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Autonomic balance revisited: Panic anxiety and heart rate variability
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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“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emotion and communication (i.e., larynx, facial muscles, Porges, 1995), and the vagal input to the heart can be quickly withdrawn to allow rapid mobilization of the body to meet a variety of environmental and metabolic demands; these include physical exercise, coping with negative emotion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
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
James, W. (1891) · Personality Culture Society · doi:10.1037/11059-000 · Cited by 25,876
The Standard Edition of the Complete Psychological Works of Sigmund Freud
Freud, S. (1953) · Cited by 17,730
Diagnostic and Statistical Manual of Mental Disorders
&NA; (1988) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-198802020-00022 · Cited by 12,603
Cognitive, social, and physiological determinants of emotional state.
Schachter, S., & Singer, J. (1962) · Psychological Review · doi:10.1037/h0046234 · Cited by 6,223
Cardiovascular neural regulation explored in the frequency domain.
Malliani, A., Pagani, M., Lombardi, F., & Cerutti, S. (1991) · Circulation · doi:10.1161/01.cir.84.2.482 · Cited by 3,569
Prigogine, I., Stengers, I., & Pagels, H. R. (1984) · Cited by 2,468
Order out of chaos : man's new dialogue with nature.
Prigogine, I., & Stengers, I. (1984) · Cited by 2,391
Bodily Changes in Pain, Hunger, Fear, and Rage.
Washburn, M. F., & Cannon, W. B. (1917) · The Journal of Philosophy Psychology and Scientific Methods · doi:10.2307/2013624 · Cited by 1,912
Personality and Individual Differences
Eysenck, H. J., & Eysenck, M. W. (1985) · doi:10.1007/978-1-4613-2413-3 · Cited by 1,893
Research works printed but not linked: 7
- Miyawaki, 1991, Autonomic nervous system tests in psychiatry: implications and potential uses of heart rate variability, Integr Psychiatry, 7, 21
- Margraf, 1990, Ambulatory psychophysiological monitoring of panic attacks, J Psychophysiol, 4, 321
- Bronis, 1983, Heart rate variability and autonomous system: some possible relations, Automedica, 4, 223
- Friedman BH, Thayer JT. Anxiety and autonomic flexibility: a cardiovascular approach. Biol Psychol (in press).
- Marks, 1982, Are there anticompulsive or antiphobic drugs?, Psychopharmacol Bull, 18, 70
- Coryell, 1986, Mortality among patients with anxiety disorders, Am J Psychiatry, 39, 508
- Friedman, 1993, Heart rate variability in generalized anxiety disorder, Psychophysiology, 30, S28
Cited by
Sorted by citations
Items 101–200 of 615
Longitudinal relations between child vagal tone and parenting behavior: 2 to 4 years
Kennedy, A. E., Rubin, K. H., Hastings, P. D., & Maisel, B. (2004) · Developmental Psychobiology · doi:10.1002/dev.20013 · Cited by 116
“Furthermore, these physiological patterns (low cardiac vagal tone) have been associated with the development of those types of maladjustment thought to be, in part, a result of dysregulated affect, in both children (El-Sheikh, Harger, & Whitson, 2001) and adults ( Friedman & Thayer, 1998 ).”
BackgroundEvaluation of linkage of markers on chromosome 6p with schizophrenia in Taiwanese families
Hwu, H., Lin, M., Lee, P.-C., Lee, S. F. ‐., Ouyang, W., & Liu, C. (2000) · American Journal of Medical Genetics · doi:10.1002/(sici)1096-8628(20000207)96:1 · Cited by 30
Unconscious emotion: A cognitive neuroscientific perspective
Smith, R. S., & Lane, R. D. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.08.013 · Cited by 118
239. Increased QT variability in patients with panic disorder and depression
Yeragani, V. K., Pohl, R. B., Jampala, V. C., Balon, R., Ramesh, C., & Srinivasan, K. (2000) · Biological Psychiatry · doi:10.1016/s0006-3223(00)00503-5 · Cited by 112
Wilhelm, F. H., & Roth, W. T. (2001) · Biological Psychology · doi:10.1016/s0301-0511(01)00091-6 · Cited by 112
“The association between PD and CHD appears to be strongest in patients with atypical chest pain or symptoms that can not be fully explained by coronary status (Fleet et al., 2000).”
InfluentialThe Relationship Between Spectral Changes in Heart Rate Variability and Fatigue
Tran, Y., Wijesuriya, N. S., Tarvainen, M. P., Karjalainen, P. A., & Craig, A. R. (2009) · Journal of Psychophysiology · doi:10.1027/0269-8803.23.3.143 · Cited by 111
Thayer, J. F. (2006) · Dose-Response · doi:10.2203/dose-response.004.01.002.thayer · Cited by 110
“Consistent with our suggestion of the importance of HRV as an index of prefrontal inhibitory control we have reported decreased HRV in both anxiety disorders and addiction (Friedman & Thayer, 1998; Ingjaldsson, Laberg, & Thayer, 2003).”
