Salivary cortisol responses to a psychosocial laboratory stressor and later verbal recall of the stressor: The role of trait and state rumination

Study protocol for a randomized controlled trial investigating the effect of online interpretation bias intervention on stress reactivity in the children of parents with depression: the CoCo study

BACKGROUND

Current preventive interventions for the children of parents with depression demonstrate modest effects on depression incidence. This may be because existing interventions tend to comprise general psychotherapeutic tools, rather than targeting the specific mechanisms underlying familial transmission. Improved theoretical models of familial transmission could enhance the development of targeted interventions. Although existing models assume that cognitive and biological vulnerability factors influence one another, the precise mechanisms are unknown. This project is the first to experimentally test whether negative interpretation bias has an impact on cortisol response in children of parents with depression. This study protocol reports a randomised controlled trial of an interpretation bias intervention which aims to shift participants' interpretation bias in a more positive direction and thereby alter their stress response.

METHODS

Children aged 10-14 years who have i) one parent with a current or previous depression diagnosis, with at least one episode occurring during the child's lifetime and ii) do not have a current or previous psychiatric diagnosis themselves, will be assigned to one of two conditions: an interpretation bias intervention (n = 50) or a structurally similar placebo intervention (n = 50). The interpretation bias intervention consists of a short lab-based cognitive reappraisal of interpretations training, a four-week app-based Cognitive Bias Modification of Interpretations intervention and interpretation bias specific if-then plans. Interpretation bias will be assessed before and after the intervention using the Scrambled Sentences Task. The effect of the intervention on participants' stress response will be assessed by salivary cortisol collected at five different time points: from immediately before until 45 min after administering the Trier Social Stressor Test for Children. Stress reactivity will be measured via baseline to peak cortisol and stress recovery will be measured via the 45 min cortisol marker. We hypothesise that children who participate in the interpretation bias intervention will display a positive shift in interpretation bias and this, in turn, will alter their stress response. Children who receive the placebo intervention are expected to show a smaller positive shift in interpretation bias and stress reactivity.

DISCUSSION

The findings of the present study will contribute to models of familial depression transmission as well as informing preventive interventions. If training a more positive interpretation bias subsequently alters participants' stress response, then incorporating such tools may increase the efficacy of existing preventive interventions.

TRIAL REGISTRATION

Deutsches Register Klinischer Studien DRKS00028842. Registered August 19, 2022.

Revisiting the stress recovery hypothesis: Differential associations of cortisol stress reactivity and recovery after acute psychosocial stress with markers of long-term stress and health

Exposure to excessive and long-term stress may result in dysregulation of the stress system, including the acute stress response. In particular, failure to downregulate stress-related reactivity may lead to prolonged stress responses and the accumulation of allostatic load. However, the contribution of altered acute cortisol recovery to chronic stress and associated health impairments has often been neglected. Addressing this lack of research, we explored whether recovery from - more so than reactivity to - acute stress captures the basal stress load of an individual. Using Piecewise Growth Curve Models with Landmark Registration, we analyzed cortisol reactivity and recovery slopes of 130 healthy participants exposed to a standardized psychosocial laboratory stressor. Reactivity and recovery were predicted by measures indicative of long-term stress and its downstream effects, including self-report questionnaires, diurnal cortisol indices [cortisol awakening response (CAR); diurnal cortisol slope], markers of pro-inflammatory activity (interleukin-6; high-sensitive C-reactive protein), and hippocampal volume (HCV). Among these measures, only an increased CAR was specifically and consistently associated with relatively impaired recovery. Since the CAR represents the physiological enhancement needed to meet the anticipated demands of the forthcoming day, this finding may highlight the contribution of cognitive processes in determining both CAR and acute stress recovery. Furthermore, greater cortisol reactivity covaried with smaller HCV, showing that increased acute reactivity translates to health-relevant downstream effects. The lack of further associations between long-term and acute stress measures may arise from biases in self-reported chronic stress and the rigorously health-screened study sample. Overall, our findings suggest that while cortisol stress recovery might not supersede reactivity as an indicator of the long-term stress load or associated health effects, recovery and reactivity have differential utility in describing individuals' allostatic states.

Adolescent effects on mothers’ bedtime cortisol: Cognitive interference as a mediating mechanism

Prior studies have shown that parent and adolescent cortisol are associated across days and that this covariation may be adolescent-driven. This study extends this literature by (a) testing whether parents' cognitive interference (i.e., distracting and ruminative thoughts potentially due to worry) mediates the linkages between adolescent and next-day parent cortisol and (b) whether these linkages were moderated by parent gender or warmth. Daily diary data, including bedtime cortisol, were collected on two samples of employees and their adolescent-aged children (N = 318 dyads, M_{youth age}  = 13.18 years, 74% mothers). We tested mediation with autoregressive cross-lagged models. Moderated mediation by parent gender was found in our bedtime cortisol models. Higher adolescent bedtime cortisol levels were associated with higher next-day levels of mothers' cognitive interference. In turn, higher levels of mothers' cognitive interference were linked to higher mothers' same-day bedtime cortisol levels. These linkages were not significant for fathers. Cognitive interference did not mediate the associations between child and parent area under the curve or cortisol awakening response. No moderation was evident for parental warmth. Results suggest that mothers' cognitions play a key role in the transmission of elevated bedtime cortisol levels from adolescents to their mothers.

Stressed in afterthought: Neuroendocrine effects of social self-threat during physical effort are counteracted by performance feedback after stress exposure

Social self-threat during physical stress, such as exposure to the cold pressor test and isometric handgrip test, has been shown to induce activation of the HPA axis, in addition to autonomic responses. However, previous research has suggested that dysfunctional post-event processing may play a major role in neuroendocrine reactivity at initial as well as subsequent social stress exposure. In the present study, we investigated how the interplay of context (i.e. performance feedback) with state (i.e., self-esteem) as well as trait-like factors (i.e., ruminative tendencies) affects stress responses to repeated, short bouts of physical activity. On two sessions, 1 week apart, 53 participants (27 women) performed an isometric handgrip task for 3 min, during which they were exposed to social-evaluative threat. In addition, participants received fake feedback on their performance immediately after the task, labeling it as either 'above' (positive) or 'below average' (negative). In addition to neuroendocrine (cortisol), cardiovascular (heart rate, blood pressure) and subjective stress reactivity, performance-related and social dimensions of state self-esteem were assessed before and after stress induction. Substantial increases in cardiovascular parameters were found on both days, regardless of feedback condition. However, positive feedback led to significantly diminished neuroendocrine responses on day 1, whereas baseline cortisol on session 2 was significantly higher in the negative feedback group. Conversely, social self-esteem decreased after stress induction on both days only for participants who had received negative feedback. Changes in self-esteem reported on day 1 were associated with increased baseline cortisol at the second session, while interindividual differences in self-reported (trait) rumination were associated with cortisol reactivity at session 1. Taken together, the results suggest that effects of social evaluation during short periods of physical stress rely on post-event processing and might be counteracted by positive appraisal directly after stress exposure. Post-hoc framing (in terms of success vs. failure) may predict subsequent stress-related hormonal effects better than task demands per se, which should be considered as a potential moderator in future acute stress research, but might also be relevant to many practical applications in fields ranging from sports/performance to health psychology.

