stress. This is known as stress recovery and it is proposed that people who take longer
to recover may be more vulnerable to future ill health (e.g. Schuler and O’Brien, 1997;
Schneider et al., 2003). For example, in a study by Steptoe and Marmot (2005) in which
the effects of stress reactivity and post-stress recovery on blood pressure 3 years later
were investigated, they showed that increases in blood pressure levels 3 years later were
most strongly associated with longer post-stress recovery. More impressively, these
effects were independent of all the other risk factors measured (e.g. age, gender, body
mass index, socio-economic status, smoking status, hypertension medication, etc.).
Steptoe and Marmot (2005) also suggested that post-stress recovery may become more
important as we get older. When we are young our recovery from stress tends to be
swift and efficient, whereas, as we age, it may become less well controlled. One reason
for this may be linked to McEwen’s concept of allostatic load – longer post-stress
recovery may develop as a result of wear and tear to the cardiovascular system caused
by the body having to frequently respond to stress over several decades. This area of
research is relatively new, therefore we cannot draw firm conclusions about the
importance of stress recovery; however, the initial findings are promising.
PERSEVERATIVE COGNITION
Recent developments in stress theory have highlighted the importance of worry,
rumination and repetitive thought in improving our understanding of stress-disease
relationships. Brosschot, Gerin and Thayer (2006), in their perseverative cognition
hypothesis (PCH), have suggested that worry or repetitive thinking may lead to disease
by prolonging stress-related physiological activation by amplifying short-term responses,
delaying recovery or reactivating responses after a stressor has been experienced. There
is a growing body of evidence that has demonstrated that perseverative cognition is
associated with somatic outcomes cross-sectionally and prospectively (see Verkuil et
al., 2010 for a review). For example, Brosschot and van der Doef (2006), in a worry
intervention study, showed that reduction in worry was associated with a decrease in
somatic complaints. In a more sophisticated design using electronic diaries, Verkuil
and colleagues (2012) clearly demonstrated that worry intensity was predictive of the
frequency of somatic complaints and intensity mediated the effect of stressful events
on these complaints. Building upon this work, another recent investigation found that
stress-related thinking (triggered by the disclosure of traumatic thoughts) was associated
with higher cortisol levels and upper respiratory infection symptoms at follow-up
(O’Connor et al., 2013). Similar to stress recovery, research exploring the effects of
perseverative cognition on health is still in its infancy, however, it represents an exciting
avenue for future work.
CONCLUSIONS
We have presented a range of perspectives on stress and its relationship with health.
These have included research that has sought to establish links between the existence
of objective stressors (such as measures of major life events) and physical health
64 STRESS AND HEALTH