Heart Rate Variability Modulates the Relationship between Anxiety Symptoms and Emotional Responses to Anxiety-Provoking Imagery: A Cross-Sectional Study

Background: Anxiety disorders have traditionally been related to low heart rate variability (HRV), whereas high HRV has been related to mental health and effective emotion regulation. This study examined if HRV indices of parasympathetic control of the heart are related to emotional responses of anx...

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Main Authors: Andronikos Strouthos, Elena Constantinou, Chrysanthi Leonidou, Maria Karekla, Georgia Panayiotou
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-05-01
Series:Heart and Mind
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Online Access:https://journals.lww.com/10.4103/hm.HM-D-25-00010
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author Andronikos Strouthos
Elena Constantinou
Chrysanthi Leonidou
Maria Karekla
Georgia Panayiotou
author_facet Andronikos Strouthos
Elena Constantinou
Chrysanthi Leonidou
Maria Karekla
Georgia Panayiotou
author_sort Andronikos Strouthos
collection DOAJ
description Background: Anxiety disorders have traditionally been related to low heart rate variability (HRV), whereas high HRV has been related to mental health and effective emotion regulation. This study examined if HRV indices of parasympathetic control of the heart are related to emotional responses of anxious individuals to anxiety imagery scenes, in a community sample. Methods: A total of 101 participants from the Cyprus Republic community, with a mean age of 28.3 years (18.8% males), were included in the study. Of these participants, those who did not meet screening criteria for anxiety disorders, based on self-report measures, were assigned to the control group (n = 55), while those meeting anxiety disorder criteria were assigned to the anxiety group (n = 30). All participants completed a task involving a 5-min baseline recording of HRV, followed by an emotional imagery task, during which their heart rate, skin conductance, and corrugator muscle responses were measured. Subjective ratings of emotional responses to imagery were also recorded. Results: No statistically significant differences in HRV were found between the anxiety and control groups. However, within the anxiety group, lower HRV was correlated with higher anxiety. Multivariate analysis of variance supported the hypothesis that greater physiological responses of anxious individuals to anxiety imagery, especially in the case of corrugator responses to generalized anxiety scenes, and skin conductance during relaxing intervals, were modified by baseline HRV levels. Compared to controls, anxious participants showed lower corrugator responses to specific anxiety scenes when their HRV was high. Subjective responses to imagery were also affected by HRV. Conclusions: The findings are consistent with prior literature and suggest that, even in community samples with high anxiety, high HRV is related to better emotion regulation and helps normalize anxious responses to threatening situations.
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spelling doaj-art-a81b99febb134fbd823fd66d815a6a3d2025-08-20T03:30:45ZengWolters Kluwer Medknow PublicationsHeart and Mind2468-64762468-64842025-05-019319420510.4103/hm.HM-D-25-00010Heart Rate Variability Modulates the Relationship between Anxiety Symptoms and Emotional Responses to Anxiety-Provoking Imagery: A Cross-Sectional StudyAndronikos StrouthosElena ConstantinouChrysanthi LeonidouMaria KareklaGeorgia PanayiotouBackground: Anxiety disorders have traditionally been related to low heart rate variability (HRV), whereas high HRV has been related to mental health and effective emotion regulation. This study examined if HRV indices of parasympathetic control of the heart are related to emotional responses of anxious individuals to anxiety imagery scenes, in a community sample. Methods: A total of 101 participants from the Cyprus Republic community, with a mean age of 28.3 years (18.8% males), were included in the study. Of these participants, those who did not meet screening criteria for anxiety disorders, based on self-report measures, were assigned to the control group (n = 55), while those meeting anxiety disorder criteria were assigned to the anxiety group (n = 30). All participants completed a task involving a 5-min baseline recording of HRV, followed by an emotional imagery task, during which their heart rate, skin conductance, and corrugator muscle responses were measured. Subjective ratings of emotional responses to imagery were also recorded. Results: No statistically significant differences in HRV were found between the anxiety and control groups. However, within the anxiety group, lower HRV was correlated with higher anxiety. Multivariate analysis of variance supported the hypothesis that greater physiological responses of anxious individuals to anxiety imagery, especially in the case of corrugator responses to generalized anxiety scenes, and skin conductance during relaxing intervals, were modified by baseline HRV levels. Compared to controls, anxious participants showed lower corrugator responses to specific anxiety scenes when their HRV was high. Subjective responses to imagery were also affected by HRV. Conclusions: The findings are consistent with prior literature and suggest that, even in community samples with high anxiety, high HRV is related to better emotion regulation and helps normalize anxious responses to threatening situations.https://journals.lww.com/10.4103/hm.HM-D-25-00010anxietycorrugatoremotional imageryheart rate variabilityskin conductance
spellingShingle Andronikos Strouthos
Elena Constantinou
Chrysanthi Leonidou
Maria Karekla
Georgia Panayiotou
Heart Rate Variability Modulates the Relationship between Anxiety Symptoms and Emotional Responses to Anxiety-Provoking Imagery: A Cross-Sectional Study
Heart and Mind
anxiety
corrugator
emotional imagery
heart rate variability
skin conductance
title Heart Rate Variability Modulates the Relationship between Anxiety Symptoms and Emotional Responses to Anxiety-Provoking Imagery: A Cross-Sectional Study
title_full Heart Rate Variability Modulates the Relationship between Anxiety Symptoms and Emotional Responses to Anxiety-Provoking Imagery: A Cross-Sectional Study
title_fullStr Heart Rate Variability Modulates the Relationship between Anxiety Symptoms and Emotional Responses to Anxiety-Provoking Imagery: A Cross-Sectional Study
title_full_unstemmed Heart Rate Variability Modulates the Relationship between Anxiety Symptoms and Emotional Responses to Anxiety-Provoking Imagery: A Cross-Sectional Study
title_short Heart Rate Variability Modulates the Relationship between Anxiety Symptoms and Emotional Responses to Anxiety-Provoking Imagery: A Cross-Sectional Study
title_sort heart rate variability modulates the relationship between anxiety symptoms and emotional responses to anxiety provoking imagery a cross sectional study
topic anxiety
corrugator
emotional imagery
heart rate variability
skin conductance
url https://journals.lww.com/10.4103/hm.HM-D-25-00010
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AT elenaconstantinou heartratevariabilitymodulatestherelationshipbetweenanxietysymptomsandemotionalresponsestoanxietyprovokingimageryacrosssectionalstudy
AT chrysanthileonidou heartratevariabilitymodulatestherelationshipbetweenanxietysymptomsandemotionalresponsestoanxietyprovokingimageryacrosssectionalstudy
AT mariakarekla heartratevariabilitymodulatestherelationshipbetweenanxietysymptomsandemotionalresponsestoanxietyprovokingimageryacrosssectionalstudy
AT georgiapanayiotou heartratevariabilitymodulatestherelationshipbetweenanxietysymptomsandemotionalresponsestoanxietyprovokingimageryacrosssectionalstudy