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Effects of Mental Stress Induction on Heart Rate Variability in Patients with Panic Disorder

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An Erratum to this article was published on 29 March 2017

Abstract

Reduced heart rate variability (HRV) constitutes a widely used marker of cardiac autonomic inflexibility which has been linked to disorders such as panic disorder (PD). To date, the pathophysiological mechanisms whereby panic leads to attenuated HRV are not fully elucidated. We aimed to investigate the hypothesis that PD patients show pathological reactivity both in response to interoceptive and psychosocial stress in comparison to healthy individuals. We performed a controlled study on 38 patients diagnosed with PD [20 males and 18 females aged 35.55 ± 10.12 years, mean ± standard deviation] and 23 age and gender matched healthy control participants. Distress was induced using the Trier Social Stress Test (TSST) and the dexamethasone–corticotropin-releasing-hormone (DEX–CRH) test. We assessed HRV prior to, during, and post-stress induction using the root mean square successive differences (RMSSD) as well as spectral analysis (high frequency; HF and low frequency; LF). Statistical analyses revealed significant main effects of time for mean heart rate (HR), HF, LF (solely DEX–CRH), LFHF-ratio (solely TSST) and the RMSSD. Significant interaction effects were observed with more pronounced increases in mean HR (TSST) and LFHF-ratio (DEX–CRH) in the healthy control participants. No significant main effects of group were observed. Overall, our results indicate “normal” HRV parameters in patients with PD. The HRV of PD patients is no worse than that of healthy control participants since the HRV profiles were similar between the study groups. The current study is one of rather rarely published studies which was unable to show an influence of PD on HRV. Implications for future studies are under discussion.

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References

  • Abelson, J. L., Khan, S., Liberzon, I., & Young, E. A. (2007). HPA axis activity in patients with panic disorder: Review and synthesis of four studies. Depression and Anxiety, 24(1), 66–76.

    Article  PubMed  Google Scholar 

  • Albert, C. M., Chae, C. U., Rexrode, K. M., Manson, J. E., & Kawachi, I. (2005). Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women. Circulation, 111(4), 480–487.

    Article  PubMed  Google Scholar 

  • Albus, M., Zahn, T. P., & Breier, A. (1992). Anxiogenic properties of yohimbine. European Archives of Psychiatry and Clinical Neuroscience, 241(6), 337–344.

    Article  PubMed  Google Scholar 

  • Alvarenga, M. E., Richards, J. C., Lambert, G., & Esler, M. D. (2006). Psychophysiological mechanisms in panic disorder: A correlative analysis of noradrenaline spillover, neuronal noradrenaline reuptake, power spectral analysis of heart rate variability, and psychological variables. Psychosomatic Medicine, 68(1), 8–16.

    Article  PubMed  Google Scholar 

  • Asmundson, G., & Stein, M. B. (1994). Vagal attenuation in panic disorder: An assessment of parasympathetic nervous system function and subjective reactivity to respiratory manipulations. Psychosomatic Medicine, 56(3), 187–193.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders DSM-IV-TR fourth edition (text revision).

  • Backs, R. W., Navidzadeh, H. T., & Xu, X. Cardiorespiratory indices of mental workload during simulated air traffic control. In Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2000 (Vol. 44, pp. 89–92). SAGE.

  • Bandelow, B. (1997). Panik-und Agoraphobie-Skala:(PAS). Göttingen: Hogrefe, Verlag für Psychologie.

    Google Scholar 

  • Beck, A. T., Steer, R., & Brown, G. (1987). Beck depression inventory manual. San Antonio, TX: The Psychological Corporation. Harcourt Brace Jovanovich. Beck, AT, Ward, CH, Mendelson, M., Mock, J., & Erbaugh, J.(1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

  • Berntson, G. G., Bigger, J. T., Eckberg, D. L., Grossman, P., Kaufmann, P. G., Malik, M., et al. (1997). Heart rate variability: Origins, methods, and interpretative caveats. Psychophysiology, 34, 623–648.

    Article  PubMed  Google Scholar 

  • Berntson, G. G., Lozano, D. L., & Chen, Y. J. (2005). Filter properties of root mean square successive difference (RMSSD) for heart rate. Psychophysiology, 42(2), 246–252.

    Article  PubMed  Google Scholar 

  • Billman, G. E. (2007). The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. In Heart Rate Variability: Clinical Applications and Interaction between HRV and Heart Rate (p. 54).

  • Bloomfield, D. M., Kaufman, E. S., Bigger, J. T., Fleiss, J., Rolnitzky, L., & Steinman, R. (1997). Passive head-up tilt and actively standing up produce similar overall changes in autonomic balance. American Heart Journal, 134(2), 316–320.

