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Higher self‐reported rumination, a common form of trait perseverative cognition, is linked with lower resting heart rate variability (HRV), which indicates poorer cardiac function and greater disease risk. A meta‐analysis and systematic review indicated that in samples with fewer European Americans, the association of rumination with both heart rate and blood pressure was stronger. Thus, trait rumination may be more strongly associated with resting HRV among ethnically minoritized populations. The current study investigated whether differences in the association of self‐reported rumination with resting HRV varied by ethnicity in a sample (N = 513; Mage = 19.41; 226 Women) of self‐identified African Americans (n = 110), Asian Americans (n = 84), and European Americans (n = 319). Participants completed a five‐minute baseline period to assess resting HRV, followed by the Ruminative Responses Scale, which contains three facets of rumination including brooding, depressive, and reflective rumination. On average, Asian Americans reported higher levels of rumination relative to European Americans. African Americans had higher resting HRV than Asian Americans. Adjusting for covariates, higher self‐reported rumination was significantly associated with lower resting HRV in both African and Asian Americans, but not significantly so in European Americans. This finding was consistent for brooding and reflective, but not depressive rumination. Overall, this study lends insight into a psychological mechanism—rumination—that may impact health disparities among ethnically minoritized individuals, contributing to an understanding of how stress gets under the skin among such minoritized populations. [ABSTRACT FROM AUTHOR]

Worry is an important mediator in the relation between stressors and health. This pilot study examined whether a smartphone-based in time worry-reduction training was feasible and improved physiological health (i.e. increased heart rate variability [HRV]). A total of 26 high-worriers were randomised to an experimental or active-control condition (EC and CC respectively). Participants in both conditions registered emotions 5 times daily for a month. The EC additionally received worry-reduction training with mindfulness exercises. Primary outcomes were feasibility and HRV measured at baseline, after 2 weeks (halfway), and at 4 weeks (post-intervention). Both training conditions were feasible and well received. HRV increased in the EC and CC, but this increase did not differ between conditions. Preliminary findings suggest that both training conditions are feasible and might improve HRV, which is an important predictor of cardiovascular disease. This pilot study only provided preliminary evidence, but it laid the groundwork for future randomised controlled trials that ought to include more participants and a waitlist control group in order to get more definitive evidence of the effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

Abstract: Self‐esteem moderates the relationship between stress and (cardiovascular) health, with low self‐esteem potentially exacerbating the impact of stressors. Boosting self‐esteem may therefore help to buffer against stress. Subliminal evaluative conditioning (SEC), which subliminally couples self‐words with positive words, has previously been successfully used to boost self‐esteem, but the existing studies are in need of replication. In this article, we aimed to replicate and extend previous SEC studies. The first 2 experiments simultaneously examined whether SEC increased self‐esteem (Experiment 1, n = 84) and reduced cardiovascular reactivity to a stressor in high worriers (Experiment 2, n = 77). On the basis of these results, the 3rd experiment was set up to examine whether an adjusted personalized SEC task increased self‐esteem and reduced cardiac activity in high worriers (n = 81). Across the 3 experiments, no effects were found of SEC on implicit or explicit self‐esteem or affect or on cardiovascular (re)activity compared to a control condition in which the self was coupled with neutral words. The results do not support the use of the subliminal intervention in its current format. As stress is highly prevalent, future studies should focus on developing other cost‐effective and evidence‐based interventions. [ABSTRACT FROM AUTHOR]

Objectives: Several studies have shown that perseverative, worrisome thoughts are prospectively related to subjective health complaints (SHC) and that a short worry postponement intervention can decrease these complaints. As SHC and worry are prevalent and costly, we tested whether the intervention can be offered online to reduce these complaints in the general population.Design: A randomized parallel-group trial was conducted with self-selected participants from the general population.Methods: Via the research website, 996 participants were instructed to register their worrying for 6 consecutive days. The intervention group was instructed to postpone worry to a special 30-min period in the early evening. The Subjective Health Complaints inventory, as administered before and after the intervention, and daily worry frequency and duration were considered the primary outcomes.Results: Three hundred and sixty-one participants completed the study. Contrary to our expectation, the registration group (n = 188) did not differ from the intervention group (n = 163) in SHC (ηp² = .000, CI [0.000-0.003]), or in worry frequency or duration. Nevertheless, the different worry parameters were moderately related to SHC (r between .238 and .340, p ≤ .001).Conclusions: In contrast to previous studies using pen-and-pencil versions of the worry postponement intervention, this study suggests that a direct online implementation was not effective in reducing SHC and worry. Overall, participants had high trait worry levels and reported difficulty with postponing worrying. Reducing SHC and worries via the Internet might require more elaborate interventions that better incorporate the advantages of delivering interventions online.Statement Of Contribution: What is already known on this subject? The perseverative cognition hypothesis argues that perseverative cognition, such as worry and rumination, acts as a mediator by which psychosocial stress may produce negative health effects. Prior research has indeed shown that worry and subjective health complaints (SHC) are prospectively related, but causality studies - that is, showing that changes in worry induce changes in health outcomes - are scarce and have mainly been conducted in young samples. These studies showed that reducing worry, using a worry postponement intervention, can reduce daily worrying and SHC. What does this study add? Trait and daily worrying are associated with SHC. An online worry postponement intervention is ineffective in reducing worry and SHC. Paper-and-pencil interventions cannot directly be used as online interventions. [ABSTRACT FROM AUTHOR]

