Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

John A Chalmers, Daniel S Quintana, Maree J-Anne Abbott, Andrew H Kemp, John A Chalmers, Daniel S Quintana, Maree J-Anne Abbott, Andrew H Kemp

Abstract

Background: Anxiety disorders increase risk of future cardiovascular disease (CVD) and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV), may be one mechanism linking anxiety disorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis.

Method: Studies comparing resting-state HRV recordings in patients with an anxiety disorder as a primary diagnosis and healthy controls were considered for meta-analysis.

Results: Meta-analyses were based on 36 articles, including 2086 patients with an anxiety disorder and 2294 controls. Overall, anxiety disorders were characterized by lower HRV [high frequency (HF): Hedges' g = -0.29. 95% CI: -0.41 to -0.17, p < 0.001; time domain: Hedges' g = -0.45, 95% CI: -0.57 to -0.33, p < 0.001] than controls. Panic disorder (n = 447), post-traumatic stress disorder (n = 192), generalized anxiety disorder (n = 68), and social anxiety disorder (n = 90), but not obsessive-compulsive disorder (n = 40), displayed reductions in HF HRV relative to controls (all ps < 0.001).

Conclusion: Anxiety disorders are associated with reduced HRV, findings associated with a small-to-moderate effect size. Findings have important implications for future physical health and well-being of patients, highlighting a need for comprehensive cardiovascular risk reduction.

Keywords: anxiety; anxiety disorders; cardiovascular disease; heart rate variability; meta-analysis; treatment.

Figures

Figure 1
Figure 1
Selection of articles for inclusion. Note: diagnostic grouping of studies do not add to 36 due to some studies reporting on multiple diagnoses.

