***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Although mindfulness meditation interventions have recently shown benefits for reducing stress in various population s , little is known about their relative efficacy compared with relaxation interventions . Purpose : This r and omized controlled trial examines the effects of a 1-month mindfulness meditation versus somatic relaxation training as compared to a control group in 83 students ( M age=25 ; 16 men and 67 women ) reporting distress . Method : Psychological distress , positive states of mind , distractive and ruminative thoughts and behaviors , and spiritual experience were measured , while controlling for social desirability . Results : Hierarchical linear modeling reveals that both meditation and relaxation groups experienced significant decreases in distress as well as increases in positive mood states over time , compared with the control group ( p<.05 in all cases ) . There were no significant differences between meditation and relaxation on distress and positive mood states over time . Effect sizes for distress were large for both meditation and relaxation ( Cohen ’s d=1.36 and .91 , respectively ) , whereas the meditation group showed a larger effect size for positive states of mind than relaxation ( Cohen ’s d=.71 and .25 , respectively ) . The meditation group also demonstrated significant pre-post decreases in both distractive and ruminative thoughts/behaviors compared with the control group ( p<.04 in all cases ; Cohen ’s d=.57 for rumination and .25 for distraction for the meditation group ) , with mediation models suggesting that mindfulness meditation ’s effects on reducing distress were partially mediated by reducing rumination . No significant effects were found for spiritual experience . Conclusions : The data suggest that compared with a no-treatment control , brief training in mindfulness meditation or somatic relaxation reduces distress and improves positive mood states . However , mindfulness meditation may be specific in its ability to reduce distractive and ruminative thoughts and behaviors , and this ability may provide a unique mechanism by which mindfulness meditation reduces distress Depressive rumination - a central characteristic of Major Depressive Disorder ( MDD ) - is a maladaptive emotion regulation strategy that prolongs sad mood and depressive episodes . Considerable research demonstrates the emotional and behavioral consequences of depressive rumination , yet few studies investigate its effect on neuroendocrine functioning . The current study examined the effect of an emotion regulation manipulation on the trajectory of cortisol concentrations among individuals with MDD and healthy controls ( CTL ) . Sadness was induced via forced failure . Participants then were r and omly assigned to a depressive rumination or distraction emotion regulation induction . MDDs in the rumination condition exhibited less cortisol decline compared to MDDs in the distraction condition and compared to CTLs in either condition . Findings suggest that depressive rumination alters the trajectory of cortisol secretion in MDD and may prolong cortisol production . Results thereby provide important insights into the interaction of biological and psychological factors through which distress contributes to MDD This study examined an experiential avoidance conceptualization of depressive rumination in 3 ways : 1 ) associations among question naire measures of rumination , experiential avoidance , and fear of emotions ; 2 ) performance on a dichotic listening task that highlights preferences for non-depressive material ; and 3 ) psychophysiological reactivity in an avoidance paradigm modeled after the one used by Borkovec , Lyonfields , Wiser , and Deihl ( 1993 ) in their examination of worry . One hundred and thirty-eight undergraduates completed question naire measures and participated in a clinical interview to diagnose current and past episodes of depression . Of those , 100 were r and omly assigned to a rumination or relaxation induction condition  and participated in a  dichotic listening task , rumination/relaxation induction , and depression induction .  Question naire measures confirmed a relationship between rumination status and avoidance ; however , no significant effects were found in the dichotic listening task . Psychophysiological measures indicated no difference in physiological response to a depression induction among high ruminators ( HR ) . However , low ruminators ( LR ) in the relaxation condition exhibited a larger IBI response than LR in the rumination condition . Overall , these results provide partial support for an avoidance conceptualization of depressive rumination . Implication s of these findings are discussed CONTEXT The terrorist attacks of 9/11 ( September 11 , 2001 ) present an unusual opportunity to examine prospect ively the physical health impact of extreme stress in a national sample . OBJECTIVE To