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Worry postponement, also called stimulus control, is a simple and easy to administer intervention that often forms part of cognitive-behavioural treatments for worry. We conducted a meta-analysis to test if worry postponement is effective in reducing daily worry. Data from 7 randomized trials were included providing a total of 999 participants, of which 250 experienced worry as a burden and of which the majority was women. When comparing worry postponement to the mere registration of worries small effect sizes were observed for worry duration (d = 0.313) and for worry frequency (d = 0.189). Moderation analyses showed that the intervention yielded larger effect sizes in studies including more women. However, long-term follow-up studies are still lacking. Worry postponement, practiced between a week or a maximum of a month, was found to effectively reduce the frequency and duration of worry in daily life. This suggests that a simple intervention is available for people whose worries (temporarily) spiral out of control. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the leading cause of death in the western world. Frequent or chronic reductions in heart rate variability (HRV) are a powerful predictor of cardiovascular disease. Psychological stress has been suggested to be an important factor in the development of reduced HRV. Recently, Verkuil et al. (2016) introduced a laboratory-based method to measure additional HRV reduction in everyday life, and reductions in HRV related to psychological stress. In the current paper, we discuss alternative methods to detect additional HRV reductions, in real life data sets without the necessity of laboratory-based calibration, and even in existing data sets. All of these methods use a subset of 24 h' worth of HRV and movement data to do so: either the first 10 min of every hour, the full 24 h, a combination of 10 min from three consecutive hours, or a classification of level of movement. We also present a method to visualize HRV and movement data to be able to detect episodes of reduced additional HRV optically. The method that used the full 24 h' worth of data detected the largest percentage of episodes of reduced additional HRV that actually match with self-reported stress levels, making this method the most promising. [ABSTRACT FROM AUTHOR]

Stress-related cognitive processes may occur outside of awareness, here referred to as unconscious stress, and affect one's physiological state. Evidence supporting this idea would provide necessary clarification of the relationship between psychological stress and cardiovascular (CV) health problems. We tested the hypothesis that increases in mean arterial pressure (MAP) and total peripheral resistance (TPR) and decreases in heart rate variability (HRV) would be larger when threatening stimuli are presented outside of awareness, or subliminally, compared with neutral stimuli. Additionally, it was expected that trait worry and resting HRV, as common risk factors for CV disease, would moderate the effect. We presented a subliminal semantic priming paradigm to college students that were randomly assigned to the threat ( n = 56) or neutral condition ( n = 60) and assessed changes from baseline of MAP, TPR, and HRV. Level of trait worry was assessed with the Penn State Worry Questionnaire. The findings indicate that CV activity changed according to the hypothesized pattern: A higher MAP and TPR and a lower HRV in the threat condition compared with the neutral condition were found with practically meaningful effect sizes. However, these findings were only statistically significant for TPR. Furthermore, changes in CV activity were not moderated by trait worry or resting HRV. This is the first study to explicitly address the role of subliminally presented threat words on health-relevant outcome measures and suggests that unconscious stress can influence peripheral vascular resistance. [ABSTRACT FROM AUTHOR]

Negative affective information may be presented outside of awareness and change physiological activity. By increasing peripheral physiological activity, subliminally presented negative affective information may contribute to the development of disease. The current systematic review evaluated 65 studies in which negative affective stimuli were presented subliminally to a healthy sample while cardiovascular, electrodermal, electromyographical, hormonal, or immunological activity was measured. Overall, 41% of the tested contrasts indicated significant increases due to negative affective stimuli compared to control stimuli. These effects were most pronounced in fear-conditioning studies measuring skin conductance response amplitude and priming studies measuring systolic blood pressure. However, across the included studies the methodology varied substantially and the number of contrasts per physiological parameter was limited. Thus, although some evidence exists that subliminally presented negative affective stimuli can induce adverse peripheral physiological changes, this has not yet been addressed sufficiently. [ABSTRACT FROM AUTHOR]

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]

Reduced heart rate variability (HRV) is proposed to mediate the relation between depressive symptoms and cardiovascular health problems. Yet, several studies have found that in women depression is associated with higher HRV levels, whereas in men depression is associated with lower HRV levels. So far, these studies have only examined gender differences in HRV levels using a single assessment. This study aimed to test the interactive effects of gender and sadness on ambulatory-assessed HRV levels. A sample of 60 (41 women) employees participated in an ambulatory study. HRV levels (mean of successive differences; MSD) were continuously measured for 24 h. During the daytime, hourly assessments of sadness and other mood states were taken, while depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale (CES-D). Gender differences were observed when examining the impact of average daily sadness on MSD. In women, but not in men, the total amount of sadness experienced during the day was associated with higher circadian MSD levels. These findings suggest that researchers need to take gender differences into account when examining the relation between sadness, HRV, and cardiovascular problems. [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]