References

    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry (2005) 62(6):593–60210.1001/archpsyc.62.6.593
    1. Kessler RC, Greenberg PE. The economic burden of anxiety and stress disorders. In Davis KL, Charney D, Coyle JT, Nemeroff C, editors. Neuropsychopharmacology: The Fifth Generation of Progress. Philadelphia: Lippincott Williams & Wilkins; (2002). p. 981–92
    1. Härter MC, Conway KP, Merikangas KR. Associations between anxiety disorders and physical illness. Eur Arch Psychiatry Clin Neurosci (2003) 253(6):313–2010.1007/s00406-003-0449-y
    1. Vogelzangs N, Seldenrijk A, Beekman AT, van Hout HP, de Jonge P, Penninx BW. Cardiovascular disease in persons with depressive and anxiety disorders. J Affect Disord (2010) 125(1–3):241–810.1016/j.jad.2010.02.112
    1. Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol (2010) 56(1):38–4610.1016/j.jacc.2010.03.034
    1. Janszky I, Ahnve S, Lundberg I, Hemmingsson T. Early-onset depression, anxiety, and risk of subsequent coronary heart disease: 37-year follow-up of 49,321 young Swedish men. J Am Coll Cardiol (2010) 56(1):31–710.1016/j.jacc.2010.03.033
    1. Shibeshi WA, Young-Xu Y, Blatt CM. Anxiety worsens prognosis in patients with coronary artery disease. J Am Coll Cardiol (2007) 49(20):2021–710.1016/j.jacc.2007.03.007
    1. Dekker JM, Crow RS, Folsom AR, Hannan PJ, Liao D, Swenne CA, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes – the ARIC study. Circulation (2000) 102(11):1239–4410.1161/01.CIR.102.11.1239
    1. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol (2010) 141(2):122–3110.1016/j.ijcard.2009.09.543
    1. Kemp AH, Quintana DS. The relationship between mental and physical health: insights from the study of heart rate variability. Int J Psychophysiol (2013) 89(3):288–9610.1016/j.ijpsycho.2013.06.018
    1. Huston JM, Tracey KJ. The pulse of inflammation: heart rate variability, the cholinergic anti-inflammatory pathway and implications for therapy. J Intern Med (2011) 269(1):45–5310.1111/j.1365-2796.2010.02321.x
    1. Pavlov VA, Tracey KJ. The vagus nerve and the inflammatory reflex – linking immunity and metabolism. Nat Rev Endocrinol (2012) 8(12):743–5410.1038/nrendo.2012.189
    1. Kemp AH, Quintana DS, Gray MA, Felmingham KL, Brown K, Gatt JM. Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biol Psychiatry (2010) 67(11):1067–7410.1016/j.biopsych.2009.12.012
    1. Quintana DS, McGregor IS, Guastella AJ, Malhi GS, Kemp AH. A meta-analysis on the impact of alcohol dependence on short-term resting-state heart rate variability: implications for cardiovascular risk. Alcohol Clin Exp Res (2013) 37(Suppl 1):E23–910.1111/j.1530-0277.2012.01913.x
    1. La Rovere MT, Pinna GD, Maestri R, Mortara A, Capomolla S, Febo O, et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation (2003) 107(4):565–7010.1161/01.CIR.0000047275.25795.17
    1. Thayer JF, Lane RD. A model of neurovisceral integration in emotion regulation and dysregulation. J Affect Disord (2000) 61(3):201–1610.1016/S0165-0327(00)00338-4
    1. Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D, Vigo A, et al. Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes (2003) 52(7):1799–80510.2337/diabetes.52.7.1799
    1. Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry (2009) 65(9):732–4110.1016/j.biopsych.2008.11.029
    1. Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P, et al. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ (2000) 321(7255):199–20410.1136/bmj.321.7255.199
    1. Gao HM, Hong JS. Why neurodegenerative diseases are progressive: uncontrolled inflammation drives disease progression. Trends Immunol (2008) 29(8):357–6510.1016/j.it.2008.05.002
    1. Friedman BH. An autonomic flexibility-neurovisceral integration model of anxiety and cardiac vagal tone. Biol Psychol (2007) 74(2):185–9910.1016/j.biopsycho.2005.08.009
    1. Mrosovsky N. Rheostasis: The Physiology of Change. New York: Oxford University Press; (1990).