BackgroundInfluentialSelf-citationNeumann, S. A., Sollers, J. J., Thayer, J. F., & Waldstein, S. R. (2004) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2004.03.008 · Cited by 109
“While prior research has found delayed physiological poststress recovery related to anxiety disorders and other forms of psychopathology (Friedman and Thayer, 1998), to the authors’ knowledge, this is the first study to document that alexithymia is associated with prolonged cardiovascular recovery from anger.”
BackgroundInfluentialSelf-citationPanic Disorder, Phobias, and Generalized Anxiety Disorder
Craske, M. G., & Waters, A. M. (2005) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.1.102803.143857 · Cited by 106
“…SAD, because by way of the narrower and highly specific set of stimuli that trigger specific phobic reactions, affected individuals are capable of greater emotional flexibility than the broader, overgeneralized anxious responding in PD (Friedman & Thayer 1998a) and GAD (Friedman & Thayer 1998b).”
BackgroundInfluentialChildhood separation anxiety and the pathogenesis and treatment of adult anxiety.
Milrod, B., Markowitz, J., Gerber, A., Cyranowski, J., Altemus, M., Shapiro, T., Hofer, M., & Glatt, C. T. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13060781 · Cited by 90
Cardiac Vagal Tone, defensiveness, and motivational style
Movius, H. L., & Allen, J. J. B. (2004) · Biological Psychology · doi:10.1016/j.biopsycho.2004.03.019 · Cited by 116
“Clinically anxious subjects exhibit lower resting vagal tone (as indexed by RSA) and less ability to suppress it (Lyonfields et al., 1995; Friedman and Thayer, 1998).”
BackgroundNarita, K., Murata, T., Hamada, T., Takahashi, T., Omori, M., Suganuma, N., Yoshida, H., & Wada, Y. (2007) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2006.01.003 · Cited by 100
Resting RSA is associated with natural and self-regulated responses to negative emotional stimuli
Demaree, H. A., Robinson, J. L., Everhart, D. E., & Schmeichel, B. J. (2004) · Brain and Cognition · doi:10.1016/j.bandc.2004.05.001 · Cited by 98
“Individuals diagnosed with an anxiety disorder have reduced cardiac vagal control (Friedman & Thayer, 1998a, 1998b; Thayer, Friedman, & Borkovec, 1996; Watkins, Grossman, Krishnan, & Sherwood, 1998).”
BackgroundInfluentialVaschillo, E. G., Bates, M. E., Vaschillo, B., Lehrer, P. M., Udo, T., Mun, E., & Ray, S. (2008) · Psychophysiology · doi:10.1111/j.1469-8986.2008.00673.x · Cited by 102
“…and is associated with reduced social competence in childhood (El-Sheikh, Harger, & Whitson, 2001), increased vulnerability to stress (Giardino et al., 2000), and somatic and emotional illnesses (Friedman & Thayer, 1998; Ingjaldsson, Laberg, & Thayer, 2003; Taylor, Carr, Myers, & Eckberg, 1998).”
BackgroundState anxiety biases estimates of uncertainty and impairs reward learning in volatile environments
Hein, T. P., de Fockert, J., & Ruiz, M. H. (2021) · NeuroImage · doi:10.1016/j.neuroimage.2020.117424 · Cited by 99
“…anxiety used during the experiment was the V of the inter-beat intervals to assess HRV, as this measure, similarly o other metrics of HRV, has been reported to show reductions durng anxious states ( Chalmers et al., 2014 ; Friedman and Thayer, 1998 ; orman and Sloan, 2000 ; Kawachi et al., 1995 ).”
MethodResultStapelberg, N. J. C., Hamilton‐Craig, I. R., Neumann, D. L., Shum, D., & McConnell, H. W. (2012) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412444624 · Cited by 101
“Anxiety is significantly associated with decreased HRV (Friedman, 2007; Friedman and Thayer, 1998; Gorman and Sloan, 2000; Watkins et al., 1998; Yeragani et al., 1991, 1995).”
BackgroundFactors influencing heart rate variability
Sammito, S., & Böckelmann, I. (2016) · International Cardiovascular Forum Journal · doi:10.17987/icfj.v6i0.242 · Cited by 98
Sammito, S., Thielmann, B., Klußmann, A., Deußen, A., Braumann, K.-M., & Böckelmann, I. (2024) · Journal of Occupational Medicine and Toxicology · doi:10.1186/s12995-024-00414-9 · Cited by 116
“P s y c h i a t r i c d i s o r d e r s P a t i e n t s w i t h a n x i e t y d i s o r d e r s a n d p a n i c a tt a c k s u s u a ll y h a v e a n i n c r e a s e d H R [ 99 ] .”
