Heart rate variability in patients with anxiety disorders: A systematic review and meta-analysis

Effects of A Brief Resonance Frequency Breathing Exercise on Heart Rate Variability and Inhibitory Control in the Context of Generalised Anxiety Disorder

Generalised anxiety disorder (GAD) is associated with cognitive and physiological symptoms including uncontrollable worry, inhibitory control deficits, and low heart rate variability (HRV). Literature linking HRV and inhibition in GAD is predominantly correlational. The present experiment investigated whether HRV has a causal role in maintaining inhibitory control. Participants (N = 135, 111 female) aged 18-37 reporting high levels of symptoms associated with GAD (GAD-7 scores ≥ 10; Penn State Worry Questionnaire scores ≥ 56) were assigned to an experimental or active control condition and completed baseline measures of HRV, respiration rate, and inhibitory control. The experimental condition completed resonance frequency breathing (RFB) training, and the control condition practiced breathing at their mean breathing rate before repeating the inhibitory control assessment. Participants also completed the breathing training before a behavioural worry task. The experimental condition was predicted to show increased HRV, alongside improved inhibitory control and better ability to stop worrying as compared to the control condition. HRV increased during the experimental condition, as compared to the control condition. However, there were no significant effects of RFB on inhibitory control or worry, or on HRV during the inhibitory control tasks. In conclusion, RFB can increase HRV in high GAD scorers, but further research is required to determine whether there is a relationship between increased HRV and symptoms of GAD in a single session experiment.

Integrating genome-wide information and wearable device data to explore the link of anxiety and antidepressants with pulse rate variability

This study explores the genetic and epidemiologic correlates of long-term photoplethysmography-derived pulse rate variability (PRV) measurements with anxiety disorders. Individuals with whole-genome sequencing, Fitbit, and electronic health record data (N = 920; 61,333 data points) were selected from the All of Us Research Program. Anxiety polygenic risk scores (PRS) were derived with PRS-CS after meta-analyzing anxiety genome-wide association studies from three major cohorts- UK Biobank, FinnGen, and the Million Veterans Program (NTotal =364,550). PRV was estimated as the standard deviation of average five-minute pulse wave intervals over full 24-hour pulse rate measurements (SDANN). Antidepressant exposure was defined as an active antidepressant prescription at the time of the PRV measurement in the EHR. Anxiety PRS and antidepressant use were tested for association with daily SDANN. The potential causal effect of anxiety on PRV was assessed with one-sample Mendelian randomization (MR). Anxiety PRS was independently associated with reduced SDANN (beta = -0.08; p = 0.003). Of the eight antidepressant medications and four classes tested, venlafaxine (beta = -0.12, p = 0.002) and bupropion (beta = -0.071, p = 0.01), tricyclic antidepressants (beta = -0.177, p = 0.0008), selective serotonin reuptake inhibitors (beta = -0.069; p = 0.0008) and serotonin and norepinephrine reuptake inhibitors (beta = -0.16; p = 2×10-6) were associated with decreased SDANN. One-sample MR indicated an inverse effect of anxiety on SDANN (beta = -2.22, p = 0.03). Anxiety and antidepressants are independently associated with decreased PRV, and anxiety appears to exert a causal effect on reduced PRV. Those observational findings provide insights into the impact of anxiety on PRV.

Electrocardiography-derived autonomic profiles in depression and suicide risk with insights from the UK Biobank

The role of the autonomic nervous system (ANS) in depression and suicidality is multifaceted. This study examined whether distinct electrocardiography based ANS profiles exist, associated with a lifetime/recent at-risk cohort or a resilient group. Using data from 15,768 participants from the UK Biobank, four unique ANS activity patterns related to heart rate variability (HRV) measures were identified. Two specific clusters, both with low HRV, showed different risks: one characterized by high relative sympathetic tonus and lower breathing rate, indicated higher resilience with less likely depressive symptoms and suicidal thoughts whereas another cluster with dominant relative parasympathetic activity and high breathing rate, aligned with greater depression and suicide attempt prevalence, potentially representing a high-risk cluster. Resilience to depression might be defined by different psychophysiological entities and coping strategies, where the resilient cluster might be characterized by cognitive coping strategies, and increased susceptibility might be linked to more rigid maladaptive coping strategies.

Efficacy and safety of an alpha 7-nicotinic acetylcholine receptor agonist, VQW-765, in subjects with performance anxiety: randomised, double-blind, placebo-controlled trial

BACKGROUND

Despite the high prevalence of social and performance anxiety, current treatments do not meet the full needs of patients. Development of novel anxiolytics with rapid onset of action for on-demand treatment of social and performance anxiety is an active area of clinical research.

AIMS

To examine the anxiolytic effect of VQW-765, an α7-nAChR agonist, in subjects with performance anxiety.

METHOD

We conducted a randomised, double-blind, placebo-controlled trial of 230 adults with a history of public speaking anxiety. Participants were randomly assigned to receive a single oral dose of 10 mg VQW-765 (n = 116) or placebo (n = 114), followed by a Trier Social Stress Test (TSST). Anxiety levels were assessed by the Subjective Units of Distress Scale (SUDS). Heart rate was monitored during the TSST. Plasma concentration of VQW-765 was measured after the TSST.

RESULTS

Subjects receiving VQW-765 showed a trend of improvement in intensity of anxiety, as measured by the SUDS, during the performance phase of a TSST compared with placebo (P = 0.1443). Females showed a larger magnitude and significant response to VQW-765 (P = 0.034). The pharmacokinetic/pharmacodynamic analysis observed an inverted U-shaped exposure-response relationship. Subjects in the middle 50% quantiles of VQW-765 plasma concentration showed significant improvement in the SUDS rating compared with placebo (P = 0.033); however, subgroup analysis revealed this was true only for females (P = 0.005). VQW-765 was safe and well tolerated.

CONCLUSIONS

This is the first study showing anxiolytic effect of an α7-nAChR agonist in humans. VQW-765 is a promising candidate to be developed for on-demand treatment of social anxiety disorder.

The unique autonomic signatures of savoring meditation for anxiety reduction: A pilot randomized controlled trial

Anxiety disorders are often characterized by excessive sympathetic activation and dysfunction. While breathing relaxation reliably reduces anxiety by dampening sympathetic activity and enhancing parasympathetic tone, the autonomic signatures underlying positive emotion interventions, such as savoring meditation, remain less understood. In this pilot randomized controlled trial, we recruited 44 participants with probable generalized anxiety disorders (GAD) by questionnaires (GAD-7 score ≥ 10, which represents moderate or higher anxiety severity), who were assigned to a savoring meditation (n = 22) or a breathing relaxation (n = 22) intervention. We measured heart rate variability (HRV) indicators (respiratory sinus arrhythmia, RSA; low-frequency HRV, LF; the low-frequency/high-frequency ratio, LF/HF) and self-reported emotional states (happiness, anxiety, sadness, calmness) before and after the intervention. Linear mixed models with multiple imputation examined outcome change between and within conditions. The savoring group exhibited increased sympathetic and decreased parasympathetic activity (significantly lower RSA, higher LF and LF/HF), contrasting with the relaxation group's pattern. Both interventions resulted in significant and similar reductions in anxiety after worrying. These preliminary results suggest that savoring meditation for anxiety reduction may have unique autonomic signatures, offering novel insights for positive emotion interventions in anxiety research.

Cardiac Vagal Efficiency Is Enhanced by Percutaneous Auricular Neurostimulation in Adolescents With Nausea: Moderation by Antidepressant Drug Exposure

OBJECTIVES

Percutaneous electrical nerve field stimulation (PENFS) is an effective treatment for disorders of gut-brain interaction (DGBI), proposed to influence vagal pathways. Cardiac metrics such as respiratory sinus arrythmia (RSA) and vagal efficiency (VE) can noninvasively assess parasympathetic output. Commonly used antidepressant drugs inhibit vagal signaling and may interfere with PENFS. This study examined immediate effects of active compared to sham PENFS on cardiac vagal function in adolescents with chronic nausea with and without concurrent drug therapy.

MATERIALS AND METHODS

Participants (n = 84) were randomized to active (3.2 V, 1-10 Hz) or sham PENFS within an 8-week prospective, double-blind clinical trial. Subjects underwent posture challenges to elicit a vagal response before and after PENFS device placement mid-way through the study. RSA, mean heart period (HP), and VE were calculated from electrocardiogram recordings. Exposure to antidepressant drugs was recorded.

RESULTS

The mean (SD) age was 15.61 (2.07) years (83% female). Fifty percent were treated with antidepressants. PENFS neurostimulation enhanced VE in patients without antidepressant exposure (mean increase after PENFS stimulation =7.56 [95% CI: 0.26, 14.86], d = 0.30, 17% increase) but not in those treated with antidepressants (mean change = -5.30 [95% CI:-14.28, 3.68]). Sham PENFS did not produce significant VE changes regardless of medication use (both p > 0.40). There were no significant effects on RSA or HP.

