Review
Assessing the relationship between rumination and cortisol: A review

https://doi.org/10.1016/j.jpsychores.2012.03.007Get rights and content

Abstract

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.

Introduction

Stress can have profound consequences on our bodies, and an abundance of research has documented the wide range of negative effects that stressors can have on health [1]. For individuals who ruminate, or mentally rehearse past stressful events, the physiological effects of a stressor may be longer lasting. This could happen via slower physiological recovery, or longer time to turn off the response. For example, elevated levels of stress hormones may continue to circulate in the body long after an argument has ended for those who dwell on it. In addition, subsequent recall of a stressor could serve to reactivate the stress response later in time. For instance, thinking about yesterday's argument may trigger increases in blood pressure again today. Both of these pathways may lead to persistent activation of stress-related systems as outlined by the Perseverative Cognition Hypothesis [2]. The majority of evidence supporting the hypothesis that perseverative cognition, such as rumination, may prolong the physiological activation originates from the cardiovascular domain [2]. A growing body of research has also examined this model in the context of the hypothalamic–pituitary–adrenal (HPA) axis and its end-product, cortisol [3].

The HPA axis is a major stress response system that is critical for survival and adaptation, and may be particularly relevant in understanding the adverse effects stressors may have on health. Release of cortisol in response to certain stressors may be adaptive in the short term, as it leads to behavioral and physical changes to deal with the acute threat [1]. Prolonged exposure to cortisol from exaggerated, extended, or repeated activation of the HPA axis, however, may be maladaptive. Indeed, a range of disorders, including insulin resistance and cardiovascular disease, have been associated with persistent activation of the HPA axis [4]. Therefore, identifying and targeting factors, such as rumination, that may lead to excessive cortisol exposure could have important health implications.

The studies that have thus far examined the association between rumination and cortisol have produced inconsistent results. Factors contributing to the mixed findings include variability in conceptualization, measurement, and manipulation of rumination, as well as differences in cortisol assessment (e.g., basal cortisol versus cortisol responses to stressors). This review summarizes these key theoretical and methodological issues, discusses these factors in the context of the 151 published studies to date that have examined the association between rumination and cortisol, and provides suggestions for future studies in this rapidly-growing area of research. In this review, the study results have been organized by rumination measure and manipulation as well as by cortisol assessment.

Section snippets

Rumination: definition and elicitors

Rumination has been defined in multiple ways and across a variety of contexts and is largely characterized by repetitive, unwanted, past-oriented thoughts about negative content [5], [6]. Rumination is generally considered to be maladaptive in nature and it has been implicated in the exacerbation and maintenance of a variety of adverse mental health outcomes, including depression [7], social anxiety [8], and post-traumatic stress disorder [9]. Rumination is related to another perseverative

SET, rumination, and cortisol

Conditions in which central goals are threatened or blocked are also potent elicitors of cortisol. This is well illustrated with social self-preservation theory [16]. According to this model, SET takes place when an important aspect of the self-identity is or could be negatively judged by others (e.g., rejection). In response to real or perceived negative social evaluation by others, one may engage in negative self-evaluation and consequently experience shame and other self-conscious emotions

Rumination: measurement and manipulation

Rumination has been operationalized in many different ways, which could lead to different relationships between rumination and cortisol. In the following section, we review the findings from the published studies for the various measures and manipulations of rumination.

Cortisol assessment

The way in which researchers assess cortisol may also contribute to the inconsistent associations between rumination and cortisol. As already reviewed, some researchers examined cortisol concentrations in response to rumination manipulations to understand whether rumination is associated with prolonged activation. Other cortisol assessment methods have also been used, including: (a) basal, or resting, cortisol levels at a specific time of day, (b) the cortisol awakening response (CAR), and (c)

General discussion and considerations for future research

Results of the studies in this review demonstrate mixed associations between rumination and cortisol. Researchers who have examined the effects of rumination on the HPA axis have utilized a heterogeneous set of methods. Patterns of cortisol results emerged based on how researchers conceptualized rumination through measures and manipulations of rumination. In addition, methods of cortisol assessment also contributed to the variable results.

