Review article
Conscious and unconscious perseverative cognition: Is a large part of prolonged physiological activity due to unconscious stress?

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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.

Section snippets

Stress and prolonged physiological activity

Psychological stress is a widespread problem and a substantial cause or co-determinant of organic disease (e.g., Ref. [1], [2]), presenting an ever-growing humanitarian and economic burden. For decades, this health risk has been explained by theorizing that stressful events are accompanied by increased physiological responses, which, if frequent and intense, may cause bodily harm. However, this “reactivity hypothesis” has received only some—and inconsistent—support [3], [4], [5], [6], [7], [8]

The role of continuing stressful thoughts: “Perseverative Cognition”

What causes the sustained physiological responses seen in laboratory and ambulatory studies? As yet, this fundamental question has rarely been addressed. We formulated the perseverative cognition hypothesis[10], which is based on two core arguments. The first is that slow recovery after stressors or the long anticipatory responses before stressors cannot be due to biological mechanisms alone. The physiological response to an average daily stressor is comparable to that of mild physical exercise

Unexplained prolonged activity: A role for unconscious perseverative cognition

One indication for a role for unconscious perseverative cognition came from our recent finding that in daily life, worry itself has prolonged physiological effects [26], again independent of mood and life style factors. In this study, we showed that up to two hours after worry episodes, autonomic activity was higher than in neutral episodes, independent of whether worrying went on or a new worry episode started. In fact, because of their statistical independence, the concurrent and prolonged

Experimental approaches to unconscious perseverative cognition

Evidence of health relevant physiological responses during subliminal threat-related stimulation would unambiguously support the hypothesis that unconscious negative emotional processes can have prolonged effects. To our current knowledge, there are only a few promising results: one accidental finding and one from a pilot study. Levy et al. [61] tested whether subliminal words in a backward masking paradigm related to either negative or positive stereotypes of aging presented to elderly

Concluding remarks

The domain of stress and health is currently facing a change of scope, from reactivity (during stressors) to prolonged activity (before[9], [10], [11] and after stressors [9], [10], [11], [12]). In our previous work, our group has promoted and studied prolonged activity and the mediating role of perseverative cognition [5], [9], [10], [11], [16], [17], [18], [25], such as worry, which previously has been largely overlooked by health psychologists. Some years ago we launched the ‘perseverative

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