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Conscious and unconscious perseverative cognition: Is a large part of prolonged physiological activity due to unconscious stress?
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.
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“This may be attributable to the role of the parasympathetic nervous system in regulating HR but not SC (Diamond & Otter-Henderson, 2007) and it is possible the construct of mindfulness is particularly salient to concordance between subjective distress and physiological reactivity in which there is parasympathetic regulation (Brosschot, Verkuil & Thayer, 2010; Williams & Thayer, 2009).”
From Dispositional Mindfulness Uncouples Physiological and Emotional Reactivity to a Laboratory Stressor and Emotional Reactivity to Executive Functioning Lapses in Daily Life (2016) · cites this paper as Brosschot, Verkuil & Thayer, 2010
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“We have recently proposed that a large part of PC may be unconscious, while still having physiological effects (Brosschot, 2010, Brosschot et al., 2010).”
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“As mentioned above, some years ago we have already hypothesized that a large part of stress is unconscious ([67,68], see also [103]), and GUTS now provides several additional arguments.”
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“Brosschot, Verkuil, and Thayer (2010) reviewed a number of these findings, which showed that worry or rumination can slow down both cortisol and cardiovascular recovery.”
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“PC may even be largely unconscious Brosschot, 2010; Brosschot et al., 2010) but still leads to prolonged hysiological stress responses (ibidem).”
BackgroundSelf-citationTeng, R., Zhou, S., Zheng, W., & Ma, C. (2023) · International Journal of Contemporary Hospitality Management · doi:10.1108/ijchm-02-2023-0240 · Cited by 180
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“Consistent with approaches to the mind-body relationship (e.g., Kim, 2000), with research on neurobiology (e.g., Brosschot et al., 2010), and with research on technostress (e.g., Riedl, 2013), the combined evidence of (1) the lack of a significant positive correlation and (2) the explanation of…”
BackgroundMethodVerkuil, B., Brosschot, J. F., Gebhardt, W. A., & Thayer, J. F. (2010) · Journal of Experimental Psychopathology · doi:10.5127/jep.009110 · Cited by 155
“The perseverative cognition hypothesis is therefore not limited to conscious thinking about stressors, but also accommodates unconscious stressrelated cognition (Brosschot et al., 2010).”
BackgroundFlexibility as the key for somatic health: From mind wandering to perseverative cognition
Ottaviani, C., Shapiro, D., & Couyoumdjian, A. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.05.003 · Cited by 166
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“As ruminative and worrisome thoughts show different content but no differences in appraisals and strategies (Watkins et al., 2005), we collapsed them into one category under the umbrella term of perseverative cognition (PC) (see Brosschot et al., 2010).”
BackgroundResultInfluentialBrain-heart interaction in perseverative cognition
Ottaviani, C. (2018) · Psychophysiology · doi:10.1111/psyp.13082 · Cited by 129
Alcántara, C., Patel, S. R., Carnethon, M. R., Castañeda, S. F., Isasi, C. R., Thomas, S., Ramos, A. R., Arredondo, E. M., Redline, S. S., Zee, P. C., et al. (2017) · SSM - Population Health · doi:10.1016/j.ssmph.2017.08.004 · Cited by 130
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“, 2003) and has been posited as a mediator of the effects of stressful experiences on various health outcomes (Brosschot et al., 2010; Gerin et al., 2012).”
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Cognitive rigidity is mirrored by autonomic inflexibility in daily life perseverative cognition
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“Based on prominent approaches that include rumination and worry under the umbrella term of PC (reviewed in Brosschot et al., 2010), we collapsed reported ruminative and worrisome thoughts into this single category.”
BackgroundAnger in brain and body: the neural and physiological perturbation of decision-making by emotion
Garfinkel, S. N., Zorab, E., Navaratnam, N., Engels, M., Mallorquí‐Bagué, N., Minati, L., Dowell, N. G., BROSSCHOT, J. F., Thayer, J. F., & Critchley, H. (2015) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsv099 · Cited by 81
“interference effect afforded by the subliminal ANGER prime in the majority of participants appears to support the notion that implicit negative emotions or ‘unconscious stress’ may enhance physiological levels in daily life and may even play a role in the stress-health link (Brosschot, 2010; Brosschot et al., 2010).”
