Physiological concomitants of perseverative cognition: A systematic review and meta-analysis.
Abstract
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.
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Post stressor rumination appears to be a particularly important stress process that may prolong cortisol activation during stress recovery, altering allostatic states.
“Post stressor rumination appears to be a particularly important stress process that may prolong cortisol activation during stress recovery, altering allostatic states (Gianferante et al., 2014; Ottaviani et al., 2016; Verkuil et al., 2009).”
From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Ottaviani et al., 2016
Social stressors, worry and rumination, and cognitive tasks requiring increased attention lead to a phasic reduction in vagally mediated HRV.
“Previous research converges in demonstrating that social stressors (Allen and Friedman 2016), worry and rumination (Ottaviani et al. 2016; Era et al. 2021), and cognitive tasks requiring increased attention (see, e.g., Hansen et al. 2003; Balzarotti et al. 2017 for review) lead to a phasic reduction in vagally mediated HRV (i.e., vagal withdrawal).”
From Interpersonal Physiological Synchrony During Dyadic Joint Action Is Increased by Task Novelty and Reduced by Social Anxiety (2025) · cites this paper as Ottaviani et al. 2016
The study had a dropout rate of only 11%, which was significantly lower than the typical range of 24-50% observed in mental health RCTs delivered via smartphones.
“Our study also had a dropout rate of only 11%, which was significantly lower than the typical range of 24–50% observed in mental health RCTs delivered via smartphones [97-99].”
ANS function is purportedly modulated by the core-ICNs and one of the most robust ANS disturbances found in IDs is cardiac dysautonomia in the form of reduced HRV.
“ANS function is purportedly modulated by the core-ICNs and one of the most robust ANS disturbances found in IDs is cardiac dysautonomia in the form of reduced HRV [52, 96, 103, 280, 282–293].”
Studies of other MBIs in healthy participants indicate improvements in working memory, cognitive flexibility, and inhibition, with very limited evidence for attentional improvements.
“Studies examining other MBIs with healthy participants similarly indicated improvements in cognitive abilities such as working memory (76–77), cognitive flexibility (78–79) and inhibition (80), with very limited evidence regarding attentional improvements (see (73) for a review).”
From Mindfulness-Based Interventions in Psychiatry (2018) · cites this paper as [80]
Distress disorders involve negative self-referentiality including worry, rumination, self-criticism, and loneliness.
“negative self-referentiality including worry, rumination [15, 16], self-criticism [17] and loneliness (i.e., perceived social isolation) [18, 19]”
From All together now: utilizing common functional change principles to unify cognitive behavioral and mindfulness-based therapies (2019) · cites this paper as [16]
The combined use of ecological momentary assessment self-reports with daily physiological monitoring already showed potential in the field of rumination and perseverative negative thinking.
“In that sense, the combined use of EMA self-reports with daily physiological monitoring already showed its potential in the field of rumination and perseverative negative thinking (Ottaviani et al., 2016), highlighting the association between this strategy and heightened activation of the hypothalamic pituitary adrenal axis (HPAA) and decreased heart rate variability (HRV) during waking, which is”
From New Technologies for the Understanding, Assessment, and Intervention of Emotion Regulation (2019) · cites this paper as Ottaviani et al., 2016
Rumination is associated with heightened activation of the hypothalamic pituitary adrenal axis and decreased heart rate variability during waking, which is considered a robust predictor of maladaptive emotion regulation.
“highlighting the association between this strategy and heightened activation of the hypothalamic pituitary adrenal axis (HPAA) and decreased heart rate variability (HRV) during waking, which is considered a robust predictor of maladaptive ER.”
From New Technologies for the Understanding, Assessment, and Intervention of Emotion Regulation (2019) · cites this paper as Ottaviani et al., 2016
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“However, co-rumination is described as a group form of rumination in which interpersonal discussion focuses upon emotions and problems (Rose, 2002) but was not included here as it is not a purely cognitive form of PC (a similar approach was adopted by Ottaviani et al., 2015).”
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- Authors
- Ottaviani, C., Thayer, J. F., Verkuil, B., Lonigro, A., Medea, B., Couyoumdjian, A., & Brosschot, J. F.
- Affiliations
- Fondazione Santa Lucia (IT)
- The Ohio State University (US)
- Leiden University (NL)
- Sapienza University of Rome (IT)
- ORCID
- Venue
- Psychological Bulletin
- Published
- 2016-03
- Volume
- 142
- Issue
- 3
- Pages
- 231-259
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- OpenAlex
- W2409629706
- Cited by
- 476
- References
- 157
- Citations by year
- 2026: 46 · 2025: 45 · 2024: 36 · 2023: 39 · 2022: 52 · 2021: 50 · 2020: 57 · 2019: 51 · 2018: 45 · 2017: 29 · 2016: 23 · 2015: 2
- FWCI
- 4.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Iris (Roma Tre University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Italian Ministry of Health (GR-2010-2312442)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- perseverative cognition, rumination, worry, physiological correlates, blood pressure, heart rate, cortisol, heart rate variability, autonomic nervous system, endocrine system, cardiovascular reactivity, chronic stress, physical health
- MeSH terms
- Blood Pressure, Cognition, Heart Rate, Humans, Hydrocortisone, Stress, Psychological, Thinking
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