CONCLUSIONS

Acute enhancement of cardiac VE is demonstrated with PENFS in patients not exposed to chronic antidepressant drug therapy. Findings indicate that VE is a sensitive metric for rapid assessment of PENFS effects but raise concern for possible interaction or interference by standard of care medications.

TRIAL REGISTRATION

Clinicaltrials.gov #: 1064187-2.

The effect of social anxiety on social attention in naturalistic situations

BACKGROUND AND OBJECTIVES

This multimodal two-phase study investigated the impact of trait social anxiety on exploration, social attention, and autonomic responses in a naturalistic setting. We expected higher avoidance of potentially crowded spaces, reduced visual attention on other people, and heightened physiological arousal in social situations for participants with higher social anxiety levels.

DESIGN AND METHODS

Eighty-seven participants, pre-screened for high variance in trait social anxiety, first completed a half-hour walk on a freely chosen route and subsequently had a staged social interaction with a confederate consisting of a non-interactive waiting phase and a short conversation.

RESULTS

While social anxiety did not modulate the choice of route during the walk phase, socially anxious participants avoided gazing at other individuals in non-interactive situations, i.e., during the walk and the waiting phase. In contrast, during actual interaction, they showed increased visual attention towards the confederate's face. Across all experimental phases, highly socially anxious individuals showed elevated heart rates, but this effect was independent of the social context.

CONCLUSIONS

This study showed that social anxiety affects social exploration behavior not in a way of general avoidance, but rather in nuanced adaptations depending on the concrete situation, likelihood of interaction and associated socio-evaluative threat.

Heart Rate Variability Applications in Medical Specialties: A Narrative Review

HRV is clinically considered to be a surrogate measure of the asymmetrical interplay of the sympathetic and parasympathetic nervous system. While HRV has become an increasingly measured variable through commercially-available wearable devices, HRV is not routinely monitored or utilized in healthcare settings at this time. The purpose of this narrative review is to discuss and evaluate the current research and potential future applications of HRV in several medical specialties, including critical care, cardiology, pulmonology, nephrology, gastroenterology, endocrinology, infectious disease, hematology and oncology, neurology and rehabilitation, sports medicine, surgery and anesthesiology, rheumatology and chronic pain, obstetrics and gynecology, pediatrics, and psychiatry/psychology. A narrative literature review was conducted with search terms including HRV and relevant terminology to the medical specialty in question. While HRV has demonstrated promise for some diagnoses as a non-invasive, easy to use, and cost-effective metric for early disease detection, prognosis and mortality prediction, disease monitoring, and biofeedback therapy, several issues plague the current literature. Substantial heterogeneity exists in the current HRV literature which limits its applicability in clinical practice. However, applications of HRV in psychiatry, critical care, and in specific chronic diseases demonstrate sufficient evidence to warrant clinical application regardless of the surmountable research issues. More data is needed to understand the exact impact of standardizing HRV monitoring and treatment protocols on patient outcomes in each of the clinical contexts discussed in this paper.

Combined Proxies for Heart Rate Variability as a Global Tool to Assess and Monitor Autonomic Dysregulation in Fibromyalgia and Disease-Related Impairments

BACKGROUND

Heart rate variability (HRV) provides both linear and nonlinear autonomic proxies that can be informative of health status in fibromyalgia (FM), where sympatho-vagal abnormalities are common. This retrospective observational study aims to: 1. detect differences in correlation dimension (D2) between FM patients and healthy controls (HCs); 2. correlate D2 with standard HRV parameters; 3. correlate the degree of HRV changes using a global composite parameter called HRV grade, derived from three linear indices (SDNN = intervals between normal sinus beats; RMSSD = mean square of successive differences; total power), with FM clinical outcomes; 4. correlate all linear and nonlinear HRV parameters with clinical variables in patients.

METHODS

N = 85 patients were considered for the analysis and compared to 35 healthy subjects. According to standard diagnostic protocol, they underwent a systematic HRV protocol with a 5-min paced breathing task. Disease duration, pain intensity, mood, sleep, fatigue, and quality of life were assessed. Non-parametric tests for independent samples and pairwise correlations were performed using JMP (all p < 0.001).

RESULTS

Mann-Whitney U found a significant difference in D2 values between FM patients and HCs (p < 0.001). In patients, D2 was associated with all HRV standard indices (all p < 0.001) and FM impairment (FIQ = -0.4567; p < 0.001). HRV grade was also associated with FM impairment (FIQ = 0.5058; p < 0.001).

CONCLUSION

Combining different HRV measurements may help understand the correlates of autonomic dysregulation in FM. Specifically, clinical protocols could benefit from the inclusion and validation of D2 and HRV parameters to target FM severity and related dysautonomia.

Psychophysiological stress response, emotion dysregulation and sleep parameters as predictors of psychopathology in adolescents and young adults

BACKGROUND

Increased emotional reactivity to stress, emotional dysregulation and sleep disturbances are interdependent trans-diagnostic processes that are present in internalising disorders such as depression and anxiety disorders. This study investigated which objective and subjective parameters of stress reactivity, sleep and emotional processing would predict symptoms of anxiety and depression in adolescents and young adults.

METHODS

Participants were adolescents and young adults between the ages of 14 to 21 (N = 106, 25[24 %] male, M age = 17.93). Heart rate, heart rate variability, and subjective stress levels were measured before, during and after a stress induction using the Trier Social Stress Test (TSST). Questionnaires on internalising symptoms, emotion dysregulation, and sleep quality were used. For seven consecutive nights, objective sleep parameters were measured with a wearable device.

RESULTS

Heart rate and heart rate variability after (but not during) the stress induction and emotion dysregulation predicted depressive and anxiety symptoms. Lower subjective sleep quality (but not the objective sleep parameters) was associated with depressive and anxiety symptoms. Emotion dysregulation mediated the relationship between sleep quality and depressive symptoms.

LIMITATIONS

A cross-sectional design, no measurement of daily activity or naps, and only self-report measures of depressive and anxiety symptoms as well as emotion dysregulation.

CONCLUSION

The findings of elevated cardiovascular activation after - but not during - the stress induction and emotion dysregulation underlines problems in regulating and recovering from stress as predictors of youth internalising psychopathology. Differences between subjective and objective measures of sleep and stress reactivity suggests a role of cognitive biases in these domains.

Heart Rate Variability and Cytokines are Involved in Anxiety in Breast Cancer Patients: A Cross-Sectional Study

OBJECTIVE

To explore the correlation between heart rate variability (HRV), peripheral cytokines, anxiety and pain scores in patients with breast cancer (BC).

METHODS

We collected blood samples from 100 BC patients and measured the concentrations of Interleukin 6 (IL-6), Interleukin 4 (IL-4) and Interferon gamma (IFN-γ). We collected the patients' 5-minute dynamic electrocardiograms and evaluated their anxiety and pain levels through the Anxiety Self-Rating Scale and the Short-Form McGill Pain Questionnaire (SF-MPQ) Scale.

RESULTS

Compared with patients in the high HRV group, the low HRV group had lower IL-4 levels and higher IFN-γ/IL-4 concentrations. At the same time, the level of anxiety was also higher, but there was no significant difference in pain. Spearman correlation analysis showed that the normal-to-normal cardiac intervals (SDNN), the square root of the mean of the sum of the squares of differences between adjacent normal-to-normal cardiac intervals (RMSSD), high frequency -HRV (HF-HRV) and IL-4 were positively correlated, SDNN and RMSSD were negatively correlated with IFN-γ/IL-4. HRV is negatively correlated with anxiety. Higher SDNN predicts higher IL-4 levels.

CONCLUSION

Our results indicate that BC patients with low HRV are associated with higher levels of inflammation and anxiety. Therefore, the measurement of HRV may serve as an objective and non-invasive measurement method for monitoring the immune system and anxiety problems of BC patients.

Heart rate variability in mental disorders: an umbrella review of meta-analyses

Heart rate variability (HRV) monitoring is increasingly applied in the realm of mental disorders; however, it remains a subject of controversy. This umbrella review summarizes HRV differences between individuals with mental disorders and healthy controls (HCs), as well as changes in HRV before and after treatment in patients with mental disorders. A literature search was conducted using Medline, PubMed, Embase, and the Cochrane Database. Meta-analyses on HRV changes in patients with mental disorders, as well as meta-analyses comparing HCs and patients with mental disorders were included. We computed the summary effect size using random effects models, along with 95% confidence and prediction intervals. We assessed heterogeneity, p value of the largest study, excess significance bias, and small-study effects. Evidence levels were classified as convincing, highly suggestive, suggestive, weak, or not significant. Twenty-one systematic reviews on HRV, covering 19 mental disorders (53 meta-analyses) and 8 treatment modalities (18 meta-analyses), included 442 primary studies and 34,625. For differences between mental disorders and HCs, evidence was suggestive for 7 (13.2%) pooled analyses, indicating decreased HRV in dementia, PTSD, somatic symptom disorders, functional somatic syndromes, and schizophrenia. For other disorders, including autism spectrum disorder, alcohol use disorder, bipolar disorder, generalized anxiety disorder, insomnia, and major depressive disorder, the evidence was weaker and below the suggestive level. For treatment effects, 5 pooled analyses (27.8%) had weak evidence, indicating altered HRV before and after antipsychotic treatment, repetitive transcranial magnetic stimulation treatment, physiotherapy, and psychotherapy. The credibility of HRV evidence in mental disorders varied across HRV variables and diseases. No two diseases exhibited identical altered HRV patterns, highlighting the potential significance of overall HRV profiles in delineating distinct disorders.