Understanding associations between rumination and inflammation: A scoping review

A growing body of evidence suggests that rumination, or focused attention on mental representations of negative events, may have physiological consequences that adversely affect long term health. We conducted a scoping review on quantitative studies of humans examining associations between rumination and inflammation, which included 13 studies representing 14 samples and 1,102 unique participants. The review included 8 biomarkers measured in plasma, serum and saliva (C reactive protein, and C-C motif chemokine 11, interleukin (IL)- 1β, IL-4, IL-6, IL-8, IL-10 and tumor necrosis factor alpha). More consistent findings of an association between greater rumination and increased inflammation were found in studies that used experimental designs and manipulated rumination. Emerging research suggests rumination may interact with other factors (e.g., socioeconomic status, anxiety) to predict inflammation. This review offers an up to date synthesis of the emerging research focused on rumination and inflammation. The relationship between inflammation and rumination may be contingent on how rumination is conceptualized and measured, as well as the measure of inflammation (i.e., at rest/ in response to stress).

Type of self-talk matters: Its effects on perceived exertion, cardiorespiratory, and cortisol responses during an iso-metabolic endurance exercise

Self-talk is an effective mental training technique that has been shown to facilitate or debilitate an athlete's performance, depending on its valence. Although the effects of self-talk have been supported by observing change in sport performance, little is known about how self-talk can induce physiological changes. Specifically, it is important to understand if the type of self-talk (positive, neutral, or negative) and can influence stress-related parameters, such as perceived exertion, cardiorespiratory, and cortisol responses. The study's objective was therefore to investigate the top-down effect of positive and negative self-talk compared to a dissociative activity during an iso-metabolic running exercise on autonomic regulation of cardiorespiratory function. Twenty-nine well-trained male runners [38 ± 13 years, 177 ± 7 cm and 73 ± 7 kg] volunteered to participate in a randomized-group design study that included a negative self-talk (NST), a positive self-talk, and a dissociative group (DG). First, participants underwent an incremental running test on a treadmill to determine the maximal oxygen uptake (V̇O_2max ). Next, participants received a mental training session on self-talk and created three positive and three negative self-talk statements. Finally, participants underwent a 60-min steady-state running exercise on a treadmill at 70% of V̇O_2max , during which they were cued at 20-, 35-, and 50-min with their personal self-created positive or negative self-talk statements while the DG listened to a documentary. Cardiorespiratory parameters and rate of perceived exertion (RPE) were recorded throughout the 60-min endurance exercise. In addition, salivary cortisol samples were obtained at waking and after treatment. Although oxygen uptake, carbon dioxide production, RPE, and heart rate significantly changed overtime during the 60-min steady-state running exercise, no significant main treatment effect was found. However, RPE scores, minute ventilation, breathing frequency, and salivary cortisol were significantly higher in the NST group compared to the two other groups. These data suggest that NST [emotion-induced stress, as reflected by elevated cortisol] altered the breathing frequency response. In conclusion, manipulating self-talk alters hormonal response patterns, modulates cardiorespiratory function, and influences perceived exertion.

Measuring state pre-event and post-event rumination in Social Anxiety Disorder: Psychometric properties of the Socially Anxious Rumination Questionnaire (SARQ)

Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known as the Thoughts Questionnaire. In particular, we examined the factor structure, internal consistency, test-retest reliability, construct validity, sensitivity to treatment response, clinical cut-off scores (relative to non-clinical participants), and associated test performance indicators of the SARQ. The sample comprised 505 adults with a principal diagnosis of SAD and 130 non-clinical controls. Pre-event and post-event rumination were assessed in relation to a three-minute impromptu speech. Results indicated single factors for the SARQ: Pre-event and SARQ: Post-event scales, along with excellent internal consistency, good test-retest reliability, sound sensitivity to cognitive-behavioural treatment response, and a clear ability to discriminate between individuals with a principal diagnosis of SAD and non-clinical controls. The findings justify the SARQ's use as a robust and reliable measure of state rumination for individuals with SAD that can be used both before and after encountering a social threat.

Resilience and Psychobiological Response to Stress in Older People: The Mediating Role of Coping Strategies

Resilience, the ability to overcome adversity and face stressful demands and experiences, has been strongly associated with successful aging, a low risk of diseases and high mental and physical functioning. This relationship could be based on adaptive coping behaviors, but more research is needed to gain knowledge about the strategies employed to confront social stress. Thus, we aimed to investigate the role of the use of active or passive coping strategies by resilient people in dealing with stressful situations. For this purpose, we measured resilience, coping strategies, and perceived stress in 66 healthy older adults (31 men and 35 women) between 56 and 75 years old who were exposed to stress (Trier Social Stress Test, TSST) or a control situation. The stress response was analyzed at endocrine (cortisol) and psychological (anxiety) levels. In the stress condition, moderated mediation analysis showed a conditional indirect effect of resilience on cortisol reactivity through active coping. However, passive coping strategies did not mediate the resilience-cortisol relationship. In addition, neither active nor passive coping mediated the relationship between resilience and the anxiety response. These results suggest that resilience is associated with active coping strategies, which in turn could explain, at least in part, individual differences in the cortisol response to a psychosocial laboratory stressor. These factors may prevent the development of stress-related pathologies associated with aging and facilitate healthy and satisfactory aging.

Is It Personal? Context Moderates BPD Effects on Spontaneous Rumination and Distress

Borderline personality disorder (BPD) is associated with the use of maladaptive emotion regulation (ER) that predicts unstable interpersonal relationships and emotion dysregulation. Rumination, a maladaptive cognitive ER response, may be one mechanism by which those with BPD experience emotion dysregulation. However, it remains unclear whether emotion dysregulation is linked to rumination in general, or to rumination during interpersonal situations that often prove challenging for those with BPD. The present study examined whether interpersonal exclusion conferred an increased risk to spontaneously ruminate among those with elevated BPD features relative to an impersonal negative mood induction, and whether spontaneous rumination mediated the effects of BPD features on distress reactivity. Overall, BPD features predicted stronger tendencies to spontaneously ruminate and higher levels of distress following interpersonal exclusion; spontaneous rumination following interpersonal exclusion mediated the effects of BPD features on distress. These findings highlight the importance of context when examining ER outcomes.

