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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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In the citing paper
“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emotion and communication (i.e., larynx, facial muscles, Porges, 1995), and the vagal input to the heart can be quickly withdrawn to allow rapid mobilization of the body to meet a variety of environmental and metabolic demands; these include physical exercise, coping with negative emotion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
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Cited by
Sorted by citations
Porges, S. W. (2007) · Biological Psychology · doi:10.1016/j.biopsycho.2006.06.009 · Cited by 3,415
“Clinically anxious subjects exhibit lower and less suppression of RSA (Lyonsfield et al., 1995; Friedman and Thayer, 1998).”
BackgroundA model of neurovisceral integration in emotion regulation and dysregulation
Thayer, J. F., & Lane, R. D. (2000) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00338-4 · Cited by 3,092
“…complex system, as it moves through attractors defines the behavioral repertoire, emotional time on numerous time-scales, requires various feed- topography or state-space of each individual. back and feedforward circuits for its efficient func- We have asserted (Friedman and Thayer, 1998; tioning.”
BackgroundMethodInfluentialSelf-citationPsychological flexibility as a fundamental aspect of health
Kashdan, T. B., & Rottenberg, J. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.03.001 · Cited by 3,054
“…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 & Thayer, 1998), and extreme survival threats (George et al., 1989).”
BackgroundThayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2009.09.543 · Cited by 2,276
“are maintained through variability in the dynamic relationship among system elements [1,15–17].”
BackgroundSelf-citationThayer, J. F., & Lane, R. D. (2009) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2008.08.004 · Cited by 2,040
“…in the absence of panic symptoms (Friedman et al., 1993; Friedman and Thayer, 1998b), (4) within families low HRV and panic disorder co-aggregate (Friedman and Thayer, 1998a; Friedman, 2007), and (5) lower HRV is found in children of patients with panic disorder compared to children of healthy…”
InfluentialSelf-citation
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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