Alterations in cerebral resting state functional connectivity associated with social anxiety disorder and early life adversities

Social Anxiety Disorder (SAD) involves fear of negative evaluation and social avoidance, impacting quality of life. Early life adversities (ELA) are recognized as risk factors for SAD. Previous research indicated inconsistent alterations in resting state functional connectivity (RSFC) in SAD, particularly in the prefrontal cortex and precuneus. This study investigated the interaction between SAD and ELA at the RSFC level. Functional magnetic resonance imaging (fMRI) was conducted on 120 participants (aged 19-48). Four groups were formed: low/ high ELA controls (n = 49, n = 22) and low/ high ELA SAD participants (n = 30, n = 19). Seed-based correlation analyses (SCA) and multi-voxel pattern analysis (MVPA) were applied. A network in which ELA moderates the neural correlates of SAD during the resting state was identified, involving key nodes like the subgenual anterior cingulate cortex, left middle frontal gyrus, and an area in the calcarine fissure/precuneus. Five distinct interaction patterns of SAD and ELA were observed, showcasing opposite RSFC patterns in individuals with SAD based on ELA experience. Results remained significant when controlled for general anxiety and depression measures. Emotional aspects of ELA played a significant role in these interactions. These findings stress the necessity of considering primarily emotional ELA as covariate in neuroimaging studies investigating SAD and potentially also other psychiatric disorders, addressing inconsistencies in prior research. The left middle frontal gyrus emerges as a link in the SAD-ELA interaction during resting state and anxiety-relevant stimulation. Longitudinal studies, starting from childhood, are needed to understand ELA's impact on brain function and to identify potential neuromarkers for SAD predisposition post-ELA exposure.

Efficacy of a 4-week yoga module on the sympatho-vagal balance among healthcare workers in a tertiary care hospital: a randomised controlled trial

Healthcare workers (HCWs) actively involved in patient care at tertiary care hospitals face significant stress and workload, which may adversely impact their sympatho-vagal balance (SVB). Research has extensively investigated SVB using various techniques, such as heart rate variability (HRV). With its multifaceted approach, yoga has been suggested to influence autonomic nervous system function and, consequently, SVB. Thus, this study aims to investigate the efficacy of a 4-week yoga module on SVB among HCWs. This randomised controlled trial will involve 108 HCWs aged 19-60 years. Participants will be randomised to either (1) a yoga intervention group or (2) a medium-paced walking control group. The primary outcome is a change in HRV after 4 weeks of intervention. Secondary outcomes comprise immediate change in state anxiety, selective attention and HRV compared pre- and post-intervention on days 1, 14 and 28. Intention-to-treat and per-protocol analysis will be performed to gain a comprehensive understanding of the effects of intervention. Multivariate linear model will adjust covariates in baseline HRV data in both groups. Independent t-test will compare pre- and postdata on all outcomes between groups. Paired t-test will be used to compare pre- and postdata on all outcomes within the group. The study protocol is registered on the Clinical Trials Registry - India (CTRI) (CTRI/2024/09/074132).

A propensity score-adjusted HRV analysis of social avoidance and distress in patients with panic disorders

Panic disorder (PD) may accompany elevated social avoidance and distress (SAD). Higher SAD in patients with PD predicts a poorer prognosis and response to treatment. As heart rate variability (HRV) reflects the self-regulatory capacity underlying SAD, applying HRV to distinguish PD heterogeneity would be clinically beneficial in formulating personalized treatment strategies. We hypothesized that HRV would be lower in patients with PD and severe SAD (PD-SAD group) than in those without SAD (PD group). A total of 288 patients met the eligibility criteria, with complete collection of variables of interest and HRV. The inverse probability of treatment weighting (IPTW) method was used to balance the groups for the baseline characteristics of patients. Following IPTW adjustment, the average treatment effects were computed using inverse propensity weighting with regression adjustment (IPW-RA). All characteristics were similar in both groups after IPTW adjustment. The PD-SAD group showed a decreased tendency in time domain parameters, including mean heart rate, SDNN, RMSSD, and pNN50 with a nonlinear domain of SD1. However, no significant intergroup differences were observed in the frequency domain. Higher SAD in PD was associated with reduced HRV, mainly in the time domain, which may be attributed to the shared neural networks between dysfunctional self-regulation statuses, as indexed by reduced HRV. As respiratory sinus arrhythmia is mainly reflected in the frequency domain, the time domain may be more reliable for identifying heterogeneity within patients with PD, who are frequently associated with respiratory pattern abnormalities.

Heart rate variability, a potential assessment tool for identifying anxiety, depression, and sleep disorders in elderly individuals

Introduction

This study investigates how anxiety, depression, and sleep disorders impact heart rate variability (HRV) in the elderly, exploring the clinical implications of HRV changes.

Methods

We examined 355 patients (163 men, 192 women) at Xijing Hospital from July 2021 to December 2022 during health check-ups. Demographics were recorded, and emotional status was assessed using the Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD). The Pittsburgh Sleep Quality Scale (PSQI) evaluated sleep quality. Patients were categorized into groups A-G based on the presence of emotional states and sleep disorders. HRV indices-SDNN, SDANN, RMSSD, PNN50, LF/HF, LF, and HF-were analyzed using ANOVA and multivariate logistic regression.

Results

No statistically significant differences were observed in demographic, clinical, and lifestyle factors across the eight groups. Variables assessed included age, sex, body mass index (BMI), fasting blood glucose, glycated hemoglobin (HbA1c), blood lipids, blood pressure, heart rate, and histories of smoking and alcohol consumption. Additionally, the presence of hypertension, diabetes, coronary heart disease, marital status, income, and education level were evaluated, with all showing equivalence (P > 0.05). Significant differences in HRV indices were observed across groups, particularly in group G (patients with anxiety, depression and sleep disorders), which showed decreased HRV parameters except LF/HF, and group H (control group), which showed increased parameters, also except LF/HF (P < 0.01). Anxiety was an independent risk factor for reduced SDNN, SDANN, and LF (P ≤ 0.01), and increased LF/HF ratio (P < 0.01). Depression was linked to decreased SDNN, RMSSD, PNN50, and HF (P < 0.05). Sleep disorders independently predicted reduced PNN50 and SDANN (P < 0.01).

Conclusion

HRV indices of individuals with varying emotional states and sleep disorders exhibited varying degrees of decrease. Anxiety, depression, and sleep disorders presented a superimposed effect on HRV. SDNN, SDANN, RMSSD, PNN50, HF and LF of HRV are of great reference value in the diagnosis of emotional and sleep disorders. For elderly patients experiencing cognitive impairment, HRV is anticipated to serve as a convenient and effective tool for assessing mood and sleep disorders.

Sniffing out a solution: How emotional body odors can improve mindfulness therapy for social anxiety

BACKGROUND

Human body odors (BOs) serve as an effective means of social communication, with individuals exposed to emotional BOs experiencing a partial replication of the sender's affective state. This phenomenon may be particularly relevant in conditions where social interactions are impaired, such as social anxiety. Our study aimed to investigate if emotional human BOs could augment the benefits of mindfulness-based interventions.

METHODS

We enrolled 48 women with social anxiety symptoms and assigned them to groups exposed to happiness BO, fear BO, or clean air. Participants engaged in mindfulness practice over two consecutive days, which included breathing, meditation, and relaxation exercises. During these interventions, the odor specific to each group was presented. Affective symptoms were assessed at the beginning and end of each day, with heart rate variability (HRV) and skin conductance level (SCL) recorded during the intervention.

RESULTS

Self-reported anxiety level revealed a significant reduction in anxiety on the second day for both happiness and fear conditions, but not for the clean air group. However, on a physiological level, fear BO exposure compared to clean air led to decreased HRV, indicating that fear BO may induce a less physiological relaxed state. No significant differences were observed in SCL between odor conditions.

CONCLUSIONS

These findings suggest that exposure to BOs triggers the perception of a "social presence", improving the ecological validity of a psychological treatment. If replicated and expanded, these findings could pave the way for using BOs as catalysts in existing therapies.

Depressive symptoms and heart rate variability in perinatal women: A narrative review

AIM

This study aims to review research on heart rate variability and psychiatric symptoms in perinatal women and explains how heart rate variability can be useful in preventing depressive symptoms in perinatal women.

METHODS

Data were collected from PubMed, CINAHL, PsycINFO, and Google Scholar. The literature search encompassed articles published until July 2024, with the inclusion criteria targeting studies on women within 1 year postpartum, starting from the gestation period. Further, articles exploring this population that discussed the relationship between anxiety, depression, stress, and heart rate variability were selected. The exclusion criterion was studies that confirmed a correlation between stressors and heart rate variability.