Background: Cognitive models explaining medically unexplained complaints propose that activating illness-related memory causes increased complaints such as pain. However, our previous studies showed conflicting support for this theory. Purpose: Illness-related memory is more likely to influence reporting of complaints when its activation is enmeshed with that of self-related memory. We, therefore, investigated whether inducing this association would cause a stronger decrease in pain tolerance. In addition, we examined whether SFA acted as a moderator of this effect. Methods: We used subliminal evaluative conditioning (SEC) to induce an association between activated self-related and illness-related memory. Seventy-six participants were randomly assigned to four combinations of two priming factors: (1) the self-referent word “I” versus the nonself-referent “X” to manipulate activated self-related memory and (2) health complaint (HC) words versus neutral words to manipulate activated illness-related memory. Pain tolerance was assessed using a cold pressor task (CPT). Results: Participants primed with the self-referent “I” and HC words did not demonstrate the expected lower pain tolerance. However, SFA acted as a moderator of the main effect of the self-prime: priming with “I” resulted in increased pain tolerance in participants with low SFA. Conclusions: The current study did not support the hypothesis that associations between activated self-related memory and illness-related memory cause increased reporting of complaints. Instead, activating self-related memory increased pain tolerance in participants with low SFA. This seems to indicate that the self-prime might cause an increase in SFA and suggests possible new ways to promote adaptive coping with pain. [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]

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]

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: Appropriate regulation of emotions is an important component of health. The physiological effects of coping with anger are a topic of particular interest. In a pioneering series of studies Hokanson found that the mode of anger expression following anger instigation had differential effects on vascular recovery. These differential effects were thought to be a result of social learning of avoidance responses. The present study examined this hypothesis in the context of ethnic differences in cardiovascular recovery responses to anger instigation. Twenty-four African American (AA) and 26 European American (EA) males engaged in two debates, one racially themed and one non-racially themed, with an EA confederate. Cardiovascular measures were recorded at baseline, during the debates and during 10-minute recovery periods following each debate. Anger expression preceding the recovery period was manipulated such that half the participants could express their anger toward the confederate and half had to inhibit their anger toward the confederate. Results showed that both AA and EA participants that inhibited their anger had delayed total peripheral resistance recovery. Importantly, for the other dependent variables differential recovery responses were observed such that EA participants that expressed their anger recovered more quickly whereas AA participants that expressed their anger recovered more slowly. These results are consistent with Hokanson''s social learning theory of recovery from anger instigation and have important implications for research on emotion regulation and health. [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]

This study examines whether worry is prospectively associated with somatic complaints and whether a worry reduction intervention can decrease these complaints. One hundred and seventy-one high school students (16–17  years old) kept a log of their worry duration and frequency for 6 days, of whom half were instructed to try to postpone worrying to a special 30-min worry period each day (‘postponers’). Somatic symptoms during ‘the last 3 days’ were assessed before and after the 6 days. At follow-up, postponers reported fewer complaints than controls, controlled for baseline. This reduction appeared to be mediated by worry duration, and pertained to, amongst others, lower back pain, neck pain, coughing/bronchitis, breathing difficulties and stomach pains. Thus, daily worry appears to be prospectively related to a broad set of somatic complaints, and its effect might be reversed by a simple intervention. Possible underlying mechanisms include prolonged physiological activity and illness-related perseverative cognition. [ABSTRACT FROM AUTHOR]

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]

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]

Background: Prolonged physiological activation before or after stressors has gained recognition as a decisive element in theories that explain the link between stress and disease, specifically cardiovascular (CV) disease. This view is opposed to the conventional reactivity hypothesis that emphasizes responses during stressors.Purpose: Prolonged activity has not often been an explicit research goal of real-life stress studies. Nevertheless, a growing number of these studies have provided evidence for prolonged activity, often as a secondary research goal.Methods: An overview of this evidence is lacking and is provided in this article.Results: The combined data from the reviewed studies suggest that discrete and chronic stress sources, as well as negative emotional episodes and dispositions, are related to prolonged CV activity of various durations, including sleep periods. On the other hand, evidence supporting the assumption that prolonged stress-related activation predicts disease is still very modest.Conclusions: In this article we suggest that future research of prolonged activation should give priority to (a) the establishment of clear beginnings and endings of stressful events, (b) the prediction of disease by prolonged activation, and (c) potential psychological mediators of stress-related prolonged activation. These mediators may include, for example, worry and rumination, or other processes characterized by perseverative cognition, including unconscious processes. [ABSTRACT FROM AUTHOR]