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“events [77], both describe a transdiagnostic process.”
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Gerin, W., Zawadzki, M. J., BROSSCHOT, J. F., Thayer, J. F., Christenfeld, N. J. S., Campbell, T. S., & Smyth, J. M. (2012) · International Journal of Hypertension · doi:10.1155/2012/453465 · Cited by 77
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“This framework also delineates that such repetitive or recurring thoughts may largely occur outside of conscious awareness (Brosschot, 2010; Brosschot et al., 2010).”
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“Other authors have explained this perseveration in terms of an unconscious part of the mind, and they refer to this hypothesis as the unconscious perseverative cognition hypothesis (Brosschot et al., 2010).”
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“, perseverative cognition) does not need to be conscious to take a toll on health and is disadvantageous whether it occurs in anticipation of or following stressors (Brosschot 2010; Brosschot et al. 2006; Brosschot et al. 2010).”
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“Prolonged perseverative cognition has been associated with a range of negative physical (Brosschot et al., 2006, 2010; Verkuil et al., 2010; Ottaviani et al., 2016), and psychological conditions (Garnefski and Kraaij, 2006; Aldao et al., 2010).”
BackgroundCapturing the cardiac effects of racial discrimination: Do the effects “keep going”?
Hoggard, L. S., Hill, L. K., Gray, D. L., & Sellers, R. M. (2015) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2015.04.015 · Cited by 60
“Indeed, in a more recent extension of the Perseverative CognitionHypothesis, Brosschot and colleagues purport that a considerable – and perhaps themost significant portion of perseverative cognition – occurs unconsciously (Brosschot, 2010; Brosschot et al., 2010).”
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“…regulating HR but not SC (Diamond and Otter-Henderson, 2007) and it is possible the construct of mindfulness is particularly salient to concordance between subjective distress and physiological reactivity in which there is parasympathetic regulation (Brosschot et al. 2010;Williams and Thayer 2009).”
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“These data lend support for PCH (Brosschot et al., 2010; Verkuil et al., 2010); our data is the first to provide direct evidence that, individuals with lower resting vmHRV report highermaladaptive perseverative cognition and thereby possibly experience negative psychological outcomes such as anxiety.”
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“, 2006) with the pragmatic definition of unconscious thought by Dijksterhuis, Bos, Nordgren, and van Baaren (2006), in which ‘attention’ is the decisive element: The ongoing activated cognitive representation of threat that occurs while conscious attention is directed elsewhere (Brosschot, 2010; Brosschot et al., 2010…”
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“Those who are more prone to fixate on and ruminate about a stressor will experience long-term physiological responses (Brosschot et al., 2010; Brosschot, 2010).”
InfluentialSalomon, K., Burgess, K. D., & Bosson, J. K. (2015) · Journal of Experimental Psychology General · doi:10.1037/xge0000061 · Cited by 41
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Stress dynamically reduces sleep depth: temporal proximity to the stressor is crucial
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“…models, Brosschot and colleagues assume that a large part of the detrimental and prolonged effect of stressors on health and sleep is caused by unconscious perseverative cognition, for example unconsciously worrying about a future stressor (Brosschot et al. 2007; Brosschot et al. 2010, 2018).”
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“Per-severative cognition indicates repetitive or sustained activation of cognitive representations of past stressful events or feared events in the future [77].”
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“Moreover, increased autonomic activity during stress and worry is mediated by worry and duration of worry episodes, and these relations are not only found during an awake state, but also during sleep (Brosschot et al., 2010).”
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Ever at the ready for events that never happen
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“Verkuil, Thayer and I published the new theory about unconscious stress (Brosschot, 2010; Brosschot et al., 2010), and we have also more recently published some evidence in support.”