Daily rumination about stress, sleep, and diurnal cortisol activity

Rumination is an involuntary cognitive process theorized to prolong arousal and inhibit proper emotion regulation. Most available research has examined individual differences in cognitive dispositions to ruminate about stress as a risk marker for psychopathology and other health problems. This intensive longitudinal study extended previous research by examining day-to-day associations of rumination about stress with objectively-measured actigraph-based sleep and diurnal salivary cortisol activity. Sixty-one healthy participants (Mage = 20.91) completed up to five ecological momentary assessments (EMA) each day and wore actigraph wristwatches for eight days (N = 488). On three of these days, participants provided five saliva samples assayed for cortisol (N = 910). On average, greater daily stress levels were associated with shorter sleep duration and higher waking cortisol levels. In day-to-day analyses, greater daily stress levels, when combined with ruminating about daily stress more than usual, was associated with higher waking cortisol levels the following morning. Ruminating more than usual about daily stress, in the context of low-stress days, was also associated with flatter diurnal cortisol slopes the next day. These findings highlight the potential influences of daily stress, and rumination about stress, on sleep and diurnal cortisol activity - two important markers of health and well-being.

A time to be chronically stressed? Maladaptive time perspectives are associated with allostatic load

Living in the past, the present, or the future can affect stress and health. Our group has shown that acute stress (cortisol reactivity) is modulated by time perspectives, the ways we psychologically relate to time. Here, we expand this research with a comprehensive measure of multi-systemic chronic stress (allostatic load). Among 204 healthy adults (60 men; 144 women), we examined whether time perspectives modulate allostatic load measured with 23 neuroendocrine, immune, metabolic, and cardiovascular biomarkers. Five time perspective categories were measured (past negative, past positive, present hedonistic, present fatalistic, future). Multiple regressions controlling for sex, age, and depressive symptoms were used. Increased present fatalistic time perspective was positively correlated with allostatic load, while future time perspective was negatively correlated with allostatic load. Our preliminary findings link time perspective to multisystemic chronic stress and are discussed in the context of potential clinical implications.

The effect of neurostimulation applied to the left dorsolateral prefrontal cortex on post-stress adaptation as a function of depressive brooding

Depressive brooding following a stressful event predicts negative affect and neuroendocrine responses related to psychological stress. The dorsolateral prefrontal cortex (DLPFC) has been associated with the top-down regulation of thoughts and emotions, and abnormal neural activity within this region has been associated with increased psychological stress and ruminative thinking. The aim of this study was to investigate whether the modulation of the DLPFC could have beneficial effects on ruminative thoughts and the endocrine response following a self-relevant stressor. Using a sham-controlled within-subjects crossover-design, two sessions of intermittent theta-burst stimulation (iTBS) were administered over the left DLPFC to thirty-eight healthy-volunteers after they were confronted with a social-evaluative stressor, the Trier Social Stress Test. To assess stress recovery, momentary rumination was measured before and after a resting period subsequent to the encounter with the stressor. In addition, cortisol levels were measured between and after the two iTBS sessions that were applied during the stress recovery phase. Overall, iTBS did not significantly influence ruminative thinking and cortisol secretion during the stress recovery phase. However, taking into account participants ruminative tendencies, our results revealed that for participants with higher levels of brooding ruminative thinking remained stable after iTBS, whereas in the sham condition there was a marginal significant increase in ruminative thinking. Moreover, only after iTBS, there was a significant reduction in cortisol secretion (i.e. a faster return to baseline as compared to sham) for high brooders during the recovery from the stressor. These results show that the prefrontal cortex plays a role in stress recovery mechanisms in individuals who are more vulnerable for psychopathology.

HPA axis responses to psychological challenge linking stress and disease: What do we know on sources of intra- and interindividual variability?

Stress is an ubiquitous phenomenon with significant impact on human physiology when it lasts too long, when it is too intense, or when it hits vulnerable individuals. Examining the mechanisms linking stress exposure with health and disease is an important endeavor in psychoneuroendocrine research. Empirical evidence so far revealed large intra- as well as inter-individual variability in hypothalamic-pituitary-adrenal (HPA) axis responses to acute psychosocial stress, showing that the HPA axis is a highly adaptive system. Thus, the characterization of intra- und inter-individual patterns of HPA axis reactivity is of high scientific interest and forms the basis on which mechanistic links between stress response (dys)regulation and health impairments can be examined. To date, basic knowledge has been, and still is, accumulated on demographic, biological (including genetic and epigenetic) factors, lifestyle behavioral variables, consumption of substances and medication, psychological and personality factors, as well as on methodological aspects. Besides this, there is also very recent progress in respect to the development of laboratory stress paradigms that can be applied in virtual reality or inside an MRI-scanner. In sum, the present review updates our current knowledge on moderating and intervening factors as sources of intra- und inter-individual variability in human cortisol stress responses and offers recommendations for future research designs.

Relationship between Personality and Biological Reactivity to Stress: A Review

Objective Personality traits can be the basis for individual differences in the biological response of stress. To date, many psychobiological studies have been conducted to clarify the relationship between personality and biological reactivity to stress. This review summarizes the most important findings in this area of research. Results Key findings related to the relationship between personality factors and stress-sensitive biological systems in four research models have been summarized; model of psychosocial characteristics, model based on Rumination and Emotional Inhibition, Eysenck's biopsychological model, and Five-Factor Approach of Personality. Conclusion According to the results of this review, it can be concluded that personality typology of individuals influenced their biological reactivity to stressful events. Understanding the biological basis of personality can help to better understand vulnerability to stress. Future research can be continuing based on framework of the four models.

Cognitive Control and Flexibility in the Context of Stress and Depressive Symptoms: The Cognitive Control and Flexibility Questionnaire

Cognitive control and (cognitive) flexibility play an important role in an individual's ability to adapt to continuously changing environments. In addition to facilitating goal-directed behaviors, cognitive control and flexibility have been implicated in emotion regulation, and disturbances of these abilities are present in mood and anxiety disorders. In the context of stressful experiences, the reported studies examined processes related to cognitive control and flexibility, emotional regulation and depressive symptoms. To this end, a brief (18-item) self-report measure - the Cognitive Control and Flexibility Questionnaire (CCFQ) - was developed. This questionnaire measures an individual's perceived ability to exert control over intrusive, unwanted (negative) thoughts and emotions, and their ability to flexibly cope with a stressful situation. In Study 1, the CCFQ was assessed among both university students (N = 300) and a community sample (N = 302). Preliminary analyses suggested a stable and reliable two-factor structure, that of cognitive control over emotion, and appraisal and coping flexibility. Scores on the CCFQ were strongly associated with greater depressive symptoms, even after controlling for other measures that had been taken to reflect cognitive control and (in)flexibility (e.g., the Ruminative Response Scale; Perseverative Thinking Questionnaire). In Study 2 (N = 368), lower scores on the CCFQ were related to more negative stressor appraisals (i.e., greater perceived threat and uncontrollability) of a personally meaningful stressful event. Perceptions of threat and uncontrollability, in turn, partially accounted for the association between CCFQ subscale scores and depressive symptoms. The relation between lower CCFQ scores and heightened depressive symptoms was also partially accounted for by less frequent engagement in problem-focused coping and more use of emotion-focused methods. In Study 3 (N = 47 females), lower scores on the cognitive control over emotion component of the CCFQ predicted elevated negative affect and an exacerbated cortisol response following an acute psychosocial stressor (Trier Social Stress Test). The present research points to the CCFQ as a useful self-report tool to identify ways through which cognitive control and flexibility might be manifested in stressful situations, and how reductions in flexibility might be accompanied by elevated symptoms of depression.