RESULTS

We identified 36 relevant articles. The results demonstrated that, since 2022, research has been conducted using smartwatches, smartphones, and so on. The effectiveness of using heart rate variability has been confirmed, particularly in studies linking it to depression. However, some studies lacked controls during measurements. Intervention studies demonstrated the effectiveness of heart rate variability biofeedback.

CONCLUSIONS

This is the first review to investigate the relationship between psychiatric symptoms and heart rate variability in perinatal women. Understanding and using the characteristics of heart rate variability may lead to the detection of psychiatric symptoms in perinatal women and to self-care among women.

Heart rate variability is not associated with multiple chemical sensitivity in a cross-sectional population-based study - The Danish study of functional disorders

OBJECTIVE

Multiple chemical sensitivity (MCS), a functional somatic disorder (FSD), is a multisystem, polysymptomatic disease, characterized by various individual symptoms attributed to low level of volatile chemical exposures. Symptoms relate to the autonomic nerve system (ANS) among others which is mandatory in the MCS delimitations. An accepted measure of ANS is heart rate variability (HRV). The aim was to explore associations between HRV and MCS in the general Danish population.

METHODS

In the Danish Study of Functional Disorders, 7493 adults filled in questionnaires and participated in a physical health examination (2012-2015). The "E motion" heart rate monitor device assessed time and frequency measures of HRV. For this study, 143 were categorized with MCS of which, 84 were subcategorized as MCS without comorbid FSD. The remaining population (n = 5525) was used as comparison group. Logistic regression models to assess odds ratio (OR) with 95 % confidence intervals (95 % CI) of MCS, and MCS without comorbid FSD for each HRV exposure adjusted for age, sex, and chronic stress.

RESULTS

Compared to the general population, median resting heart rate was higher (64.7 vs 63.1 bpm, p = 0.007) and median normal-to-normal intervals was lower (930 vs 952 ms, p = 0.007) in MCS individuals. Resting heart rate was associated with MCS (OR: 1.019, 95 %CI: 1.003; 1.037); but not after adjustment for chronic stress. No other associations with other HRV measures nor in MCS without comorbid FSD were found.

CONCLUSION

HRV was not associated with MCS. The magnitude of the differences between groups was small and of uncertain clinical significance.

Interoceptive Mechanisms and Emotional Processing

Interoception, the sensing of internal bodily signals, is intricately linked with the experience of emotions. Various theoretical models of emotion incorporate aspects of interoception as a fundamental component alongside higher-order processes such as the appraisal of internal signals guided by external context. Interoception can be delineated into different dimensions, which include the nature of afferent signals, the accuracy with which they can be sensed, their neural processing, and the higher-order interpretation of these signals. This review methodically evaluates these interoceptive dimensions through empirical research to illustrate their role in shaping emotions. Clinical and neurodevelopmental conditions characterized by altered emotional profiles, such as anxiety, depression, schizophrenia, posttraumatic stress disorder, emotionally unstable personality disorder, and autism, exhibit distinct changes in interoception. Various therapeutic approaches, including behavioral, pharmacological, and psychological strategies, may be efficacious for treating conditions associated with emotional alterations by targeting interoceptive mechanisms.

Seasonal variations in the mental state and heart rate variability in adolescents residing beyond the Arctic Circle

Background — Residence beyond the Arctic Circle is associated with a distinct condition, Polar Tension Syndrome (PTS), which shares similarities with Seasonal Affective Disorder (SAD). However, the interplay of mental state and heart rate variability within the context of seasonal photoperiodicity in both PTS and SAD remains poorly understood. Objectives — This study investigated the effects of polar photoperiodicity on the mental and physiological states of male adolescents living in the Kola Peninsula, Russia (67°34′ N, 33°23′ E), a region beyond the Arctic Circle. Methods — Mental state was assessed using the State-Trait Anxiety Inventory (STAI) and the Self-Esteem of health, Activity, and Mood (SAM) scales. Heart rate variability (HRV) indices provided objective measures of the psychophysiological state. Results — Significant associations were found between state and trait anxiety (StA and TrA) and seasonal photoperiodicity in adolescents residing beyond the Arctic Circle. Reduced parasympathetic (HF) and increased sympathetic (LF) Autonomic Nervous System (ANS) contributions to heart rate (HR) regulation during the polar night may underlie the physiological manifestations of polar tension syndrome (PTS) and seasonal sffective disorder (SAD), both characterized by elevated anxiety. Analysis revealed monthly fluctuations in the dominance of HF and LF contributions to HR regulation, with LF predominating during the polar night and in March. Conclusion — This study demonstrates an association between state and trait anxiety (StA and TrA), heart rate regulation, and seasonal photoperiodicity in adolescents residing beyond the Arctic Circle. Adolescents with anxiety and low parasympathetic (HF) HRV activity show an increased risk of developing PTS and SAD symptoms.

Auxiliary identification of depression patients using interpretable machine learning models based on heart rate variability: a retrospective study

OBJECTIVE

Depression has emerged as a global public health concern with high incidence and disability rates, which are timely imperative to identify and intervene in clinical practice. The objective of this study was to explore the association between heart rate variability (HRV) and depression, with the aim of establishing and validating machine learning models for the auxiliary diagnosis of depression.

METHODS

The data of 465 outpatients from the Affiliated Hospital of Southwest Medical University were selected for the study. The study population was then randomly divided into training and test sets in a 7:3 ratio. Logistic regression (LR), support vector machine (SVM), random forest (RF) and eXtreme gradient boosting (XGBoost) algorithm models were used to construct risk prediction models in the training set, and the model performance was verified in the test set. The four models were evaluated by the area under the receiver operating characteristic curve (ROC), calibration curve and the decision curve analysis (DCA). Furthermore, we employed the SHapley Additive exPlanations (SHAP) method to illustrate the effects of the features attributed to the model.

RESULTS

There were 237 people in the depressed group and 228 in the non-depressed group. In the training set (n = 325) and test set (n = 140), the area under of the curve(AUC) values of the XGBoost model are 0.92 [95% confidence interval (CI) 0.888,0.95] and 0.82 (95% CI 0.754,0.892)] respectively, which are higher than the other three models. The XGBoost model has excellent predictive efficacy and clinical utility. The SHAP method was ranked according to the importance of the degree of influence on the model, with age, heart rate, Standard deviation of the NN intervals (SDNN), two nonlinear parameters of HRV and sex considered to be the top 6 predictors.

CONCLUSION

We provided a feasibility study of HRV as a potential biomarker for depression. The proposed model based on HRV provides clinicians with a quantitative auxiliary diagnostic tool, which is assist to improving the accuracy and efficiency of depression diagnosis, and can also be utilized for the monitoring and prevention of depression.

Heart rate variability wrist-wearable biomarkers identify adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure

Adverse posttraumatic neuropsychiatric sequelae (APNS) are common after traumatic events. We examined whether wrist-wearable devices could provide heart rate variability (HRV) biomarkers for recovery after traumatic stress exposure in a large socioeconomically disadvantaged cohort. Participants were enrolled in the emergency department within 72 hours after a traumatic event as part of the AURORA (Advancing Understanding of RecOvery afteR traumA) multicenter prospective observational cohort study and followed over 6 months. HRV biomarkers were derived and validated for associations with specific APNS symptoms at a point in time and changes in symptom severity over time. Sixty-four HRV characteristics were derived and validated as cross-sectional biomarkers of APNS symptoms, including pain (26), re-experiencing (8), somatic (7), avoidance (7), concentration difficulty (6), hyperarousal (5), nightmares (1), anxiety (1), and sleep disturbance (3). Changes in 22 HRV characteristics were derived and validated as biomarkers identifying changes in APNS symptoms, including reexperiencing (11), somatic (3), avoidance (2), concentration difficulty (1), hyperarousal (1), and sleep disturbance (4). Changes in HRV variables over time predicted symptom improvement (PPV 0.68-0.87) and symptom worsening (NPV 0.71-0.90). HRV biomarkers collected from wrist-wearable devices may have utility as screening tools for APNS symptoms that occur after traumatic stress exposure in high-risk populations.

Effects of Heart Rate Variability Biofeedback Training on Anxiety Reduction and Brain Activity: a Randomized Active-Controlled Study Using EEG

Heart rate variability biofeedback (HRVBF) is a promising anxiety-reducing intervention that increases vagally-mediated heart rate variability (vmHRV) through slow-paced breathing and feedback of heart rhythm. Several studies have reported the anxiety-reducing effects of HRVBF; however, some studies have reported such training as ineffective. Furthermore, the effects of training and underlying brain activity changes remain unclear. This study examined the anxiety-reducing effects of HRVBF training and related brain activity changes by randomly assigning participants, employing an active control group, and measuring anxiety-related attentional bias using the emotional Stroop task and electroencephalography (EEG). Fifty-five healthy students with anxiety were randomly assigned to the HRVBF or control groups, and 21 in the HRVBF group and 19 in the control group were included in the analysis. Both groups performed 10 training sessions of 20 min each within 3 weeks. They were assessed using resting vmHRV, event-related potential (ERP), time-frequency EEG, attentional bias, and the State-Trait Anxiety Inventory-JYZ (STAI-JYZ) before and after training. The results demonstrated increased resting vmHRV in the HRVBF group compared to the control group after training. However, no differences were observed in ERP, time-frequency EEG, attentional bias, and STAI-JYZ. Participants with higher pre-training resting vmHRV achieved higher heart rhythm coherence in HRVBF training and had reduced attentional bias. This study suggests that individuals with higher resting vmHRV are more likely to be proficient in HRVBF training and benefit from its anxiety-reducing effects. The findings contribute to participant selection to benefit from HRVBF training and modification of the training protocols for non-responders.Clinical trial registrationOrganization: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), JapanRegistration number: UMIN000047096Registration date: March 6, 2022.