    1. Bar-Haim Y, Lamy D, Pergamin L, Bakermans-Kranenburg MJ, van IJzendoorn MH. Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol Bull (2007) 133(1):1.10.1037/0033-2909.133.1.1
    1. Lyonfields JD, Borkovec TD, Thayer JF. Vagal tone in generalized anxiety disorder and the effects of aversive imagery and worrisome thinking. Behav Ther (1995) 26(3):457–6610.1016/S0005-7894(05)80094-2
    1. Thayer JF, Friedman BH, Borkovec TD. Autonomic characteristics of generalized anxiety disorder and worry. Biol Psychiatry (1996) 39(4):255–6610.1016/0006-3223(95)00136-0
    1. Brosschot JF, Van Dijk E, Thayer JF. Daily worry is related to low heart rate variability during waking and the subsequent nocturnal sleep period. Int J Psychophysiol (2007) 63(1):39–4710.1016/j.ijpsycho.2006.07.016
    1. Brosschot JF, Gerin W, Thayer JF. The perseverative cognition hypothesis: a review of worry, prolonged stress-related physiological activation, and health. J Psychosom Res (2006) 60(2):113–2410.1016/j.jpsychores.2005.06.074
    1. Tully PJ, Cosh SM, Baune BT. A review of the affects of worry and generalized anxiety disorder upon cardiovascular health and coronary heart disease. Psychol Health Med (2013) 18(6):627–4410.1080/13548506.2012.749355
    1. Pittig A, Arch JJ, Lam CW, Craske MG. Heart rate and heart rate variability in panic, social anxiety, obsessive-compulsive, and generalized anxiety disorders at baseline and in response to relaxation and hyperventilation. Int J Psychophysiol (2013) 87(1):19–2710.1016/j.ijpsycho.2012.10.012
    1. Cohen H, Benjamin J, Geva AB, Matar MA, Kaplan Z, Kotler M. Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks. Psychiatry Res (2000) 96(1):1–1310.1016/S0165-1781(00)00195-5
    1. Garakani A, Martinez JM, Aaronson CJ, Voustianiouk A, Kaufmann H, Gorman JM. Effect of medication and psychotherapy on heart rate variability in panic disorder. Depress Anxiety (2009) 26(3):251–810.1002/da.20533
    1. Petruzzello SJ, Landers DM, Hatfield BD, Kubitz KA, Salazar W. A meta-analysis on the anxiety-reducing effects of acute and chronic exercise. Outcomes and mechanisms. Sports Med (1991) 11(3):143–8210.2165/00007256-199111030-00002
    1. McEntee DJ, Halgin RP. Cognitive group therapy and aerobic exercise in the treatment of anxiety. J College Stud Psychother (1999) 13(3):37–5510.1300/J035v13n03_04
    1. Rennie KL, Hemingway H, Kumari M, Brunner E, Malik M, Marmot M. Effects of moderate and vigorous physical activity on heart rate variability in a British study of civil servants. Am J Epidemiol (2003) 158(2):135–4310.1093/aje/kwg120
    1. Porges SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. NewYork, NY: W.W. Norton & Company; (2011).
    1. Alvarenga ME, Richards JC, Lambert G, Esler MD. Psychophysiological mechanisms in panic disorder: a correlative analysis of noradrenaline spillover, neuronal noradrenaline reuptake, power spectral analysis of heart rate variability, and psychological variables. Psychosom Med (2006) 68(1):8–1610.1097/01.psy.0000195872.00987.db
    1. Chang HA, Chang CC, Tzeng NS, Kuo TB, Lu RB, Huang SY. Decreased cardiac vagal control in drug-naive patients with panic disorder: a case-control study in Taiwan. Asia Pac Psychiatry (2013) 5(2):80–910.1111/appy.12032
    1. Ito T, Inoue Y, Sugihara T, Yamada H, Katayama S, Kawahara R. Autonomic function in the early stage of panic disorder: power spectral analysis of heart rate variability. Psychiatry Clin Neurosci (1999) 53(6):667–7210.1046/j.1440-1819.1999.00623.x
    1. Kang EH, Lee IS, Park JE, Kim KJ, Yu BH. Platelet serotonin transporter function and heart rate variability in patients with panic disorder. J Korean Med Sci (2010) 25(4):613–810.3346/jkms.2010.25.4.613
    1. Kikuchi M, Hanaoka A, Kidani T, Remijn GB, Minabe Y, Munesue T, et al. Heart rate variability in drug-naive patients with panic disorder and major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry (2009) 33(8):1474–810.1016/j.pnpbp.2009.08.002