Prolonged performance-related neuroendocrine activation and perseverative cognition in low- and high-anxious university music students

Music performances are social-evaluative situations that can elicit marked short-term neuroendocrine activation and anxious thoughts especially in musicians suffering from music performance anxiety (MPA). The temporal patterns of neuroendocrine activity and concert-related worry and rumination (perseverative cognition, PC) days before and after a concert in low- and high-anxious musicians are unknown. The first goal of the present study was to investigate the prolonged effects of a solo music performance and the effects of trait MPA on salivary cortisol (sC), alpha-amylase (sAA), and concert-related PC. The second goal was to investigate whether concert-related PC is associated with neuroendocrine activity and mediates the effects of measurement day and trait MPA on neuroendocrine responses. Seventy-two university music students collected saliva samples and reported their PC for seven consecutive days. On the fifth day, they performed solo. Measurement day and trait MPA were tested as main predictors of the diurnal area under the curve with respect to ground (sC AUCg, sAA AUCg), awakening responses, and PC. SC AUCg, sAA AUCg, and concert-related PC were highest on concert day. SC AUCg decreased only partially on post-concert days. SAA AUCg remained elevated on the first post-concert day among students with moderate to very high trait MPA. Throughout the assessment period, trait MPA was associated with smaller sC AUCg and higher concert-related PC. Concert-related PC showed significant positive associations with sC AUCg and sAA AUCg but did not mediate the effects of measurement day and trait MPA on these measures. These findings suggest that solo music performances have prolonged neuroendocrine effects and that trait MPA is an important factor having specific effects on university music students' hypothalamic-pituitary-adrenal axis, autonomic nervous system, and cognitive activity.

The cortisol reactivity threshold model: Direction of trait rumination and cortisol reactivity association varies with stressor severity

Various internalizing risk factors predict, in separate studies, both augmented and reduced cortisol responding to lab-induced stress. Stressor severity appears key: We tested whether heightened trait-like internalizing risk (here, trait rumination) predicts heightened cortisol reactivity under modest objective stress, but conversely predicts reduced reactivity under more robust objective stress. Thus, we hypothesized that trait rumination would interact with a curvilinear (quadratic) function of stress severity to predict cortisol reactivity. Evidence comes from 85 currently non-depressed emerging adults who completed either a non-stressful control protocol (n = 29), an intermediate difficulty Trier Social Stress Test (TSST; n = 26), or a robustly stressful negative evaluative TSST (n = 30). Latent growth curve models evaluated relationships between trait rumination and linear and quadratic effects of stressor severity on the change in cortisol and negative affect over time. Among other findings, a significant Trait Rumination x Quadratic Stress Severity interaction effect for cortisol's Quadratic Trend of Time (i.e., reactivity, B = .125, p = .017) supported the hypothesis. Rumination predicted greater cortisol reactivity to intermediate stress (r_p = .400, p = .043), but blunted reactivity to more robust negative evaluative stress (r_p = -0.379, p = 0.039). Contrasting hypotheses, negative affective reactivity increased independently of rumination as stressor severity increased (B = .453, p = 0.044). The direction of the relationship between an internalizing risk factor (trait rumination) and cortisol reactivity varies as a function of stressor severity. We propose the Cortisol Reactivity Threshold Model, which may help reconcile several divergent reactivity literatures and has implications for internalizing psychopathology, particularly depression.

Trait rumination and response to negative evaluative lab-induced stress: neuroendocrine, affective, and cognitive outcomes

Theoretical models of depression posit that, under stress, elevated trait rumination predicts more pronounced or prolonged negative affective and neuroendocrine responses, and that trait rumination hampers removing irrelevant negative information from working memory. We examined several gaps regarding these models in the context of lab-induced stress. Non-depressed undergraduates completed a rumination questionnaire and either a negative-evaluative Trier Social Stress Test (n = 55) or a non-evaluative control condition (n = 69), followed by a modified Sternberg affective working memory task assessing the extent to which irrelevant negative information can be emptied from working memory. We measured shame, negative and positive affect, and salivary cortisol four times. Multilevel growth curve models showed rumination and stress interactively predicted cortisol reactivity; however, opposite predictions, greater rumination was associated with blunted cortisol reactivity to stress. Elevated trait rumination interacted with stress to predict augmented shame reactivity. Rumination and stress did not significantly interact to predict working memory performance, but under control conditions, rumination predicted greater difficulty updating working memory. Results support a vulnerability-stress model of trait rumination with heightened shame reactivity and cortisol dysregulation rather than hyper-reactivity in non-depressed emerging adults, but we cannot provide evidence that working memory processes are critical immediately following acute stress.

Cortisol and salivary alpha-amylase trajectories following a group social-evaluative stressor with adolescents

Intraindividual variability in stress responsivity and the interrelationship of multiple neuroendocrine systems make a multisystem analytic approach to examining the human stress response challenging. The present study makes use of an efficient social-evaluative stress paradigm - the Group Public Speaking Task for Adolescents (GPST-A) - to examine the hypothalamic-pituitary-adrenocortical (HPA)-axis and Autonomic Nervous System (ANS) reactivity profiles of 54 adolescents with salivary cortisol and salivary alpha-amylase (sAA). First, we account for individuals' time latency of hormone concentrations between individuals. Second, we use a two-piece multilevel growth curve model with landmark registration to examine the reactivity and recovery periods of the stress response separately. This analytic approach increases the models' sensitivity to detecting trajectory differences in the reactivity and recovery phases of the stress response and allows for interindividual variation in the timing of participants' peak response following a social-evaluative stressor. The GPST-A evoked typical cortisol and sAA responses in both males and females. Males' cortisol concentrations were significantly higher than females' during each phase of the response. We found no gender difference in the sAA response. However, the rate of increase in sAA as well as overall sAA secretion across the study were associated with steeper rates of cortisol reactivity and recovery. This study demonstrates a way to model the response trajectories of salivary biomarkers of the HPA-axis and ANS when taking a multisystem approach to neuroendocrine research that enables researchers to make conclusions about the reactivity and recovery phases of the HPA-axis and ANS responses. As the study of the human stress response progresses toward a multisystem analytic approach, it is critical that individual variability in peak latency be taken into consideration and that accurate modeling techniques capture individual variability in the stress response so that accurate conclusions can be made about separate phases of the response.