Insomnia symptoms as long-term predictors of anxiety symptoms in middle-aged and older adults from the English Longitudinal Study of Ageing (ELSA), and the role of systemic inflammation

Insomnia, i.e., difficulties in sleep onset and sleep maintenance, may increase the risk of anxiety symptoms, although long-term follow-up studies are rarely reported. Here, we examined whether insomnia symptoms may predict anxiety symptoms in a 9-year follow-up, and whether inflammation may play a mediating role. Data from 1355 participants (63.44 ± 7.47 years, 55.1 % females) from the English Longitudinal Study of Ageing (ELSA) were analysed. Insomnia symptoms were assessed in 2012/13. High-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, was measured in 2016/17. Anxiety symptoms were assessed in 2020/21. After adjusting for confounders and baseline levels, structural equation modelling (SEM) revealed that insomnia symptoms significantly predicted anxiety symptoms (β = 0.357, p < .001) but not hs-CRP (β = -0.016, p = .634). Similarly, hs-CRP was not related to anxiety symptoms (β = -0.024, p = .453). The hs-CRP mediation hypothesis was therefore rejected (β = 0.0004; 95 % BCI -0.001 to 0.005), and multi-group SEM showed that sex did not moderate these paths. However, baseline diagnoses of anxiety disorders prospectively predicted higher hs-CRP (B = 0.083, p = .030). Results of the current study suggest that individuals with baseline anxiety disorders may be at higher risk of developing low-grade chronic inflammation. Several alternative psychophysiological mechanisms linking insomnia and anxiety symptoms should be explored, including autonomic and cortical pre-sleep arousal, cortisol reactivity, and pro-inflammatory cytokines. Finally, insomnia symptoms may be a treatment target to lower the risk of anxiety symptoms in elderly.

Neuropsychobiology of fear-induced bradycardia in humans: progress and pitfalls

In the last century, the paradigm of fear conditioning has greatly evolved in a variety of scientific fields. The techniques, protocols, and analysis methods now most used have undergone a progressive development, theoretical and technological, improving the quality of scientific productions. Fear-induced bradycardia is among these techniques and represents the temporary deceleration of heart beats in response to negative outcomes. However, it has often been used as a secondary measure to assess defensive responding to threat, along other more popular techniques. In this review, we aim at paving the road for its employment as an additional tool in fear conditioning experiments in humans. After an overview of the studies carried out throughout the last century, we describe more recent evidence up to the most contemporary research insights. Lastly, we provide some guidelines concerning the best practices to adopt in human fear conditioning studies which aim to investigate fear-induced bradycardia.

Beyond HIV Shame: Effects of Self-Forgiveness in Improving Mental Health in HIV-Positive Individuals in Poland

Guided by the bio-psycho-socio-spiritual approach, this randomized controlled trial assessed the efficacy of a self-forgiveness intervention among 60 HIV-positive individuals in Poland. Participants underwent a 90-min "Restore: The Journey Toward Self-Forgiveness" session, in contrast to a wait-list control group. The intervention significantly enhanced self-forgiveness, spirituality, mental well-being, and heart rate variability in response to a cognitive stressor (i.e., a mental arithmetic challenge). Significant effects were observed in both between-group and within-subject comparisons. These results support the incorporation of self-forgiveness into psychological rehabilitation programs for HIV to improve quality of life and health outcomes.

The relationship between cardiac activity, behaviour and endogenous oxytocin and vasopressin in Prader-Willi Syndrome: An exploratory study

This study aimed to increase our understanding of cardiac activity abnormalities in Prader-Willi Syndrome (PWS) and the relationship between cardiac activity, PWS behaviours thought to be associated with cardiac vagal tone and endogenous oxytocin and vasopressin levels. We compared cardiac activity (respiratory sinus arrhythmia (RSA), low-frequency heart rate variability (LF-HRV), heart period) in 30 adolescents and adults with PWS to 30 typically developing age-matched controls. RSA, LF-HRV, and heart period were lower in individuals with PWS than in the control group. In the control group, RSA was higher for females than males. However, for those with PWS, there was no difference between the sexes. Individuals with the mUPD genetic subtype had lower RSA and LF-HRV than participants with the PWS deletion subtype and compared to typically developing controls, no difference was found between the latter two groups. Heart period was also lower for those with mUPD compared to controls. Higher RSA reduced the odds of having temper outbursts and skin-picking. RSA was lower in those with PWS and psychosis compared to those with PWS without psychosis. Finally, we found RSA correlated with vasopressin for those with mUPD but not deletion. There was no relationship between RSA and oxytocin plasma or saliva levels. Our findings suggest autonomic dysfunction in PWS that is more marked in mUPD than deletion and potentially due to greater loss of parasympathetic activity in mUPD.

Anxiety is related to slower RSA oscillation during stress response and regulation

Respiratory sinus arrhythmia (RSA), an index of the parasympathetic nervous system activity, has been considered indicative of stress response and emotion regulation. However, the relationship between RSA and anxiety remains inconclusive, partly because previous research has primarily focused on static RSA levels. In this nonclinical sample (N = 75, Mage = 20.89 ± 1.72 SD, 48 males), we used a damped oscillator model to characterize RSA dynamics across 30-s epochs while participants completed the Trier social stress test. Results showed that RSA constantly oscillated during the three periods of TSST (namely Rest, Stress, and Recovery). Importantly, slower RSA oscillation in the Stress period was related to elevated state anxiety, whereas in the Recovery period, it was related to higher trait anxiety. These findings demonstrated the dynamic nature of RSA during the whole course of stress response. Slower RSA oscillation may indicate inflexible and tardy physiological regulation which may give rise to anxiety issues.

Evaluating the Effects of Different Cognitive Tasks on Autonomic Nervous System Responses: Implementation of a High-Precision, Low-Cost Complementary Method

INTRODUCTION

We developed a low-cost, user-friendly complementary research tool to evaluate autonomic nervous system (ANS) activity at varying levels of cognitive workload. This was achieved using visual stimuli as cognitive tasks, administered through a specially designed computer-based test battery.

METHODS

To assess sympathetic stress responses, skin conductance response (SCR) was measured, and electrocardiograms (ECG) were recorded to evaluate heart rate variability (HRV), an indicator of cardiac vagal tone. Twenty-five healthy adults participated in the study. SCR and ECG recordings were made during both tonic and phasic phases using a computer-based system designed for visual stimuli. Participants performed a button-pressing task upon seeing the target stimulus, and the relationship between reaction time (RT) and cognitive load was evaluated.

RESULTS

Analysis of the data showed higher skin conductance levels (SCLs) during tasks compared to baseline, indicating successful elicitation of sympathetic responses. RTs differed significantly between simple and cognitive tasks, increasing with mental load. Additionally, significant changes in vagally mediated HRV parameters during tasks compared to baseline highlighted the impact of cognitive load on the parasympathetic branch of the ANS, thereby influencing the brain-heart connection.

CONCLUSION

Our findings indicate that the developed research tool can successfully induce cognitive load, significantly affecting SCL, RTs, and HRV. This validates the tool's effectiveness in evaluating ANS responses to cognitive tasks.

Neuropsychological features of somatic symptom disorder and depression/anxiety in Taiwan: An analysis based on the comorbidity status

Individuals with somatic symptom disorder (SSD) often have comorbid depression or anxiety, but whether SSD is associated with specific neuropsychological functions has yet to be fully examined. We analyzed which neuropsychological features are more closely associated with SSD, anxiety, and depression. In this case-control study, we recruited 140 individuals with SSD, 104 individuals with affective disorders without SSD, and 159 healthy controls in Taiwan. We collected DSM-5 diagnoses, questionnaire scores, and performance on eight tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) for each participant. Several CANTAB tasks involving attention, executive function, and social cognition showed significant group differences. In the adjusted analysis, the tasks significantly associated with SSD were the Match to Sample Visual Search (MTS) and the Emotion Recognition Task (ERT). Among the questionnaires, the Cognitions about Body and Health Questionnaire showed the most significant associations with the tasks, specifically with Rapid Visual Information Processing, MTS, Paired Associates Learning, Spatial Working Memory, Intra-Extra Dimensional Set Shift, and ERT. We conclude that the MTS and ERT tasks show significant relationships with both SSD diagnosis and related questionnaires. These tasks primarily involve selective attention and negative emotion regulation.

