Cited by 529Heart Rate Variability and Autonomic ControlNeural and Behavioral Psychology StudiesChild and Adolescent Psychosocial and Emotional Development

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

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Beauchaine, Theodore P·2015·Current Opinion in Psychology

DOI 10.1016/j.copsyc.2015.01.017PMC PMC4389219

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Abstract

In the past two decades, respiratory sinus arrhythmia (RSA)-an index of parasympathetic nervous system (PNS)-mediated cardiac control-has emerged as a reliable peripheral biomarker of emotion regulation (ER). Reduced RSA and excessive RSA reactivity (i.e., withdrawal) to emotional challenge are observed consistently among individuals with poor ER capabilities, including those with various forms of internalizing and externalizing psychopathology, and those with specific psychopathological syndromes, including anxiety, phobias, attention problems, autism, callousness, conduct disorder, depression, non-suicidal self-injury, panic disorder, and trait hostility. Emerging evidence suggests that low RSA and excessive RSA reactivity index poor ER because they are downstream peripheral markers of prefrontal cortex (PFC) dysfunction. Poorly modulated inhibitory efferent pathways from the medial PFC to the PNS result in reduced RSA and excessive RSA reactivity. According to this perspective, RSA is a non-invasive proxy for poor executive control over behavior, which characterizes most forms of psychopathology.