Trait Rumination Predicts Elevated Evening Cortisol in Sexual and Gender Minority Young Adults

Stress may contribute to illness through the impaired recovery or sustained activity of stress-responsive biological systems. Rumination, or mental rehearsal of past stressors, may alter the body’s stress-responsive systems by amplifying and prolonging exposure to physiological mediators, such as cortisol. The primary aim of the current investigation was to test the extent to which the tendency to ruminate on stress predicts diminished diurnal cortisol recovery (i.e., elevated evening cortisol) in a sample of sexual and gender minority young adults. Participants included 58 lesbian, gay, bisexual, and transgender young adults (M_age = 25.0, SD = 4.1) who completed an initial online survey that assessed trait rumination and current depressed mood. Participants completed daily evening questionnaires and provided salivary cortisol samples at wake, 45 min post-wake, 12 h post-wake, and at bedtime over seven consecutive days. Trait rumination predicted significantly higher cortisol concentrations at bedtime, but was unrelated to other cortisol indices (e.g., morning cortisol, diurnal slope, total output). The association with trait rumination was not accounted for by daily negative affect, and was largely independent of depressed mood. These results have implications for identifying and treating those who may be at risk for impaired diurnal cortisol recovery and associated negative health outcomes.

Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder

Although studies have documented heightened stress sensitivity in major depressive disorder (MDD) and generalized anxiety disorder (GAD), the mechanisms involved are poorly understood. One possible mechanism is the tendency to ruminate in response to stress. We used ecological momentary assessment to study ruminative thoughts after stressful events in 145 adults with MDD, GAD, comorbid MDD-GAD, or no psychopathology. Diagnosed individuals reported more event-related rumination than controls, even after adjusting for event stressfulness. Rumination was equally common in MDD and GAD and was especially severe among comorbid cases. More rumination immediately after the event predicted poorer affect, more maladaptive behavior, and more MDD and GAD symptoms at the next signal, even when pre-event levels of these variables were controlled. Rumination mediated, but did not moderate, the association of stress with affect and with symptoms. Stress-related rumination was more deleterious for diagnosed than healthy individuals, more intense for more severe clinical cases, and more persistent for cases with a greater temperamental vulnerability for emotional disorders. These results implicate rumination as a mechanism of stress sensitivity and suggest pathways through which it may maintain depression and anxiety in everyday life.

Trait and state rumination interact to prolong cortisol activation to psychosocial stress in females

There is a growing realization that cognitive processes associated with stress coping, such as rumination and distraction, can impact the hypothalamic-pituitary-adrenal-axis (HPA-axis). Yet, little is known about what aspects of the HPA-axis stress response (rate of activation, duration of activation, rate of recovery) is impacted by such cognitive processes. This study examines the impact of both ruminative trait tendencies and experimentally induced rumination on salivary cortisol responses to a social evaluative stress task. Participants (n=71) were exposed to the Trier Social Stress Test (TSST) and were then randomized to complete either a rumination or distraction task. Trait rumination was also assessed at baseline. Results showed no main effects of either trait rumination or experimental condition, but they interacted to predict the cortisol response. Specifically, participants high in trait rumination had prolonged duration of cortisol activation in the rumination condition, compared to those in the distraction condition. In contrast, cortisol responses of participants with low trait rumination did not differ by condition. Notably, our interaction effect was only significant in females. Our findings highlight the complex relationship between rumination and HPA-axis activity, suggesting an interaction of trait and state rumination in shaping HPA-axis responses to stress, and call attention to sex differences in this relationship.

What constitutes effective coping and efficient physiologic regulation following psychosocial stress depends on involuntary stress responses

This study utilized a random-assignment experimental design to examine the interactive contributions of youth-reported trait involuntary stress responses (ISRs) and effortful coping on physiologic reactivity and recovery patterns in preadolescent boys and girls. Fourth- and fifth-grade child-parent dyads (N=126) participated in this study. Children were exposed to the Trier Social Stress Test (TSST-C) and then to one of two randomly-assigned experimental coping conditions: behavioral distraction and cognitive avoidance. Children's ISRs were examined as predictors of salivary cortisol and alpha-amylase (sAA) reactivity as well as moderators of the effect of coping condition on cortisol and sAA recovery trajectories. Multi-level modeling analyses did not link ISRs to physiologic reactivity patterning. ISRs and coping condition interacted to predict differential physiologic recovery trajectories. In the distraction condition, children reporting high ISR levels displayed less efficient cortisol and sAA recovery than children reporting low ISR levels. Surprisingly, the opposite was found for children reporting high ISR levels in the avoidance condition. These children displayed more efficient physiologic recovery relative to their high ISR level peers in the distraction condition. Findings suggest that the efficiency of preadolescents' physiologic recovery following stress may depend on regulatory fit between children's ISR levels and cues from their coping environment.

Nonsynonymous HTR2C polymorphism predicts cortisol response to psychosocial stress I: Effects in males and females

BACKGROUND

Genetic influences on stress reactivity may provide insight into depression risk mechanisms. The C-allele of rs6318, a putatively functional polymorphism located within the HTR2C gene, has been reported to predict greater cortisol and negative affective reactivity to lab-induced stress. However, the potential moderating effect of sex has not been examined despite X-linkage of HTR2C. We hypothesized that sex moderates the effect of rs6318 on cortisol and affective reactivity to lab-induced stress, with males showing stronger effects.

METHODS

Non-depressed young adults (N=112; 39 female) screened via clinical interview provided a DNA sample and completed either a negative evaluative Trier Social Stress Test, or a non-evaluative control protocol. Salivary cortisol and self-reported affect were assessed at four timepoints.

RESULTS

Contrary to hypotheses, C-carriers showed blunted rather than exaggerated cortisol responses to lab-induced stress in multilevel models (b=0.467, p<0.001), which persisted when covarying subclinical depressive symptoms. This effect was not moderated by sex (b=0.174, p=0.421), and remained significant when examining females (b=0.362, p=0.013) and males (b=0.537, p<0.001) separately. C-carriers also exhibited marginally greater reactivity in negative self-focused affect in response to stress than non-carriers when covarying subclinical depressive symptoms (b=-0.360, p=0.067), and exhibited higher levels of subclinical depressive symptoms than non-carriers (F=6.463, p=0.012).

CONCLUSIONS

Results support a role for the rs6318 C-allele in dysregulated stress responding, and suggest that the C-allele may contribute to risk for depression.

