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An experiment was conducted to test whether a cognitive bias in the processing of information on spiders caused fear in children. The reactions of a group of children classified as spider fearing and non-spider fearing to spider related matters were observed. The children were also subjected to a card format and single-trial format of the Stroop test to determine the degree of bias being exhibited by their cognitive processes. Resulsts showed that fear of spiders in children is not due to a bias in the processing of knowledge. Both groups to receive information about spiders were also observed to favor spider-related information.

Trait anxiety fails to show any relationship with threat-related cognitive processing bias in children, in spite of their state anxiety. Two related studies show that high and low anxious children exhibit high priority towards information processing related to physical harm. They show processing bias for threatening information under nonstressful conditions, while such bias is absent under stressful conditions. High anxious girls exhibit processing bias for threatening information, which gradually diminishes in the presence of stressor.

Based on neurobiological and evolutionary arguments, the generalized unsafety theory of stress (GUTS) hypothesizes that the stress response is a default response, and that chronic stress responses are caused by generalized unsafety (GU), independent of stressors or their cognitive representation. Three highly prevalent conditions are particularly vulnerable to becoming ‘compromised’ in terms of GU, and carry considerable health risks: (1) ‘Compromised bodies’: in conditions with reduced bodily capacity, namely obesity, low aerobic fitness and older age, GU is preserved due to its evolutionary survival value; (2) ‘Compromised social network’: in loneliness the primary source of safety is lacking, i.e. being part of a cohesive social network; (3) ‘Compromised contexts’: in case of specific stressors (e.g. work stressors), daily contexts that are neutral by themselves (e.g. office building, email at home) may become unsafe by previously being paired with stressors, via context conditioning. Thus, GUTS critically revises and expands stress theory, by focusing on safety instead of threat, and by including risk factors that have hitherto not been attributed to stress. [ABSTRACT FROM AUTHOR]

From a combined neurobiological and evolution-theoretical perspective, the stress response is a subcortically subserved response to uncertainty that is not 'generated' but 'default': the stress response is 'always there' but as long as safety is perceived, the stress response is under tonic prefrontal inhibition, reflected by high vagally mediated heart rate variability. Uncertainty of safety leads to disinhibiting the default stress response, even in the absence of threat. Due to the stress response's survival value, this 'erring on the side of caution' is passed to us via our genes. Thus, intolerance of uncertainty is not acquired during the life cycle, but is a given property of all living organisms, only to be alleviated in situations of which the safety is learned. When the latter is deficient, generalized unsafety ensues, which underlies chronic anxiety and stress and their somatic health risks, as well as other highly prevalent conditions carrying such risks, including loneliness, obesity, aerobic unfitness and old age. [ABSTRACT FROM AUTHOR]

Abstract: The Penn State Worry Questionnaire (PSWQ) is a widely used self report scale to assess pathological worry. Several studies have shown that the paper-and-pencil version of the PSWQ shows satisfactory psychometric properties. Yet, it is unknown whether the PSWQ is suited to be administered on Internet. As the amount of assessments conducted online is vastly increasing, we examined the factor structure, predictive validity and reliability of the online version of the PSWQ in a large community sample (N =1025). Confirmatory factor analyses demonstrated that the best fit to the data was provided by a one factor model wherein the reverse-worded items also loaded on a separate method factor. In a second part of the study a self-selected subsample of the total sample (n =189) kept a log of the frequency and duration of worry episodes for six consecutive days. Worry frequency and worry duration were both predicted by the PSWQ, thereby lending support to its predictive validity. These findings provide preliminary evidence that the online version of the PSWQ possesses psychometric properties that are similar to the paper-and-pencil version. [Copyright &y& Elsevier]