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“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].”
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Background
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“Notably, the finding of low RSA at rest in clinical populations, as compared to HC, is not limited to BPD but also characterizes patients with anxiety disorders, conduct disorders, autism spectrum disorders, depression and schizophrenia (see for a review [61]) and, in this study, also patients with MDD in remission.”
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“Respiratory sinus arrhythmia (RSA), a measure of heart rate variability as a function of the rate of spontaneous respiration, is a well established and noninvasive method for assessing cardiac vagal tone in both adults [29,48] and children [49–51].”
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“For example, Respiratory Sinus Arrhythmia (RSA) has been proposed as a particularly sensitive biomarker for heightened interoceptive awareness and as an index of emotional regulation (Beauchaine, 2001; Beauchaine, 2015).”
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“Low resting RSA is broadly indicative of deficiencies in self- and emotion regulatory capacities, including the decreased capacity to maintain regulatory control over affective arousal (Beauchaine, 2001; Hinnant & El-Sheikh, 2009), and has demonstrated consistent links with various psychopathology across the lifespan,…”
BackgroundInfluential
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Background
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“…activity has been considered an indicator of flexible responding when faced with emotional challenge (Calkins et al., 2019; Gyurak & Ayduk, 2008) and is related to varied aspects of mental health (Beauchaine, 2015; Gonçalves et al., 2021; McLaughlin, et al., 2014; Vazquez et al., 2016).”
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“…and excessive RSA withdrawal (i.e. low and high RSA reactivity), on the other hand, may suggest diminished regulatory ability and has been associated with young children’s poor self-regulation and social functioning (Beauchaine, 2015; Liew et al., 2011; Schmitz et al., 2011; Sulik et al., 2015).”
Background
Vagal Flexibility Moderates the Links between Observed Sensitive Caregiving in Infancy and Externalizing Behavior Problems in Middle Childhood
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“Mean RSA changes to stressors relative to the resting state (i.e., reactivity) and following stressors (i.e., recovery) are reliable peripheral measures of emotion regulatory capacity (Beauchaine, 2001, 2015; Calkins, 1997; Porges, 2007).”
BackgroundInfluential
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Background
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“This finding suggests elevated prenatal exposure to maternal cortisol may program a phenotype characterized by enhanced PNS responding to stress in boys, which in turn has been associated with several psychopathological syndromes, as previously reviewed (Beauchaine, 2015).”
Result
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“Basal respiratory sinus arrhythmia (RSA), a measure of vagus-mediated parasympathetic influence on the heart, has thus been conceptualized as a biomarker of vulnerability to negative emotion and one’s capacity to effectively respond to their emotional contexts (Beauchaine, 2001, 2015).”
Background
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“, 1995) do not warrant a clear hypothesis regarding the direction of this association, it was expected that differences would be found mostly at the level of PNS activity due to its link to emotion regulation (Beauchaine, 2015).”
BackgroundInfluential
Resting respiratory sinus arrhythmia moderates the association between social phobia symptoms and self‐reported physical symptoms
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“Studies of cardiac reactivity and vmHRV-withdrawal in response to emotional stimuli, therefore, represents an important source of information that can increase insight into emotion regulation and psychopathology (Beauchaine 2015; Beauchaine and Thayer 2015; Porges 1995).”
Background
Child maltreatment severity and sleep variability predict mother–infant RSA coregulation
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“Resting RSA correlates consistently with self-regulation, socioemotional adjustment, and social engagement (Beauchaine, 2001, 2015; Calkins et al., 2007; Patriquin et al., 2013).”
BackgroundSelf-citation
Emotion Regulation and Cognitive and Social Functioning in Early Development: The Interface Between Neurophysiological and Behavioural Perspectives
Cruz, S., Sousa, M., & Mateus, V. (2024) · IntechOpen eBooks · doi:10.5772/intechopen.1004233 · Cited by 7
Autonomic variability, depression and the disability paradox in spinal cord injury
Singh, V., & Mitra, S. (2022) · Spinal Cord Series and Cases · doi:10.1038/s41394-022-00542-6 · Cited by 7
Parental sensitivity modifies the associations between maternal prenatal stress exposure, autonomic nervous system functioning and infant temperament in a diverse, low-income sample
Jones‐Mason, K., Coccia, M., Alkon, A., Thomas, K. C.-P. M., Laraia, B. A., Adler, N. E., Epel, E. S., & Bush, N. R. (2023) · Attachment & Human Development · doi:10.1080/14616734.2023.2257669 · Cited by 9