The Place of Stress and Emotions in the Irritable Bowel Syndrome
Sonia Pellissier, A., & Bonaz, B. L. (2016) · Vitamins and hormones · doi:10.1016/bs.vh.2016.09.005 · Cited by 102
Useche, S. A., Cendales, B., Montoro, L. V., & Estéban, C. (2018) · PeerJ · doi:10.7717/peerj.6249 · Cited by 111
Neumann, S. A., Waldstein, S. R., Sellers, J. J., Thayer, J. F., & Sorkin, J. D. (2004) · Health Psychology · doi:10.1037/0278-6133.23.6.631 · Cited by 100
Self-citationRoeser, K., Obergfell, F., Meule, A., Vögele, C., Schlarb, A. A., & Kübler, A. (2012) · Physiology & Behavior · doi:10.1016/j.physbeh.2012.01.023 · Cited by 95
“Accordingly, sleep disturbances [31], general anxiety disorder [32], panic disorder [33], and depression [34] were related to diminished vagally mediated HRV.”
BackgroundCardiac vagal tone is correlated with selective attention to neutral distractors under load
Park, G., Vasey, M. W., Bavel, J. J. V., & Thayer, J. F. (2013) · Psychophysiology · doi:10.1111/psyp.12029 · Cited by 96
Self-citationKemp, A. H., Quintana, D. S., Quinn, C. R., Hopkinson, P., & Harris, A. W. F. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01387 · Cited by 95
“ORIGINAL RESEARCH ARTICLE published: 27 November 2014 doi: 10.3389/fpsyg.2014.01387 Major depressive disorder with melancholia displays robust alterations in resting state heart rate and its variability: implications for future morbidity and mortality”
BackgroundInfluentialAnxiety Reduces Baroreflex Cardiac Control in Older Adults With Major Depression
Watkins, L. L., Grossman, P., Krishnan, R. R., & Blumenthal, J. A. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199905000-00012 · Cited by 94
Resting respiratory sinus arrhythmia and posttraumatic stress disorder: A meta-analysis
Campbell, A. A., Wisco, B. E., Silvia, P. J., & Gay, N. G. (2019) · Biological Psychology · doi:10.1016/j.biopsycho.2019.02.005 · Cited by 100
Anxiety, depression and autonomic nervous system dysfunction in hypertension
Bajkó, Z., Szekeres, C., Kovács, K. R., Csapó, K., Molnár, S., Soltész, P., Nyitrai, E., Magyar, M. T., Oláh, L., Bereczki, D., et al. (2012) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2012.02.014 · Cited by 93
“The analysis of heart rate variability (HRV) and baroreflex sensitivity (BRS) is becoming widely used in clinical research to provide a window into the autonomic control of the heart [1].”
BackgroundEl‐Sheikh, M. (2001) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.110.4.499 · Cited by 96
Dirks, A., Groenink, L., Bouwknecht, J. A., Hijzen, T. H., van der Gugten, J., Ronken, E., Verbeek, J. S., Veening, J. G., Dederen, P. J. W. C., Kőrösi, A., et al. (2002) · European Journal of Neuroscience · doi:10.1046/j.1460-9568.2002.02245.x · Cited by 91
“Furthermore, in humans a link has been proposed between low heart rate variability and risk for anxiety disorders (e.g. Friedman & Thayer, 1998a, b), or major depressive disorder (see Nemeroff et al., 1998), both associated with elevated CRH levels.”
BackgroundMethodAgorastos, A., Boel, J. A., Heppner, P. S., Hager, T., Moeller-Bertram, T., Haji, U., Motazedi, A., Yanagi, M. A., Baker, D. G., & Stiedl, O. (2013) · Stress · doi:10.3109/10253890.2012.751369 · Cited by 88
Gillie, B. L., & Thayer, J. F. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.00758 · Cited by 106
“Blechert et al. (2007) found that individuals with PTSD exhibited lower levels of vagally mediated HRV at rest relative to healthy controls and patients with panic disorder, another anxiety disorder also characterized by low resting HRV (Friedman and Thayer, 1998).”
BackgroundSelf-citationThe impact of menstrual cycle phase on cardiac autonomic regulation
McKinley, P. S., King, A. R., Shapiro, P. A., Slavov, I., Fang, Y., Chen, I. S., Jamner, L. D., & Sloan, R. P. (2009) · Psychophysiology · doi:10.1111/j.1469-8986.2009.00811.x · Cited by 90
“Some have suggested that LF power represents cardiac sympathetic regulation (Friedman & Thayer, 1998; Pagani et al., 1986), and evidence suggests that, at least under certain conditions, the sympathetic nervous systemmay contribute to LF power (Pomeranz et al., 1985).”