examine the degree to which acute stress reactions to the 9/11 terrorist attacks predict cardiovascular outcomes in a national probability sample over the subsequent 3 years . DESIGN , SETTING , AND PARTICIPANTS A national probability sample of 2729 adults ( 78.1 % participation rate ) , 95.0 % of whom had completed a health survey before 9/11 ( final health sample , 2592 ) , completed a Web-based assessment of acute stress responses approximately 9 to 14 days after the terrorist attacks . Follow-up health surveys reassessed physician-diagnosed cardiovascular ailments 1 ( n = 1923 , 84.3 % participation rate ) , 2 ( n = 1576 , 74.2 % participation rate ) , and 3 ( n = 1950 , 78.9 % participation rate ) years following the attacks . MAIN OUTCOME MEASURES Reports of physician-diagnosed cardiovascular ailments over the 3 years following the attacks . RESULTS Acute stress responses to the 9/11 attacks were associated with a 53 % increased incidence of cardiovascular ailments over the 3 subsequent years , even after adjusting for pre-9/11 cardiovascular and mental health status , degree of exposure to the attacks , cardiovascular risk factors ( ie , smoking , body mass index , and number of endocrine ailments ) , total number of physical health ailments , somatization , and demographics . Individuals reporting high levels of acute stress immediately following the attacks reported an increased incidence of physician-diagnosed hypertension ( rate ratios , 2.15 at 1 year and 1.75 at 2 years ) and heart problems ( rate ratios , 2.98 at 1 year and 3.12 at 2 years ) over 2 years . Among individuals reporting ongoing worry about terrorism post-9/11 , high 9/11-related acute stress symptoms predicted increased risk of physician-diagnosed heart problems 2 to 3 years following the attacks ( rate ratios , 4.67 at 2 years and 3.22 at 3 years ) . CONCLUSION Using health data collected before 9/11 as a baseline , acute stress response to the terrorist attacks predicted increased reports of physician-diagnosed cardiovascular ailments over 3 years following the attacks BACKGROUND Worry is an important component of anxiety , which recent work suggests is related to increased incidence of coronary heart disease ( CHD ) . Chronic worry has also been associated with decreased heart rate variability . We hypothesized that high levels of worry may increase CHD risk . METHOD AND RESULTS We examined prospect ively the relationship of worry with CHD incidence in the Normative Aging Study , an ongoing cohort of older men . In 1975 , 1759 men free of diagnosed CHD completed a  Worries Scale  , indicating the extent to which they worried about each of five worry domains : social conditions , health , financial , self-definition , and aging . During 20 years of follow-up , 323 cases of incident CHD occurred : 113 cases of nonfatal myocardial infa rct ion ( MI ) ; 86 cases of fatal CHD ; and 124 cases of angina pectoris . Worry about social conditions was the domain most strongly associated with incident CHD . Compared with men reporting the lowest levels of social conditions worry , men reporting the highest levels had multivariate adjusted relative risks of 2.41 ( 95 % CI , 1.40 to 4.13 ) for nonfatal MI and 1.48 ( 95 % CI , 0.99 to 2.20 ) for total CHD ( nonfatal MI and fatal CHD ) . A dose-response relation was found between level of worry and both nonfatal MI ( P for trend , .002 ) and total CHD ( P for trend , .04 ) . CONCLUSIONS These results suggest that high levels of worry in specific domains may increase the risk of CHD in older men Objective : Cardiovascular recovery of prestress baseline blood pressure has been implicated as a possible additional determinant of sustained blood pressure elevation . We hypothesize that angry ruminations may slow the recovery process . Method : A within-subjects design was used in which resting baseline blood pressure and heart rate measurements were assessed on 60 subjects , who then took part in two anger-recall tasks .  After each task , subjects sat quietly and alone during a 12-minute recovery period r and omized to with or without distractions . During baseline , task , and recovery , blood pressure was continuously monitored ; during recovery , subjects reported their thoughts at five fixed intervals . Results : Fewer angry thoughts were reported in the distraction condition ( 17 % ) compared with no distraction ( 31 % ; p = .002 ) ; an interaction showed that this effect was largely the result of the two intervals immediately after the anger-recall task . Trait rumination interacted with distraction condition such that high ruminators in the no-distraction condition evidence d the poorest blood pressure recovery , assessed as area under the curve ( p = .044 [ systolic blood pressure ] and p = .046 [ diastolic pressure ] ) . Conclusions : People who have a tendency to ruminate about past anger-provoking events may be at greater risk for target organ damage as a result of sustained blood pressure