Abstract: Prolonged physiological activity is believed to be a key factor mediating between stress and later disease outcomes. Few studies, however, have investigated the crucial psychological factors that cause prolonged activity. This article proposes that conscious as well as unconscious perseverative cognition are the critical factors. Perseverative cognition indicates repetitive or sustained activation of cognitive representations of past stressful events or feared events in the future. In daily life, most prolonged physiological activity is not due to stressful events but to perseverative cognition about them. We and others have already found evidence that conscious perseverative cognition, i.e., worry, has physiological effects, in both laboratory and real life settings, and that perseverative cognition mediates prolonged responses to stressful events. Yet, there are convincing reasons to expect that unconscious perseverative cognition has an even larger role in stress-related prolonged activity. Firstly, since the greater part of cognitive processing operates without awareness, a considerable part of perseverative cognition is likely to be unconscious too. People may not be aware of most of their stress-related cognitive processes. Secondly, our recent studies have shown that increased activity of the autonomic nervous system continues after conscious perseverative cognition has stopped: It goes on for several hours and even during sleep. This and several other findings suggest that a considerable part of increased physiological activity may be due to unconscious perseverative cognition. The article closes with suggesting methods to test unconscious perseverative cognition and ways to change it, and concludes with stating that the notion of unconscious perseverative cognition potentially opens an entirely new area within stress research. [Copyright &y& Elsevier]

Abstract: In daily life, not stressful events themselves but their sustained cognitive representation is likely to cause prolonged physiological activity, which is believed to lead to a pathogenic state and finally somatic disease. The typically human ability to make cognitive representations of past stressful events (rumination) or feared events in the future (worry) is called perseverative cognition (PC). PC is associated with increased activity in various bodily systems, and there is emerging evidence that it mediates the prolonged effects of stressors on physiology and on disease. Yet, there are strong reasons to believe that people may not be aware of the greater part of their stress-related cognitive processes, while several studies suggest that these processes may still cause increased physiological activity, during sleep as well as during waking. This may imply that unconscious PC is an even more important source of prolonged stress-related activity than conscious PC. Thus, ‘unconscious stress’ research has the potential to become a new important area and may yield new important markers of chronic stress. [ABSTRACT FROM AUTHOR]

Worry has been associated with adverse mental and somatic health outcomes, which have been attributed to the pathogenic physiological activity caused by worry. However, experimental evidence is scarce, and existing studies did not address whether the physiological effects of worry do actually exceed those of mere mental load during cognitive problem solving. In the present experiment, heart rate (HR) and heart rate variability (HRV) of fifty-three participants were continuously measured during induced worrying, problem solving concerning issues that were not personally relevant, and relaxation. The results showed that HR was higher and HRV lower during both worrying and problem solving than during relaxation. Differences in emotional responses did not account for these results. This suggests that mere mental load is responsible for - at least a part of - the physiological effects of worry. Consequently, long term health effects of worry might be due to prolonged mental load of worry rather than to its emotional aspects. [ABSTRACT FROM AUTHOR]

Abstract: Recent work suggests that the ability to disengage attention from threatening information is impaired in people who suffer from anxiety and dysphoria. It has been suggested that this impaired ability to disengage from threat might specifically be associated with the tendency to perseverate about threat (i.e., worry), which is a main characteristic of anxiety disorders and a wide range of other psychopathologies. However, no studies have yet addressed this issue. The present study examined whether trait worry as well as worry intensity after experimental worry induction are associated with impaired ability to disengage attention from threatening cues (angry faces), independently from or in conjunction with anxiety. Sixty-one participants performed a visual cueing experiment that required detection of a target stimulus at one of two possible locations. Prior to the target neutral, happy or angry facial cues appeared at one of these two locations; when there is a relatively long period between the cue and the target (>300ms), an overall faster responding to invalidly cued trials relative to validly cued trials is believed to indicate inhibition of return (IOR) to a recently attended location. A reduced IOR for angry faces was only found when both trait worry and anxiety were high. When anxiety was kept constant, both trait worry and state worry were associated with enhanced IOR for neutral faces instead. The results seem to suggest that specific threat-related deficiencies in IOR may be a function of the co-occurrence of worry and anxiety. [Copyright &y& Elsevier]

