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
Associations Between Cortical Thickness and Parasympathetic Nervous System Functioning During Middle Childhood
Korom, M., Tabachnick, A. R., Sellers, T., Valadez, E. A., Tottenham, N., & Dozier, M. E. (2023) · Psychophysiology · doi:10.1111/psyp.14391 · Cited by 2
Effects of prenatal opioid exposure on infant sympathetic and parasympathetic nervous system activity
Tabachnick, A. R., Eiden, R. D., Labella, M. H., & Dozier, M. (2023) · Psychophysiology · doi:10.1111/psyp.14470 · Cited by 2
A Prospective Study of Co-Rumination in Parent-Adolescent Conversations Several Years After a Devastating Tornado
Abel, M. R., Vernberg, E. M., Lochman, J. E., McDonald, K. L., Jarrett, M. A., & Powell, N. P. (2023) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2023.2286588 · Cited by 3
“Second, resting RSA being a consistent predictor of how children cope with or respond to stress (Beauchaine, 2015), including among at-risk aggressive youth (Kassing et al., 2018).”
Influential
Temporal Stability of Resting Respiratory Sinus Arrhythmia: Choosing the Quantification Method
Šarlija, M., Popović, S., Jovanović, T., & Ćosić, K. (2023) · IEEE International Workshop on Technologies for Defense and Security (TechDefense) · doi:10.1109/techdefense59795.2023.10380811 · Cited by 2
“Furthermore, baseline RSA has been shown to impact the cognitive performance of military personnel, with those scoring higher on RSA outperforming those with lower scores [5], [13].”
Background
Autonomic Activity in Individuals with Autism and Anxiety Symptoms: a Systematic Review and Meta-analysis
Yarger, H. A., Sarkar, M., Harrington, E., & Redcay, E. (2024) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-024-00449-y · Cited by 2
“In nonau-tistic samples, anxiety has been identified as associated with greater RSA withdrawal (e.g., Beauchaine, 2015; Skoranski & Lunkenheimer, 2021) and lower HRV (Friedman, 2007).”
Disruptive mood dysregulation disorder: the relationship between cardiac vagal tone, emotion recognition, and expressive prosody
Leal, M., Adan, M., Heilman, K. J., Kołacz, J., & Cockcroft, K. (2024) · South African Journal of Psychology · doi:10.1177/00812463241250134 · Cited by 3
“Research on the link between RSA and emotional and behavioural dysregulation is equivocal (e.g., Beauchaine, 2015).”
Background
Maternal psychophysiology profiles: associations with prenatal opioid use, maternal emotion dysregulation, and newborn neurobehavior
Maylott, S. E., Reese, S. E., Zhou, A. M., Kaliush, P. R., Terrell, S., Saenz, C., Brown, L., Crowell, S. E., Lester, B. M., Smid, M. C., et al. (2024) · Pediatric Research · doi:10.1038/s41390-024-03399-7 · Cited by 2
A Pilot Controlled Trial of Relaxation Training Combined with a Video Game Reinforcing Emotional Regulation to Improve Anger Management in Children and Adolescents
Vaudreuil, C., Abel, M. R., Barnett, Y., DiSalvo, M., & Hirshfeld‐Becker, D. R. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01259-w · Cited by 3
“…of this hypothesis, prior studies of aggressive youth have demonstrated that greater heart rate control is associated with greater potential for emotion regulation and lower inter-nalizing and externalizing behaviors (Beauchaine, 2015; Bunford et al., 2016; Kassing et al., 2018; Porges, 1995).”
Children’s vagal flexibility is a predictor and moderator of treatment response to early parenting interventions for inhibited youth
Wagner, N. J., Shakiba, N., Bui, H. N. T., Novick, D. M., Sem, K., Danko, C. M., Rubin, K. H., & Chronis-Tuscano, A. M. (2024) · International Journal of Behavioral Development · doi:10.1177/01650254241306118 · Cited by 2
“…et al., 2021), observed patterns of RSA suppression and recovery assessed across relevant contexts are associated with emotion dysregulation and psychopathology (Beauchaine, 2012, 2015; Wagner & Waller, 2020), including anxiety (Friedman & Thayer, 1998; Ugarte et al., 2021; Wagner et al., 2016).”
Associations of adverse childhood experiences with youths’ depressive symptoms: respiratory sinus arrhythmia reactivity matters
Zhang, H., Zhao, Y., Huang, J., & Davis, T. (2025) · Current Psychology · doi:10.1007/s12144-025-07483-x · Cited by 3
“RSA reactivity is a measure of an individual’s adaptability in response to environmen - tal stressors, whereas tonic RSA provides an indication of an individual’s capacity to maintain physiological balance (Beauchaine, 2015 ; Beauchaine et al., 2019 ; Porges, 2007).”
