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Heart Rate Variability (HRV) Reduced in Anxiety Disorders (2024 Study)

In the quest to understand anxiety disorders more profoundly, scientists have turned to the rhythms of the heart, specifically heart rate variability (HRV), for answers.

By employing wearable technology in a novel study design, researchers have uncovered intriguing insights into how the variability in our heartbeats might be linked to anxiety disorders.

This approach not only reaffirms the potential of HRV as a biomarker for anxiety but also highlights the power of wearables in psychiatric research, opening new avenues for remote monitoring and personalized interventions.


  1. HRV as a Biomarker for Anxiety: Recent studies suggest that low resting HRV, an indicator of less variability between heartbeats, is closely associated with anxiety disorders, hinting at its potential as a non-invasive biomarker for diagnosing and understanding anxiety.
  2. Wearable Technology in Research: The use of wearable devices for measuring HRV introduces a cost-effective, scalable, and participant-friendly method, enabling large-scale studies and real-time monitoring in naturalistic settings.
  3. Anxiety Disorders & HRV: Individuals with anxiety disorders, particularly those of European ancestry, have been found to exhibit significantly lower HRV compared to healthy controls, suggesting a link between reduced vagal tone and anxiety.
  4. Potential Clinical Applications: Understanding the connection between HRV and anxiety disorders opens the door to exploring novel therapeutic interventions such as vagus nerve stimulation and HRV biofeedback training, which could offer new hope for individuals struggling with anxiety.

Source: Journal of Affective Disorders (2024)

Heart Rate Variability (HRV) & the Autonomic Nervous System (ANS)

Heart Rate Variability (HRV) is a measure of the variation in time intervals between consecutive heartbeats.

It is considered a non-invasive marker of the autonomic nervous system’s (ANS) activity, reflecting the balance between the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).

The SNS is responsible for the body’s ‘fight or flight’ response, while the PNS regulates ‘rest and digest’ activities.

HRV is a critical physiological indicator, as it provides insight into the body’s stress responses, emotional regulation, and overall heart health.

HRV in Anxiety Disorders

Anxiety disorders are characterized by excessive worry, fear, and a state of heightened physiological arousal.

The abnormal HRV observed in anxiety disorders can be attributed to several factors, including heightened physiological arousal, chronic stress, and poor emotional regulation, all of which can disrupt autonomic nervous system balance.

Specifically, lower HRV is often observed in these individuals, pointing towards an overactivation of the SNS or an underactivation of the PNS, or both.

This imbalance can lead to less flexibility in heart rate adjustments in response to environmental demands, reflecting a state of chronic stress or decreased adaptive capacity.

Conversely, interventions that enhance parasympathetic activity, such as deep breathing, meditation, and physical exercise, have been shown to improve HRV, suggesting potential pathways for therapeutic strategies aimed at restoring autonomic balance and alleviating anxiety symptoms.

Factors Influencing HRV: High vs. Low Variability

Causes of High HRV

  • Enhanced Parasympathetic Activity: A high HRV typically indicates a strong vagal tone, where the parasympathetic nervous system effectively modulates heart rate. This condition is associated with better stress resilience, emotional regulation, and overall cardiovascular health.
  • Physical Fitness: Individuals who are physically fit often exhibit higher HRV, as regular exercise enhances parasympathetic activity and improves the heart’s ability to respond to different stress levels.
  • Relaxation & Recovery: Periods of relaxation, meditation, and good quality sleep are associated with increased HRV, as these states allow the body to recover from stress and restore autonomic balance.

Causes of Low HRV

  • Chronic Stress: Exposure to prolonged stress leads to sustained activation of the sympathetic nervous system, reducing HRV. This condition limits the body’s ability to adapt to new stressors, increasing vulnerability to anxiety and other stress-related disorders.
  • Poor Emotional Regulation: Difficulty in managing emotions can result in continuous psychological distress, which, in turn, can lead to lower HRV due to constant sympathetic nervous system activation.
  • Unhealthy Lifestyle Factors: Poor diet, lack of exercise, smoking, and excessive alcohol consumption can negatively impact HRV. These lifestyle choices can lead to diminished parasympathetic activity and increased heart rate, reducing the variability between heartbeats.
  • Medical Conditions: Certain medical conditions, including heart disease, hypertension, and diabetes, can also contribute to lower HRV by impairing autonomic nervous system function.