Abstract: Objectives: Psychobiological sensitization and health worry appear to be involved in the etiology of clinical manifestations of subjective health complaints (SHCs) via amplified processing of health-related information. However, it is not clear whether sensitization and health worry are also associated with common SHCs, which are extremely prevalent and are responsible for a large part of both human suffering and health care costs. In this study, we investigated whether SHCs are associated with health worry and two types of sensitization: cognitive health-related sensitization and somatic sensitization. We also examined whether health worry mediates the relationship between cognitive sensitization and SHCs and whether both levels of sensitization interact. Methods: A nonclinical sample of 47 female students completed questionnaires about their recent subjective health as well as health worry and underwent tests for cognitive sensitization, operationalized as Stroop interference and free recall performance, and somatic sensitization, operationalized as pain tolerance and pain threshold in a cold pressor task. Results: Severity of health complaints was positively related with recall of health-related stimuli, but not with Stroop interference, and with worrying about health complaints. In addition, worry mediated the relationship between recall bias and severity of health complaints. Both the number and severity of recent health complaints were associated with pain tolerance. Pain threshold was associated with Stroop interference for health-related information. Conclusions: The results suggest that specific types of cognitive sensitization and somatic sensitization are associated with common health complaints and that worrying about one''s complaints might play a role by enhancing biased memory of health-related information. [Copyright &y& Elsevier]

Abstract: Worry is crucial in the development and maintenance of anxiety disorders and has been associated with several other adverse health outcomes. Yet, little is known about the frequency and perseveration of worry in daily life, and its predictability by widely used trait questionnaires. In this study 432 students completed the Penn State Worry Questionnaire (PSWQ), the Worry Domains Questionnaire (WDQ) and the State-Trait Anxiety Inventory-Trait version (STAI-T) and kept a log of worry frequency and duration during six consecutive days and nights. The results showed that worry is a very common phenomenon that is predicted by the two trait worry questionnaires, independent of trait anxiety. The often clinically utilized PSWQ predicted worry duration better than the WDQ, and exclusively predicted night-time worry and several other indices of perseverative and potentially pathogenic worry. Although this study provides some support for the predictive validity of the PSWQ and the WDQ, these questionnaires did not account for the larger part of variance in daily worry. Future studies of worry and its associated perseverative processes should consider using momentary assessments. [Copyright &y& Elsevier]

Abstract: Perseverative cognition, as manifested in worry and rumination, is a common response to stress, but biopsychological models of stress and health have largely ignored it. These models have generally focused on physiological activation that occurs during stress and have insufficiently addressed effects that occur in anticipation of, or following, stressful events. We argue that perseverative cognition moderates the health consequences of stressors because it can prolong stress-related affective and physiological activation, both in advance of and following stressors. We review evidence that worry, rumination, and anticipatory stress are associated with enhanced cardiovascular, endocrinological, immunological, and neurovisceral activity. The findings yield preliminary support for our hypothesis, suggesting that perseverative cognition might act directly on somatic disease via enhance activation via the cardiovascular, immune, endocrine, and neurovisceral systems. [Copyright &y& Elsevier]

Summary: The autonomic nervous system (ANS) plays a role in a wide range of somatic and mental diseases. Using a model of neurovisceral integration, this article describes how autonomic imbalance and decreased parasympathetic tone in particular may be the final common pathway linking negative affective states and conditions to ill health. The central nervous system (CNS) network that regulates autonomic balance (central autonomic network, CAN) is closely related and partially overlaps with networks serving executive, social, affective, attentional, and motivated behavior (anterior executive region, AER; and Damasio''s [Damasio, A.R., 1998. Emotion in the perspective of an integrated nervous system. Brain Res. Rev. 26, 83–86.] ‘emotion circuit’). A common reciprocal inhibitory cortico-subcortical neural circuit serves to regulate defensive behavior, including autonomic, emotional and cognitive features. This inhibitory cortico-subcortical circuit may structurally, as well as functionally, link psychological processes with health-related physiology. When the prefrontal cortex is taken ‘offline’ for whatever reason, parasympathetic inhibitory action is withdrawn and a relative sympathetic dominance associated with disinhibited defensive circuits is released, which can be pathogenic when sustained for long periods. This state is indicated by low heart rate variability (HRV), which is a marker for low parasympathetic activation and prefrontal hypoactivity. Consistent with this, HRV is associated with a range of psychological and somatic pathological conditions, including immune dysfunction. Finally, we discuss supportive evidence from recent studies of the reflexive startle blink, attention and working memory, which shows that low HRV predicts hypervigilance and inefficient allocation of attentional and cognitive resources. [Copyright &y& Elsevier]