Pubertal developmental, body mass index, and cardiovascular autonomic function in children and adolescents with and without autism spectrum disorder: a four-time point accelerated longitudinal study
Muscatello, R. A., Cola, M., Vandekar, S., & Corbett, B. A. (2025) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-025-09602-y · Cited by 3
“For example, there is evidence that traits such as emotion regulation [6], attention [33], executive function [58], biological sex [38, 52], and internalizing characteristics (e.g., [13, 51]) are all influenced by or influence autonomic physiology.”
Effects of Moral Elevation on Children’s Implicit and Explicit Prosociality: Evidence from Behavioral and Physiological Responses
Wang, Q., Zhou, X., & Xun, L. (2025) · Behavioral Sciences · doi:10.3390/bs15091246 · Cited by 3
“The parasympathetic system, indexed by measures such as respiratory sinus arrhythmia (RSA) and high-frequency heart rate variability (HF-HRV), undergoes progressive maturation during this time, evidenced by age-related increases in vagal tone (El-Sheikh et al., 2009; Beauchaine, 2015).”
Het meten van emotieregulatie bij kinderen en jongeren
Beveren, M. V., Vervoort, L., & Braet, C. (2019) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-2308-1_2 · Cited by 2
The Psychophysiological Experience of Solving Moral Dilemmas Together: An Interdisciplinary Comparison Between Participants With and Without Depression
Koskinen, E., Tuhkanen, S., Järvensivu, M., Savander, E. È., Valkeapää, T., Valkia, K., Weiste, E., & Stevanovic, M. (2021) · Frontiers in Communication · doi:10.3389/fcomm.2021.625968 · Cited by 2
Conduct problems among children in low-income, urban neighborhoods: A developmental psychopathology- and RDoC-informed approach
Drabick, D. A. G., Jakubovic, R. J., Everett, V. S., Friedman, A. L., Emory, G. O., & Kalchthaler, F. B. (2021) · Development and Psychopathology · doi:10.1017/s0954579421001103 · Cited by 4
Autonomic Measures in Differentiating Depressive Disorders: A Potential AID.
Guccione, C., Heilman, K. J., Porges, S. W., Gentile, S., Caretti, V., & Halaris, A. E. (2022) · PubMed Central · doi:10.36131/cnfioritieditore20220105 · Cited by 2
“It is generally well known that there is an increased psychophysiological stress in psychiatric disorders that could negatively affect the outcome and prognosis (Kim et al., 2018; Beauchaine, 2015; Beauchaine & Thayer, 2015; Chambers & Allen, 2007).”
Background
Temperamental and physiological regulatory capacity in infancy: Links with toddler behavior problems.
Hassan, R., Poole, K., Smith, A., Niccols, A., & Schmidt, L. (2022) · Infant Behavior and Development · doi:10.1016/j.infbeh.2022.101754 · Cited by 2
Associations of resilience and respiratory sinus arrhythmia with alienation among college students.
Lin, S.-Y., Liu, D., Zhang, H., & Longobardi, C. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.10.050 · Cited by 2
Caregiver and Child Distress as Predictors of Dyadic Physiological Attunement During Vaccination
DiLorenzo, M. G., Waxman, J. A., Flora, D. B., Schmidt, L. A., Garfield, H., Flanders, D., Weinberg, E., Savlov, D., & Riddell, R. P. (2023) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001125 · Cited by 3
Getting Better with Age? A Review of Psychophysiological Studies of Fear Extinction Learning Across Development
Stenson, A. F., France, J. M., & Jovanović, T. (2023) · Current topics in behavioral neurosciences · doi:10.1007/7854_2023_441 · Cited by 2
Association Between Dynamic Parasympathetic Reactivity to Frustration and Children’s Social Success with Peers in Kindergarten
Fry, C. M., & Gatzke‐Kopp, L. M. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00844-7 · Cited by 4
“Third, although parasympathetic regulation (i.e., RSA) has been proposed as an index of emotion regulation capacity (Beauchaine, 2015), future research is needed to examine whether affective reactivity is more precisely captured by a broader assessment of arousal that considers coordination between…”
BackgroundInfluential
Emotion in non-suicidal self-injury: A contradiction between global self-reports and real-time responses
Robinson, K. (2021) · Open Access Victoria University of Wellington | Te Herenga Waka (Figshare) · doi:10.26686/wgtn.16960195.v1 · Cited by 2
The dyadic effects of posttraumatic stress symptoms on the regulation of respiratory sinus arrhythmia following an acute stress induction among couples
Barden, E. P., Wang, B. A., Gates, M. V., Poole, L. Z., & Balderrama-Durbin, C. M. (2025) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0001765 · Cited by 1
The Protective Role of the Autonomic Nervous System in Intergenerational Cycles of Neglect
Carvalho, C., & Oshri, A. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01580-3 · Cited by 1
“Withdrawal of PNS activity during challenges quickly and moderately increases arousal and is thought to reflect effective emotion regulation (Beauchaine 2015).”
