medical statistics (5th ed.). Oxford:Blackwell.

Dancey, C. P., & Reidy, J. (2004). Statistics without maths for psychology (3rd ed.). London: PrenticeHall.

Support reactivity and recovery 489

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

Earle, T. L., Linden, W., & Weinberg, J. (1999). Differential effects of harassment oncardiovascular and salivary cortisol stress reactivity and recovery in women and men.Journal of Psychosomatic Research, 46(2 Suppl), 125–141.

Edens, J. L., Larkin, K. T., & Abel, J. L. (1992). The effect of social support and physical touchon cardiovascular reactions to mental stress. Journal of Psychosomatic Research, 36(4 Suppl),371–381.

Ewart, C. K., & Kolodner, K. B. (1993). Predicting ambulatory blood pressure during school:Effectiveness of social and nonsocial reactivity tasks in black and white adolescents.Psychophysiology, 30, 30–38.

Fontana, A. M., Diegnan, T., Villeneuve, A., & Lepore, S. J. (1999). Non-evaluative social supportreduces cardiovascular reactivity in young women during acutely stressful performancesituations. Journal of Behavioral Medicine, 22, 75–91.

Fritz, H. L., Nagurney, A. J., & Helgeson, V. S. (2003). Social interactions and cardiovascularreactivity during problem disclosure among friends. Personality and Social Psychology Bulletin, 29,713–725.

Gallo, L. C., Smith, T. W., & Kircher, J. C. (2000). Cardiovascular and electrodermal responses tosupport and provocation: Interpersonal methods in the study of psychophysiological reactivity.Psychophysiology, 37, 289–301.

Ganster, D. C., Schaubroeck, J., Sime, W. E., & Mayes, B. T. (1991). The nomological validityof the type-A Personality among employed adults. Journal of Applied Psychology, 76, 143–168.

Gerin, W., & Pickering, T. G. (1995). Association between delayed recovery of blood pressure afteracute mental stress and parental history of hypertension. Journal of Hypertension, 13, 603.

Gerin, W., Pieper, C., Levy, R., & Pickering, T. G. (1992). Social support in social interaction:A moderator of cardiovascular reactivity. Psychosomatic Medicine, 54, 324–336.

Glynn, L. M., Christenfeld, N., & Gerin, W. (1999). Gender, social support, and cardiovascularresponses to stress. Psychosomatic Medicine, 61, 234–242.

Glynn, L. M., Christenfeld, N., & Gerin, W. (2002). The role of rumination in recovery fromreactivity: Cardiovascular consequences of emotional states. Psychosomatic Medicine, 64,714–726.

Greenwood, D. C., Muir, K. R., Packham, C. J., & Madeley, R. J. (1996). Coronary heart disease:A review of the role psychosocial stress and social support. Journal of Public Health Medicine, 18,221–231.

Haynes, S. N., Gannon, L. R., Orimoto, L., O’Brien, W. H., & Brandt, M. (1991).Psychophysiological assessment of post-stress recovery. Psychological Assessment: A Journal of

Consulting and Clinical Psychology, 3, 356–365.Hines, E., & Brown, G. (1936). The cold pressor test for measuring the reactibility of blood

pressure: Data concerning 571 normal and hypertensive subjects. American Heart Journal, 11,1–9.

Hocking-Schuler, J. L., & O’Brien, S. W. H. (1997). Cardiovascular recovery from stress andhypertension risk factors: A meta-analytic review. Psychophysiology, 34, 649–659.

House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241,540–545.

Julius, S. (1988). The blood pressure seeking properties of the central nervous system. Journal ofHypertension, 6, 177–185.

Kamarck, T. W., Manuck, S. B., & Jennings, J. R. (1990). Social support reduces cardiovascularreactivity to psychological challenge: A laboratory model. Psychosomatic Medicine, 52, 42–58.

Kamarck, T. W., Annunziato, B., & Amateau, L. M. (1995). Affiliation moderates the effects ofsocial threat on stress-related cardiovascular responses: Boundary conditions for a laboratorymodel of social support. Psychosomatic Medicine, 57, 183–194.

Kamarck, T. W., Jennings, J. R., Debski, T. T., Glickman-Weiss, E., Johnson, P. S., Eddy, M. J.,et al. (1992). Reliable measures of behaviorally-evoked cardiovascular reactivity froma PC-based test battery: Results from student and community samples. Psychophysiology, 29,17–28.

490 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

Kasprowicz, A. L., Manuck, S. B., Malkoff, S. B., & Krantz, D. S. (1990). Individual differences inbehaviorally evoked cardiovascular response: Temporal stability and hemodynamic patterning.Psychophysiology, 27, 605–619.

Kiecolt-Glaser, J. K., & Greenberg, B. (1984). Social support as a moderator of the after effectsof stress in female psychiatric inpatients. Journal of Personality and Social Psychology, 93,192–199.

Krantz, D. S., & Manuck, S. B. (1984). Acute psychophysiologic reactivity and riskof cardiovascular disease: A review and methodologic critique. Psychological Bulletin, 96,435–464.

Lai, J., & Linden, W. (1992). Gender, anger expression style, and opportunity for anger releasedetermine cardiovascular reaction to and recovery from anger provocation. Psychosomatic

Medicine, 54, 297–310.Lawler, K. A., Kline, K., Adlin, R., Wilcox, Z., Craig, F., Krishnamoorthy, J., et al. (2001).

Psychophysiological correlates of individual differences in patterns of hemodynamic reactivity.International Journal of Psychophysiology, 40, 93–107.

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.Lepore, S. J. (1998). Problems and prospects for the social support-reactivity hypothesis.