“Because the ANS plays a critical role in stress reactivity and regulation (Beauchaine, 2015) and is one mechanism through which exposure to early adversity affects emotional and behavioral outcomes, research examining the association between prenatal stress and infant ANS function is expanding…”
BackgroundInfluential
Maternal sensitivity as a predictor of change in respiratory sinus arrhythmia activity from infancy to toddlerhood
Tacana, T., Speck, B., Isenhour, J., Conradt, E. D., Crowell, S. E., & Raby, K. L. (2024) · Infant and Child Development · doi:10.1002/icd.2545 · Cited by 7
Mitigating Risk? Set-Shifting Ability in High Threat Sensitive Individuals Predicts Approach Behavior During Simulated Peer-Rejection
Coifman, K. G., Halachoff, D. J., & Nylocks, K. M. (2018) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2018.37.7.481 · Cited by 7
When are Worry and Rumination Negatively Associated with Resting Respiratory Sinus Arrhythmia? It Depends: The Moderating Role of Cognitive Reappraisal
Plate, A. J., Dunn, E., Christensen, K. A., & Aldao, A. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10099-z · Cited by 7
“Clinically speaking, resting RSA has been shown to be a reliable and transdiagnostic biomarker of emotion dysregulation and psychopathology given its associations with both internalizing and externalizing disorders (Beauchaine 2015).”
Background
High-Frequency Heart Rate Variability and Emotion-Driven Impulse Control Difficulties During Adolescence: Examining Experienced and Expressed Negative Emotion as Moderators
Gonçalves, S. F., Chaplin, T. M., López, R., Regalario, I., Niehaus, C. E., McKnight, P. E., Stults‐Kolehmainen, M., Sinha, R., & Ansell, E. B. (2020) · The Journal of Early Adolescence · doi:10.1177/0272431620983453 · Cited by 7
“Indeed, a large body of literature has linked higher resting HF-HRV to better emotion regulation and psychosocial functioning in children, adolescents, and adults (Beauchaine, 2015; Cui et al., 2015; Geisler, Vennewald, Kubiak, & Weber, 2010; McLaughlin, Alves, & Sheridan, 2014; Vazquez et al., 2016).”
BackgroundInfluential
Resting Parasympathetic Nervous System Activity is Associated with Greater Antiviral Gene Expression
Rahal, D., Tashjian, S. M., Karan, M., Eisenberger, N. I., Galván, A., Fuligni, A. J., Hastings, P. D., & Cole, S. W. (2021) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2021.08.229 · Cited by 7
The relation of baseline respiratory sinus arrhythmia to problematic internet use: Impulsiveness and difficulties in emotion regulation matter
Zhao, Y., Zhang, H., & Xu, J. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.02.001 · Cited by 7
Effects of an attachment‐based intervention on autonomic regulation among opioid‐exposed infants
Tabachnick, A. R., Eiden, R. D., Labella, M. H., & Dozier, M. (2022) · Developmental Psychobiology · doi:10.1002/dev.22286 · Cited by 8
Parasympathetic withdrawal indexes risk for emotion dysregulation in children with autism spectrum disorder
Baker, J. K., Fenning, R. M., Erath, S. A., & Fabian, S. (2022) · Autism Research · doi:10.1002/aur.2814 · Cited by 6
“Interpretations of withdrawal of RSA in response to challenge (RSA reactivity; RSA-R) are more complex and may depend upon population and measurement context (e.g., Beauchaine et al., 2019; Graziano & Derefinko, 2013).”
Background
PEP reward reactivity moderates the effects of RSA reactivity on antisocial behavior and substance use
Chen, F. R., & French, K. (2023) · Psychophysiology · doi:10.1111/psyp.14445 · Cited by 8
Lower catecholamine activity is associated with greater levels of anger in adults
Schwartz, J. A., & Portnoy, J. (2017) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2017.07.005 · Cited by 7
“Similarly, studies have implicated PNS activity as a significant risk factor for the development of behavioral problems (Grossman and Taylor, 2007; Beauchaine, 2001, 2015; El-Sheikh et al., 2009; Porges, 2007).”
BackgroundInfluential
Effects of maternal and paternal postnatal depressive symptoms on infants’ parasympathetic regulation in low‐income, Mexican American families
Lin, B., Yeo, A. J., Luecken, L. J., & Roubinov, D. S. (2020) · Developmental Psychobiology · doi:10.1002/dev.22073 · Cited by 8
“…the finding that both maternal and paternal postnatal depressive symptoms were associated with lower RSA at 24 weeks—a biomarker of self-regulation (Beauchaine, 2015; Bell & Deater-Deckard, 2007)—sheds light on one possible mechanism through which parent psychopathology and mental health…”
BackgroundInfluential
Leveraging the developmental science of psychosocial risk to strengthen youth psychotherapy
Vaughn, R., & Weisz, J. R. (2021) · Development and Psychopathology · doi:10.1017/s0954579420002035 · Cited by 12
“Further, correlations between more frequent threat exposure (community violence combined with peer victimization) and higher depression symptom severity are amplified by lower resting-state parasympathetic nervous system activity – indexed by respiratory sinus arrhythmia (RSA), an established proxy for emotion regulat…”
Background
Cardiac autonomic functioning across stress and reward: Links with depression in emerging adults
Choi, J. W., Thakur, H., & Cohen, J. R. (2021) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2021.07.625 · Cited by 10
Humanity's evolved nest and its relation to cardiac vagal regulation in the first years of life
