When worries make you sick: a review of perseverative cognition: the default stress response and somatic health
Open accessAbstract
Perseverative cognition, such as worry and rumination, is a common reaction to stressful events. In this review, we present a self-regulation perspective on perseverative cognition and propose that it forms part of the default response to threat, novelty and ambiguity. This default response is enhanced in chronic worriers who show difficulties in recognizing signals of safety, due to excessive goal commitment and the use of perseverative cognition as a strategy to cope with perceived threats to goal attainment. It is proposed that worrying about stressful events increases the total amount of time that stress has a ‘wear and tear’ effect on the human body. Studies supporting this perseverative cognition hypothesis are reviewed. Moreover, we provide preliminary evidence that unconscious forms of perseverative cognition have substantial somatic health effects as well. In conclusion, a focus on perseverative cognition is warranted when investigating links between stressful events and somatic health.
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Chronic cognitive perseveration is linked to ongoing emotional reactions and downstream stress physiology that ultimately progresses to stress-related chronic disease.
“This model articulates a pathway by which chronic cognitive perseveration is linked to ongoing emotional reactions and downstream stress physiology (e.g., cardiovascular, metabolic, neuroendocrine, and immune/inflammatory systems) that ultimately progresses to stress-related chronic disease [13, 14].”
Despite growing evidence that PC causes prolonged physiological responses, it is still far from explaining most protracted stress responses associated with chronic stressors.
“Despite growing evidence that PC causes prolonged physiological responses, especially for cardiovascular and endocrine (i.e.cortisol) activity (Brosschot et al., 2006;Ottaviani et al., 2015;Verkuil et al., 2010;Zoccola and Dickerson, 2012), it is still far from explaining most of, let alone all of, the often extremely protracted stress responses associated with chronic stressors such as work stres”
From Exposed to events that never happen: generalized unsafety, the default stress response, and prolonged autonomic activity (2017) · cites this paper as Verkuil et al., 2010
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Worry Affects the Immune Response to Phobic Fear
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Emotion control, stress, and health
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A Mood‐as‐Input Account of Perseverative Worrying
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Experimental effects of rumination styles on salivary cortisol responses
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Fearful and Sexual Pictures Not Consciously Seen Modulate the Startle Reflex in Human Beings
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Anger Cognitions and Cardiovascular Recovery Following Provocation
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Worry and heart rate variables: autonomic rigidity under challenge
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The tendency to suppress, inhibiting thoughts, and dream rebound
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Mowrer's revised two-factor theory and the motive-expectancy-value model.
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Pain Catastrophizing and Symptom Severity During Upper Respiratory Tract Illness
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Physiological concomitants of perseverative cognition: A systematic review and meta-analysis.
Ottaviani, C., Thayer, J. F., Verkuil, B., Lonigro, A., Medea, B., Couyoumdjian, A., & Brosschot, J. F. (2016) · Psychological Bulletin · doi:10.1037/bul0000036 · Cited by 476 · see citing works
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Workplace bullying and mental health: a meta-analysis on cross-sectional and longitudinal data
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“For example, theorists have suggested that rumination prolongs the impact of a stressor by keeping the stressor “alive”—and the individual activated—even after the stressor has ended (Brosschot et al., 2006; Verkuil et al., 2010).”
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Assessing the relationship between rumination and cortisol: a review
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Flexibility as the key for somatic health: From mind wandering to perseverative cognition
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Extended work availability and its relation with start-of-day mood and cortisol.
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The effects of transcutaneous vagus nerve stimulation on conditioned fear extinction in humans.
Burger, A., Verkuil, B., Diest, I. V., van der Does, W., Thayer, J., & Brosschot, J. (2016) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2016.05.007 · Cited by 123 · see citing works
Brain-heart interaction in perseverative cognition
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Perseverative Cognition and Health Behaviors: A Systematic Review and Meta-Analysis
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“As the PCH aimed to model how stress-related thinking may impact on health outcomes in otherwise healthy populations, the aim here was also to review studies involving physically and mentally healthy participants.”
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Pros and cons of a wandering mind: a prospective study
Ottaviani, C., & Couyoumdjian, A. (2013) · Frontiers in Psychology · doi:10.3389/fpsyg.2013.00524 · Cited by 107 · see citing works
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Pathways to well-being: Untangling the causal relationships among biopsychosocial variables
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The role of anxiety in the development, maintenance, and treatment of childhood aggression
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Vahle‐Hinz, T., Bamberg, E., Dettmers, J., Friedrich, N., & Keller, M. (2014) · Journal of Occupational Health Psychology · doi:10.1037/a0036009 · Cited by 89 · see citing works
Matthews, G., Panganiban, A. R., Wells, A., Wohleber, R. W., & Reinerman-Jones, L. E. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00640 · Cited by 85 · see citing works
Cognitive rigidity is mirrored by autonomic inflexibility in daily life perseverative cognition
Ottaviani, C., Medea, B., Lonigro, A., Tarvainen, M. P., & Couyoumdjian, A. (2015) · Biological Psychology · doi:10.1016/j.biopsycho.2015.02.011 · Cited by 71 · see citing works
The Association between Work-Related Rumination and Heart Rate Variability: A Field Study
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Azam, M. A., Katz, J. D., Mohabir, V., & Ritvo, P. (2016) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2016.10.011 · Cited by 59 · see citing works
Greeson, J. M., Zarrin, H., Smoski, M. J., Brantley, J. G., Lynch, T. R., Webber, D. M., Hall, M. H., Suarez, E. C., & Wolever, R. Q. (2018) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2018/4505191 · Cited by 55 · see citing works
“, cardiovascular, metabolic, neuroendocrine, and immune/inflammatory systems) that ultimately progresses to stress-related chronic disease [13, 14].”