Influential
Resting Heart Rate Variability Is Positively Associated With Proneness to Guilt but not Shame in Chinese Young Adults
Ip, I. N., Ching, F., Chiu, H. T., Keung, A. H. Y., & Wong, S. (2024) · Journal of Psychophysiology · doi:10.1027/0269-8803/a000330 · Cited by 1
Childhood Family Stress and Women’s Health: Parasympathetic Activity as a Risk and Resiliency Factor
Chong, L. S., Yeo, A. J., & Lin, B. (2024) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-024-09661-2 · Cited by 1
“…HF-HRV withdrawal in response to stress have been associated with emotion dysregulation, especially among individuals who experienced psychological distress or psychosocial stress (Beauchaine, 2015; Beauchaine & Zalewski, 2016; however, see also Hamilton & Alloy, 2016; Yaroslavsky et al., 2014).”
Discrimination, sleep, and physical health: Moderation by respiratory sinus arrythmia reactivity
McWood, L. M., Erath, S. A., Hinnant, J. B., & El‐Sheikh, M. (2025) · Journal of Health Psychology · doi:10.1177/13591053241310165 · Cited by 1
“Respiratory sinus arrythmia (RSA) refers to heart rate variability across the respiration cycle and indexes the influence of the ventral branch of the vagus nerve on the heart (Beauchaine, 2015).”
Influential
Socio-economic status modulates the link between vagal tone and chocolate consumption
Weick, M., & Vasiljevic, M. (2025) · Food Quality and Preference · doi:10.1016/j.foodqual.2025.105491 · Cited by 1
Reduced Respiratory Sinus Arrhythmia in Infants with the FMR1 Premutation
Chase, A., Hamrick, L. R., Arnold, H. P., Smith, J., Hantman, R. M., Cortez, K. B., Adayev, T., Tortora, N. D., Dahlman, A., & Roberts, J. E. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26052186 · Cited by 1
“…only recently started to emerge and indicates developmental delays or impairments that are Importantly, RSA has been conceptualized as a peripheral marker of emotion regulation capacity, which makes its study in clinical populations at risk for autism or affective disorders highly relevant [49].”
The Feasibility of Ambulatory Heart Rate Variability Monitoring in Non‐Suicidal Self‐Injury
van Hoorn, A., Mankee‐Williams, A., Lewis, G. A., Mellili, R., Eccles, J., Ottaviani, C., Laugharne, R. A., & Shankar, R. (2025) · Healthcare Technology Letters · doi:10.1049/htl2.70007 · Cited by 1
“HRV has been proposed as a biomarker of self-regulation capacity [14].”
Associations between the quality of family interactions during a mother–father–adolescent conflict discussion task and physiological emotion regulation in adolescents
Romet, M., Favez, N., Ranjbar, S., Urben, S., & Tissot, H. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000246 · Cited by 3
New Mothers’ Experiences of Childhood Adversity and Current Context of Economic Adversity Predict Parent and Infant RSA
Thompson, S. F., Moini, N., Shimomaeda, L., Green, L. M., Whiley, D. J., & Lengua, L. J. (2025) · Developmental Psychobiology · doi:10.1002/dev.70043 · Cited by 1
Longitudinal Mediating Role of Dynamic Vagal Regulation in the Link Between Childhood Abuse and Neglect and Psychopathological Symptoms Among Adolescents
Huang, Y., & Lu, W. D. (2025) · Child Development · doi:10.1111/cdev.70027 · Cited by 1
Maternal Mental Health and Infant Parasympathetic Activity in the Context of Forced Displacement: Insights From the Rohingya Camps and Surrounding Communities in Cox's Bazar, Bangladesh
Ugarte, E., Hiott, C., Elahi, M., Hossain, E., Ahamed, M. S., Rahman, M. S., Tofail, F., Hastings, P. D., & Wuermli, A. J. (2025) · Developmental Psychobiology · doi:10.1002/dev.70102 · Cited by 1
The Quadratic Association Between Resting Respiratory Sinus Arrhythmia and Adolescents’ Prosociality: The Moderating Role of Parental Marital Conflict
Li, X., & Wang, Z. (2025) · Developmental Psychobiology · doi:10.1002/dev.70106 · Cited by 1
A developmental psychopathology model of social anxiety
Gazelle, H., Rubin, K. H., & Brendgen, R. M. (2026) · Social Anxiety · doi:10.1016/b978-0-443-14146-1.00012-7 · Cited by 1
Coupling of Rhythms in Prefrontal Cortex and Autonomic Nervous System in School‐Age Children
Steffen, G., Lindig, K., Howard, C. J., Jerry, C. M., Bell, C. J., Morrow, K. E., Gallegos, D. J., Oshri, A., Suveg, C. M., Kello, C. T., et al. (2026) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.70203
“Low resting RSA and disproportionately high or low RSA reactivity during challenging and/or emotional tasks have been associated with poor self-regulatory skills in both adults and children [ 6, 19 ].”