Groenink, L., Pattij, T., de Jongh, R., van der Gugten, J., Oosting, R. S., Dirks, A., & Olivier, B. (2003) · European Journal of Pharmacology · doi:10.1016/s0014-2999(03)01281-0 · Cited by 89
Zafar, M. U., Paz-Yepes, M., Shimbo, D., Vilahur, G., Burg, M. M., Chaplin, W. F., Fuster, V., Davidson, K. W., & Badimón, J. J. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehp602 · Cited by 93
The prediction of nonresponse to pharmacotherapy in panic disorder: A review
Slaap, B. R., & den Boer, J. A. (2001) · Depression and Anxiety · doi:10.1002/da.1053 · Cited by 88
Is Heart Rate Variability Related to Memory Performance in Middle-Aged Men?
Shah, A. J., Su, S., Veledar, E., Bremner, J. D., Goldstein, F. C., Lampert, R. J., Goldberg, J. H., & Vaccarino, V. (2011) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182227d6a · Cited by 93
“It is influenced by several factors, including age, hypertension (6), genetic factors (7), diet (8), and emotional factors such as depression (9) and anxiety (10).”
Effects of orally administered lavender essential oil on responses to anxiety‐provoking film clips
Bradley, B. F., Brown, S. L., Chu, S., & Lea, R. W. (2009) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.1016 · Cited by 86
“…(HRV) is vagally mediated and an index of the central peripheral feedback capacity, and decreases in anxious participants (Brosschot et al., 2007; Friedman and Thayer, 1998; Gorman and Sloan, 2000; Johnsen et al., 2003; McCraty et al., 1995; Thayer and Friedman, 2002; Thayer and Lane, 2007;…”
BackgroundAkintola, A. A., van de Pol, V., Bimmel, D., Maan, A. C., & van Heemst, D. (2016) · Frontiers in Physiology · doi:10.3389/fphys.2016.00391 · Cited by 88
Perceiving blocks of emotional pictures and sounds: effects on physiological variables.
Brouwer, A.-M., van Wouwe, N., Mühl, C., van Erp, J., & Toet, A. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00295 · Cited by 85
“Studies on heart rate variability and emotions are mostly dealing with fear or anxiety (George et al., 1989; Friedman and Thayer, 1998; Rao and Yeregani, 2001) where heart rate variability decreases with increased levels of fear.”
Ottaviani, C., Watson, D. R., Meeten, F., Makovac, E., Garfinkel, S. N., & Critchley, H. (2016) · Biological Psychology · doi:10.1016/j.biopsycho.2016.06.009 · Cited by 87
“In their “autonomic flexibility-neurovisceral integration model of anxiety”, Friedman and Thayer (1998) view anxiety as a systemic inflexibility, grounded in poor inhibition.”
BackgroundMaternal anxiety in late pregnancy: effect on fetal movements and fetal heart rate
Sjöström, K., Valentin, L., Thelin, T., & Maršál, K. (2002) · Early Human Development · doi:10.1016/s0378-3782(01)00256-0 · Cited by 84
“This is interesting in view of our finding that FHR variability in FHR patterns A and B tended to be lower in the high state anxiety group (Table 3) and in view of a reported association between panic disorders and reduced heart rate variability in adults [20].”
BackgroundEffects of Laughing and Weeping on Mood and Heart Rate Variability.
Sakuragi, S., Sugiyama, Y., & Takeuchi, K. (2002) · Journal of PHYSIOLOGICAL ANTHROPOLOGY and Applied Human Science · doi:10.2114/jpa.21.159 · Cited by 86
“Numerous studies have reported changes in autonomic nervous function assessed by heart rate variability (HRV) in relation to emotions (Dishman et al., 2000; Friedman and Thayer, 1998a; Friedman and Thayer, 1998b; McCraty et al., 1999; Piccirillo et al., 1997; Pine et al., 1998).”
Effect of Forest Therapy on Depression and Anxiety: A Systematic Review and Meta-Analysis
Yeon, P., Jeon, J. Y., Jung, M.-S., Min, G.-M., Kim, G.-Y., Han, K.-M., Shin, M., Jo, S.-H., Kim, J.-G., & Shin, W.-S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312685 · Cited by 97
“This is because significant correlations between physiological findings such as EEG asymmetry [125,126], heart rate variability [127,128], and perceived levels of depression and anxiety have been reported.”
BackgroundCardiac vagal tone predicts attentional engagement to and disengagement from fearful faces.