    1. Lavoie KL, Fleet RP, Laurin C, Arsenault A, Miller SB, Bacon SL. Heart rate variability in coronary artery disease patients with and without panic disorder. Psychiatry Res (2004) 128(3):289–9910.1016/j.psychres.2004.06.005
    1. Martinez JM, Garakani A, Kaufmann H, Aaronson CJ, Gorman JM. Heart rate and blood pressure changes during autonomic nervous system challenge in panic disorder patients. Psychosom Med (2010) 72(5):442–910.1097/PSY.0b013e3181d972c2
    1. McCraty R, Atkinson M, Tomasino D, Stuppy WP. Analysis of twenty-four hour heart rate variability in patients with panic disorder. Biol Psychol (2001) 56(2):131–5010.1016/S0301-0511(01)00074-6
    1. Melzig CA, Weike AI, Hamm AO, Thayer JF. Individual differences in fear-potentiated startle as a function of resting heart rate variability: implications for panic disorder. Int J Psychophysiol (2009) 71(2):109–1710.1016/j.ijpsycho.2008.07.013
    1. Middleton HC, Ashby M. Clinical recovery from panic disorder is associated with evidence of changes in cardiovascular regulation. Acta Psychiatr Scand (1995) 91(2):108–1310.1111/j.1600-0447.1995.tb09749.x
    1. Prasko J, Latalova K, Diveky T, Grambal A, Kamaradova D, Velartova H, et al. Panic disorder, autonomic nervous system and dissociation-changes during therapy. Neuro Endocrinol Lett (2010) 32(5):641–51
    1. Slaap BR, Nielen MM, Boshuisen ML, van Roon AM, den Boer JA. Five-minute recordings of heart rate variability in obsessive-compulsive disorder, panic disorder and healthy volunteers. J Affect Disord (2004) 78(2):141–810.1016/S0165-0327(02)00240-9
    1. Wang SM, Yeon B, Hwang S, Lee HK, Kweon YS, Lee CT, et al. Threat-induced autonomic dysregulation in panic disorder evidenced by heart rate variability measures. Gen Hosp Psychiatry (2013) 35(5):497–50110.1016/j.genhosppsych.2013.06.001
    1. Wise V, McFarlane AC, Clark CR, Battersby M. An integrative assessment of brain and body function ‘at rest’ in panic disorder: a combined quantitative EEG/autonomic function study. Int J Psychophysiol (2011) 79(2):155–6510.1016/j.ijpsycho.2010.10.002
    1. Yeragani VK, Balon R, Pohl R, Ramesh C, Glitz D, Weinberg P, et al. Decreased R-R variance in panic disorder patients. Acta Psychiatr Scand (1990) 81(6):554–910.1111/j.1600-0447.1990.tb05498.x
    1. Yeragani VK, Pohl R, Berger R, Balon R, Ramesh C, Glitz D, et al. Decreased heart rate variability in panic disorder patients: a study of power-spectral analysis of heart rate. Psychiatry Res (1993) 46(1):89–10310.1016/0165-1781(93)90011-5
    1. Asmundson GJ, Stein MB. Vagal attenuation in panic disorder: an assessment of parasympathetic nervous system function and subjective reactivity to respiratory manipulations. Psychosom Med (1994) 56(3):187–9310.1097/00006842-199405000-00002
    1. Blechert J, Michael T, Grossman P, Lajtman M, Wilhelm FH. Autonomic and respiratory characteristics of posttraumatic stress disorder and panic disorder. Psychosom Med (2007) 69(9):935–4310.1097/PSY.0b013e31815a8f6b
    1. Klein E, Cnaani E, Harel T, Braun S, Ben-Haim SA. Altered heart rate variability in panic disorder patients. Biol Psychiatry (1995) 37(1):18–2410.1016/0006-3223(94)00130-U
    1. Petrowski K, Herold U, Joraschky P, Mück-Weymann M, Siepmann M. The effects of psychosocial stress on heart rate variability in panic disorder. German J Psychiatry (2010) 13:66–73
    1. Yeragani VK, Pohl R, Srinivasan K, Balon R, Ramesh C, Berchou R. Effects of isoproterenol infusions on heart rate variability in patients with panic disorder. Psychiatry Res (1995) 56(3):289–9310.1016/0165-1781(95)02608-Y
    1. Agorastos A, Boel JA, Heppner PS, Hager T, Moeller-Bertram T, Haji U, et al. Diminished vagal activity and blunted diurnal variation of heart rate dynamics in posttraumatic stress disorder. Stress (2013) 16(3):300–1010.3109/10253890.2012.751369
    1. Cohen H, Kotler M, Matar MA, Kaplan Z, Miodownik H, Cassuto Y. Power spectral analysis of heart rate variability in posttraumatic stress disorder patients. Biol Psychiatry (1997) 41(5):627–910.1016/S0006-3223(96)00525-2