Depressed Adolescents' Pupillary Response to Peer Acceptance and Rejection: The Role of Rumination

Heightened emotional reactivity to peer feedback is predictive of adolescents' depression risk. Examining variation in emotional reactivity within currently depressed adolescents may identify subgroups that struggle the most with these daily interactions. We tested whether trait rumination, which amplifies emotional reactions, explained variance in depressed adolescents' physiological reactivity to peer feedback, hypothesizing that rumination would be associated with greater pupillary response to peer rejection and diminished response to peer acceptance. Twenty currently depressed adolescents (12-17) completed a virtual peer interaction paradigm where they received fictitious rejection and acceptance feedback. Pupillary response provided a time-sensitive index of physiological arousal. Rumination was associated with greater initial pupil dilation to both peer rejection and acceptance, and diminished late pupillary response to peer acceptance trials only. Results indicate that depressed adolescents high on trait rumination are more reactive to social feedback regardless of valence, but fail to sustain cognitive-affective load on positive feedback.

The role of glucocorticoid receptor phosphorylation in the model of negative affective states

OBJECTIVES

To develop a structural equation model of negative affectivity (NA) that involves interaction of glucocorticoid receptor (GR) signaling, personality dimensions and recent stressful life events.

METHODS

Seventy participants - 35 diagnosed with major depression and 35 healthy controls, were enrolled in the study. Morning plasma cortisol levels were determined by chemiluminescent immunometric assays. Molecular parameters (total nuclear and cytoplasmatic GR, nuclear GR phosphorylated at serine 211 (pGR-211) and at serine 226 (pGR-226) and cytoplasmic FKBP51) were analysed from peripheral blood lymphocytes by Western blot. NA, personality dimensions and stressful life events were assessed by self-report instruments.

RESULTS

GR signalling parameters had direct independent effect on measures of NA, with pGR-226 levels showing the strongest correlation, followed by FKBP51 and pGR-211 levels. Neuroticism and extraversion also demonstrated strong independent effect on NA, while recent stressful events did not predict NA directly, but demonstrated a significant effect on personality dimensions. Cortisol, total nuclear GR and total cytoplasmatic GR levels were excluded from the model due to non-significant correlations with NA.

CONCLUSIONS

Negative affectivity is a transdiagnostic factor in vulnerability to affective disorders and possible therapeutic target. Molecular signature of negative affectivity should incorporate GR phosphorylation with other known biological underpinnings.

Extending the recovery window: Effects of trait rumination on subsequent evening cortisol following a laboratory performance stressor

Mental rehearsal of past stressors through rumination may extend the physiological stress response and exposure to stress-related physiological mediators, such as cortisol. If repeated over time, this prolonged activation may contribute to a number of chronic health conditions. Findings from the emerging literature on the tendency to ruminate and its association with cortisol have been somewhat mixed. In the present study, we tested whether trait rumination predicted elevated cortisol concentrations in response to a performance stressor, and whether this association varied by the social-evaluative context of the stressor and gender. We also examined whether associations persisted into the evening of the stressor. Participants (50% female; mean age=19.83, SD=1.62) were randomly assigned to complete a laboratory speech stressor either in a social-evaluative (SET; n=86) or non-evaluative context (non-SET; n=58). Salivary cortisol concentrations were measured throughout the laboratory visit and later that evening. There was a main effect of trait rumination on greater total cortisol exposure into the evening of the stressor. In addition, trait rumination interacted with stressor context to predict cortisol declines: on the night of the SET stressor, high trait ruminators did not exhibit typical declines in cortisol. Different cortisol patterns emerged for men and women with tendencies to ruminate: women with higher rumination scores had flatter cortisol slopes with greater evening cortisol, whereas men with higher trait rumination scores had greater initial cortisol reactivity to the stressor. Together, these findings suggest that the relationship between the tendency to ruminate and cortisol concentrations is qualified by individual differences (gender) and stressor characteristics (social-evaluative threat).

Influence of maternal depression on children's brooding rumination: Moderation by CRHR1 TAT haplotype

There is growing evidence that brooding rumination plays a key role in the intergenerational transmission of major depressive disorder (MDD) and may be an endophenotype for depression risk. However, less is known about the mechanisms underlying this role. Therefore, the goal of the current study was to examine levels of brooding in children of mothers with a history of MDD (n = 129) compared to children of never depressed mothers (n = 126) and to determine whether the variation in a gene known to influence hypothalamic-pituitary-adrenal axis functioning--corticotropin-releasing hormone receptor 1 (CRHR1)--would moderate the link between maternal MDD and children's levels of brooding. We predicted children of mothers with a history of MDD would exhibit higher levels of brooding than children of mothers with no lifetime depression history but that this link would be stronger among children carrying no copies of the protective CRHR1 TAT haplotype. Our results supported these hypotheses and suggest that the development of brooding among children of depressed mothers, particularly children without the protective CRHR1 haplotype, may serve as an important mechanism of risk for the intergenerational transmission of depression.

Brooding rumination and cardiovascular reactivity to a laboratory-based interpersonal stressor

There is a well-known link between stress and depression, but diathesis-stress models suggest that not all individuals are equally susceptible to stress. The current study examined if brooding rumination, a known risk factor for depression, influences cardiovascular reactivity to a laboratory-based interpersonal stressor. Sixty-five women watched a baseline video and were exposed to an interpersonal stressor while high frequency heart rate variability (HRV) was collected. We found that women who endorsed higher levels of brooding rumination exhibited greater HRV withdrawal from baseline to stressor, an effect that was maintained when we controlled for levels of depression. This physiological vulnerability, when combined with high levels of stress, may be one mechanism underlying how brooding rumination increases depression risk.

Post-stress rumination predicts HPA axis responses to repeated acute stress

Failure of the hypothalamus-pituitary-adrenal (HPA) axis to habituate to repeated stress exposure is related with adverse health outcomes, but our knowledge of predictors of non-habituation is limited. Rumination, defined as repetitive and unwanted past-centered negative thinking, is related with exaggerated HPA axis stress responses and poor health outcomes. The aim of this study was to test whether post-stress rumination was related with non-habituation of cortisol to repeated stress exposure. Twenty-seven participants (n=13 females) were exposed to the Trier Social Stress Test (TSST) twice on consecutive afternoons. Post-stress rumination was measured after the first TSST, and HPA axis responses were assessed by measuring salivary cortisol 1 min before, and 1, 10, 20, 60, and 120 min after both TSSTs. Stress exposure induced HPA axis activation on both days, and this activation showed habituation indicated by lower responses to the second TSST (F=3.7, p=0.015). Post-stress rumination after the first TSST was associated with greater cortisol reactivity after the initial stress test (r=0.45, p<0.05) and with increased cortisol responses to the second TSST (r=0.51, p<0.01), indicating non-habituation, independently of age, sex, depressive symptoms, perceived life stress, and trait rumination. In summary, results showed that rumination after stress predicted non-habituation of HPA axis responses. This finding implicates rumination as one possible mechanism mediating maladaptive stress response patterns, and it might also offer a pathway through which rumination might lead to negative health outcomes.

