Perseverative Cognition and vagally mediated heart rate variability in laboratory studies: A series of meta-analyses

Perseverative cognition (PC), including worry and rumination, is linked to adverse health outcomes and reduced vagally-mediated heart rate variability (vmHRV) among healthy subjects. While PC-vmHRV associations across resting, reactivity, and recovery conditions represent distinct regulatory mechanisms, they have not been meta-analyzed separately. This study conducted six meta-analyses to examine within- and between-subjects effect sizes across resting, reactivity, and recovery conditions. Web of Science, PubMed, and PsycINFO were searched for laboratory studies of healthy samples including PC inductions/measurements alongside vmHRV. Risk of bias was. Effect sizes (Hedges' g) were computed using random-effects models. Moderators included age, sex, PC subtype, recording duration, and study quality. 60 effect sizes were extracted from 28 eligible studies. PC was significantly associated with lower resting vmHRV (k = 14, g = 0.46, 95% CI [0.26, 0.66]), within-subjects reactivity vmHRV (k = 18, g = 0.22, 95% CI [0.11, 0.33]), and within-subjects recovery vmHRV (k = 9, g = 0.19, 95% CI [0.03, 0.36]). Between-subjects effect sizes were non-significant. Significant heterogeneity was detected across meta-analyses but not accounted for by the examined moderators. Sensitivity analyses supported the stability of these findings. PC is significantly associated with reduced vmHRV across resting, reactivity, and recovery conditions. Effect magnitudes vary by measurement period and study design. The findings aligned with leading theories on PC and health vulnerability, supporting PC as a promising modifiable target in improving well-being. Within-subjects designs appear most sensitive for detecting the PC-vmHRV relationships. Implications for mechanistic and intervention research were discussed.