Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Duration of Perseverative Thinking as Related to Perceived Stress and Blood Pressure

An Ambulatory Monitoring Study

Birk, Jeffrey L. PhD; Cornelius, Talea PhD; Edmondson, Donald PhD; Schwartz, Joseph E. PhD

doi: 10.1097/PSY.0000000000000727

Objective Psychological distress may be intensified and prolonged by perseverative thinking (e.g., rumination, worry). The tendency to engage frequently in perseverative thinking has been linked to increased blood pressure (BP). Research is needed to investigate the physiological consequences of time spent perseverating by testing the momentary association between the duration of perseverative thinking and BP. The present study examines the extent to which the duration of perseverative thinking is associated with momentary perceived stress and ambulatory BP elevations during daily life.

Methods Participants (N = 373) drawn from a larger project on BP and cardiovascular health completed 24-hour ambulatory BP monitoring accompanied by ecological momentary assessments of their perseverative thoughts and feelings. Multilevel models tested associations among perseveration duration, momentary perceived stress, and systolic and diastolic BP, adjusting for person-level and momentary covariates.

Results Higher within-subject perseveration duration was associated with higher stress (B = 0.29; 95% confidence interval [CI] = 0.24–0.33; p < .001). Although higher perseveration duration was not associated with substantially higher systolic (B = 0.16 mm Hg; 95% CI = 0.00–0.33 mm Hg; p = .056) or diastolic (B = 0.07 mm Hg; 95% CI = −0.05 to 0.19 mm Hg; p = .25) BP, the associations between higher perseveration duration and higher systolic (p = .032) and diastolic (p = .036) BP were significantly mediated by a higher intensity of momentary perceived stress.

Conclusions Findings support the clinically important notion that physiological consequences of perceived stress can be maintained and even heightened by maladaptively prolonged mental activity.

From the Center for Behavioral Cardiovascular Health, Columbia University Medical Center (Birk, Cornelius, Edmondson, Schwartz), New York, New York.

Address correspondence to Jeffrey L. Birk, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St, PH9-319, New York, NY 10032. E-mail:

Received for publication August 2, 2018; revision received April 23, 2019.

Supplemental Content

Online date: July 5, 2019

Copyright © 2019 by American Psychosomatic Society
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website