elevations ; the effect is exacerbated when distractions are not available to interrupt the ruminative process . ANOVA = analysis of variance ; AUC = area under the curve ; BP = blood pressure ; HTN = hypertension ; CHD = coronary heart disease ; CVR = cardiovascular reactivity ; CVD = cardiovascular disease ; HR = heart rate ; DAB-VR = Destructive Anger Behavior-Verbal Rumination ; DBP = diastolic BP ; HPA = hypothalamic-pituitary-adrenal ; SBP = systolic BP In this study we examined the prospect i ve relationships between perseverative thoughts , internalizing negative emotions , and somatic complaints in children aged 9 - 13 , and evaluated whether a perseverative thoughts intervention had a beneficial effect on these experiences . Children ( N=227 ) from 7 primary schools in Leiden , the Netherl and s , recorded their perseverative thoughts during one week , 138 of whom were instructed to postpone these thoughts to a special 30min period in the early evening . Children who had received the postponement instructions showed a reduction in the frequency of perseverative thoughts , and girls also in the duration of them . Girl 's perseverative thoughts were positively associated with the number of somatic complaints and with negative emotions . The postponement intervention also seemed to reduce somatic complaints in the seventh grade children . These findings confirm the previously found prospect i ve relationship between perseverative thoughts and children 's well-being and provide initial validation for the use of the postponement intervention to reduce perseverative thoughts in this age group , particularly for girls Recent models of generalized anxiety disorder ( GAD ) have exp and ed on Borkovec 's avoidance theory by delineating emotion regulation deficits associated with the excessive worry characteristic of this disorder ( see Behar , DiMarco , Hekler , Mohlman , & Staples , 2009 ) . However , it has been difficult to determine whether emotion regulation is simply a useful heuristic for the avoidant properties of worry or an important extension to conceptualizations of GAD . Some of this difficulty may arise from a focus on purported maladaptive regulation strategies , which may be confounded with symptomatic distress components of the disorder ( such as worry ) . We examined the implementation of adaptive regulation strategies by participants with and without a diagnosis of GAD while watching emotion-eliciting film clips .  In a between-subjects design , participants were r and omly assigned to accept , reappraise , or were not given specific regulation instructions . Implementation of adaptive regulation strategies produced differential effects in the physiological ( but not subjective ) domain across diagnostic groups . Whereas participants with GAD demonstrated lower cardiac flexibility when implementing adaptive regulation strategies than when not given specific instructions on how to regulate , healthy controls showed the opposite pattern , suggesting they benefited from the use of adaptive regulation strategies . We discuss the implication s of these findings for the delineation of emotion regulation deficits in psychopathology Comorbidity among affective disorders is high . Rumination has been found to mediate cross-sectional and prospect i ve relations between anxiety and depressive symptoms in adolescents and adults . We examined whether rumination and worry , both forms of repetitive negative thinking , also explain the associations between affective disorders . This was studied using a prospect i ve cohort study . In a mixed sample of 2981 adults ( persons with a prior history of or a current affective disorder and healthy individuals ) we assessed  DSM-IV affective disorders ( CIDI ) , rumination ( LEIDS-R ) and worry ( PSWQ ) . All measures were repeated 2 years and 4 years later . Using structural equation models , we found that baseline rumination and worry partly mediated the association of baseline fear disorders ( social anxiety disorder , panic disorder , agoraphobia ) with distress disorders ( dysthymia , major depressive disorder , generalized anxiety disorder ) . Moreover , baseline fear disorders predicted changes in distress disorders and changes in worry and rumination mediated these associations . The association between baseline distress disorders and changes in fear disorders was mediated by changes in rumination but not by changes in worry . From these results it can be concluded that repetitive negative thinking is an important transdiagnostic factor . Rumination and worry are partly responsible for the cross-sectional and prospect i ve co-occurrence of affective disorders 
    Output:
    
Results show that perseverative cognition affects cardiovascular , autonomic , and endocrine nervous system activity , suggesting a pathogenic pathway to long-term disease outcomes and clarifying the still unexplained relationship between chronic stress and health vulnerability