Respiratory sinus arrhythmia: a transdiagnostic biomarker of emotion dysregulation and psychopathology

“Since most forms of psychopathology are characterized by PFC dysfunction [44,45 ], they are also characterized by low resting RSA and excessive RSA reactivity, peripheral biomarkers of poor executive control [41].”

“Doing so provides considerably more specificity in distinguishing among psychiatric disorders [10 ,48].”

“…HF-HRV to assorted challenges—particularly emotion evocation—are associated with symptoms of both internalizing and externalizing psychopathology (see Beauchaine, 2001, 2012, 2015a, 2015b; Porges, 2007; Vasilev et al., 2009), andwith a wide range of psychopathological syndromes, including anxiety…”

“…such as the amygdala and ventral striatum, facilitate emotional reactivity and motivational processes that may be more automatic and tendency related, whereas top-down control mediated by prefrontal regions may be more involved in the volitional regulation of emotion (see Beauchaine, 2015a).”

“begun to rely on objective, psychophysiological measures believed to index emotion regulatory capacity—such as respiratory sinus arrhythmia [87,88] and cardiac vagal tone measured through heart rate variability [89].”

“…index of emotion dysregulation is RSA—which quantifies, usually via spectral analysis of the electrocardiogram R-R time series, parasympathetically mediated ebbing and flowing of heart rate across successive respiratory cycles (see Beauchaine, 2001, 2015; Zisner & Beauchaine, in press-b).”

“more in general−because they are peripheral markers of prefrontal cortex inhibitory activity (Beauchaine, 2015).”

“On the contrary, the combination of a low resting cardiac vagal control and a higher cardiac vagal control decrease may be maladaptive, this is why cardiac vagal control over-reactivity is used as marker of emotion dysregulation (Beauchaine, 2015).”

“This system is modulated by the parasympathetic branch (parasympathetic nervous system; PNS) of the ANS, which has been specifically implicated in self-regulatory processes (Beauchaine 2015).”

“…can be measured as reduction in high frequency heart rate variability, has been associated with effortful control (Spangler & Friedman, 2015) and emotion regulation (Beauchaine, 2015), but a recent meta-analysis supports a more general role in top-down self-regulation (Holzman & Bridgett, 2017).”

“Through these negative reinforcement mechanisms, emotion dysregulation and associated deficiencies in RSA emerge over time among affected children (Beauchaine, 2015a).”

“Despite strong theory around prenatal programming of offspring stress physiology across stress-responsive systems (Wadhwa, Entringer, Buss, & Lu, 2011), there are very few studies of prenatal programming of the infant autonomic nervous system (ANS), a key system in stress and behavior regulation that underlies mental…”

“Anticholinergic medications and SSRIs may be related to psychophysiological measurement [Beauchaine et al., 2019; Green, Nuechterlein, & Satz, 1989]; only one child was reported to take the former, and no children were taking SSRIs at the time of the present study.”

“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript capacity that may represent a transdiagnostic marker of psychopathology (Balzarotti et al., 2017; Beauchaine, 2015).”

“As noted above, high trait impulsivity is expressed as a preference for immediate, smaller rewards over larger, delayed rewards, and often results in behaviors that are socially inappropriate, maladaptive, and short-sighted (see Neuhaus & Beauchaine, in press; Zisner & Beauchaine, 2015).”

“Many if not most forms of psychopathology are characterized by emotion dysregulation (see, e.g., Beauchaine, 2001; Beauchaine, 2015a, 2015b; Beauchaine, Gatzke-Kopp, & Mead, 2007; Beauchaine & Thayer, in press; Cole, Hall, & Hajal, 2013; Goldsmith, Pollak, & Davidson, 2008), but most are not…”

“The PNS plays an inhibitory role and underpins emotional regulation and flexible adaptation to changing environmental conditions (Beauchaine, 2015; Porges, 2007).”

“One such variable is respiratory sinus arrhythmia, a measure of parasympathetic nervous system activity that is associated with emotional and mental health states [52].”

“…with lower resting RSA and blunted or excessive RSA reactivity demonstrate poorer emotion regulation and higher incidence of psychopathology (e.g., Beauchaine, 2015), whereas individuals with higher resting RSA report greater subjective well-being supported by adaptive regulation (e.g., Geisler…”

“Lower baseline vagal tone may index greater vigilance to environmental cues and preparedness to engage threat-related responses, whereas higher baseline vagal tone may reflect a propensity to evaluate safety in the environment and decreased need for active coping (Beauchaine, 2015; Porges, 2011; Thayer et al., 2012).”

“Second, RSA and other psychophysiological measures do not allow for adequately differentiating the impact of adaptive and maladaptive ERSs on psychopathology.”

“Emotion dysregulation is a multilevel construct that is commonly assessed through self-report measures and parasympathetic (PNS) activity of the autonomic nervous system (Beauchaine, 2015b).”

