Physiological concomitants of perseverative cognition: A systematic review and meta-analysis

Cristina Ottaviani, Julian F. Thayer, Bart Verkuil, Antonia Lonigro, Barbara Medea, Alessandro Couyoumdjian, Jos F. Brosschot

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)231-259
Number of pages29
JournalPsychological Bulletin
Issue number3
Publication statusPublished - Mar 1 2016


  • Blood pressure
  • Cortisol
  • Heart rate
  • Heart rate variability
  • Perseverative cognition

ASJC Scopus subject areas

  • Psychology(all)
  • History and Philosophy of Science


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