BackgroundSelf-citationBrown, S. B. R. E., BROSSCHOT, J. F., Versluis, A., Thayer, J. F., & Verkuil, B. (2017) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2017.10.007 · Cited by 32
Self-citationJob insecurity and subjective sleep quality: The role of spillover and gender
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“These findings suggest that lOFC may contribute to perseverative cognition and ruminations evoked by negative events (Mellers et al., 1999; Connolly and Butler, 2006; Brosschot et al., 2010), which is consistent with previous studies relating OFC and ventrolateral PFC activity to negative mood and rumination (Ray et a…”
BackgroundResultInfluentialHemodynamic profiles of functional and dysfunctional forms of repetitive thinking
Ottaviani, C., Brosschot, J. F., Lonigro, A., Medea, B., Van Diest, I., & Thayer, J. F. (2017) · Annals of Behavioral Medicine · doi:10.1007/s12160-016-9851-3 · Cited by 29
“, perseverative cognition) cause a “fight-or-flight” action tendency, followed by a cascade of biological events such as increases in cardiovascular activity and this persistent physiological activation may have an impact on an individual’s health ultimately leading to somatic disease [2, 3].”
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“Brosschot and colleagues (Brosschot, 2010; Brosschot et al., 2010) have hypothesized that this part is explained by ongoing unconscious (or “implicit”) stressrelated cognition.”
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“…vmHRV, is thought to represent immediate physiological consequences of a stressor, that is, the degree to which the stressor is remaining subjectively active, which can have a detrimental impact one health and longevity (Brosschot, Gerin, and Thayer 2006; Brosschot, Verkuil, and Thayer 2010).”
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“Brosschot, Verkuil, & Thayer, 2010 ; Campbell-Sills et al, 2011 ; Suveg, Morelen, Brewer, & Thomassin, 2010 ).”
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“This inability to perceive and report stress has been termed as ‘unconscious stress,’ which can be defined as the cognitive representation of stressful events when attention is directed elsewhere (Brosschot et al., 2010).”
BackgroundResultInfluentialSelf-citationStressful experiences in youth: “Set-up” for diminished resilience to chronic pain
Nelson, S., Burns, M. T. S., McEwen, B. S., & Borsook, D. (2020) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2020.100095 · Cited by 26
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“, heart rate variability) would be highly recommended, especially since prolonged stress can also occur unconsciously [91].”
Molina, V. M., Oriol, X., & Lira, M. M. (2018) · RICYDE Revista Internacional de Ciencias del Deporte · doi:10.5232/ricyde2018.05301 · Cited by 30
Fairclough, S. H., & Dobbins, C. (2020) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2020.102499 · Cited by 28
“According to the model of preservative cognition (Brosschot et al, 2010), this association is pernicious because physiological changes underpinning inflammation, which coincide with the experience of negative emotional states, can be sustained and often occur outside the conscious awareness of the…”
BackgroundHerr, R. M., Bosch, J. A., Vianen, A. E. M. V., Jarczok, M. N., Thayer, J. F., Li, J., Schmidt, B., Fischer, J. E., & Loerbroks, A. (2014) · Annals of Behavioral Medicine · doi:10.1007/s12160-014-9669-9 · Cited by 26
“” Such perseverative cognition can involve both conscious and unconscious mental processing extending the physiological impact of a stressful experience for hours, persisting even during sleep [89].”
BackgroundSelf-citationEgo defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity
Albuquerque, S. C., Carvalho, E. R., Lopes, R. S., Marques, H. S., Macêdo, D. S., Pereira, E. D. B., Hyphantis, T. N., & Carvalho, A. F. (2011) · Quality of Life Research · doi:10.1007/s11136-011-9884-9 · Cited by 24
Three Views of Emotion Regulation and Health
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Versluis, A., Verkuil, B., Spinhoven, P., & BROSSCHOT, J. F. (2018) · Psychology and Health · doi:10.1080/08870446.2018.1456660 · Cited by 25
Self-citationKocsel, N., Köteles, F. G., Szemenyei, E., Szabó, E., Galambos, A., & Kökönyei, G. (2019) · Biological Psychology · doi:10.1016/j.biopsycho.2019.04.004 · Cited by 22
Delayed psychophysiological recovery after self-concept-inconsistent negative performance feedback
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“Applying the perseverative cognition hypothesis to occupational stress, work-related thinking may be the critical factor in explaining prolonged stress experiences and should be associated with risks to employee well-being [4,5].”