“, 2011) suggesting decreased emotion regulation (Beauchaine, 2015) and increased emotional reactivity, factors that may affect the stress response.”

“…e.g. from associations with cancer and heart disease, on the one hand, to psychiatric and behavioral disorders, on the other hand (Benichou et al., 2018; Giese-Davis et al., 2015; La Rovere et al., 1998; Beauchaine, 2015; Campbell & Wisco; Cheng et al., 2020; Clamor et al., 2016; Kemp et al. 2012).”

“…from studies that report on effects of music–evoked emotions, arranging our review across levels of neural functions, beginning with subcortical functions involved in emotion generation, and ending with cortical functions involved in ER (see Beauchaine, 2015b; Beauchaine and Zisner, in press).”

“…that includes a lack of awareness and acceptance of emotions, an inability to control behaviors when experiencing distress, a lack of access to adaptive strategies for regulating emotion, and an unwillingness to experience emotional distress (Beauchaine, 2015; Leventhal and Zvolensky, 2015).”

“Low resting RSA (i.e., low vagal tone) and greater RSA withdrawal, reflected in reduced RSA reactivity to a stressor, is associated with maladaptive parasympathetic activity, poor emotion regulation, and increased risk of fight or flight responding (Beauchaine et al., 2001; Beauchaine, 2015).”

“…(RSA) is frequently used as a noninvasive index of inhibitory cardiac control by the vagus nerve, and is considered a reliable biomarker of emotion dysregulation (Beauchaine, 2001, 2015b; Beauchaine & Thayer, 2015; Porges, 2007; reviewed in Balzarotti, Biassoni, Colombob, & Ciceri, 2017).”

“…PNS control has been interpreted to reflect greater conservation of resources, allowing for more flexible range of response (Porges, 2007), including greater emotion regulation capacity (Balzarotti, Biassoni, Colombo, & Ciceri, 2017; Beauchaine, 2015; Pace-Schott et al., 2019; Thayer & Lane, 2000).”

“the central autonomic network (Porges, 2007; Thayer & Lane, 2009), a low HF-HRV has been conceptualized as a physiological, transdiagnostic marker of emotional dysregulation (Beauchaine, 2015; Thayer & Lane, 2009).”

“…childhood maltreatment may predict both lower baseline PNS activity and stronger withdrawal of parasympathetic influence in response to challenges, parallel to the pattern that Beauchaine (2015) contends is typical of individuals with poor emotion regulation and multiple forms of psychopathology.”

“…role of autonomic nervous system functioning in physical health has been well established, growing evidence suggests that activity of the parasympa-L thetic branch also may serve as an important, global index of mental health (Beauchaine, 2015; Beauchaine & Thayer, 2015; Kemp & Quintana, 2013).”

“…lower baseline RSA or RSA suppression (i.e., increases or low decreases in RSA) have been associated with psychopathology and other indices of maladjustment, such as emotion dysregulation, externalizing and internalizing problems (Beauchaine, 2015; Davis et al., 2016; Eisenberg et al., 2012).”

“…with competent emotion regulation (Perry & Calkins, 2018), excessive reactivity has also been linked to dysregulation and psychopathology (Beauchaine, 2015; Boyce et al., 2001), especially in samples exposed to adversity (Calkins, Graziano, & Keane, 2007; Obradović, Bush, Stamperdahl,…”

“, withdrawal) have been consistently observed in a wider range of emotion regulation related disorders (Beauchaine, 2015).”

“Changes in RSA have been associated with performance on executive function tasks (a reflection of prefrontal activity) as well as the disruption in self-regulatory skills (observed in pathological mental states) (Beauchaine 2015), both of which are components of self-regulation.”

“to adapt to environmental stressors (Beauchaine, 2015; Fabes & Eisenberg, 1997).”

“1 3 sinus arrhythmia (RSA) is an index of parasympathetic activity that has emerged as a potential biomarker of poor regulation across diagnostic groups (Beauchaine 2015) and has been linked with emotion recognition, social functioning, and internalizing and externalizing symptoms in children with ASD (Bal et al.”

“, 2021a, 2022c) and has been proposed as a transdiagnostic biomarker of stress vulnerability across psychopathologies (Beauchaine, 2015; Beauchaine and Bell, 2020).”

“Increasing vagus nerve stimulation, also known as the tenth Cranial Nerve, and consequently reducing symptoms of psychopathology aligns with previous research investigating respiratory sinus arrhythmia (RSA), the online biomarker of parasympathetic functioning (Beauchaine, 2015).”

“Much of this research has focused on parasympathetic functioning as a physiological substrate of emotional reactivity and regulation (Beauchaine, 2015; Berntson, Quigley, & Lozano, 2007; Blandon, Calkins, Keane, & Brien, 2010).”

“RSA may serve as a downstream marker of regulatory ability related to cortical development or dysfunction (Beauchaine 2015).”