    Article  PubMed  Google Scholar 

  • Chalmers, J. A., Quintana, D. S., Abbott, M. J., & Kemp, A. H. (2014). Anxiety disorders are associated with reduced heart rate variability: A meta-analysis. Frontiers in psychiatry, 5, 80.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, H., Benjamin, J., Geva, A. B., Matar, M. A., Kaplan, Z., & Kotler, M. (2000). 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 Research, 96(1), 1–13.

    Article  PubMed  Google Scholar 

  • Dekker, J. M., Crow, R. S., Folsom, A. R., Hannan, P. J., Liao, D., Swenne, C. A., et al. (2000). 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, 102(11), 1239–1244.

    Article  PubMed  Google Scholar 

  • Derogatis, L. (1977). SCL-90: Administration and Procedures Manual-I for the R (evised) Version. Baltimore: Clinical Psychometrics Research.

    Google Scholar 

  • Eckberg, D. L. (1997). Sympathovagal balance a critical appraisal. Circulation, 96(9), 3224–3232.

    Article  PubMed  Google Scholar 

  • Erhardt, A., Ising, M., Unschuld, P. G., Kern, N., Lucae, S., Pütz, B., et al. (2006). Regulation of the hypothalamic–pituitary–adrenocortical system in patients with panic disorder. Neuropsychopharmacology, 31(11), 2515–2522.

    Article  PubMed  Google Scholar 

  • Fleet, R., Lavoie, K., & Beitman, B. D. (2000). Is panic disorder associated with coronary artery disease? A critical review of the literature. Journal of Psychosomatic Research, 48(4), 347–356.

    Article  PubMed  Google Scholar 

  • Franke, G. H., & Derogatis, L. R. (2002). SCL-90-R: Symptom-Checkliste von LR Derogatis: Deutsche version: Manual. Weinheim: Beltz Test.

    Google Scholar 

  • Friedman, B. H. (2007). An autonomic flexibility–neurovisceral integration model of anxiety and cardiac vagal tone. Biological Psychology, 74(2), 185–199.

    Article  PubMed  Google Scholar 

  • Friedman, B. H., & Thayer, J. F. (1998). Autonomic balance revisited: panic anxiety and heart rate variability. Journal of Psychosomatic Research, 44(1), 133–151.

    Article  PubMed  Google Scholar 

  • Goldstein, D. S., Bentho, O., Park, M. Y., & Sharabi, Y. (2011). Low-frequency power of heart rate variability is not a measure of cardiac sympathetic tone but may be a measure of modulation of cardiac autonomic outflows by baroreflexes. Experimental Physiology, 96(12), 1255–1261.

    Article  PubMed  PubMed Central  Google Scholar 

  • Goodwin, R. D., Faravelli, C., Rosi, S., Cosci, F., Truglia, E., de Graaf, R., et al. (2005). The epidemiology of panic disorder and agoraphobia in Europe. European Neuropsychopharmacology, 15(4), 435–443.

    Article  PubMed  Google Scholar 

  • Grillon, C., Lissek, S., Rabin, S., McDowell, D., Dvir, S., & Pine, D. S. (2008). Increased anxiety during anticipation of unpredictable but not predictable aversive stimuli as a psychophysiologic marker of panic disorder. American Journal of Psychiatry, 165(7), 898–904.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hautzinger, M., Bailer, M., Worall, H., & Keller, F. (1994). Beck-depressions-inventar (BDI). Bearbeitung der deutschen Ausgabe. Testhandbuch. Bern: Huber.

    Google Scholar 

  • Heuser, I., Yassouridis, A., & Holsboer, F. (1994). The combined dexamethasone/CRH test: A refined laboratory test for psychiatric disorders. Journal of Psychiatric Research, 28(4), 341–356.

    Article  PubMed  Google Scholar 

  • Hollander, E., Liebowitz, M. R., Gorman, J. M., Cohen, B., Fyer, A., & Klein, D. F. (1989). Cortisol and sodium lactate—Induced Panic. Archives of General Psychiatry, 46(2), 135–140.

    Article  PubMed  Google Scholar 

  • Katerndahl, D. A. (2008). The association between panic disorder and coronary artery disease among primary care patients presenting with chest pain: An updated literature review. Primary Care Companion to The Journal of Clinical Psychiatry, 10(4), 276–285.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kemp, A. H., Quintana, D. S., Gray, M. A., Felmingham, K. L., Brown, K., & Gatt, J. M. (2010). Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biological Psychiatry, 67(11), 1067–1074.