Annals of Behavioral Medicine, 20(4 Special Issue), 257–269.Lepore, S. J., Allen, K. A. M., & Evans, G. W. (1993). Social support lowers cardiovascular

reactivity to an acute stressor. Psychosomatic Medicine, 55, 518–524.Light, K. C., Turner, J. R., Hinderliter, A. L., Girdler, S. S., & Sherwood, A. (1994).

Comparison of cardiac versus vascular reactors and ethnic groups in plasmaepinephrine and norepinephrine responses to stress. International Journal of Behavioral

Medicine, 1, 229–246.Manuck, S. B. (1994). Cardiovascular reactivity in cardiovascular disease: ‘‘Once more unto the

breach’’. International Journal of Behavioral Medicine, 1, 4–31.Manuck, S. B., Kasprowicz, A. L., & Muldoon, M. (1990). Behaviorally-evoked cardiovascular

reactivity and hypertension: Conceptual issues and potential associations. Annals of BehavioralMedicine, 12, 17–29.

McCaffery, J. M., Muldoon, M. F., Bachen, E. A., Jennings, J. R., & Manuck, S. B. (2000).Behaviorally-evoked plasma catecholamine response and 24-hour excretion of urinarycatecholamines among cardiac and vascular reactors. Biological Psychology, 52, 53–69.

Mookadam, F., & Arthur, H. M. (2004). Social support and its relationship to morbidity andmortality after acute myocardial infarction: Systematic overview. Archives of Internal Medicine,164, 1514–1518.

Obrist, P. A., Light, K. C., James, S. A., & Strogatz, D. S. (1987). Cardiovascular responses tostress: I. Measures of myocardial response and relationship to high resting systolic pressure andparental hypertension. Psychophysiology, 24, 65–78.

Orth-Gomer, K. (1994). International epidemiological evidence for a relationship between socialsupport and cardiovascular disease. In S. Shumaker & S. Czajkowski (Eds), Social support andcardiovascular disease (pp. 97–117). New York: Plenum Press.

Papillo, J. F., & Shapiro, D. (1990). The cardiovascular system. In L. G. Tassinary (Ed.),Principles of Psychophysiology: Physical, Social and Inferential Elements (pp. 456–512). Cambridge:Cambridge University Press.

Rusting, C. L., & Nolen-Hoeksema, S. (1998). Regulating responses to anger: Effects ofruminationn and distraction on angry mood. Journal of Personality and Social Psychology, 74,790–803.

Sarason, I. G., Sarason, B. R., Shearin, E. N., & Pierce, G. R. (1987). A brief measure ofsocial support: Practical and theoretical implications. Journal of Social and Personal Relationships,4, 497–510.

Schwartz, A. R., Gerin, W., Christenfeld, N., Glynn, L. M., Davidson, K., & Pickering, T. G.(2000). Effects of an anger-recall task on post-stress rumination and blood pressure recoveryin men and women. Psychophysiology, 37(suppl 1), S12–S13.

Support reactivity and recovery 491

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5

Sheffield, D., & Carroll, D. (1994). Social support and cardiovascular reactions to active laboratorystressors. Psychology and Health, 9, 305–316.

Sheffield, D., & Carroll, D. (1996). Task-induced cardiovascular activity and the presence ofa supportive or undermining other. Psychology and Health, 11, 583–591.

Sherwood, A. (1991). Use of impedance cardiography in cardiovascular reactivity research.Paper presented at the Cardiovascular reactivity to psychological stress & disease, Buffalo; NY.

Siegman, A. W., Dembroski, T. M., & Ringel, N. (1987). Components of hostility and the severityof coronary artery disease. Psychosomatic Medicine, 49, 127–135.

Simes, R. J. (1986). An improved Bonferroni procedure for multiple tests of significance.Biometrica, 73, 751–754.

Snydersmith, M. A., & Cacioppo, J. T. (1992). Parsing complex social factors to determinecomponent effects: I. Autonomic activity and reactivity as a function of human association.Journal of Social and Clinical Psychology, 11, 263–278.

Stroebe, M. S., & Stroebe, W. (1983). Who suffers more? Sex differences in health risks of thewidowed. Psychological Bulletin, 93, 279–301.

Suarez, E. C., & Williams, R. B. (1990). The relationships between dimensions of hostilityand cardiovascular reactivity as a function of task characteristics. Psychosomatic Medicine, 52,558–570.

Sukhodolsky, D. G., Golub, A., & Cromwell, E. N. (2001). Development and validation of theanger rumination scale. Personality and Individual Differences, 31, 689–700.

Suls, J., & Wan, C. K. (1993). The relationship between trait hostility and cardiovascular reactivity:A quantitative review and analysis. Psychophysiology, 30, 615.

Tabachnik, B. G., & Fidell, L. S. (2001). Using Multivariate Statistics (4th ed.) Boston: Allyn andBacon.

Thorsteinsson, E. B., & James, J. J. (1999). A meta-analysis of the effects of experimentalmanipulations of social support during laboratory stress. Psychology and Health, 14, 869–886.

Uchino, B. N., & Garvey, T. S. (1997). The availability of social support reduces cardiovascularreactivity to acute psychological stress. Journal of Behavioral Medicine, 20, 15–27.

Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J. K. (1996). The relationship between socialsupport and physiological processes: A review with emphasis on underlying mechanisms andimplications for health. Psychological Bulletin, 119, 488–531.

Uno, D., Uchino, B. N., & Smith, T. W. (2002). Relationship quality moderates the effect of socialsupport given by close friends on cardiovascular reactivity in women. International Journal ofBehavioral Medicine, 9, 243–262.

492 T. Closa Leon et al.

Dow

nloa

ded

by [

Tri

ni C

losa

Leo

n] a

t 15:

32 1

7 M

arch

201

5