Summary: Several theories of the stress-disease link have now incorporated prolonged activation. This article argues that these theories still lack an important element, that is, the cognitive nature of the mechanism that causes stress responses to be sustained. The perception of stress and the initial response to it do not automatically lead to prolonged activation. The active cognitive representations of stressors need to be prolonged in order to extend their physiological concomitants. We call this mediating process perseverative cognition, and it is manifested in phenomena such as worry, rumination, and anticipatory stress. We summarize evidence suggesting that these phenomena are indeed associated with physiological activation, including cardiovascular, endocrinological and immunological parameters. This evidence is still far from sufficient, due to the many methodological insufficiencies in the studies involved. Nevertheless, it makes clear that cognitive phenomena characterized by perseverative cognition may be likely candidates to mediate the effects of stress sources on somatic disease. We also argue that there is a dearth of evidence supporting the role of prolonged activation. There are a limited number of studies demonstrating prolonged activity related to stressors and emotional episodes, and their methodologies often do not allow unambiguous conclusions. Even more important, the crucial assumption that prolonged activation actually leads to pathogenic states and disease has received hardly any attention yet and therefore is still largely unsupported. There are only a few studies that showed that anticipatory responses and slow recovery from stress predicted disease states. [Copyright &y& Elsevier]

Summary: Background: An association between stress and autoimmune thyroid disease (AITD) (especially Graves’ hyperthyroidism) has been reported, but all studies so far on this topic have been retrospective. Objective: To evaluate prospectively the relationship between stress and (i) de novo occurrence of thyroid antibodies and (ii) development of overt autoimmune hyper-/hypothyroidism. Study design: Two nested case–control studies in a prospective cohort of 790 euthyroid women who were 1st or 2nd degree relatives of AITD patients. Follow-up was five year, with annual assessments including questionnaires on stressful life events, daily hassles, and mood. In study A, cases were subjects who developed TPO-Ab but remained euthyroid during follow-up (called event). In study B, cases were subjects who developed overt hypothyroidism (TSH>5.7mU/l and FT4<9.3pmol/l) or overt hyperthyroidism (TSH<0.4mU/l and FT4>20.1pmol/l) during follow-up (called event). For each case, two controls were selected, matched for age and duration of follow-up; controls in study A remained TPO-Ab negative, and in study B remained without overt hyper-/hypothyroidism. Outcomes: Contrast in questionnaire responses between cases and controls at baseline, at one year prior to the event and at time of event. Results: Exposure to stress was not different between subjects who developed or did not develop TPO-Ab (study A). No differences were observed in stress questionnaires between hyper-/hypothyroid cases and controls at any time point, but hypothyroid cases had less negative feelings than controls at the time of diagnosis (study B). Conclusion: The data suggest that stress is not involved in the pathogenesis of AITD. [Copyright &y& Elsevier]

Abstract: Objective: Medically unexplained symptoms (MUSs) are a humanitarian and economic burden. Among them, pain complaints without organic pathology are the most prevalent. Theoretically, activated illness-related memory may cause reporting of symptoms by changing perception and interpretation of bodily signals to the extent that they are not tolerated and become complaints. We tested whether activating illness-related memory without conscious awareness leads to decreased pain tolerance (PT). Methods: Activation of illness-related memory without conscious awareness was manipulated by a subliminal priming technique. Eighty participants were randomly assigned to four conditions, with prime words describing either (a) health complaints (HCs), to activate an illness-related memory, or three control categories: (b) neutral content, (c) general bodily sensations, and (d) negative valence. The latter two conditions were added to test the alternative hypotheses that reduced PT could be observed with the semantic activation of these two components of HCs. We measured PT using a cold pressor task. Results: Participants who were subliminally primed with HC words reported lower PT compared with participants who were primed with neutral words. Priming with the other words did not lead to significantly different effects relative to priming with neutral words. Conclusions: The findings suggest that PT can be involuntarily decreased by activating illness-related memory. This implies partial evidence for a crucial element of a cognitive model of medically unexplained symptoms, which holds that chronically activated illness-related memory causes the development of somatic complaints without observable bodily pathology. [Copyright &y& Elsevier]

