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Cited by 616Heart Rate Variability and Autonomic ControlCardiac Health and Mental HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Autonomic balance revisited: Panic anxiety and heart rate variability

Friedman, Bruce H., Thayer, Julian F.·1998·Journal of Psychosomatic Research
DOI 10.1016/s0022-3999(97)00202-x
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Abstract

The analysis of heart rate variability (HRV) is becoming widely used in clinical research to provide a window into autonomic control of HR. This technique has been valuable in elucidating the autonomic underpinnings of panic disorder (PD), a condition that is marked by reports of heart palpitations. A body of research has emerged that implicates a relative reduction in HRV and cardiac vagal tone in PD, as indicated by various HRV measures. These data are consistent with the cardiac symptoms of panic attacks, as well as with developmental evidence that links high vagal tone with enhanced attention, effective emotion regulation, and organismic responsivity. Implications of these findings for nosology and pathophysiology are discussed. Reports of reduced HRV in PD contrast with portrayals of excess autonomic lability in anxiety. This contradiction is addressed in the context of traditional homeostatic models versus a systems perspective that views physiologic variability as essential to overall stability.

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159 of 159 references verified0 citation errors · 0 not checkable

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  • Cardiac vagal control has a plausible functional relationship to the body: the vagus nerve innervates end organs involved in emotion and communication, and vagal input to the heart can be quickly withdrawn to allow rapid mobilization for demands such as exercise, coping with negative emotion, and survival threats.

    “the vagus nerve innervates a number of end organs that are involved in emotion and communication (i.e., larynx, facial muscles, Porges, 1995), and the vagal input to the heart can be quickly withdrawn to allow rapid mobilization of the body to meet a variety of environmental and metabolic demands; these include physical exercise, coping with negative emotion (e.g., Beauchaine, 2001; Friedman & Tha”

    From Psychological flexibility as a fundamental aspect of health (2010) · cites this paper as Friedman & Thayer, 1998

  • Processes that may contribute to over-responsivity of networks involved in emotional processing include increased threat perception, increased and misinterpreted perception of bodily sensations, or decreased inhibition of the fear response.

    “Processes that may contribute to this over-responsivity include increased threat perception, increased and misinterpreted perception of bodily sensations [34], or decreased inhibition of the fear response.”

    From Functional autonomic nervous system profile in children with autism spectrum disorder (2014) · cites this paper as [34]

  • Chronically elevated heart rate has been reported in anxiety disorders.

    “Highlighting the role of the physiological dimension, chronically elevated HR has been reported in anxiety disorders [32-34].”

    From Functional autonomic nervous system profile in children with autism spectrum disorder (2014) · cites this paper as [34]

  • Hyperarousal at the central level may be associated with over-responsivity of networks involved in perception, processing, and responding to emotional stimuli.

    “At this level, hyperarousal may be associated with over-responsivity of networks involved in perception, processing, and responding to emotional stimuli [34].”

    From Functional autonomic nervous system profile in children with autism spectrum disorder (2014) · cites this paper as [34]

  • Reduced HRV is a clinically relevant feature of stress-related disorders including anxiety, depression, and epilepsy.

    “Reduced HRV is a clinically relevant feature of stress-related disorders including anxiety, depression, and epilepsy (Carney et al., 1995b; Friedman and Thayer, 1998; Brown and Gerbarg, 2005; Mativo et al., 2010).”

    From Hypothesis: Pulmonary Afferent Activity Patterns During Slow, Deep Breathing Contribute to the Neural Induction of Physiological Relaxation (2019) · cites this paper as Friedman and Thayer, 1998

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Authors
Friedman, B. H., & Thayer, J. F.
Affiliations
  • Washington University in St. Louis (US)
  • University of Missouri (US)
Corresponding author
Friedman, Bruce H.
ORCID
Venue
Journal of Psychosomatic Research
Publisher
Elsevier BV
Published
1998-01
Volume
44
Issue
1
Pages
133-151
ISSN
0022-3999 (ISSN-L)
DOI
10.1016/s0022-3999(97)00202-x
OpenAlex
W2167377065
Cited by
616
References
173
Citations by year
2026: 6 · 2025: 14 · 2024: 15 · 2023: 16 · 2022: 18 · 2021: 20 · 2020: 25 · 2019: 27 · 2018: 22 · 2017: 36 · 2016: 43 · 2015: 28 · 2014: 33 · 2013: 25 · 2012: 29
FWCI
2.04
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Psychosomatic Research (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
heart rate variability, panic disorder, sympathovagal balance, cardiac vagal tone, palpitations, anxiety, emotion regulation, homeostatic model, systems approach, disease classification, pathophysiology
MeSH terms
Anxiety Disorders, Arrhythmias, Cardiac, Autonomic Nervous System, Epinephrine, Heart Rate, Homeostasis, Humans, Models, Biological, Sympathetic Nervous System, Vagus Nerve, Comorbidity, Panic Disorder

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