    1. Hauschildt M, Peters MJ, Moritz S, Jelinek L. Heart rate variability in response to affective scenes in posttraumatic stress disorder. Biol Psychol (2011) 88(2–3):215–2210.1016/j.biopsycho.2011.08.004
    1. Keary TA, Hughes JW, Palmieri PA. Women with posttraumatic stress disorder have larger decreases in heart rate variability during stress tasks. Int J Psychophysiol (2009) 73(3):257–6410.1016/j.ijpsycho.2009.04.003
    1. Lakusic N, Fuckar K, Mahovic D, Cerovec D, Majsec M, Stancin N. Characteristics of heart rate variability in war veterans with post-traumatic stress disorder after myocardial infarction. Mil Med (2007) 172(11):1190–3
    1. Norte CE, Souza GGL, Vilete L, Marques-Portella C, Coutinho ESF, Figueira I, et al. They know their trauma by heart: an assessment of psychophysiological failure to recover in PTSD. J Affect Disord (2013) 150(1):136–4110.1016/j.jad.2012.11.039
    1. Shah AJ, Lampert R, Goldberg J, Veledar E, Bremner JD, Vaccarino V. Posttraumatic stress disorder and impaired autonomic modulation in male twins. Biol Psychiatry (2013) 73(11):1103–1010.1016/j.biopsych.2013.01.019
    1. Tucker P, Pfefferbaum B, Jeon-Slaughter H, Khan Q, Garton T. Emotional stress and heart rate variability measures associated with cardiovascular risk in relocated Katrina survivors. Psychosom Med (2012) 74(2):160–810.1097/PSY.0b013e318240a801
    1. Wahbeh H, Oken BS. Peak high-frequency HRV and peak alpha frequency higher in PTSD. Appl Psychophysiol Biofeedback (2013) 38(1):57–6910.1007/s10484-012-9208-z
    1. Cohen H, Kotler M, Matar M, Kaplan Z. Normalization of heart rate variability in post-traumatic stress disorder patients following fluoxetine treatment: preliminary results. Isr Med Assoc J (2000) 2(4):296–301
    1. Shaikh al arab A, Guedon-Moreau L, Ducrocq F, Molenda S, Duhem S, Salleron J, et al. Temporal analysis of heart rate variability as a predictor of post traumatic stress disorder in road traffic accidents survivors. J Psychiatr Res (2012) 46(6):790–610.1016/j.jpsychires.2012.02.006
    1. Hammel JC, Smitherman TA, McGlynn FD, Mulfinger AM, Lazarte AA, Gothard KD. Vagal influence during worry and cognitive challenge. Anxiety Stress Coping (2011) 24(2):121–3610.1080/10615806.2010.490912
    1. Kollai M, Kollai B. Cardiac vagal tone in generalised anxiety disorder. Br J Psychiatry (1992) 161(6):831–510.1192/bjp.161.6.831
    1. Bornas X, Llabrés J, Noguera M, López AM, Gelabert JM, Vila I. Fear induced complexity loss in the electrocardiogram of flight phobics: a multiscale entropy analysis. Biol Psychol (2006) 73(3):272–910.1016/j.biopsycho.2006.05.004
    1. Alvares GA, Quintana DS, Kemp AH, Van Zwieten A, Balleine BW, Hickie IB, et al. Reduced heart rate variability in social anxiety disorder: associations with gender and symptom severity. PLoS One (2013) 8(7):e70468.10.1371/journal.pone.0070468
    1. Gaebler M, Daniels JK, Lamke JP, Fydrich T, Walter H. Heart rate variability and its neural correlates during emotional face processing in social anxiety disorder. Biol Psychol (2013) 94(2):319–3010.1016/j.biopsycho.2013.06.009
    1. Einvik G, Hrubos-Strom H, Randby A, Nordhus IH, Somers VK, Omland T, et al. Major depressive disorder, anxiety disorders, and cardiac biomarkers in subjects at high risk of obstructive sleep apnea. Psychosom Med (2011) 73(5):378–8410.1097/Psy.0b013e318219e64e
    1. Licht CM, de Geus EJ, van Dyck R, Penninx BW. Association between anxiety disorders and heart rate variability in The Netherlands Study of Depression and Anxiety (NESDA). Psychosom Med (2009) 71(5):508–1810.1097/PSY.0b013e3181a292a6
    1. Martens EJ, Nyklicek I, Szabo BM, Kupper N. Depression and anxiety as predictors of heart rate variability after myocardial infarction. Psychol Med (2008) 38(3):375–8310.1017/S0033291707002097
    1. Moher D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med (2009) 151(4):264.10.7326/0003-4819-151-4-200908180-00135
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III. Washington, DC: American Psychiatric Association; (1980).