Abstract: Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. The understanding of the risk factors for CVD may yield important insights into the prevention, etiology, course, and treatment of this major public health concern. Autonomic imbalance, characterized by a hyperactive sympathetic system and a hypoactive parasympathetic system, is associated with various pathological conditions. Over time, excessive energy demands on the system can lead to premature aging and diseases. Therefore, autonomic imbalance may be a final common pathway to increased morbidity and mortality from a host of conditions and diseases, including cardiovascular disease. Heart rate variability (HRV) may be used to assess autonomic imbalances, diseases and mortality. Parasympathetic activity and HRV have been associated with a wide range of conditions including CVD. Here we review the evidence linking HRV to established and emerging modifiable and non-modifiable CVD risk factors such as hypertension, obesity, family history and work stress. Substantial evidence exists to support the notion that decreased HRV precedes the development of a number of risk factors and that lowering risk profiles is associated with increased HRV. We close with a suggestion that a model of autonomic imbalance may provide a unifying framework within which to investigate the impact of risk factors, including psychosocial factors and work stress, on cardiovascular disease. [Copyright &y& Elsevier]

Abstract: In this study we examined the prospective relationships between perseverative thoughts, internalizing negative emotions, and somatic complaints in children aged 9–13, and evaluated whether a perseverative thoughts intervention had a beneficial effect on these experiences. Children (N =227) from 7 primary schools in Leiden, the Netherlands, recorded their perseverative thoughts during one week, 138 of whom were instructed to postpone these thoughts to a special 30min period in the early evening. Children who had received the postponement instructions showed a reduction in the frequency of perseverative thoughts, and girls also in the duration of them. Girl''s perseverative thoughts were positively associated with the number of somatic complaints and with negative emotions. The postponement intervention also seemed to reduce somatic complaints in the seventh grade children. These findings confirm the previously found prospective relationship between perseverative thoughts and children''s well-being and provide initial validation for the use of the postponement intervention to reduce perseverative thoughts in this age group, particularly for girls. [Copyright &y& Elsevier]

Background: Depression is a major risk factor for cardiovascular disease. An important risk factor for cardiovascular disease, low heart rate variability, often has been found in depressed patients and has been associated with impulsivity. The present study investigated whether experimental lowering of serotonin would decrease heart rate variability and increase impulsivity in remitted depressed patients, in particular in those patients with disturbed impulse control. Methods: Nineteen patients in remission from depression received high-dose and low-dose acute tryptophan depletion in a randomized, counterbalanced, double-blind crossover design. Heart rate variability and impulsivity were assessed during each acute tryptophan depletion session and during a baseline session. Suicidal ideation during past depression was used as an index for individual differences in impulse control. Results: High-dose acute tryptophan depletion led to a larger increase in depressive symptoms than did low-dose acute tryptophan depletion. High-dose acute tryptophan depletion decreased heart rate variability and increased impulsivity and anxiety, but only in patients with a history of suicidal ideation. Symptom effects of high-dose acute tryptophan depletion correlated with low heart rate variability at baseline. Conclusions: Depressed patients who have problems with controlling impulsivity might be more at risk for developing cardiovascular disease, possibly related to increased vulnerability to impaired 5-hydroxytryptamine function. [Copyright &y& Elsevier]

Abstract: This study investigated the effects of a compressed working week with high cognitive and emotional work demands within the population of Dutch Helicopter Emergency Medical Service (HEMS) pilots. Work stressors were measured and levels of well-being were examined before, during and after a series of day and night shifts. Results revealed that (i) the start of a series of day shifts was more taxing for well-being than the start of a series of night shifts, (ii) there were no differences in the decrease in well-being during day and night shifts, (iii) distress during shifts was more strongly related to a decrease in well-being during night than during day shifts and (iv) it took HEMS pilots more time to recover from a series of night shifts than from a series of day shifts. It is concluded that HEMS pilots should not start earlier during day shifts, nor have longer series of night shifts. [Copyright &y& Elsevier]