“(63) Positive change in emotion regulation capacity has been largely based on the premise that this process involves prefrontally mediated down-regulation of subcortical structures, such as the amygdala.(32) Specifically, the vagus nerve appears to mediate the link between the prefrontal cortex and cardiovascular outp…”

“Lower resting RSA is associated with more negative affect (Bleil et al., 2008), depression (e.g., Kemp et al., 2010; Koenig et al., 2016), anxiety (e.g., Thayer et al., 1996), and post- traumatic stress and panic disorders (Cohen et al., 2000; for a review, see Beauchaine, 2015).”

“Vagal control has been studied as a key support for self-regulation (Porges, 1995), which may be compromised in depression and other mental conditions (Beauchaine, 2015).”

“Finally, there is evidence that low vagal tone is associated with difficulties in emotion regulation and impulse control (Beauchaine, 2015; Wilson et al., 2016) – both being associated with suicidal behavior (e.g., Dumais et al., 2005).”

“A large body of work has suggested that HRV may serve as a physiological marker of emotion regulation in children (Beauchaine, 2015; Fox, 1989; Fox et al., 2000; Harper et al., 1977; Propper & Moore, 2006).”

“In general, individual differences in RSA have been found across a wide range of psychopathologies and across age (Beauchaine, 2015).”

“For example, both MDD and ruminative responses to stress have been linked with excessive respiratory sinus arrhythmia (RSA) withdrawal in response to stress (Beauchaine, 2015; LeMoult et al., 2015).”

“RSA had been proposed to reflect PFC dysfunction [58].”

“To measure the metrics of RSA, two indicators including root mean square of successive differences (RMSSD) and peak-valley respiratory sinus arrhythmia (pvRSA) were calculated.”

“…is a noninvasive measure of parasympathetic influences on heart rate during inhalation versus exhalation (Allen, Chambers, & Towers, 2007; Porges, 2007) and has been proposed as a transdiagnostic biomarker of emotion (dys)regulation (for reviews, see Beauchaine, 2015; Beauchaine & Thayer, 2015).”

“…normal circumstances, the prefrontal Cortex identifies safety cues in the environment and exerts inhibitory control over subcortical circuits associated with sympathetic activation, including the central nucleus of the Amygdala (Thayer et al., 2009; Heatherton and Wagner, 2011; Beauchaine, 2015).”

“A low resting vagal HRV and/or an excessive vagal tone withdrawal when one faces an acute challenge has been associated with poor health and poor effectiveness in coping with a variety of stimuli and challenges [49].”

“tivity as an indicator of clinical emotion dysregulation (Beauchaine 2015).”

“…internalizing problems and that children from clinical/at-risk samples exhibited less RSA suppression in response to challenging tasks (e.g., negative mood inductions, cognitive tasks, social tasks) than children from community samples (Graziano & Derefinko, 2013; but see also Beauchaine, 2015).”

“For example, although it is generally assumed that higher resting levels of RSA are adaptive throughout development (see Beauchaine, 2001, 2015; Beauchaine, Gatzke-Kopp, & Mead, 2007), higher resting RSA may not predict positive outcomes in low-SES samples or in very young children (Conradt et al.,…”

“Such a tradeoff may help account for infants’, and by proxy mothers’, differential interactive behaviors during feeding as compared to play (Beauchaine, 2015).”

“Emotion dysregulation is characterized by problems with maintaining goal-directed behavior and accepting, identifying, and managing emotions (Beauchaine, 2015; Gratz & Roemer, 2004).”

“Individual variability in tonic and phasic RSA has been the focus of a growing body of literature aimed at identifying neurobiological indices of risk for psychopathology in youth (Beauchaine, 2015).”

“…or suppression, indicating withdrawal of the vagus nerve control over the heart and increased PNS reactivity; Zhang et al., 2017) is associated with several stress-related disorders such as anxiety, depression, and internalizing and externalizing symptoms (for a review, see Beauchaine, 2015).”

“…support the theory that low resting RSA is an indicator of poor emotion and attentional regulation due to inefficient prefrontal functioning (Beauchaine, 2001, 2015; Crowell et al., 2006), and demonstrate that resting RSA offers independent longitudinal prediction of behavior problems, over…”

“Decreased highfrequency heart rate variability is now considered a transdiagnostic biomarker of emotion dysregulation as well as psychopathology (Beauchaine, 2015).”

“Lower basal RSA is posited to be a biomarker of generally poorer emotion regulation (Beauchaine 2015).”

“Dysfunctional or maladaptive patterns of emotion regulation (including excessive emotional reactivity, or an inability to modulate the intensity or duration of emotional expressions) are wellestablished risk factors for a wide range of childhood adjustment problems (Beauchaine, 2015; Cicchetti, Ackerman, & Izard, 1995…”

“However, most studies to date have focused solely on cardiac vagal control (e.g., Beauchaine, 2015; Rottenberg, 2007).”