Tarsha, M. S., & Narvaez, D. F. (2024) · Early Human Development · doi:10.1016/j.earlhumdev.2024.106033 · Cited by 7
Autonomic regulation and comorbid symptoms in children with attention deficit hyperactivity disorder
Kehm, K., Schloß, S., Mann, C., Becker, K., König, U., Pott, W., Chavanon, M., & Pauli‐Pott, U. (2024) · Journal of Neural Transmission · doi:10.1007/s00702-024-02832-9 · Cited by 7
“The autonomic nervous system (ANS) controls heart rate (HR) and the variability between between vmHRV (measured during resting state and in response to emotion-eliciting stimuli) and several internalizing and externalizing disorders (Beauchaine 2015).”
Coupling between prefrontal brain activity and respiratory sinus arrhythmia in infants and adults
Nguyen, T., Hoehl, S., Bertenthal, B. I., & Abney, D. H. (2022) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2022.101184 · Cited by 6
“Coupling is more likely to occur during periods of heightened arousal and/or need for regulation, as a function of stress (Beauchaine, 2015; Black et al., 2021).”
Influential
Nonlinear Moderation Effect of Vagal Regulation on the Link between Childhood Trauma and Adolescent Internalizing and Externalizing Symptoms
Huang, Y., & Lu, W. D. (2023) · Journal of Youth and Adolescence · doi:10.1007/s10964-023-01860-0 · Cited by 6
“Respiratory sinus arrhythmia (RSA) suppression to stress as a marker of individual vulnerability is considered as a moderator of the association between adverse experiences and psychopathological symptoms (Beauchaine, 2015; Porges, 2007).”
Influential
Preschool children's high‐frequency heart rate variability during low and high emotional challenge in relation to their self‐regulation
Clark, C. A. C., de Almeida, P. C., & Joshi, K. (2024) · Infant and Child Development · doi:10.1002/icd.2507 · Cited by 7
Sustained Attention and Individual Differences in Adolescents’ Mood and Physiological Reactivity to Stress
Feurer, C., James, K. M., Foster, C. E., & Gibb, B. E. (2020) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-020-00679-8 · Cited by 8
“Specifically, diminished inhibitory control of the prefrontal cortex over amygdala reactivity is associated with difficulties directing attention away from dysphoric stimuli in depression (Disner et al., 2011) and with increased RSA reactivity (Beauchaine, 2015).”
Background
The Mediating Role of Emotion Dysregulation in the Association Between Trait Mindfulness and PTSD Symptoms among Trauma-Exposed Adults
Powers, A. D., Dixon, H. D., Guelfo, A., Mekawi, Y., Bradley, B., Kaslow, N. J., & Fani, N. (2021) · Mindfulness · doi:10.1007/s12671-021-01684-8 · Cited by 6
“It would be beneficial in future research to add in psychophysiological measures of ED, such as respiratory sinus arrhythmia (RSA), which measures vagal tone and is seen as a biological marker of ED (Beauchaine, 2015).”
Background
Using Virtual Reality to Examine the Association Between Respiratory Sinus Arrhythmia and Adolescent Substance Use
Hadley, W. S., Houck, C. D., Barker, D., Bogner, J., & Franz, D. J. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01308-1 · Cited by 5
Resilience and Internet Addiction: A Moderated Mediation Model of Loneliness and Resting Respiratory Sinus Arrhythmia
Zhao, Y., Xu, J., Zhou, J., & Zhang, H. (2022) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2022.0059 · Cited by 6
Cognitive reappraisal moderates the quadratic association between heart rate variability and negative affectivity
Gray, J. M., & Tully, E. C. (2020) · Psychophysiology · doi:10.1111/psyp.13584 · Cited by 6
Behavioral and physiological stress responses: Within-person concordance during pregnancy
Vlisides‐Henry, R. D., Deboeck, P. R., Grill-Velasquez, W., Mackey, S., Ramadurai, D. K. A., Urry, J. O., Neff, D., Terrell, S., Gao, M. M., Thomas, L. R., et al. (2021) · Biological Psychology · doi:10.1016/j.biopsycho.2021.108027 · Cited by 6
The Adaptive Calibration Model of Stress Responsivity
Ellis, B. J., Giudice, M. D., & Shirtcliff, E. A. (2017) · Wiley eBooks · doi:10.1002/9781394258932.ch8 · Cited by 7
The moderating role of attachment in the association between physiological synchrony in married couples and supportive behavior in the transition to parenthood
Fogel‐Yaakobi, S., Golland, Y., Levit‐Binnun, N., Borelli, J. L., Mikulincer, M., & Shai, D. (2023) · Psychophysiology · doi:10.1111/psyp.14263 · Cited by 7
Maternal Emotion Regulation and Parenting: A Physiological Perspective
Li, F. H., Froidevaux, N. M., Kerr, M. L., Smiley, P. A., Hastings, P. D., & Borelli, J. L. (2025) · Developmental Psychobiology · doi:10.1002/dev.70044 · Cited by 7
“This may be because higher resting RSA can reflect individuals’ PNS flexibility, the degree to which it can flexibly respond to stressors without being excessively activated (Beauchaine 2015).”
Music for displaced dyads: a mixed methods feasibility study on the impact of music therapy on the mental health and wellbeing of Ukrainian refugee families
Slabu, L., Coombes, E., Mangiacotti, A. M. A., Hadar, T., & Franco, F. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1707023 · Cited by 6
Advancing Research on Suicide and Mental Health in Autistic Adults Through a Research Domain Criteria-Inspired Framework
Mazefsky, C. A., Conner, C. M., Siegle, G. J., Scott, L. N., Bylsma, L. M., Beck, K. B., Antezana, L., Hu, X., Cohen, A. D., Borue, X., et al. (2025) · Autism in Adulthood · doi:10.1177/25739581251393807 · Cited by 6