Study Findings: HRV, Anxiety Disorders, Wearable Technology (2024)

Tomasi et al. examined the link between heart rate variability (HRV) and anxiety disorders, leveraging wearable technology to collect data remotely.

1. HRV & Anxiety Disorders: A Strong Link

Lower HRV in Anxiety Disorders

A major finding of the study was the significant reduction in vagally-mediated HRV among individuals with anxiety disorders compared to healthy controls, particularly in those of European ancestry.

This reduction was evident in the resting state, suggesting an underlying dysregulation of the autonomic nervous system among those with anxiety disorders.

Ancestry-Specific Outcomes

The study uniquely stratified results by ancestry, uncovering that the significant difference in HRV between individuals with anxiety disorders and healthy controls was most pronounced in the European subsample.

This stratification underscores the potential influence of genetic background on the physiological manifestations of anxiety disorders.

2. HRV & Anxiety-Related Traits: Detailed Associations

HAM-A & HRV Correlation

The study found a notable association between HRV metrics (specifically RMSSD) and the Hamilton Anxiety Rating Scale (HAM-A) scores within the European ancestry group.

This correlation indicates that individuals with higher physical anxiety symptoms exhibit lower HRV, pointing to a somatic dimension of anxiety that correlates with autonomic dysregulation.

Lack of Association with Antidepressant Use

Contrary to expectations, the study did not find a significant relationship between antidepressant use and HRV metrics within the European ancestry group.

This finding suggests that the observed HRV reductions in individuals with anxiety disorders may not be directly modifiable through the use of common antidepressant medications, at least in the short term or within the dosages and types considered in this study.

3. Wearable Technology: Feasibility & Insights

Remote Monitoring Success

Employing wearable technology facilitated successful remote monitoring of HRV, demonstrating the feasibility of this approach for psychiatric research.

The use of wearables enabled the collection of physiological data in a naturalistic setting, which is particularly relevant for conditions like anxiety disorders that can be influenced by the environment.

Data Quality & Wearable Advantages

Despite potential concerns about data accuracy due to motion artifacts and the non-standardized setting of measurements, the study confirmed the reliability of wearable devices in capturing meaningful HRV data.

This finding highlights the potential of wearables to offer a scalable, participant-friendly approach to monitoring physiological markers associated with mental health conditions.

HRV & Anxiety Disorders: Examining the Link (2024 Study)

The primary objective of this study was to investigate the association between heart rate variability (HRV) and anxiety disorders using wearable technology in a remote study design.


  • Participants: The study enrolled 240 participants, divided evenly between individuals diagnosed with anxiety disorders (AD = 120) and healthy controls (HC = 120), recruited during the COVID-19 pandemic. Eligible participants were aged 18 to 65, fluent in English, and had access to videoconferencing tools.
  • Study Design: Participants completed an at-home assessment of their short-term resting vagally-mediated HRV using a wearable wristband device, with data collection monitored over videoconference. The study utilized the Empatica¬© E4 wristband for HRV data collection, employing both time-domain (RMSSD) and frequency-domain (HF power) metrics to assess vagal tone.
  • Data Analysis: The study conducted analyses to compare HRV metrics between individuals with anxiety disorders and healthy controls, explore associations between HRV and anxiety-related traits, and examine the impact of antidepressants on HRV. Analyses were stratified by ancestry to account for potential genetic influences on HRV.


  • HRV & Anxiety Disorders: The study found that individuals with anxiety disorders, particularly those of European ancestry, exhibited significantly lower vagally-mediated HRV compared to healthy controls. This association suggests a link between reduced vagal tone and the presence of anxiety disorders.
  • HRV & Anxiety-Related Traits: HRV was significantly associated with the Hamilton Anxiety Rating Scale (HAM-A) scores in the European subsample, indicating that lower resting HRV correlated with elevated physical anxiety symptoms. However, no significant associations were found between HRV and antidepressant use within this group.
  • Feasibility of Wearable Devices: The study highlighted the practicality and effectiveness of using wearable devices for HRV measurement in remote research settings, demonstrating their potential for large-scale studies and real-time monitoring of physiological markers related to anxiety.