Park, G., Bavel, J. J. V., Vasey, M. W., & Thayer, J. F. (2013) · Emotion · doi:10.1037/a0032971 · Cited by 83
Self-citationThe effect of electroporation pulses on functioning of the heart
Mali, B. Č., Jarm, T., Čorović, S., Kosir, M. S. P., Čemažar, M., Serša, G., & Miklavčič, D. (2008) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-008-0346-7 · Cited by 86
“The most frequently reported symptoms in panic attacks, which are characterized by episodes of intense anxiety, are heart pounding and tachycardia [16, 32].”
BackgroundSloan, R. P., Schwarz, E., McKinley, P. S., Weinstein, M., Love, G., Ryff, C., Mroczek, D., Choo, T.-H., Lee, S., & Seeman, T. (2017) · Health Psychology · doi:10.1037/hea0000397 · Cited by 80
“Although we were unable to detect relationships between HF- HRV and indices of positive affect, our findings revealed the often-reported inverse relationship between negative affect and HF-HRV (Carney, Freedland, & Stein, 2000; Demaree et al., 2004; Friedman & Thayer, 1998; Rechlin, 1994).”
ResultParoxetine Open‐Label Treatment of Pediatric Outpatients With Obsessive‐Compulsive Disorder
Rosenberg, D. R., STEWART, C. M., Fitzgerald, K. D., TAWILE, V., & CARROLL, E. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199909000-00024 · Cited by 80
Respiratory sinus arrhythmia as a function of state anxiety in healthy individuals
Jönsson, P. (2006) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2006.08.002 · Cited by 87
Leliveld, L. M. C., Düpjan, S., Tuchscherer, A., & Puppe, B. (2016) · Physiology & Behavior · doi:10.1016/j.physbeh.2016.02.002 · Cited by 78
Neural Pathways Underlying Lactate-Induced Panic
Johnson, P. L., Truitt, W. A., Fitz, S. D., Lowry, C. A., & Shekhar, A. (2007) · Neuropsychopharmacology · doi:10.1038/sj.npp.1301621 · Cited by 78
“The finding that panic-related conditions may be a result of parasympathetic and sympathetic imbalance, and baroreflex disruption is not surprising (see review (Friedman and Thayer, 1998)).”
Autonomic Changes Associated with Enhanced Anxiety in 5-HT1A Receptor Knockout Mice
Pattij, T. (2002) · Neuropsychopharmacology · doi:10.1016/s0893-133x(02)00317-2 · Cited by 78
Autistic Cognition: Charting Routes to Anxiety
Stark, E., Stacey, J., Mandy, W., Kringelbach, M. L., & Happé, F. (2021) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2021.03.014 · Cited by 77
van der Horn, H. J., Out, M. L., de Koning, M. E., Mayer, A. R., Spikman, J. M., Sommer, I. E., & van der Naalt, J. (2019) · Journal of Neurology · doi:10.1007/s00415-019-09335-8 · Cited by 87
Attachment Style, Vagal Tone, and Empathy During Mother–Adolescent Interactions
Diamond, L. M., Fagundes, C. P., & Butterworth, M. R. (2011) · Journal of Research on Adolescence · doi:10.1111/j.1532-7795.2011.00762.x · Cited by 82
“Adults with low vagal tone have higher levels of depression, anger, mental stress, generalized anxiety, and panic anxiety (reviewed in Brosschot & Thayer, 1998; Friedman & Thayer, 1998; Horsten et al., 1999).”
BackgroundThe potential of applying immersive virtual environment to biophilic building design: A pilot study
Emamjomeh, A., Zhu, Y., & Beck, M. R. (2020) · Journal of Building Engineering · doi:10.1016/j.jobe.2020.101481 · Cited by 76
Update: factors influencing heart rate variability–a narrative review
Sammito, S., Thielmann, B., & Böckelmann, I. (2024) · Frontiers in Physiology · doi:10.3389/fphys.2024.1430458 · Cited by 84
“…et al., 2012; Alvares et al., 2016; Bassett, 2016; Brown et al., 2018), epilepsy (Lotufo et al., 2012), panic attacks (Aasman et al., 1987; Friedman and Thayer, 1998), posttraumatic stress disorder (Sammito et al., 2015) and schizophrenia (Clamor et al., 2016) have typically shown reduced…”
BackgroundWang, Z., Lu, W. D., & Qin, R. (2012) · Biological Psychology · doi:10.1016/j.biopsycho.2012.12.006 · Cited by 72
Krypotos, A., Jahfari, S., van Ast, V. A., Kindt, M., & Forstmann, B. U. (2011) · Frontiers in Psychology · doi:10.3389/fpsyg.2011.00278 · Cited by 85
“Attentional biases toward emotional stimuli can also be a potential explanation for the difference in performance between participants with low and high HRV, as previous studies have associated low HRV to poorer attentional control (Porges, 1992; Friedman and Thayer, 1998).”