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R. Washington, DC: American Psychiatric Association; (1987).
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed Washington, DC: American Psychiatric Association; (1994).
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association; (2000).
    1. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; (1992).
    1. Tsuji H, Larson MG, Venditti FJ, Jr, Manders ES, Evans JC, Feldman CL, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation (1996) 94(11):2850–510.1161/01.CIR.94.11.2850
    1. Cardiology TFotESo. the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation (1996) 93(5):1043–6510.1161/01.CIR.93.5.1043
    1. Malik M, Bigger JT, Camm AJ, Kleiger RE, Malliani A, Moss AJ, et al. Heart rate variability standards of measurement, physiological interpretation, and clinical use. Eur Heart J (1996) 17(3):354–8110.1093/oxfordjournals.eurheartj.a014868
    1. Billman GE. Heart rate variability – a historical perspective. Front Physiol (2011) 2:86.10.3389/fphys.2011.00086
    1. Berntson GG, Bigger JT, Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, et al. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology (1997) 34(6):623–4810.1111/j.1469-8986.1997.tb02140.x
    1. Reyes del Paso GA, Langewitz W, Mulder LJ, van Roon A, Duschek S. The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology (2013) 50(5):477–8710.1111/psyp.12027
    1. Heathers JA. Everything Hertz: methodological issues in short-term frequency-domain HRV. Card Electrophysiol (2014) 5:177.10.3389/fphys.2014.00177
    1. Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol (2013) 4:26.10.3389/fphys.2013.00026
    1. Thayer JF, Friedman BH. Assessment of anxiety using heart rate nonlinear dynamics. In: Ditto W, editor. Chaos in Biology and Medicine: SPIE Proceedings (1993) 2036:42–8
    1. Fei L, Copie X, Malik M, Camm AJ. Short- and long-term assessment of heart rate variability for risk stratification after acute myocardial infarction. Am J Cardiol (1996) 77(9):681–410.1016/S0002-9149(97)89199-0
    1. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to Meta-Analysis. Cornwall: John Wiley & Sons; (2011).
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed Hillsdale, NJ: Psychology Press; (1988).
    1. Hedges LV, Olkin I. Statistical Methods for Meta-Analysis. San Diego, CA: Academic; (1985).
    1. Shadish WR, Haddock CK. Combining estimates of effect size. In: Cooper H, Hedges G, editors. The Handbook of Research Synthesis and Meta-Analysis. New York: Sage; (2009). p. 257–77
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med (2002) 21(11):1539–5810.1002/sim.1186
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics (1994) 50(4):1088–10110.2307/2533446
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (1997) 315(7109):629–3410.1136/bmj.315.7109.629
    1. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics (2000) 56(2):455–6310.1111/j.0006-341X.2000.00455.x
    1. Benkelfat C, Mefford IN, Masters CF, Nordahl TE, King AC, Cohen RM, et al. Plasma catecholamines and their metabolites in obsessive-compulsive disorder. Psychiatry Res (1991) 37(3):321–3110.1016/0165-1781(91)90067-Y
    1. Hoehn-Saric R, McLeod DR, Hipsley P. Is hyperarousal essential to obsessive-compulsive disorder? Diminished physiologic flexibility, but not hyperarousal, characterizes patients with obsessive-compulsive disorder. Arch Gen Psychiatry (1995) 52(8):688.10.1001/archpsyc.1995.03950200078017
    1. McCarthy PR, Ray WJ, Foa EB. Cognitive influences on electrocortical and heart rate activity in obsessive-compulsive disorder. Int J Psychophysiol (1995) 19(3):215–2210.1016/0167-8760(95)00009-H
    1. Zahn TP, Leonard HL, Swedo SE, Rapoport JL. Autonomic activity in children and adolescents with obsessive-compulsive disorder. Psychiatry Res (1996) 60(1):67–7610.1016/0165-1781(95)02846-3
    1. Barlow DH. Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. Am Psychol (2000) 55(11):1247.10.1037/0003-066X.55.11.1247