Conclusion

In conclusion, the ways in which researchers conceptualize and assess rumination and the associated cortisol response can influence the association between rumination and cortisol. Rumination may lead to prolonged activation of the HPA axis, and for those who ruminate excessively or repeatedly, these sustained elevations in cortisol may have important health consequences.

Conflict of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

References (69)

  • J. Backhaus et al.

    Sleep disturbances are correlated with decreased morning awakening salivary cortisol

    Psychoneuroendocrinology

    (2004)
  • C. Kuehner et al.

    Decreased cortisol response to awakening is associated with cognitive vulnerability to depression in a nonclinical sample of young adults

    Psychoneuroendocrinology

    (2007)
  • H.M. Burke et al.

    Depression and cortisol responses to psychological stress: a meta-analysis

    Psychoneuroendocrinology

    (2005)
  • Y. Chida et al.

    Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis

    Biol Psychol

    (2009)
  • M. Maes et al.

    The relevance of the in- versus outpatient status for studies on HPA-axis in depression: spontaneous hypercortisolism is a feature of major depressed inpatients and not of major depression per se

    Prog Neuropsychopharmacol Biol Psychiatry

    (1994)
  • W.R. Lovallo et al.

    Use of a resting control day in measuring the cortisol response to mental stress: diurnal patterns, time of day, and gender effects

    Psychoneuroendocrinology

    (2010)
  • J.C. Pruessner et al.

    Free cortisol levels after awakening: a reliable biological marker for the assessment of adrenocortical activity

    Life Sci

    (1997)
  • A.A. Stone et al.

    Individual differences in the diurnal cycle of salivary free cortisol: a replication of flattened cycles for some individuals

    Psychoneuroendocrinology

    (2001)
  • S. Wüst et al.

    Genetic factors, perceived chronic stress, and the free cortisol response to awakening

    Psychoneuroendocrinology

    (2000)
  • P. Putman et al.

    Cortisol administration acutely reduces threat-selective spatial attention in healthy young men

    Physiol Behav

    (2010)
  • P. Putman et al.

    A single administration of cortisol acutely reduces preconscious attention for fear in anxious young men

    Psychoneuroendocrinology

    (2007)
  • A.J. Guastella et al.

    The impact of rumination on sleep quality following a stressful life event

    Pers Individ Differ

    (2007)
  • B.M. Kudielka et al.

    HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender

    Psychoneuroendocrinology

    (2004)
  • B.M. Kudielka et al.

    Sex differences in HPA axis responses to stress: a review

    Biol Psychol

    (2005)
  • G.P. Chrousos et al.

    The concepts of stress and stress system disorders

    JAMA

    (1992)
  • B. Verkuil et al.

    When worries make you sick: a review of perseverative cognition, the default stress response and somatic health

    J Exp Psychopathol

    (2010)
  • B. McEwen et al.

    Stress and affect: applicability to the concepts of allostasis and allostatic load

  • E.R. Watkins

    Constructive and unconstructive repetitive thought

    Psychol Bull

    (2008)
  • S. Nolen-Hoeksema et al.

    Response styles and the duration of episodes of depressed mood

    J Abnorm Psychol

    (1993)
  • D.M. Clark et al.

    A cognitive model of social phobia

  • T. Michael et al.

    Rumination in posttraumatic stress disorder

    Depress Anxiety

    (2007)
  • T.D. Borkovec et al.

    Worry: a cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes

    Cogn Ther Res

    (1998)
  • M. Wänke et al.

    Rumination: when all else fails

  • D. Watson et al.

    Negative affectivity: the disposition to experience aversive emotional states

    Psychol Bull

    (1984)
  • Cited by (0)

    View full text