Attention-deficit hyperactivity disorder and cardiac vagal control: a systematic review
Rash, J. A., & Aguirre-Camacho, A. (2012) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-012-0087-1 · Cited by 72
“…model of neurovisceral integration, CVC has been found to be directly related to neural structures that serve executive function, attention, motivation, and social and affective behaviour (Damasio 1998; Devinsky et al. 1995; Friedman and Thayer 1998a, b; Masterman and Cummings 1997; Spyer 1989).”
BackgroundGrossman, P. (2023) · Biological Psychology · doi:10.1016/j.biopsycho.2023.108739 · Cited by 82
“As such, it supports the concept, not so much of autonomic flexibility (Friedman and Thayer, 1998), as of the extent of a general capacity to integrate behavioral and metabolic demands by means of efficient energy exchange.”
BackgroundEffects of Aesthetic Chills on a Cardiac Signature of Emotionality
Sumpf, M., Jentschke, S., & Koelsch, S. (2015) · PLoS ONE · doi:10.1371/journal.pone.0130117 · Cited by 80
Yeh, T., Kao, L.-C., Tzeng, N., Kuo, T. B. J., Huang, S., Chang, C.-C., & Chang, H. (2015) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2015.07.007 · Cited by 72
Romanowicz, M., Schmidt, J. E., Bostwick, J. M., Mrazek, D. A., & Karpyak, V. M. (2011) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2011.01442.x · Cited by 79
Salomon, K. (2005) · Health Psychology · doi:10.1037/0278-6133.24.1.68 · Cited by 74
“Therefore, low levels of the vagal component of HPV may be a prognostic risk factor for the development of CVD. Vagal control serves to maintain homeostasis and promote growth and restoration.”
BackgroundInfluentialPerseverative Thinking and Health: Neurovisceral Concomitants
Thayer, J. F., & Lane, R. D. (2002) · Psychology and Health · doi:10.1080/08870440290025867 · Cited by 78
“Diminished tonic HRV and the associated reduction of vagally mediated cardiovascular control have been associated with a variety of pathological states and dispositions (see Malliani et al., 1991; Stein et al., 1994; Friedman and Thayer, 1998, for reviews).”
BackgroundInfluentialSelf-citationPsychophysiological Effects of Breathing Instructions for Stress Management
Conrad, A., Müller, A., Doberenz, S., Kim, S., Meuret, A. E., Wollburg, E., & Roth, W. T. (2007) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-007-9034-x · Cited by 94
“The finding of greater vagal tone in PD patients than controls was surprising, since other studies have reported lower parasympathetic tone in PD than in controls (e.g., Friedman & Thayer, 1998; McCraty, Atkinson, Tomasino, & Stuppy, 2001).”
ResultBaker, F. C., Colrain, I. M., & Trinder, J. C. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.04.008 · Cited by 71
“Patients with panic disorder have lower SDNN (31) and HF power (32) as well as a higher LF/HF ratio than controls (32).”
BackgroundJonckheere, J. D., Rommel, D., Nandrino, J., Jeanne, M., & Logier, R. (2012) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc.2012.6346703 · Cited by 70
Diamond, L. M., Hicks, A. M., & Otter-Henderson, K. D. (2011) · Personality and Social Psychology Bulletin · doi:10.1177/0146167211400620 · Cited by 77
“…tone show ineffective behavioral coping in response to stress (Fabes & Eisenberg, 1997; Fabes, Eisenberg, & Eisenbud, 1993) as well as higher levels of anger, hostility, mental stress, and generalized anxiety (reviewed in Brosschot & Thayer, 1998; Friedman & Thayer, 1998; Horsten et al., 1999).”
BackgroundA sensor fusion approach for drowsiness detection in wearable ultra-low-power systems
Kartsch, V. J., Benatti, S., Schiavone, P. D., Rossi, D., & Benini, L. (2018) · Information Fusion · doi:10.1016/j.inffus.2017.11.005 · Cited by 69
Herrmann‐Lingen, C., Binder, L., Klinge, M., Sander, J., Schenker, W., Beyermann, B., von Lewinski, D., & Pieske, B. M. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000073870.93003.c4 · Cited by 69
“Despite the known adverse effects of anxiety on, eg, autonomic cardiac control (20), higher anxiety may in part also reflect lower ANP levels, which mean less severe heart failure and a better prognosis.”
BackgroundState Regulation and Attention Deficit Hyperactivity Disorder
van der Meere, J. (2005) · Contemporary clinical neuroscience · doi:10.1385/1-59259-891-9:413 · Cited by 72
“With this in mind, one of the problems that has to be resolved in future research is that a variety of disorders other than ADHD has been repeatedly suggested to be accompanied by deficient parasympathetic (vagal) modulation processes, such as anxiety-related disorders (70, 71 ), major depression (72), and schizophren…”
BackgroundToo much of a good thing? Cardiac vagal tone’s nonlinear relationship with well-being.