Associations between physical fitness, body composition, and heart rate variability during exercise in older people: exploring mediating factors

Background

Age-related changes in body composition affect physical fitness in older adults. However, whether the autonomic response is associated with body fat percentage and its implication for physical fitness is not fully understood.

Aim

To understand the association between physical fitness, body composition, and heart rate variability in older people and its mediating factors.

Methods

A cross-sectional study with 81 older adults was conducted, assessing Short Physical Performance Battery (SPPB), Two-minute Step Test (TMST), body composition, and cardiac autonomic response. Correlation and mediation analyses were performed.

Results

Body fat percentage negatively correlated with physical fitness (SPPB: r =  - 0.273, p = 0.015; TMST: r =  - 0.279, p = 0.013) and sympathetic activity (sympathetic nervous system (SNS) index: r =  - 0.252, p = 0.030), yet positively correlated with parasympathetic tone (root mean square of successive differences (RMSSD): r = 0.253, p = 0.029; standard deviation of NN intervals (SDNN): r = 0.269, p = 0.020). Physical fitness associated with sympathetic nervous system index (SPPB: r = 0.313, p = 0.006; TMST: r = 0.265, p = 0.022) and parasympathetic nervous system index (TMST: r =  - 0.344, p = 0.003). Muscle mass mediated body fat's impact on physical fitness, while physical fitness mediated body fat's impact on autonomic response.

Conclusion

Body composition and cardiac autonomic response to exercise are associated with physical fitness in older people, highlighting a possible protective effect of muscle mass against the decline in physical fitness associated with increased body fat.

Physiological correlates of anxiety in childhood and adolescence: A systematic review and meta-analysis

Anxiety is one of the most prevalent problems that affects children and adolescents. The vast majority of diagnostic tools for anxiety depend on written or verbal reports from children and adolescents or their significant others. The validity and reliability of such reports can be compromised by their subjective nature. Thus, there is growing interest in whether anxiety can be indexed with objective physiological measures. The key aim of this systematic review and meta-analysis was to determine which physiological measures are most reliably associated with elevated levels of anxiety amongst children and adolescents. Online databases (e.g., PsycINFO, Embase, Medline) were searched for relevant studies according to pre-determined criteria. Twenty-five studies comprising 2502 participants (N = 1160 with high anxiety) met inclusion, identifying 11 groups of physiological measures. Our meta-analysis revealed that skin conductance level is the most sensitive measure of anxiety (d = 0.83), followed by electromyography (EMG) measures (d = 0.71) and skin conductance response (d = 0.58). However, the included studies varied in terms of subjective measures, study designs, experimental task measures, and physiological measures. Consideration of these differences in methodology offer potential directions for future research.

Sleep-phasic heart rate variability predicts stress severity: Building a machine learning-based stress prediction model

We propose a novel approach for predicting stress severity by measuring sleep phasic heart rate variability (HRV) using a smart device. This device can potentially be applied for stress self-screening in large populations. Using a Holter electrocardiogram (ECG) and a Huawei smart device, we conducted 24-h dual recordings of 159 medical workers working regular shifts. Based on photoplethysmography (PPG) and accelerometer signals acquired by the Huawei smart device, we sorted episodes of cyclic alternating pattern (CAP; unstable sleep), non-cyclic alternating pattern (NCAP; stable sleep), wakefulness, and rapid eye movement (REM) sleep based on cardiopulmonary coupling (CPC) algorithms. We further calculated the HRV indices during NCAP, CAP and REM sleep episodes using both the Holter ECG and smart-device PPG signals. We later developed a machine learning model to predict stress severity based only on the smart device data obtained from the participants along with a clinical evaluation of emotion and stress conditions. Sleep phasic HRV indices predict individual stress severity with better performance in CAP or REM sleep than in NCAP. Using the smart device data only, the optimal machine learning-based stress prediction model exhibited accuracy of 80.3 %, sensitivity 87.2 %, and 63.9 % for specificity. Sleep phasic heart rate variability can be accurately evaluated using a smart device and subsequently can be used for stress predication.

Genetic and polygenic investigation of heart rate variability to identify biomarkers associated with Anxiety disorders

Given that anxiety disorders (AD) are associated with reduced vagally-mediated heart rate variability (HRV), genetic variants related to HRV may provide insight into anxiety etiology. This study used polygenic risk scores (PRS) to explore the genetic overlap between AD and HRV, and investigated whether HRV-related polymorphisms influence anxiety risk. Resting vagally-mediated HRV was measured using a wearable device in 188 European individuals (AD=101, healthy controls=87). AD PRS was tested for association with resting HRV, and HRV PRS for association with AD. We also investigated 15 significant hits from an HRV genome-wide association study (GWAS) for association with resting HRV and AD and if this association is mediated through resting HRV. The AD PRS and HRV PRS showed nominally significant associations with resting HRV and anxiety disorders, respectively. HRV GWAS variants associated with resting HRV were rs12980262 (NDUFA11), rs2680344 (HCN4), rs4262 and rs180238 (GNG11), and rs10842383 (LINC00477). Mediation analyses revealed that NDUFA11 rs12980262 A-carriers and GNG11 rs180238 and rs4262 C-carriers had higher anxiety risk through lower HRV. This study supports an anxiety-HRV genetic relationship, with HRV-related genetic variants translating to AD. This study encourages exploration of HRV genetics to understand mechanisms and identify novel treatment targets for anxiety.

Heart rate response to cognitive load as a marker of depression and increased anxiety

Introduction

Understanding the interplay between cardiovascular parameters, cognitive stress induced by increasing load, and mental well-being is vital for the development of integrated health strategies today. By monitoring physiological signals like electrocardiogram (ECG) and photoplethysmogram (PPG) in real time, researchers can discover how cognitive tasks influence both cardiovascular and mental health. Cardiac biomarkers resulting from cognitive strain act as indicators of autonomic nervous system function, potentially reflecting conditions related to heart and mental health, including depression and anxiety. The purpose of this study is to investigate how cognitive load affects ECG and PPG measurements and whether these can signal early cardiovascular changes during depression and anxiety disorders.

Methods

Ninety participants aged 18 to 45 years, ranging from symptom-free individuals to those with diverse psychological conditions, were assessed using psychological questionnaires and anamnesis. ECG and PPG monitoring were conducted as volunteers engaged in a cognitive 1-back task consisting of two separate blocks, each with six progressively challenging levels. The participants' responses were analyzed to correlate physiological and psychological data with cognitive stressors and outcomes.

Results

The study confirmed a notable interdependence between anxiety and depression, and cardiovascular responses. Task accuracy decreased with increased task difficulty. A strong relationship between PPG-measured heart rate and markers of depression and trait anxiety was observed. Increasing task difficulty corresponded to an increase in heart rate, linked with elevated levels of depression and trait anxiety. A strong relationship between ECG-measured heart rate and anxiety attacks was observed. Increasing task difficulty corresponded to an increase in heart rate, linked with elevated levels of anxiety attacks, although this association decreased under more challenging conditions.

Discussion

The findings underscore the predictive importance of ECG and PPG heart rate parameters in mental health assessment, particularly depression and anxiety under cognitive stress induced by increasing load. We discuss mechanisms of sympathetic activation explaining these differences. Our research outcomes have implications for clinical assessments and wearable device algorithms for more precise, personalized mental health diagnostics.

Heart rate variability and psychological health: The key role of trait emotional awareness

Studies have shown that Trait Emotional Awareness (TEA) - the ability to recognize one's emotions - and Heart Rate Variability (HRV) are both negatively associated with psychological disorders. Although these studies imply that TEA is related to HRV and may explain the association between HRV and psychological disorders, there is limited research investigating this implication. Such investigation is essential to illuminate the psychophysiological processes linked to psychological disorders. The present study aims to investigate a) the association between TEA and HRV, b) the association between HRV and psychological disorders, and c) whether TEA explains the association between HRV and psychological disorders. A sample of 41 German students completed self-report questionnaires as indicators of psychological disorders, including the Hospital Anxiety and Depression Scale (HADS; Snaith & Zigmond, 1983) for anxiousness and depressiveness, as well as the somatization scale of the Hopkins Symptom Checklist (HSCL; Derogatis et al., 1976) for physical complaints. HRV was measured at baseline (resting HRV) and during exposure to a fear-provoking movie clip (reactive HRV). As hypothesized, a) TEA showed a positive association with reactive HRV, b) HRV showed negative associations with anxiousness and physical complaints, and c) TEA explained the relationships between reactive HRV and anxiousness, as well as physical complaints. Contrary to our hypothesis, we did not find any association between HRV and depressiveness. We discussed the contribution of TEA to psychophysiological health, limited generalizability of the current study, and direct future research to explore the underlying mechanisms linking TEA to health.

Psychophysiological wellbeing in a class of dental students attending dental school: anxiety, burnout, post work executive performance and a 24 hours physiological investigation during a working day

Aim

To the best of our knowledge, dental school students have never been evaluated for stress, anxiety, burnout, physiological indexes during a 24-h working day, and executive function performance post-work and post-work after returning from vacation; therefore, this research has been conducted.