Background: Prolonged physiological activation before or after stressors has gained recognition as a decisive element in theories that explain the link between stress and disease, specifically cardiovascular (CV) disease. This view is opposed to the conventional reactivity hypothesis that emphasizes responses during stressors. Purpose: Prolonged activity has not often been an explicit research goal of real-life stress studies. Nevertheless, a growing number of these studies have provided evidence for prolonged activity, often as a secondary research goal. Methods: An overview of this evidence is lacking and is provided in this article. Results: The combined data from the reviewed studies suggest that discrete and chronic stress sources, as well as negative emotional episodes and dispositions, are related to prolonged CV activity of various durations, including sleep periods. On the other hand, evidence supporting the assumption that prolonged stress-related activation predicts disease is still very modest. Conclusions: In this article we suggest that future research of prolonged activation should give priority to (a) the establishment of clear beginnings and endings of stressful events, (b) the prediction of disease by prolonged activation, and (c) potential psychological mediators of stress-related prolonged activation. These mediators may include, for example, worry and rumination, or other processes characterized by perseverative cognition, including unconscious processes. [ABSTRACT FROM AUTHOR]

Summary. Recent ambulatory findings showing comparable cardiovascular effects of positive and negative emotions are not consistent with the assumed etiological role of negative affect in stress-related diseases. We tested the hypothesis that regardless of initial reactivity, responses associated with negative emotions would be prolonged compared to responses associated with positive emotions. During 8 h, 33 healthy subjects from a general population reported their emotional arousal, emotional valence and physical activity and recorded their heart rates (HR) after a beep at each 60th min (‘initial HR’; T0), followed by two ‘prolonged activation’ recordings, respectively 5 min later (T1) and 10 min later (T2). While emotional arousal and activity predicted initial HR, prolonged activation at T1 was solely predicted by emotional valence (negative affect) at T0, independent of emotional recovery. The results lend support to the hypothesis that cardiovascular activation after negative emotions last longer than after positive emotions. This finding is consistent with the view that prolonged activation, and not so much reactivity, might be a mechanism underlying the etiological role of negative emotions (‘stress’) in somatic disease. Perseverative cognition (worry, rumination) might be responsible for this prolonged activation. [Copyright &y& Elsevier]

Desire for control (DC) or need for control has frequently been proposed as an important personality characteristic and as a possible crucial moderator within the fields of achievement, psychological adaptation, stress, and health. However, unlike locus of control, hardly any effort has been undertaken to assess the construct. An exception is the work of Burger and Cooper on the Desirability of Control Scale (1979). In the present study, the psychometric properties of a Dutch version of the DC scale were tested in three different samples (total N = 1044). Furthermore, relationships between DC, its subscales, and various psychological personality and outcome measures were examined. The results show that the psychometric properties of the original DC scale could be successfully transposed to the Dutch version. Furthermore, factor analyses (PCA) led to the construction of three reliable subscales: ‘control others’ (desire to be in charge of and control others), ‘control self’ (desire to control one's own life), and ‘relinquish control’ (desire to leave others in control). The pattern of relationships with convergent and outcome variables supports the interpretation of these subscales. For ‘control others’, as for the total DC scale (i.e. a total of all 20 items), the emphasis of these relationships was on dominance, active coping, and psychological adjustment. ‘Control self’ was mainly related to self-sufficiency and independence, while ‘relinquish control’ was clearly associated with passive coping and poor psychological adjustment. In summary, the DC scale appears to be a psychometrically sound instrument to assess desire for control and its subdimensions. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Sensitization is conceptually related to cognitive bias in experimental psychopathology, and they share the basic mechanism of neuronal sensitization. Every strongly relevant individual concern, like fears, can yield cognitive bias or "cognitive-emotional sensitization". It might also be present for bodily and environmental information related to illness, and could be an etiological factor in medically unexplained complaints. Physiological and cognitive sensitization are theoretically compared. There is evidence for cognitive-emotional sensitization in some medically unexplained somatic complaints, and negative affect is suggested as a catalyst. Prolonged cognitive-emotional sensitization ("perseverative negative cognition" or worry, rumination) might even have demonstrable somatic pathological effects. It is concluded that sensitization may be organized at different levels, both in the organism and in the larger living system within which the organism is subsumed. This view might not only help to clarify medically unexplained pain syndromes, but virtually every subjective complaint, both with and without recognized physiopathology. [ABSTRACT FROM AUTHOR]

Gives a multidisciplinary perspective on symptom perception in asthmatic patients. Biomedical and psychological factors influencing symptom perception; Theories on the origin of breathlessness; Physiological explanations of inaccurate symptom perception; Subtle relationship between emotion and asthma; Influence of habituation on blunted symptom perception.