Kogan, A., Gruber, J., Shallcross, A. J., Ford, B. Q., & Mauss, I. B. (2013) · Emotion · doi:10.1037/a0032725 · Cited by 87
Greaves‐Lord, K., Tulen, J. H. M., Dietrich, A., Sondeijker, F., van Roon, A. M., Oldehinkel, A. J., Ormel, J., Verhulst, F. C., & Huizink, A. C. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2009.04.014 · Cited by 73
“One factor that may indicate vulnerability towards anxiety is reduced autonomic flexibility (Friedman and Thayer, 1998a,b; Friedman, 2007).”
A cardiac signature of emotionality
Koelsch, S., Remppis, A., Sammler, D., Jentschke, S., Mietchen, D., Fritz, T. H., Bonnemeier, H., & Siebel, W. A. (2007) · European Journal of Neuroscience · doi:10.1111/j.1460-9568.2007.05889.x · Cited by 69
“…indicates that affective disorders such as anxiety and depressive disorders are associated with reduced HRV, as well as reduced QT variability (Friedman & Thayer, 1998; Yeragani et al., 1993, 2000; Carney et al., 2001), and that chronic negative emotions such as fear, hostility, depression…”
BackgroundA Neurovisceral Integration Model of Health Disparities in Aging
Anderson, N. B., Bulatao, R. A. B., & Cohen, B. (2004) · Cited by 68
Demaree, H. A., & Everhart, D. E. (2003) · Personality and Individual Differences · doi:10.1016/s0191-8869(03)00109-0 · Cited by 66
Cattaneo, L. A., Franquillo, A. C., Grecucci, A., Beccia, L., Caretti, V., & Dadomo, H. (2021) · Journal of Personalized Medicine · doi:10.3390/jpm11090872 · Cited by 73
“Regarding anxiety disorders, low HRV can be considered an endophenotype of panic disorder [62,63].”
BackgroundChang, H., Chang, C.-C., Kuo, T. B. J., & Huang, S. (2015) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2015.1017606 · Cited by 64
Effect of Training and Detraining on Heart Rate Variability in Healthy Young Men
Gamelin, F.-X., Berthoin, S., Sayah, H. A., Libersa, C., & Bosquet, L. (2007) · International Journal of Sports Medicine · doi:10.1055/s-2007-964861 · Cited by 65
Craving for alcohol and pre-attentive processing of alcohol stimuli
Ingjaldsson, J. T., Thayer, J. F., & Laberg, J. C. (2003) · International Journal of Psychophysiology · doi:10.1016/s0167-8760(03)00075-8 · Cited by 67
Self-citationDavies, C. D., Niles, A. N., Pittig, A., Arch, J. J., & Craske, M. G. (2015) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.08.002 · Cited by 62
“…heightened self-reported negative affect (Lang & McTeague, 2009), heightened amygdala activity in response to threat (Rauch et al., 2000), reduced high-frequency heart rate variability (Friedman & Thayer, 1998; Pittig, Arch, Lam, & Craske, 2013), and avoidance behavior (Chambless & Gracely, 1989).”
BackgroundMorales, S., Beekman, C. R., Blandon, A. Y., Stifter, C. A., & Buss, K. A. (2014) · Developmental Psychobiology · doi:10.1002/dev.21267 · Cited by 73
“Conversely, low baseline RSA and/or lack of RSA suppression have been associated with poor emotional regulation or extreme emotional responses (Buss, Goldsmith, & Davidson, 2005; El-Sheikh, Harger, & Whitson, 2001; Friedman & Thayer, 1998).”
Orndorff-Plunkett, F., Singh, F., Aragón, O. R., & Pineda, J. A. (2017) · Brain Sciences · doi:10.3390/brainsci7080095 · Cited by 67
“In early uses of feedback, such as biofeedback, in which learners were provided with their current physiological state, they were asked to meet a goal, such as autonomic balance [10,11].”
BackgroundHeart rate variability in premenstrual dysphoric disorder
Landén, M., Wennerblom, B., Tygesen, H., Modigh, K., Sörvik, K., Ysander, C., Ekman, A., Nissbrandt, H., Olsson, M., & Eriksson, E. (2003) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(03)00117-3 · Cited by 64
“The psychiatric condition in which low HRV most consistently has been reported is panic disorder (Yeragani et al., 1990; Friedman and Thayer, 1998; Gorman and Sloan, 2000; McCraty et al., 2001).”