  • Study Setting & Design: Measurements occurred in non-standardized, at-home environments, which may introduce variability in the data due to differences in setting and participant compliance.
  • Ancestry Group Samples: The study acknowledged unequal sample sizes among the three ancestry groups (European, East Asian, African), potentially limiting the generalizability and power of the findings across diverse populations.
  • Wearable Technology: While wearables offer a convenient and accessible means for HRV data collection, they may be prone to motion artifacts and may not capture HRV with the same precision as traditional electrocardiography (ECG).

HRV Training as Biofeedback for Anxiety?

Heart Rate Variability (HRV) training, a form of biofeedback, is emerging as a promising therapeutic tool for individuals with anxiety disorders.

This technique involves teaching individuals to consciously influence their heart rate variability through controlled breathing and relaxation techniques, thereby potentially enhancing their ability to regulate stress responses and emotional states.

How HRV Training Might Help Anxiety

  1. Enhancing Parasympathetic Activity: HRV training aims to increase parasympathetic (vagal) tone, promoting relaxation and reducing the physiological symptoms of anxiety, such as rapid heartbeat or sweating.
  2. Improving Autonomic Regulation: By improving autonomic nervous system balance, HRV training can help individuals develop better resilience against stress, potentially reducing the frequency and intensity of anxiety episodes.
  3. Empowering Self-Regulation: Providing individuals with real-time feedback on their HRV levels empowers them to actively engage in their treatment, fostering a sense of control over their physiological and emotional state.

Why Lower HRV May Correlate with Anxiety: Beyond Causation

While HRV training offers a potentially promising avenue for managing anxiety, it’s crucial to understand that the relationship between lower HRV and anxiety disorders may not be causal.

Several factors may contribute to this correlation, highlighting the complexity of the autonomic nervous system’s role in mental health.

  • Genetic Factors: Genetic predispositions can influence both autonomic nervous system regulation and susceptibility to anxiety disorders. Individuals with a genetic inclination towards heightened sympathetic activity or reduced parasympathetic activity may be more prone to both lower HRV and anxiety.
  • Chronic Stress: Long-term exposure to stress can lead to changes in autonomic nervous system functioning, resulting in lower HRV. This chronic stress may also predispose individuals to developing anxiety disorders, creating a correlational relationship.
  • Lifestyle & Environmental Influences: Unhealthy lifestyle choices (e.g., poor diet, lack of exercise, substance use) and environmental stressors can negatively impact HRV and contribute to the development of anxiety disorders.
  • Medical Conditions: Certain medical conditions that affect the heart or autonomic nervous system can lead to lower HRV and also increase stress and anxiety due to the health challenges they present.
  • Psychological & Behavioral Factors: Behavioral patterns associated with anxiety, such as hypervigilance or avoidance behaviors, may exacerbate stress responses, leading to lower HRV. Conversely, these behaviors might be a reaction to the physiological discomfort caused by autonomic imbalance.

Conclusion: HRV & Anxiety Disorders

This study underscores the intricate relationship between heart rate variability (HRV) and anxiety disorders, highlighting the potential of HRV as a biomarker for autonomic dysregulation in individuals with anxiety.

By utilizing wearable technology to remotely monitor HRV, the research not only demonstrates the feasibility of such methods in psychiatric studies but also paves the way for innovative, non-invasive approaches to understanding and managing anxiety disorders.

The findings suggest that individuals with anxiety disorders, particularly those of European ancestry, exhibit significantly lower HRV, pointing towards an imbalance in autonomic nervous system functioning.

While HRV training emerges as a promising therapeutic intervention, offering a pathway to enhance autonomic regulation and emotional resilience, the study also acknowledges the complex web of genetic, lifestyle, and environmental factors contributing to the observed HRV patterns.

This nuanced understanding of HRV’s correlation with anxiety emphasizes the importance of a personalized approach to treatment, considering the multifactorial nature of anxiety disorders.

Ultimately, this research enriches our understanding of the physiological underpinnings of anxiety and encourages further exploration into the clinical utility of HRV monitoring and training in mental health care.


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