Influential
Somato-Psychic Pathway: a universal developmental trajectory linking somatic structural–functional integrity, autonomic regulation, and the emergence of mind
Živný, B. (2026) · Frontiers in Integrative Neuroscience · doi:10.3389/fnint.2026.1771123 · Cited by 1
“Cognitively, chronic autonomic dysregulation progressively constrains executive function, working memory, and attentional stabil-ity—sustained physiological stress tends to bias behavior toward rigidity, avoidance, or repetitive patterns (Beauchaine, 2015).”
The effect of glucose on cardiac reactivity to a standardized massage in healthy adults
Meier, M., Unternäehrer, E., Ashcraft, S. J., Denk, B., Gaertner, R., Klink, E. S. C., Wienhold, S., Volkmer, N., & Pruessner, J. C. (2026) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2026.113367 · Cited by 1
The typical and atypical development of dynamic self-regulation and coregulation of respiratory sinus arrhythmia in mothers and children across early childhood
Sun, J., Li, L., Chow, S., & Lunkenheimer, E. S. (2026) · Child Development · doi:10.1093/chidev/aacag033 · Cited by 1
Emotion Regulation and Emotion Reactivity in Callous-Unemotional (CU) Traits: The Role of Dynamic Physiological Indicators in Youth with Primary and Secondary CU Traits
Stearns, N. R., Kerig, P. K., Alexander, A. R., Thomassin, K., & Craig, S. G. (2026) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-026-01443-0 · Cited by 1
Investigating Physiology‐Behavior Associations for Youth During Parent–Child Conflict Discussions
Vanwoerden, S., Vine, V., Byrd, A. L., Altman, K. B., Jennings, J. R., & Stepp, S. D. (2026) · Developmental Psychobiology · doi:10.1002/dev.70149 · Cited by 2
“Baseline RSA has been shown to predict emotional flexibility, reciprocity, and mutual positivity during mother–child interactions (Connell et al. 2011 , 2015 ; Crowell et al. 2013 ) and was therefore included as a control variable.”
Self-reported autonomic symptoms linking childhood maltreatment to relationship outcomes
Uhlich, M., Gesselman, A. N., Brunner, M., Dahlgren, J. A., Spencer, J., Lewis, G. F., Porges, S. W., Garcia, J. R., & Kołacz, J. (2026) · Sexual & Relationship Therapy · doi:10.1080/14681994.2026.2697803 · Cited by 1
“The ANS is involved in a range of psychological outcomes such as post-traumatic stress disorder (Pole, 2007), stress-related disorders (Chrousos, 2009) and emotion regulation difficulties (Beauchaine, 2015).”
Respiratory sinus arrhythmia in the fourth decade of life depends on birth weight and the DRD4 gene: Implications for understanding the development of emotion regulation
Savoy, C. D., Mathewson, K. J., Schmidt, L. A., Morrison, K. M., Krzeczkowski, J. E., & Lieshout, R. J. V. (2017) · Developmental Psychobiology · doi:10.1002/dev.21539 · Cited by 1
Making Food Decisions Together: Physiological and Affective Underpinnings of Relinquishing Preferences and Reaching Decisions
Stevanovic, M., Tuhkanen, S., Järvensivu, M., Koskinen, E., Lindholm, C., Paananen, J., Savander, E. È., Valkeapää, T., & Valkiaranta, K. (2022) · SAGE Open · doi:10.1177/21582440221078010 · Cited by 1
“…in general, depression has been associated with dysregulation in both parasympathetic and sympathetic branches of the autonomic nervous system (e.g., Beauchaine, 2015; Brush et al., 2019; Kemp et al., 2010; Koenig et al., 2016; Rottenberg, 2007; Rottenberg et al., 2007; Sarchiapone et al., 2018).”
Background
Borderline Personality Disorder and the Heart
Boldrini, A. (2020) · Springer eBooks · doi:10.1007/978-3-319-90305-7_25-1 · Cited by 1

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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