BackgroundCardiac parasympathetic regulation in obese women with binge eating disorder
Friederich, H., Schild, S., Schellberg, D., Quenter, A., Bode, C., Herzog, W., & Zipfel, S. (2005) · International Journal of Obesity · doi:10.1038/sj.ijo.0803181 · Cited by 59
Shinba, T. (2016) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12494 · Cited by 60
Dysregulated Fear, Social Inhibition, and Respiratory Sinus Arrhythmia: A Replication and Extension
Buss, K. A., Davis, E. L., Ram, N., & Coccia, M. (2017) · Child Development · doi:10.1111/cdev.12774 · Cited by 66
“…RSA suppression have been associated with internalizing problems (Calkins, Graziano, & Keane, 2007; Gentzler, Santucci, Kovacs, & Fox, 2009), poor emotional regulation, and extreme emotional response (Buss, Goldsmith, & Davidson, 2005; El-Sheikh, Harger, & Whitson, 2001; Friedman & Thayer, 1998).”
Aritzeta, A., Soroa, G., Balluerka, N., Muela, A., Gorostiaga, A., & Aliri, J. (2017) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-017-9367-z · Cited by 59
Eddie, D., Vaschillo, E. G., Vaschillo, B., & Lehrer, P. M. (2015) · Addiction Research & Theory · doi:10.3109/16066359.2015.1011625 · Cited by 83
“…serves to modulate biobehavioural resources in emotion by flexibly adjusting physiological arousal in accordance with changing situational demands (Friedman & Thayer, 1998), and therefore, serves a key role in affect regulation and substance craving (Verheul, van den Brink, & Geerlings, 1999) as…”
BackgroundGender and psychosomatic aspects of ischemic heart disease
Abbey, S. E., & Stewart, D. E. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00112-9 · Cited by 58
Depino, A. M., & Gross, C. T. (2007) · Behavioural Brain Research · doi:10.1016/j.bbr.2006.11.025 · Cited by 57
BDNF Val66Met polymorphism alters sympathovagal balance in healthy subjects
Yang, A. C., Chen, T., Tsai, S., Hong, C., Kuo, C., Yang, C., & Kao, K. (2010) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.31069 · Cited by 57
“RESEARCH ARTICLE BDNF Val66Met Polymorphism Alters Sympathovagal”
Demaree, H. A., Pu, J., Robinson, J. L., Schmeichel, B. J., & Everhart, D. E. (2006) · Cognition & Emotion · doi:10.1080/02699930500260427 · Cited by 55
“Specifically, RSA may reflect the ability to allocate and maintain attention, which are crucial to the control of mood and performance (Friedman & Thayer, 1998a; Porges, 1992; Thayer & Lane, 2000).”
BackgroundInfluentialSex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans
Brownlow, B. N., Sosoo, E. E., Long, R. N., Hoggard, L. S., Burford, T. I., & Hill, L. K. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1098-9 · Cited by 67
Reinecke, A., Filippini, N., Berna, C., Western, D. G., Hanson, B., Cooper, M. J., Taggart, P., & Harmer, C. J. (2015) · Translational Psychiatry · doi:10.1038/tp.2015.160 · Cited by 54
Meditation-induced changes in high-frequency heart rate variability predict smoking outcomes
Libby, D. J., Worhunsky, P. D., Pilver, C. E., & Brewer, J. A. (2012) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2012.00054 · Cited by 56
“…disorders including major depression (Rechlin et al., 1994; Nahshoni et al., 2004; Carney et al., 2005), bipolar disorder (Cohen et al., 2003), generalized anxiety disorder (Thayer et al., 1996), panic disorder (Friedman and Thayer, 1998) and post-traumatic stress disorder (Cohen et al., 1997).”
BackgroundSlaap, B. R. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00240-9 · Cited by 56
Dunčko, R., Makatsori, A., Ficková, E., Selko, D., & Ježová, D. (2006) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2006.04.002 · Cited by 55
“…in support of a homeodynamic concept, suggesting that healthy systems are characterized by an ability to respond flexibly to environmental demands (Friedman and Thayer, 1998; McEwen, 1998), while physiological and cognitive rigidity is associated with pathological states such as…”
BackgroundEfficacy of biofeedback for post-traumatic stress disorder
Lande, R. G., Williams, L. B., Francis, J., Gragnani, C. T., & Morin, M. L. (2010) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2010.08.004 · Cited by 54
Metadata
- Authors
- Friedman, B. H., & Thayer, J. F.
- Affiliations
- Washington University in St. Louis (US)
- University of Missouri (US)
- Corresponding author
- Friedman, Bruce H.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 1998-01
- Volume
- 44
- Issue
- 1
- Pages
- 133-151
- ISSN
- 0022-3999 (ISSN-L)
- 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
- 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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