Low accessibility of threatening information is a crucial element in the theory of repression. Despite many attempts, no empirical evidence has been found for such an inverse memory bias in normal subjects. An alternative approach is to study repressive processes as an individual difference. Adopting such a trait approach, several studies have shown impaired memory for threatening memories of real-life episodes in so-called repressors. Several other studies have yielded evidence of avoidant processing of mildly threatening information in the early stages of information processing in repressors. Thus far, little evidence for a similar avoidant bias in memory has been offered for repressors. To demonstrate the presence of memory deficits for mildly threatening information, we tested recall and cued recognition after a 30 min delay, for (i) threatening, (ii) pleasant, and (iii) neutral words in repressors and non-repressors. No proof was found for poorer recall and recognition of threatening words in repressors, or for lower numbers of threatening semantic intrusions in these individuals, while the power of the study was adequate. While repression-related avoidant processing may be present for even mildly threatening stimuli at earlier stages of information processing, the results of the present study indicate that repressed memory may only show up for relatively intense emotional events. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Examines whether anxiety-related cognitive bias for threat is stronger for threatening pictures than for threatening words. Details on the methods used to conduct the study; Suggestion from the results; Materials used to conduct the study.

Examines the effect of chronic stress on physiological responsiveness to an acute psychological stressor in male high school teachers. Effect of stressors on endocrine variables; Natural killer and T cell responses in the different stress groups; Modification of sensitivity of biological systems to stressors.

Presents a study on cognitive processing bias of children in real life stress situation and a neutral situation. Objective of study; Experiments used in study; Examinations conducted in experiments; Results of experiments; Indepth look at experiments; Interpretation of results.

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]

No abstract available Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Editorial. Introduces a series of articles on sensitization as psychobiological mechanism underlying unexplained illnesses. Range of such conditions; Theory of multiple chemical sensitivity; Theories of sensitization.

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]

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]

Chronic stress has been linked to hypertension, but the underlying mechanisms remain poorly specified. We suggest that chronic stress poses a risk for hypertension through repeated occurrence of acute stressors (often stemming from the chronic stress context) that cause activation of stress-mediating physiological systems. Previous models have often focused on the magnitude of the acute physiological response as a risk factor; we attempt to extend this to address the issue of duration of exposure. Key to our model is the notion that these acute stressors can emerge not only in response to stressors present in the environment, but also to mental representations of those (or other) stressors. Consequently, although the experience of any given stressor may be brief, a stressor often results in a constellation of negative cognitions and emotions that form a mental representation of the stressor. Ruminating about this mental representation of the stressful event can cause autonomic activation similar to that observed in response to the original incident, and may occur and persist long after the event itself has ended. Thus, rumination helps explain how chronic stress causes repeated (acute) activation of one's stress-mediating physiological systems, the effects of which accumulate over time, resulting in hypertension risk. [ABSTRACT FROM AUTHOR]

Chronic stress has been linked to hypertension, but the underlying mechanisms remain poorly specified. We suggest that chronic stress poses a risk for hypertension through repeated occurrence of acute stressors (often stemming from the chronic stress context) that cause activation of stress-mediating physiological systems. Previous models have often focused on the magnitude of the acute physiological response as a risk factor; we attempt to extend this to address the issue of duration of exposure. Key to our model is the notion that these acute stressors can emerge not only in response to stressors present in the environment, but also to mental representations of those (or other) stressors. Consequently, although the experience of any given stressor may be brief, a stressor often results in a constellation of negative cognitions and emotions that form a mental representation of the stressor. Ruminating about this mental representation of the stressful event can cause autonomic activation similar to that observed in response to the original incident, and may occur and persist long after the event itself has ended. Thus, rumination helps explain how chronic stress causes repeated (acute) activation of one's stress-mediating physiological systems, the effects of which accumulate over time, resulting in hypertension risk. [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]

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]

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]