Methods

Data were acquired at the Dental School of the University of Padua on 16 students in their 4th year, far from the exam session. While performing clinical activity on the dental chair and during a working day, electrodermal activity (EDA), heart rate variability (HRV), and heart rate (HR) were recorded. Participants' stress was measured with the Perceived Stress Scale (PSS-10 scale) and anxiety with the General Anxiety Disorder Questionnaire (GAD-7) and State-Trait Anxiety Inventory (STAI-Y-2), while burnout with the Maslach Burnout Inventory (MBI-HSS). Executive functions were evaluated using the Tower of London test (TOL-R).

Results

Three students (2F/1M) had a GAD-7 score ≥ 10. Five students (4F/1M) showed trait anxiety. Moderate levels of perceived stress were reported in 85% of participants. MBI-HSS showed that 7 participants scored high on emotional exhaustion and 7 on depersonalization. TOL-R performance (M = 15.85, SD = 4.01) was below the normative value p < 0.00001. A second test, after the holidays, showed normal values. EDA was higher during children's treatment (p < 0.05), ANOVA showed high HR during working time (p < 0.001), and HRV was higher in males (p < 0.001).

Conclusion

Based on the sample size evaluated, it is reported that being a dental student has a moderate impact on stress, anxiety, and burnout while a strong impact on executive functions buffered by rest.

Need to Take Heart? Talk to Your Psychiatrist for 20 Minutes

ABSTRACT

A powerful correlation exists between the equilibrium of the sympathetic and parasympathetic nervous systems and heart rate variability (HRV). Thus, HRV is useful as a physiological index of both physical and emotional health; autonomic nervous system dysregulation, with a sympathetic predominance and a low HRV, has been associated with a variety of physical (cardiovascular, neurological) and psychiatric disorders. We used a validated algorithm of measuring the HRV (noninvasive, 2-minute approach) in new psychiatric outpatients in first author's private practice. The subjects had an initial measurement, followed by a 20-minute consultation with minimal supportive psychotherapy, followed by an exit measurement. The initial study spanned the "COVID months"; to control for this variable, an identical study was performed in 2023. There was a highly significant decrease in the sympathetic predominance in the test groups; no such trend was found in the control groups. A short psychiatry consultation may be sufficient to decrease patients' sympathetic hyperactivity and improve their well-being.

Investigating the association of anxiety disorders with heart rate variability measured using a wearable device

BACKGROUND

Reduced vagally-mediated heart rate variability (HRV) has been associated with anxiety disorders (AD). The aim of this study was to use a wearable device and remote study design to re-evaluate the association of HRV with ADs, anxiety-related traits, and confounders.

METHODS

240 individuals (AD = 120, healthy controls = 120) completed an at-home assessment of their short-term resting vagally-mediated HRV using a wristband, monitored over videoconference. Following quality control, analyses were performed investigating differences in HRV between individuals with AD (n = 119) and healthy controls (n = 116), associations of HRV with anxiety-related traits and confounders, and antidepressants effects on HRV in patients, including analyses stratified by ancestry (i.e., European, East Asian, African).

RESULTS

Among the confounders investigated, only age had a significant association with HRV. Patients with an AD had significantly lower vagally-mediated HRV than healthy controls in the European subsample, with a trend of significance in the whole sample. HRV was significantly associated with the Hamilton Anxiety Rating Scale (HAM-A) but not with antidepressant use in the European subsample.

LIMITATIONS

The study measures occurred in a non-standardized at-home setting, and the three ancestry group sample sizes were unequal.

CONCLUSIONS

This study demonstrates reduced vagally-mediated HRV among patients with ADs compared to healthy controls. Results also point to low HRV being related to more physical anxiety symptoms (measured via HAM-A), suggesting a possible anxiety subtype. Overall, this study highlights the feasibility of using wearables for patients and encourages exploration of the biological and clinical utility of HRV as a risk factor for ADs.

Music therapy and anxiety: A bibliometric review from 1993 to 2023

BACKGROUND

Music therapy (MT) has received increasing attention from scholars in the efficacy treatment of anxiety symptoms, which is of great significance to human physical and mental health. The visual mapping functionality of CiteSpace and Vosviewer software was applied in this study to assess the status of MT in the treatment of anxiety symptoms.

METHODS

In order to find research on MT and anxiety that were relevant for this research, we searched the Web of Science database. We also utilized CiteSpace and VOSviewer software to examine institutions, journals, authors, publications, and keywords for scientometric and visual analysis.

RESULTS

Our findings show that since 2009, the field has developed rapidly and publications on MT and anxiety have gradually increased. The journal Complement Therapies In Medicine published the most relevant articles, the Cochrane Database Of Systematic Reviews journal had the highest citation frequency, and the United States had the most publications. The majority of the top academic institutions in the region are found in the United States, with the University of London having the most publications. The evolution of this field was significantly influenced by Gold C., the author with the most publications, and Bradt J., the author with the most co-citations. The topics of anxiety, nursing, cancer, and pain management have been the focus of this research.

CONCLUSION

This study has the potential to increase public understanding of MT and anxiety as well as mental health awareness, all of which are crucial for lowering the prevalence of mental diseases.

The gut-brain axis and cognitive control: A role for the vagus nerve

Survival requires the integration of external information and interoceptive cues to effectively guide advantageous behaviors, particularly foraging and other behaviors that promote energy acquisition and consumption. The vagus nerve acts as a critical relay between the abdominal viscera and the brain to convey metabolic signals. This review synthesizes recent findings from rodent models and humans revealing the impact of vagus nerve signaling from the gut on the control of higher-order neurocognitive domains, including anxiety, depression, reward motivation, and learning and memory. We propose a framework where meal consumption engages gastrointestinal tract-originating vagal afferent signaling that functions to alleviate anxiety and depressive-like states, while also promoting motivational and memory functions. These concurrent processes serve to favor the encoding of meal-relevant information into memory storage, thus facilitating future foraging behaviors. Modulation of these neurocognitive domains by vagal tone is also discussed in the context of pathological conditions, including the use of transcutaneous vagus nerve stimulation for the treatment of anxiety disorders, major depressive disorder, and dementia-associated memory impairments. Collectively, these findings highlight the contributions of gastrointestinal vagus nerve signaling to the regulation of neurocognitive processes that shape various adaptive behavioral responses.

The relationship between emotional disorders and heart rate variability: A Mendelian randomization study

OBJECTIVE

Previous studies have shown that emotional disorders are negatively associated with heart rate variability (HRV), but the potential causal relationship between genetic susceptibility to emotional disorders and HRV remains unclear. We aimed to perform a Mendelian randomization (MR) study to investigate the potential association between emotional disorders and HRV.

METHODS

The data used for this study were obtained from publicly available genome-wide association study datasets. Five models, including the inverse variance weighted model (IVW), the weighted median estimation model (WME), the weighted model-based method (WM), the simple model (SM) and the MR-Egger regression model (MER), were utilized for MR. The leave-one-out sensitivity test, MR pleiotropy residual sum and outlier test (MR-PRESSO) and Cochran's Q test were used to confirm heterogeneity and pleiotropy.

RESULTS

MR analysis revealed that genetic susceptibility to broad depression was negatively correlated with HRV (pvRSA/HF) (OR = 0.380, 95% CI 0.146-0.992; p = 0.048). However, genetic susceptibility to irritability was positively correlated with HRV (pvRSA/HF, SDNN) (OR = 2.017, 95% CI 1.152-3.534, p = 0.008) (OR = 1.154, 95% CI 1.000-1.331, p = 0.044). Genetic susceptibility to anxiety was positively correlated with HRV (RMSSD) (OR = 2.106, 95% CI 1.032-4.299; p = 0.041). No significant directional pleiotropy or heterogeneity was detected. The accuracy and robustness of these findings were confirmed through a sensitivity analysis.

CONCLUSIONS

Our MR study provides genetic support for the causal effects of broad depression, irritable mood, and anxiety on HRV.

Sleep, physical activity and panic attacks: A two-year prospective cohort study using smartwatches, deep learning and an explainable artificial intelligence model

BACKGROUND

Sleep and physical activity suggestions for panic disorder (PD) are critical but less surveyed. This two-year prospective cohort study aims to predict panic attacks (PA), state anxiety (SA), trait anxiety (TA) and panic disorder severity (PDS) in the upcoming week.

METHODS

We enrolled 114 PD patients from one general hospital. Data were collected using the DSM-5, the MINI, clinical app questionnaires (BDI, BAI, PDSS-SR, STAI) and wearable devices recording daily sleep, physical activity and heart rate from 16 June 2020 to 10 June 2022. Our teams applied RNN, LSTM, GRU deep learning and SHAP explainable methods to analyse the data.