The Relationship between Rumination and Affective, Cognitive, and Physiological Responses to Stress in Adolescents

Although previous studies have established that rumination influences responses to stressful life events, the mechanisms underlying this relationship remain inadequately understood. The current study examines the relationship between trait rumination and affective, cognitive, and physiological responses to a standardized laboratory-based stressor in adolescents. A community-based sample of adolescents (N = 157) aged 13-17 completed the Trier Social Stress Test (TSST). Affective, cognitive, and physiological responses were obtained before, during, and after the TSST. Adolescents who engaged in habitual rumination experienced greater negative affect and more negative cognitive appraisals in response to the TSST than adolescents with lower levels of rumination. Rumination was unrelated to heart rate reactivity, but predicted slower heart rate recovery from the TSST, indicating that rumination might be specifically associated with physiological recovery from stress. Rumination is associated with negative affective, cognitive, and physiological responses following stressors, suggesting potential mechanisms through which it might increase risk for psychopathology.

Biological and psychological markers of stress in humans: focus on the Trier Social Stress Test

Validated biological and psychological markers of acute stress in humans are an important tool in translational research. The Trier Social Stress Test (TSST), involving public interview and mental arithmetic performance, is among the most popular methods of inducing acute stress in experimental settings, and reliably increases hypothalamic-pituitary-adrenal axis activation. However, although much research has focused on HPA axis activity, the TSST also affects the sympathetic-adrenal-medullary system, the immune system, cardiovascular outputs, gastric function and cognition. We critically assess the utility of different biological and psychological markers, with guidance for future research, and discuss factors which can moderate TSST effects. We outline the effects of the TSST in stress-related disorders, and if these responses can be abrogated by pharmacological and psychological treatments. Modified TSST protocols are discussed, and the TSST is compared to alternative methods of inducing acute stress. Our analysis suggests that multiple readouts are necessary to derive maximum information; this strategy will enhance our understanding of the psychobiology of stress and provide the means to assess novel therapeutic agents.

State Rumination: Associations with Emotional Stress Reactivity and Attention Biases

Within dysphoria, rumination has been identified as a particularly maladaptive emotion regulation strategy linked to prolonged negative affect and the onset of depressive episodes. Until now, the majority of research assessing naturally occurring rumination has utilized trait rumination measures; however, additional information may be obtained by assessing state rumination. The current study examined the association between state rumination and participants' emotional recovery from stress. In addition, biased attention toward emotional information was investigated as a mechanism that might underlie state rumination. Participants completed the exogenous cuing task to assess attentional engagement and disengagement from emotional facial expressions followed by a psychosocial stressor. State rumination and self-reported sadness were measured during the recovery period. As expected, state rumination was associated with less recovery in sadness scores, even after controlling for trait rumination and depressive symptoms. Moreover, within the high dysphoria group, participants who had more difficulty disengaging from emotional expressions reported higher levels of rumination in response to the stressor. Results highlight an important association between state rumination and individuals' recovery from stress, and suggest that difficulty disengaging attention from emotional expressions might be one mechanism underlying state rumination in dysphoria.

Psychoendocrine validation of a short measure for assessment of perceived stress management skills in different non-clinical populations

BACKGROUND

We investigated the psychometric properties of a short questionnaire for combined assessment of different perceived stress management skills in the general population and tested whether scores relate to physiological stress reactivity.

METHODS

For psychometric evaluation, we determined the factor structure of the questionnaire and investigated its measurement invariance in the participant groups and over time in three different independent samples representing the general population (total N=332). Reliability was tested by estimating test-retest reliability, internal consistency, and item reliabilities. We examined convergent and criterion validity using selected criterion variables. For endocrine validation, 35 healthy non-smoking and medication-free men in a laboratory study and 35 male and female employees in a workplace study underwent an acute standardized psychosocial stress task. We assessed stress management skills and measured salivary cortisol before and several times up to 60 min (workplace study) and 120 min (laboratory study) after stress. Potential confounders were controlled.

RESULTS

The factor structure of the questionnaire consists of five scales reflecting acceptably distinct stress management skills such as cognitive strategies, use of social support, relaxation strategies, anger regulation, and perception of bodily tension. This factor structure was stable across participant groups and over time. Internal consistencies, item reliabilities, and test-retest reliabilities met established statistical requirements. Convergent and criterion validity were also established. In both endocrine validation studies, higher stress management skills were independently associated with lower cortisol stress reactivity (p's<.029).

CONCLUSIONS

Our findings suggest that the questionnaire has good psychometric properties and that it relates to subjective psychological and objective physiological stress indicators. Therefore, the instrument seems a suitable measure for differential assessment of stress management skills in the general population.

Cortisol and depression: three questions for psychiatry

BACKGROUND

Cortisol plays a multifaceted role in major depression disorder (MDD). Diurnal rhythms are disturbed, there is increased resistance to the feedback action of glucocorticoids, excess cortisol may induce MDD, basal levels may be higher and the post-awakening cortisol surge accentuated in those at risk for MDD. Does this suggest new avenues for studying MDD or its clinical management?

METHOD

The relevant literature was reviewed.

RESULTS

Cortisol contributes to genetic variants for the risk for MDD and the way that environmental events amplify risk. The corticoids' influence begins prenatally, but continues into adulthood. The impact of cortisol at each phase depends not only on its interaction with other factors, such as psychological traits and genetic variants, but also on events that have, or have not, occurred previously.

CONCLUSIONS

This review suggests that the time is now right for serious consideration of the role of cortisol in a clinical context. Estimates of cortisol levels and the shape of the diurnal rhythm might well guide the understanding of subtypes of MDD and yield additional indicators for optimal treatment. Patients with disturbed cortisol rhythms might benefit from restitution of those rhythms; they may be distinct from those with more generally elevated levels, who might benefit from cortisol blockade. Higher levels of cortisol are a risk for subsequent depression. Should manipulation of cortisol or its receptors be considered as a preventive measure for some of those at very high risk of future MDD, or to reduce other cortisol-related consequences such as long-term cognitive decline?

Trait mindfulness modulates neuroendocrine and affective responses to social evaluative threat

BACKGROUND

Individual differences in mindfulness have been associated with numerous self-report indicators of stress, but research has not examined how mindfulness may buffer neuroendocrine and psychological stress responses under controlled laboratory conditions. The present study investigated the role of trait mindfulness in buffering cortisol and affective responses to a social evaluative stress challenge versus a control task.