    1. Berntson GG, Sarter M, Cacioppo JT. Anxiety and cardiovascular reactivity: the basal forebrain cholinergic link. Behav Brain Res (1998) 94(2):225–4810.1016/S0166-4328(98)00041-2
    1. Thayer JF, Sternberg E. Beyond heart rate variability: vagal regulation of allostatic systems. Ann N Y Acad Sci (2006) 1088(1):361–7210.1196/annals.1366.014
    1. Tracey KJ. The inflammatory reflex. Nature (2002) 420(6917):853–910.1038/nature01321
    1. Kubzansky LD, Kawachi I, Spiro A, Weiss ST, Vokonas PS, Sparrow D. Is worrying bad for your heart? A prospective study of worry and coronary heart disease in the Normative Aging Study. Circulation (1997) 95(4):818–2410.1161/01.CIR.95.4.818
    1. Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Borkovec TD, Rickels K, et al. Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry (2001) 62:53–8
    1. Tucker P, Adamson P, Miranda R, Jr, Scarborough A, Williams D, Groff J, et al. Paroxetine increases heart rate variability in panic disorder. J Clin Psychopharmacol (1997) 17(5):370–610.1097/00004714-199710000-00006
    1. Baker B, Khaykin Y, Devins G, Dorian P, Shapiro C, Newman D. Correlates of therapeutic response in panic disorder presenting with palpitations: heart rate variability, sleep, and placebo effect. Can J Psychiatry (2003) 48(6):381–7
    1. Agelink MW, Majewski TB, Andrich J, Mueck-Weymann M. Short-term effects of intravenous benzodiazepines on autonomic neurocardiac regulation in humans: a comparison between midazolam, diazepam, and lorazepam. Crit Care Med (2002) 30(5):997–100610.1097/00003246-200205000-00008
    1. Vogel LR, Muskin PR, Collins ED, Sloan RP. Lorazepam reduces cardiac vagal modulation in normal subjects. J Clin Psychopharmacol (1996) 16(6):449–5310.1097/00004714-199612000-00008
    1. Michaloudis D, Kochiadakis G, Georgopoulou G, Fraidakis O, Chlouverakis G, Petrou A, et al. The influence of premedication on heart rate variability. Anaesthesia (1998) 53(5):446–5310.1046/j.1365-2044.1998.00323.x
    1. Diveky T, Prasko J, Kamaradova D, Grambal A, Latalova K, Silhan P, et al. Comparison of heart rate variability in patients with panic disorder during cognitive behavioral therapy program. Psychiatr Danub (2013) 25(1):62–7
    1. Mathewson KJ, Schmidt LA, Miskovic V, Santesso DL, Duku E, McCabe RE, et al. Does respiratory sinus arrhythmia (RSA) predict anxiety reduction during cognitive behavioral therapy (CBT) for social anxiety disorder (SAD)? Int J Psychophysiol (2013) 88(2):171–8110.1016/j.ijpsycho.2013.03.016
    1. Bornas X, del Amo AR, Tortella-Feliu M, Llabrés J. Heart rate variability profiles and exposure therapy treatment outcome in flight phobia. Appl Psychophysiol Biofeedback (2012) 37(1):53–6210.1007/s10484-011-9179-5
    1. Busscher B, Spinhoven P, van Gerwen LJ, de Geus EJ. Anxiety sensitivity moderates the relationship of changes in physiological arousal with flight anxiety during in vivo exposure therapy. Behav Res Ther (2013) 51(2):98–10510.1016/j.brat.2012.10.009
    1. Sack M, Lempa W, Lamprecht F. Assessment of psychophysiological stress reactions during a traumatic reminder in patients treated with EMDR. J EMDR Pract Res (2007) 1(1):15–2310.1891/1933-3196.1.1.15
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry (2005) 62(6):617–2710.1001/archpsyc.62.6.617
    1. Kemp AH, Quintana DS, Felmingham KL, Matthews S, Jelinek HF. Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk. PLoS One (2012) 7(2):e30777.10.1371/journal.pone.0030777
    1. Phillips AC, Batty GD, Gale CR, Deary IJ, Osborn D, MacIntyre K, et al. Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study. Psychosom Med (2009) 71(4):395–40310.1097/Psy.0b013e31819e6706
    1. National-Institute-for-Clinical-Excellence. Anxiety: Management of Anxiety (Panic Disorder, With or Without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care. London: NICE; (2004).

Source: PubMed

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