BackgroundThe psychophysiology of medical communication. Linking two worlds of research
Hulsman, R. L., Smets, E. M. A., Karemaker, J. M., & de Haes, J. C. J. M. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.05.008 · Cited by 20
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“Rumination may negatively affect physical and mental health [48,49].”
BackgroundDaily Mindfulness Is Associated With Recovery Processes Among Coaches—A 4-Week Diary Study
Pawsey, F., Wong, J. H. K., Kenttä, G., & Näswall, K. (2021) · International Sport Coaching Journal · doi:10.1123/iscj.2020-0045 · Cited by 26
Reflecting on Existential Threats Elicits Self-Reported Negative Affect but No Physiological Arousal
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“This relationship has been suggested to reflect unconscious stressrelated cognition (Brosschot, 2010; Brosschot et al., 2010).”
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“It has been suggested that heart rate measures are related to listening effort (Mackersie & Calderon-Moultrie, 2016) and other factors, such as memory, attention, and stress (Brosschot et al., 2010; Campos & Johnson, 1966).”
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“For another, Brosschot et al. (2010) proved that conscious perseverative cognition, that is, worry and annoyance, has physiological effects (Brosschot et al., 2010).”
BackgroundHigh Trait Rumination Is Associated with Blunted Nighttime Diastolic Blood Pressure Dipping
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“Brosschot and colleague’s theory of perseverative cognition [55] suggests the possibility of unconscious perseverative or ruminative thought occurring during periods of sleep that might account in part for such findings, although this remains speculative in the absence of evidence.”
A Lagged Experience Sampling Methodology Study on Spillover Effects of Customer Mistreatment
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“This can cause sleep-related problems by prolonging negative physiological activation during the sleep stage (Brosschot, Gerin, and Thayer 2006), such as disordering endocrine activities as well as slowing down cortisol and cardiovascular recovery (Brosschot, Verkuil, and Thayer 2010).”
BackgroundLin, I., Weng, C., Lin, T., & Lin, C. (2015) · Europe PMC (PubMed Central) · doi:10.6515/acs20141027b · Cited by 12
Ma, D., Serbin, L. A., & Stack, D. M. (2018) · Development and Psychopathology · doi:10.1017/s0954579417001870 · Cited by 14
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A Model of Our Contemplative Nature
Kaufman, J. A. (2015) · Ecopsychology · doi:10.1089/eco.2015.0014 · Cited by 13
“Inherent in such appraisal is the risk that the individual will become conditioned to perseverate on the stressful events (Brosschot et al., 2010) unless presented with opportunities to do otherwise.”
The Effects of a Recovery-Focused Program for Stress Management in Women —An Exploratory Study
Lisspers, J., Almén, N., & Sundin, Ö. (2014) · Health · doi:10.4236/health.2014.620321 · Cited by 11
Versluis, A., Verkuil, B., & BROSSCHOT, J. F. (2017) · Stress and Health · doi:10.1002/smi.2777 · Cited by 13
“This latter finding is not in line with the idea that unconscious levels of stress can be associated with physiological activity (Brosschot et al., 2010),”
BackgroundResultInfluentialSelf-citation
Metadata
- Authors
- Brosschot, J. F., Verkuil, B., & Thayer, J. F.
- Affiliations
- Leiden University (NL)
- The Ohio State University (US)
- Corresponding author
- Brosschot, Jos F.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2010-10
- Volume
- 69
- Issue
- 4
- Pages
- 407-416
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2167618279
- Cited by
- 176
- References
- 89
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 9 · 2023: 9 · 2022: 10 · 2021: 9 · 2020: 12 · 2019: 11 · 2018: 16 · 2017: 16 · 2016: 17 · 2015: 16 · 2014: 15 · 2013: 7 · 2012: 5
- FWCI
- 0.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- perseverative cognition, unconscious cognition, stress, worry, autonomic nervous system, stress-related disorders
- MeSH terms
- Cognition, Humans, Stress, Psychological
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