RESULTS

The 7-day prediction accuracies for PA, SA, TA, and PDS were 92.8 %, 83.6 %, 87.2 %, and 75.6 % from the LSTM model. Using the SHAP explainable model, higher initial BDI or BAI score and comorbidities with depressive disorder, generalized anxiety disorder or agoraphobia predict a higher chance of PA. However, PA decreased under the following conditions: daily average heart rate, 72-87 bpm; maximum heart rate, 100-145 bpm; resting heart rate, 55-60 bpm; daily climbing of more than nine floors; total sleep duration between 6 h 23 min and 10 h 50 min; deep sleep, >50 min; and awake duration, <53 min.

LIMITATIONS

Moderate sample size and self-report questionnaires were the limitations.

CONCLUSIONS

Deep learning predicts recurrent PA and various anxiety domains with 75.6-92.8 % accuracy. Recurrent PA decreases under adequate daily sleep and physical activity.

Heart rate variability: Evaluating a potential biomarker of anxiety disorders

Establishing quantifiable biological markers associated with anxiety will increase the objectivity of phenotyping and enhance genetic research of anxiety disorders. Heart rate variability (HRV) is a physiological measure reflecting the dynamic relationship between the sympathetic and parasympathetic nervous systems, and is a promising target for further investigation. This review summarizes evidence evaluating HRV as a potential physiological biomarker of anxiety disorders by highlighting literature related to anxiety and HRV combined with investigations of endophenotypes, neuroimaging, treatment response, and genetics. Deficient HRV shows promise as an endophenotype of pathological anxiety and may serve as a noninvasive index of prefrontal cortical control over the amygdala, and potentially aid with treatment outcome prediction. We propose that the genetics of HRV can be used to enhance the understanding of the genetics of pathological anxiety for etiological investigations and treatment prediction. Given the anxiety-HRV link, strategies are offered to advance genetic analytical approaches, including the use of polygenic methods, wearable devices, and pharmacogenetic study designs. Overall, HRV shows promising support as a physiological biomarker of pathological anxiety, potentially in a transdiagnostic manner, with the heart-brain entwinement providing a novel approach to advance anxiety treatment development.

Effects of 3-month Qigong exercise on heart rate variability and respiration in anxious college students

OBJECTIVE

This longitudinal study aimed to investigate the effects of Qigong on the anxiety state, heart rate variability (HRV), and breathing of anxious college students.

METHODS

A total of 37 individuals (18-25 years old) were randomly allocated to the control (n = 19) and intervention (n = 18) groups. Qigong interventions were conducted five times weekly for 12 weeks, with each session lasting 60 min. Hamilton Anxiety Scale, Fatigue Scale 14, Pittsburgh Sleep Quality Index, and 36-item Short Form Survey, HRV, and respiration data were collected before and after the 3-month intervention.

RESULTS

Individuals who participated in the three-month Qigong exercise intervention showed a significant reduction in anxiety, particularly mental anxiety (p < 0.05). Subjects in the intervention group presented a decrease in skin temperature (p < 0.05) and an increase in blood volume pulsation (p < 0.05). Meanwhile, HRV exhibited a significant increase in the standard deviation of interbeat interval before and after comparisons (p < 0.05) and between the two groups (p = 0.039) and a reduction in the normalized low-frequency power after the intervention. Moreover, the intervention group experienced increased abdominal breathing depth and abdominal breathing per minute (p < 0.05).

CONCLUSION

These findings indicate that Qigong is an effective mind-body exercise strategy for relieving anxiety. HRV and breathing were improved accordingly among college students after the completion of the 3-month Qigong program.

Putting back respiration into respiratory sinus arrhythmia or high-frequency heart rate variability: Implications for interpretation, respiratory rhythmicity, and health

Research on respiratory sinus arrhythmia, or high-frequency heart rate variability (its frequency-domain equivalent), has been popular in psychology and the behavioral sciences for some time. It is typically interpreted as an indicator of cardiac vagal activity. However, as research has shown for decades, the respiratory pattern can influence the amplitude of these noninvasive measures substantially, without necessarily reflecting changes in tonic cardiac vagal activity. Although changes in respiration are systematically associated with experiential and behavioral states, this potential confound in the interpretation of RSA, or HF-HRV, is rarely considered. Interpretations of within-individual changes in these parameters are therefore only conclusive if undertaken relative to the breathing pattern. The interpretation of absolute levels of these parameters between individuals is additionally burdened with the problem of residual inspiratory cardiac vagal activity in humans. Furthermore, multiple demographic, anthropometric, life-style, health, and medication variables can act as relevant third variables that might explain associations of RSA or HF-HRV with experiential and behavioral variables. Because vagal activity measured by these parameters only represents the portion of cardiac vagal outflow that is modulated by the respiratory rhythm, alternative interpretations beyond cardiac vagal activity should be considered. Accumulating research shows that activity of multiple populations of neurons in the brain and the periphery, and with that organ activity and function, are modulated rhythmically by respiratory activity. Thus, observable health benefits ascribed to the cardiac vagal system through RSA or HF-HRV may actually reflect beneficial effects of respiratory modulation. Respiratory rhythmicity may ultimately provide the mechanism that integrates central, autonomic, and visceral activities.

Visually assessing work performance using a smartwatch via day-to-day fluctuations in heart rate variability

Objective

To optimize workplace health promotion, a simple method for quantifying allostatic load response is needed. This study examines the feasibility of optimizing objective anxiety and presenteeism monitoring using daily smartwatch-measured ultra-short heart rate variability (HRV).

Methods

Office workers without diagnosed disease prospectively performed 30 s HRV self-measurement each morning for two months and responded to the State-Trait Anxiety Inventory (STAI) and Work Limitation Questionnaire (WLQ). Logistic regression analysis examined daily HRV parameters in the high-trait anxiety group (HTA, STAI ≥ 40) using mean and variance HRV, age, self-reported gender, and body mass index (BMI). The ideal cutoff value enabled comparison of WLQ using the Mann-Whitney U test. Heart rate variability data were collected for 279 participants (male ratio, 83.9%; age, 42 ± 10 years) who completed questionnaires and monitored HRV for 30+ days.

Results

Compared to the low-trait anxiety group, HTA exhibited higher variance of the log-transformed coefficient of component variance of high-frequency component (LnccvHF) and low-frequency per HF (Lnccv L/H), in addition to differences in the means of these HRV parameters. In addition to BMI (odds ratio [OR] = 0.92, p = 0.02) and mean LnccvL/H (OR = 10.75, p < 0.01), the variance of Lnccv L/H was an independent predictor of HTA (OR = 2.39E + 8, p = 0.011). The daily Lnccv L/H dispersion group had a lower WLQ productivity loss score (p = 0.02, r = 0.17).

Conclusions

By focusing on HRV dispersion status, this simple and instantly applicable daily HRV monitoring system enables optimized quantitative monitoring of anxiety and productivity.

Heart Rate Variability Measurement through a Smart Wearable Device: Another Breakthrough for Personal Health Monitoring?

Heart rate variability (HRV) is a measurement of the fluctuation of time between each heartbeat and reflects the function of the autonomic nervous system. HRV is an important indicator for both physical and mental status and for broad-scope diseases. In this review, we discuss how wearable devices can be used to monitor HRV, and we compare the HRV monitoring function among different devices. In addition, we have reviewed the recent progress in HRV tracking with wearable devices and its value in health monitoring and disease diagnosis. Although many challenges remain, we believe HRV tracking with wearable devices is a promising tool that can be used to improve personal health.

Heart rate variability and tension-type headache: A population-based cross-sectional study

Background

The relationship between tension-type headache (TTH) and autonomic functions is poorly understood, although TTH is one of the most prevalent disorders in the general population. The aim of this study was to investigate the direct and indirect effects of TTH on the autonomic functions measured by heart rate variability (HRV).

Methods

This population-based cross-sectional study was carried out in the general population of Ulaanbaatar between July and September in 2020. After physical examination, trained researchers applied structured interviews to examine the remote history of TTH and mental distress, followed by a recording of HRV to detect autonomic activity. Psychological factors and the quality of life were measured using Hospital Anxiety Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality of Life-Brief (WHOQOL-BREF). Binary logistic regression and GLM mediation model analysis were used to examine the effects of risk factors on the associations between TTH and autonomic functions.

Results

Among participants (n = 217, mean age=41.8 ± 11.5 years), a total of 117 (53.9%) participants had a remote history of TTH. The age and sex-adjusted prevalence was 43%. Groups did not differ statistically in the HRV indices. LF/HF (ratio of low-frequency to high frequency), the index of sympathovagal balance, was correlated with the HADS anxiety. TTH was associated with mental distress. Binary logistic regression analysis confirms the relationship suggesting that TTH was associated with increased likelihood of mental distress, and decreasing RMSSD (root mean square of the sum of the squares of differences between adjacent NN intervals) and pNN50 (NN50 divided by the total number of NN intervals) were the independent predictors of TTH. GLM mediation model indicated that the relationship between TTH and RMSSD was mediated by mental distress.

Conclusions

The present study suggests that mental distress is a critical factor in the association between TTH and autonomic dysfunction. Additionally, our findings demonstrate the influence of age and gender on TTH. These results highlight the need to understand the mechanisms underlying pathophysiology to facilitate targeted and efficacious prevention and management approaches for TTH.