Defining Healthy Masculinity & How to Build It | Terry Real

In research on Type A personality and cardiovascular disease, individuals who suppress and hold their emotions inside have higher early heart attack mortality compared to those who express emotions outwardly.

"that original typing of people who tend to die early from heart attack, it was the people who hold it inside. It was about people who who manage a lot, do a lot, but hold inside. And it's kind of interesting because the ones that turned out, and I'm not suggesting people do that, screamed and yelled a lot. That that catharsis actually helped them in terms of longevity." (said at 0:22:39)

The speaker conflates the original 'Type A' behavioral concept with subsequent research on anger coping ('anger-in' vs. 'anger-out') and 'Type D' (distressed/inhibited) personality. The original Type A pattern described by Friedman and Rosenman was characterized by outward competitiveness, time urgency, and hostility, rather than emotional suppression. Prospective observational studies, such as the Tecumseh Community Health Study (PMID 3728438) and CAD cohort studies (PMID 20494661), did find that suppressing anger ('anger-in') was associated with higher all-cause mortality (OR 1.7–2.0) and cardiac events (OR 2.87 for cardiac death/MI) compared to outward anger expression. However, claiming that outward screaming and yelling ('catharsis') promotes longevity overstates the findings, as explosive anger and hostility are well-established acute triggers and risk factors for adverse cardiovascular events.

• partial: Anger, suppressed anger, and risk of adverse events in patients with coronary artery disea… (The American journal of cardiology 2010) · cited 86x in the literature

  "However, suppressed anger remained associated with the more rigorous end point of cardiac death or myocardial infarction (odds ratio 2.87, 95% confidence interval 1.15 to 7.15, p = 0.024) after controlling for decreased systolic function, poor exercise tolerance, extent of CAD, and revascularization." (abstract, results, passage verified)

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• partial: Anger-coping types, blood pressure, and all-cause mortality: a follow-up in Tecumseh, Mich… (American journal of epidemiology 1986) · cited 110x in the literature

  "Subjects who indicated that they were likely to suppress their anger in response to two hypothetical anger-provoking situations had 1.7 times the mortality risk of those who expressed their anger (95% confidence interval (CI) = 1.03-3.05). Subjects who suppressed their anger when unjustifiably confronted by their spouse had twice the mortality risk of those who expressed their anger (95% CI = 1.13-3.38)." (abstract, results, passage verified)

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Thousands of peer-reviewed studies show that mindfulness meditation improves focus, mood, and stress and anxiety management.

"And by now, there are thousands of quality peer-reviewed studies that emphasize how useful mindfulness meditation can be for improving our focus, managing stress and anxiety, improving our mood, and much more." (said at 1:53:43)

Mindfulness-based interventions (such as MBSR) are supported by systematic reviews and randomized controlled trials demonstrating small-to-moderate benefits for anxiety, depressive symptoms/mood, and stress. However, the speaker's claim of 'thousands of quality peer-reviewed studies' is an overstatement of the volume of rigorous evidence. Landmark meta-analyses (e.g., Goyal et al., 2014) screened over 18,000 citations but identified only 47 randomized controlled trials with active controls meeting rigorous standards, noting low or insufficient evidence for positive mood and attention/focus compared to active controls. Subsequent cognitive meta-analyses also show modest or mixed effects on attention and executive function.

• partial: Meditation programs for psychological stress and well-being: a systematic review and meta-… (JAMA internal medicine 2014) · cited 2355x in the literature

  "Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight." (abstract, results, passage verified)

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• partial: Mindfulness induction and cognition: A systematic review and meta-analysis. (Consciousness and cognition 2020) · cited 106x in the literature

  "A total of 34 studies were included. The outcomes were categorized into four cognitive domains: attentional functioning, memory, executive functioning and higher-order function. A small effect was found across all cognitive domains (Hedges' g = 0.18, 95% IC = 0.07-0.29). Separated analyses for each cognitive domain revealed an effect only in higher-order cognitive functions" (abstract, results, passage verified)

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