Objectives In this study, we tested whether high levels of daily worrying are associated with linking, a tendency to overvalue the attainment of specific lower level goals for attaining higher level goals, and more specifically the attainment of experiencing happiness. Methods Thirty-two patients suffering from work stress complaints and awaiting a stress management treatment and 31 healthy adults, who formed the comparison group, filled in a goal linking questionnaire and two widely used trait worry questionnaires. Subsequently, they reported the frequency and duration of worry during 14 consecutive days and nights. Results The patients suffering from work stress complaints scored higher on the linking questionnaire and worried almost twice as much as the healthy comparison group, especially during the night-time. Furthermore, goal linking was a stronger predictor of the frequency and duration of worry in daily life than the trait worry questionnaires and this was independent of the observed group differences in daily worry. Conclusions These findings provide evidence that people who believe that their happiness is strongly dependent on the attainment of specific lower level goals worry frequently in daily life. Linking seems to be at least partly responsible for the excessive worry found in high work stress. Practitioner points Worry is elevated in patients seeking professional help for work stress complaints, compared to healthy controls, The higher levels of worry in the patient group were related to elevated tendencies to overvalue the attainment of specific lower level goals as a means to attain higher level goals ('linking')., It could be beneficial for high worriers to learn how to reduce linking tendencies., No strong inferences on the direction of the association between worry and linking can be made, as we relied on correlational data in which a linking questionnaire predicted worry in daily life. [ABSTRACT FROM AUTHOR]

Abstract: Excessive cardiac responses to stressful events are a risk factor for morbidity and mortality. Adverse cardiac responses are usually attributed to conscious negative stress and emotions. Yet, cardiac responses might also be affected by emotions that are not consciously reported. Here we tested this hypothesis. Sixty participants were randomly allocated to an evaluated speaking stressor or control condition. Trait, state and implicit anxiety were assessed with the State Trait Anxiety Inventory, visual analog scales and the Implicit Association Test for assessing anxiety, with the latter two assessed before and after the stressor. Results showed that the stressor did not significantly affect implicit anxiety. Yet, participants with high implicit anxiety after the stressor had an overall enhanced heart rate and larger stressor-induced decreases in heart rate variability. These associations were independent of conscious anxiety. The implications of the results for a better understanding of excessive cardiac activity are discussed. [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]

Abstract: Slow cardiovascular (CV) recovery after stress is a predictor of adverse CV outcomes. Perseverative cognition (PC) about stress has been hypothesized to co-determine slow recovery. In the present study, it was investigated whether two types of trait PC, i.e. trait worry and trait rumination, predicted delayed cardiac recovery after a cognitive stressor. Furthermore, it was examined whether explicit state PC (i.e. negative intrusive thoughts) or implicit state PC (i.e. automatic vigilance) additionally predicted delayed cardiac recovery. Fifty-nine participants performed a stressful task, which consisted of an unsolvable synonym task. After a 6-minute recovery period, participants reported on their level of negative intrusive thoughts (i.e. explicit state PC), and performed a lexical decision task (LDT) to measure automatic vigilance for task-related information (i.e. implicit state PC). Cardiac activity was continuously measured using heart rate (HR) and heart rate variability (HRV). Trait worry and rumination were measured by the Penn State Worry Questionnaire (PSWQ) and the Ruminative Response Scale (RRS), respectively. The results showed that high trait worriers had a slower HR recovery from the cognitive stressor compared to low trait worriers. They also showed delayed HRV recovery, but only when the tendency to dwell upon one''s negative mood (the ‘brooding’ subscale of the RRS) was low. Slow HR recovery was associated with high levels of negative intrusive thoughts and with automatic vigilance, but in the unexpected direction for the latter. These results provide evidence that delayed cardiac recovery is associated with trait as well as state PC, and suggest that brooding attenuates the HRV suppressing effect of high trait worry. [Copyright &y& Elsevier]