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Kinnunen, U. M., Feldt, T., de Bloom, J., Sianoja, M., Korpela, K., & Geurts, S. A. E. (2016) · Journal of Occupational Health Psychology · doi:10.1037/ocp0000037 · Cited by 56 · see citing works
Williams, D. P., Feeling, N. R., Hill, L. K., Spangler, D. P., Koenig, J., & Thayer, J. F. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00520 · Cited by 54 · see citing works
Does Unconscious Stress Play a Role in Prolonged Cardiovascular Stress Recovery?
BROSSCHOT, J. F., Geurts, S. A. E., Kruizinga, I., Radstaak, M., Verkuil, B., Quirin, M., & Kompier, M. A. J. (2014) · Stress and Health · doi:10.1002/smi.2590 · Cited by 49 · see citing works
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Worry as an adaptive avoidance strategy in healthy controls but not in pathological worriers
Ottaviani, C., Borlimi, R., Brighetti, G., Caselli, G., Favaretto, E., Giardini, I., Marzocchi, C., Nucifora, V., Rebecchi, D., Ruggiero, G. M., et al. (2014) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2014.05.010 · Cited by 45 · see citing works
Gender differences in the impact of daily sadness on 24‐h heart rate variability
Verkuil, B., BROSSCHOT, J. F., Marques, A. H., Kampschroer, K., STERNBERG, E. M., & Thayer, J. F. (2015) · Psychophysiology · doi:10.1111/psyp.12541 · Cited by 43 · see citing works
Worry and rumination in breast cancer patients: perseveration worsens self-rated health
Renna, M. E., Rosie Shrout, M., Madison, A. A., Lustberg, M., Povoski, S. P., Agnese, D. M., Reinbolt, R. E., Wesolowski, R., Williams, N. O., Ramaswamy, B., et al. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-020-00192-9 · Cited by 41 · see citing works
“These processes, collectively termed perseveration, also contribute to poorer self-rated health in physically healthy adults (Verkuil et al., 2010).”
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Stress, fatigue, and sleep quality leading up to and following a stressful life event
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Ever at the ready for events that never happen
BROSSCHOT, J. F. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1309934 · Cited by 34 · see citing works
van der Ploeg, M. M., BROSSCHOT, J. F., Thayer, J. F., & Verkuil, B. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00425 · Cited by 29 · see citing works
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Recovery from Work During Off-Job Time
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Ambulatory assessed implicit affect is associated with salivary cortisol
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Resting heart rate variability and the startle reflex to briefly presented affective pictures
Ruiz‐Padial, E., & Thayer, J. F. (2014) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2014.10.005 · Cited by 24 · see citing works
Struggling to Meet the Bar: Occupational Progress Failure and Informal Leadership Behavior
Schaubroeck, J. M., Peng, A. C., Hannah, S. T., Ma, J., & Cianci, A. M. (2020) · Academy of Management Journal · doi:10.5465/amj.2018.0956 · Cited by 23 · see citing works
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Transcutaneous vagus nerve stimulation does not affect attention to fearful faces in high worriers
Verkuil, B., & Burger, A. M. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.12.009 · Cited by 22 · see citing works
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Being busy, feeling poor: The scale development and validation of perceived time poverty
Zheng, X., Zhang, Q., Li, X., & Wu, B. (2022) · International Journal of Selection and Assessment · doi:10.1111/ijsa.12395 · Cited by 22 · see citing works
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Heart rate variability predicts outcome of short‐term psychotherapy at the workplace
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Adolescents' Daily Worry, Morning Cortisol, and Health Symptoms
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- Authors
- Verkuil, B., Brosschot, J. F., Gebhardt, W. A., & Thayer, J. F.
- Affiliations
- Leiden University (NL)
- The Ohio State University (US)
- Venue
- Journal of Experimental Psychopathology
- Publisher
- SAGE Publications
- Published
- 2010-01
- Volume
- 1
- Issue
- 1
- ISSN
- 2043-8087 (ISSN-L)
- OpenAlex
- W2070911503
- Cited by
- 155
- References
- 153
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 9 · 2023: 13 · 2022: 15 · 2021: 14 · 2020: 14 · 2019: 11 · 2018: 7 · 2017: 16 · 2016: 12 · 2015: 15 · 2014: 5 · 2013: 4 · 2012: 4
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Experimental Psychopathology (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Mind wandering and attention
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- perseverative cognition, worry, rumination, physical health, chronic worry, self-regulation, threat detection, goal commitment, unconscious cognition
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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