Better forbearance, lower depression: Evidence based on heart rate variability
Su, T., Guo, X., Liu, M., Xiao, R., & Xiao, Z. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1019402 · Cited by 5
“RSA is a reliable biomarker of emotion regulation capacity in individuals (Beauchaine, 2015), which is thought to isolate the parasympathetic influence on the heart (Scott et al., 2021).”
BackgroundInfluential
Social context in stress and autism: comparing physiological profiles across two social paradigms in youth with and without autism spectrum disorder
Muscatello, R. A., McGonigle, T., Vandekar, S., & Corbett, B. A. (2024) · Research in Autism · doi:10.1016/j.rasd.2024.102354 · Cited by 7
Unveiling gender differences in psychophysiological dynamics: support for a two-dimensional autonomic space approach
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“PNS control is theorized to reﬂect our capacity to ﬂexibly respond to changes in environmental cues and stressors (Thayer and Lane, 2000; Porges, 2007), including the ability to regulate emotions (Thayer and Lane, 2000; Beauchaine, 2015; Balzarotti et al., 2017; Pace-Schott et al., 2019).”
Background
Differential effects of trait-like emotion regulation use and situational emotion regulation ability across the affective and anxiety disorders spectrum: a transdiagnostic examination
Adolph, D., & Margraf, J. (2024) · Scientific Reports · doi:10.1038/s41598-024-76425-7 · Cited by 7
“…variability (vmHRV) in a treatment seeking sample of patients with emotion disorders 47 . vmHRV indexes the activity of a top-down regulation system 48,49 involved in the organisms flexible physiological responding to emotional or stress-related environmental demands, and is associated with…”
A Review on Physiological Signal Based Emotion Detection
Shahzad, H. F., Saleem, A. A., Ahmed, A. M., Shehzadi, K., & Siddiqui, H. U. R. (2021) · Annals of Emerging Technologies in Computing · doi:10.33166/aetic.2021.03.003 · Cited by 5
“Respiration represents the emotions [8] as various breathing patterns indicates different emotions [9].”
Background
Innovative approaches in investigating inter‐beat intervals: Graph theoretical method suggests altered autonomic functioning in adolescents with ADHD
Kvadsheim, E., Fasmer, O. B., Fasmer, E. E., Hauge, E. R., Thayer, J. F., Osnes, B., Haavik, J., Koenig, J., Adólfsdóttir, S., Plessen, K. J., et al. (2022) · Psychophysiology · doi:10.1111/psyp.14005 · Cited by 5
Correlates of externalizing psychopathology in incarcerated men
Rodrik, O., Weaver, S. S., Kiehl, K., & Koenigs, M. (2022) · Psychological Assessment · doi:10.1037/pas0001161 · Cited by 5
“Emotion (dys)regulation cuts across diagnostic criteria (Beauchaine, 2015; Beauchaine & McNulty, 2013), occurs in most internalizing and externalizing disorders, and is associated with substance use, aggression, impulsivity, and risk-taking (Bonn-Miller et al., 2008; Cohn et al., 2010; Garofalo et…”
The role of strategy-use and parasympathetic functioning in maternal emotion regulation.
Zhang, X., Gatzke‐Kopp, L. M., Cole, P. M., & Ram, N. (2022) · Journal of Family Psychology · doi:10.1037/fam0001017 · Cited by 5
Parents’ depressive symptoms and reflective functioning predict parents’ proficiency in relational savoring and children’s physiological regulation
Borelli, J. L., Hong, K., Kazmierski, K. F. M., Smiley, P. A., Sohn, L. M., & Guo, Y. (2022) · Development and Psychopathology · doi:10.1017/s095457942200102x · Cited by 8
“Parents ’ ability to regulate their emotions is central to children ’ s ability to manage their own emotions (Bariola et al., 2011; Dix, 1991; Eisenberg et al., 1998), which in turn is a key predictor of risk for psychopathology (Beauchaine, 2015; Compas et al., 2017).”
BackgroundInfluential
Differentiated processing of emotional cues in adolescents and young adults with ICD‐11 PTSD and complex PTSD after child abuse
Iffland, B., Eilers, R., Rosner, R., Renneberg, B., Steil, R., & Neuner, F. (2023) · Brain and Behavior · doi:10.1002/brb3.2904 · Cited by 4
Child emotion lability is associated with within‐task changes of autonomic activity during a mirror‐tracing task
Rawn, K. P., & Keller, P. S. (2023) · Psychophysiology · doi:10.1111/psyp.14354 · Cited by 5

Authors: Beauchaine, T. P.
Affiliations: The Ohio State University (US)
Corresponding author: Beauchaine, Theodore P
ORCID: Beauchaine, Theodore P
Venue: Current Opinion in Psychology
Publisher: Elsevier BV
Published: 2015-06
Volume: 3
Pages: 43-47
ISSN: 2352-250X (ISSN-L)
DOI: 10.1016/j.copsyc.2015.01.017
PMC: PMC4389219
OpenAlex: W2008969489
Cited by: 529
References: 50
Citations by year: 2026: 52 · 2025: 51 · 2024: 47 · 2023: 53 · 2022: 47 · 2021: 79 · 2020: 63 · 2019: 47 · 2018: 36 · 2017: 28 · 2016: 17 · 2015: 8
FWCI: 5.12
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Current Opinion in Psychology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R01MH063699)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: respiratory sinus arrhythmia, emotion regulation, parasympathetic nervous system, emotional dysregulation, psychopathology, internalizing disorders, externalizing disorders, anxiety, autism spectrum disorder, depression, non-suicidal self-injury, panic disorder, trait hostility, prefrontal cortex dysfunction, executive function, peripheral biomarkers

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

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