METHODS

Participants completed measures of trait mindfulness, perceived stress, anxiety, and fear of negative evaluation before being randomized to complete the Trier Social Stress Test (TSST; Kirschbaum et al., 1993) or a control task. At points throughout the session, participants provided five saliva samples to assess cortisol response patterns, and completed four self-report measures of anxiety and negative affect to assess psychological responses.

RESULTS

In accord with hypotheses, higher trait mindfulness predicted lower cortisol responses to the TSST, relative to the control task, as well as lower anxiety and negative affect. These relations remained significant when controlling for the role of other variables that predicted cortisol and affective responses.

CONCLUSIONS

The findings suggest that trait mindfulness modulates cortisol and affective responses to an acute social stressor. Further research is needed to understand the neural pathways through which mindfulness impacts these responses.

The multiple systems model of angry rumination

Angry rumination is perseverative thinking about a personally meaningful anger-inducing event and is a risk factor for aggression. This article presents a new model for understanding angry rumination across five levels of analysis: cognitive, neurobiological, affective, executive control, and behavioral. The type of rumination that occurs at the cognitive level moderates affective responding and neurobiological activation, which influences executive control and aggression. Angry rumination recruits brain regions implicated in cognitive control, emotion regulation, negative affect, physiological arousal, social cognition, and self-reflection on emotional states. Moreover, angry rumination temporarily reduces self-control, which can increase aggression. The article suggests a functional account of angry rumination, identifies gaps in our knowledge, and proposes future research directions based on hypotheses derived from the model.

Stress-coping and cortisol analysis in patients with non-syndromic cleft lip and palate: an explorative study

Background

Non-syndromic clefts of the orofacial region occur in approximately 1 per 500 to 2,500 live births, depending on geographical area and ethnicity. It can be supposed that the disruption of the normal facial structure and the long-standing pressure of treatment from birth to adulthood bring about a range of life stressors which may lead to a long-lasting impact on affected subjects throughout their lives. Therefore, the present study aimed to assess different aspects of psychosocial stress in affected individuals.

Methods

The study was divided into two parts: first, the Trier Social Stress Test which involves uncontrollability and high levels of social-evaluative stress under real conditions and second, the query of various aspects of coping with psychosocial stress. The test group consisted of 30 affected adult subjects, and an equally sized control group of unaffected volunteers. Cortisol dysregulation was determined by saliva samples before and after stress induction. Meanwhile, participants were asked to complete the SVF 120 stress-coping questionnaire.

Results

The analysis of saliva samples showed a similar baseline concentration as well as a similar increase in cortisol levels after stress induction for both groups. Subsequently, the decline in cortisol concentrations was significantly faster in the CLP group (course: p<0.001; groups: p = 0.102; interaction: p = 0.167). The evaluation of the stress-coping questionnaire revealed a significantly shorter rumination about a stressful event in individuals with CLP-related malformations (p = 0.03).

Conclusion

We conclude that adults with CLP have significantly better stress-coping strategies than their healthy peers.

Trial Registration

German Clinical Trials Organization DRKS00003466

Assessing the relationship between rumination and cortisol: a review

OBJECTIVE AND METHODS

For individuals who ruminate, or mentally rehearse past stressful events, the physiological effects of a stressor may be longer lasting. This is well-supported within the cardiovascular domain. In the context of the hypothalamic-pituitary-adrenal (HPA) axis and cortisol, the results are inconsistent. This review summarizes key theoretical and methodological issues that contribute to these mixed findings among the 15 studies to date that have examined the association between rumination and cortisol.

RESULTS

State measures of rumination were consistently linked to increased cortisol concentrations. Stress-related rumination questionnaires were often positively associated with cortisol, whereas depression-related rumination scales predicted lower cortisol concentrations or were unrelated to cortisol. Rumination manipulations in the laboratory (e.g., ruminative self-focused writing tasks compared to distraction writing tasks) influenced cortisol concentrations, but often did not increase cortisol relative to baseline values. Studies that utilized social-evaluative stressor tasks to examine the relationship between rumination and cortisol levels generally showed that rumination predicted greater cortisol reactivity or delayed recovery. Results from studies examining rumination and basal cortisol or the cortisol awakening response were inconsistent.

CONCLUSION

The ways in which researchers conceptualize and assess rumination and the associated cortisol response influences the association between rumination and cortisol. Suggestions for future studies in this area of research are provided.

Self-focus and social evaluative threat increase salivary cortisol responses to acute stress in men

This experiment tested the hypothesis that self-focused attention might increase cortisol release. Social self-preservation theory suggests that social evaluation and associated feelings of shame are associated with cortisol reactivity, whereas one implication of objective self-awareness theory is that self-critical awareness and associated feelings of anxiety might be associated with increases in cortisol. 120 participants completed a public speech task either in front of an evaluative panel (social threat), in a non-evaluative setting while watching themselves in real-time on a television (self-focus), or in the mere presence of a non-evaluative person (control). Cortisol increased comparably among men in the social threat and self-focus conditions, but not among men in the control condition. There were no effects for women. Shame was correlated with increased cortisol in the social threat condition, whereas anxiety was correlated with increased cortisol in the self-focus condition. One broad implication of this work is that negative evaluation may increase cortisol regardless of whether this source comes from oneself or others.

Sleep loss due to worry and future risk of cardiovascular disease and all-cause mortality: the Scottish Health Survey

BACKGROUND

The association between specific sleeping disorders and risk of cardiovascular disease (CVD) is unclear. We assessed the association between sleep loss due to worry and future risk of CVD and death in a representative sample of community dwelling adults.

METHODS

A cohort of 11,905 adults (aged 53.4 ± 12.2 years, 42.2% male) without known history of CVD were drawn from the Scottish Health Surveys. Self-reported sleep disturbance was measured using a single item from the General Health Questionnaire. Incident CVD events (comprising CVD death, nonfatal myocardial infarction, coronary surgical procedures, stroke, and heart failure) over 8-year follow up were ascertained by a linkage to national registers; a total of 1448 CVD events and 1249 all-cause deaths were recorded.

RESULTS

15.6% of the sample reported 'rather more' or 'much more than usual' sleep loss due to worry over the prior 4 weeks. Sleep loss due to worry (much more than usual) was associated with elevated risk of CVD [age- and sex-adjusted hazard ratio (HR) 1.74, 95% confidence interval (CI) 1.35-2.25] and all-cause mortality (age- and sex-adjusted HR 2.02, 95% CI 1.57-2.61). Adjustment for a range of psychosocial, behavioural, and clinical risk factors partly attenuated the association, and in particular health behaviours (smoking, alcohol, physical inactivity) accounted for approximately 40% of the sleep-CVD relation.

CONCLUSION

Sleep loss due to worry was associated with a greater risk of CVD and all-cause mortality, but the association can be largely explained by intermediate risk factors such as health behaviours.