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: 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: Stress and anxiety are risk factors for cardiovascular (CV) disease. Worry might be a mediator of their risks by prolonging their cognitive representation and concomitant CV activity. We hypothesized that daily stressors and worry, and trait anxiety and trait worry would be associated with high heart rate (HR) and low heart rate variability (HRV) during waking and the subsequent nocturnal sleep period, and that worry would mediate the effects of daily stressors. Low HRV and high HR are physiological risk factors for CV disease. Using an hourly diary, stressors, worry frequency and duration, and biobehavioral variables were measured during one day in 52 healthy subjects. During this time and the subsequent nocturnal sleep period, ambulatory ECG was measured. Stressors, worry and traits were related to higher HR and lower HRV during waking, and the effects of stressors and worry were extended into the sleeping period. Worry duration mediated the effects of stressors. The results were largely independent of biobehavioral variables including sleep quality. The results support the notion that worry, by prolonging CV activity, is a mediator of the CV risks of stress. They also imply a role for unconscious cognitive representation of stress. [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: 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]

An introduction is presented in which the editor discusses various reports published within the issue on brain-body interactions in perseverative cognition.

Stress, whether daily stress, work stress or traumatic stress, is unhealthy. This lecture covers three recent theoretical approaches in explaining the mechanisms underlying the influence of psychological stress on somatic health. It is argued that stress research should focus less on stressors themselves and put more emphasis on prolonged stress responses. Three mechanisms are identified that cause this unhealthy prolonged stress response: first, the partly-proven mechanism of perseverative cognition; second, the mechanism of unconscious stress, which is currently being explored; and third, the notion of the stress response being a default response that is inhibited only when safety is perceived. All three mechanisms are deeply rooted in millions of years of our evolution. Although the dangers of the past have virtually disappeared, many of us remain ever at the ready for events that never happen. [ABSTRACT FROM AUTHOR]

Abstract: This study examined the psychological processes that may impede or facilitate cardiovascular recovery. It was hypothesized that cardiovascular recovery would be hampered by negative affect and rumination, and facilitated by positive affect. In an experimental study, stress was elicited by exposing participants (N =110) to a mental arithmetic task with harassment. After the stress task, affective levels were manipulated via a movie scene with negative, neutral, or positive emotional valence, or without an affect manipulation (control condition). During the entire experiment, heart rate and systolic and diastolic blood pressure levels were measured continuously. Results indicated that blood pressure recovery was hampered by the negative affect manipulation and by rumination. However, the positive affect manipulation did not facilitate blood pressure recovery. No effects were found on heart rate recovery. In sum, the findings emphasize the importance of negative affect and rumination in stress recovery. [Copyright &y& Elsevier]

Rumination about the past and worries about the future (perseverative cognition) are extremely common, although pervasive and distressing, dysfunctional cognitive processes. Perseverative cognition is not only implicated in psychological health, contributing to mood worsening and psychopathology but, due to its ability to elicit prolonged physiological activity, is also considered to play a role in somatic health. Although there is emerging evidence that such negative and persistent thoughts have consequences on the body, this association has not yet been quantified. The aim of this study was to meta-analyze available studies on the physiological concomitants of perseverative cognition in healthy subjects. Separate meta-analyses were performed on each examined physiological parameter. Sixty studies were eligible for the analyses. Associations emerged between perseverative cognition and higher systolic blood pressure (SBP) (g = .45) and diastolic blood pressure (DBP) (g = .51) in experimental studies, and higher heart rate (HR) (g = .28 and g = .20) and cortisol (g = .36 and g = .32), and lower heart rate variability (HRV) (g = .15 and g = .27) in experimental and correlational studies, respectively. Significant moderators were sex, ethnicity, type of induction used to elicit perseverative cognition, assessment of state versus trait perseverative cognition, focus on worry or rumination, duration of physiological assessment, and quality of the studies. With the exception of blood pressure, results were not influenced by publication bias. Results show that perseverative cognition affects cardiovascular, autonomic, and endocrine nervous system activity, suggesting a pathogenic pathway to long-term disease outcomes and clarifying the still unexplained relationship between chronic stress and health vulnerability. [ABSTRACT FROM AUTHOR]