    Article  PubMed  Google Scholar 

  • Kirschbaum, C., Pirke, K.-M., & Hellhammer, D. H. (1993). The ‘Trier Social Stress Test’–a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28(1–2), 76–81.

    PubMed  Google Scholar 

  • Klein, E., Cnaani, E., Harel, T., Braun, S., & Ben-Haim, S. A. (1995). Altered heart rate variability in panic disorder patients. Biological Psychiatry, 37(1), 18–24.

    Article  PubMed  Google Scholar 

  • Lehrer, P., & Leiblum, S. (1981). Physiological, medical, and cognitive measures of assertiveness and assertion anxiety. Behavioral Counseling Quarterly, 1(261), 274.

    Google Scholar 

  • Levin, A. P., Doran, A. R., Liebowitz, M. R., Fyer, A. J., Gorman, J. M., Klein, D. F., et al. (1987). Pituitary adrenocortical unresponsiveness in lactate-induced panic. Psychiatry Research, 21(1), 23–32.

    Article  PubMed  Google Scholar 

  • McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological Psychiatry, 52(10), 938–946.

    Article  PubMed  Google Scholar 

  • Middleton, H. C., Ashby, M., & Robbins, T. W. (1994). Reduced plasma noradrenaline and abnormal heart rate variability in resting panic disorder patients. Biological Psychiatry, 36(12), 847–849.

    Article  PubMed  Google Scholar 

  • Pellegrino, P. R., & Schiller, A. M. (2015). Letter to the editor: Does low-frequency power of heart rate variability correlate with cardiac sympathetic tone in normal sheep? American Journal of Physiology-Heart and Circulatory Physiology, 308(2), H146.

    Article  PubMed  PubMed Central  Google Scholar 

  • Petrowski, K., Herold, U., Joraschky, P., Mück-Weymann, M., & Siepmann, M. (2010). The effects of psychosocial stress on heart rate variability in panic disorder. German Journal of Psychiatry, 13(2), 66–73.

    Google Scholar 

  • Petrowski, K., Wintermann, G.-B., Kirschbaum, C., & Bornstein, S. R. (2012). Dissociation between ACTH and cortisol response in DEX–CRH test in patients with panic disorder. Psychoneuroendocrinology, 37(8), 1199–1208.

    Article  PubMed  Google Scholar 

  • Phebe, T., Adamson, P., Scarborough, A., Williams, D., Groff, J., & McClean, H. (1997). Paroxetine increases heart rate variability in panic disorder. Journal of Clinical Psychopharmacology, 17(5), 370–376.

    Article  Google Scholar 

  • Pohl, R., & Yeragani, V. K. (2001). QT interval variability in panic disorder patients after isoproterenol infusions. The International Journal of Neuropsychopharmacology, 4(01), 17–20.

    Article  PubMed  Google Scholar 

  • Ponikowski, P., Anker, S. D., Chua, T. P., Szelemej, R., Piepoli, M., Adamopoulos, S., et al. (1997). Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. The American journal of cardiology, 79(12), 1645–1650.

    Article  PubMed  Google Scholar 

  • Porges, S. W. (2011). The Polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation (Norton series on interpersonal neurobiology). New York: WW Norton & Company.

    Google Scholar 

  • Radespiel-Tröger, M., Rauh, R., Mahlke, C., Gottschalk, T., & Mück-Weymann, M. (2003). Agreement of two different methods for measurement of heart rate variability. Clinical Autonomic Research, 13(2), 99–102.

    Article  PubMed  Google Scholar 

  • Schreiber, W., Lauer, C. J., Krumrey, K., Holsboer, F., & Krieg, J.-C. (1996). Dysregulation of the hypothalamic-pituitary-adrenocortical system in panic disorder. Neuropsychopharmacology, 15(1), 7–15.

    Article  PubMed  Google Scholar 

  • Sinha, S. S., Coplan, J. D., Gorman, J. M., Pine, D. S., Martinez, J. A., & Klein, D. F. (1999). Panic induced by carbon dioxide inhalation and lack of hypothalamic–pituitary–adrenal axis activation. Psychiatry Research, 86(2), 93–98.

    Article  PubMed  Google Scholar 

  • Smit, F., Cuijpers, P., Oostenbrink, J., Batelaan, N., de Graaf, R., & Beekman, A. (2006). Costs of nine common mental disorders: Implications for curative and preventive psychiatry. Journal of Mental Health Policy and Economics, 9(4), 193–200.

    PubMed  Google Scholar 

  • Smoller, J. W., Pollack, M. H., Wassertheil-Smoller, S., Jackson, R. D., Oberman, A., Wong, N. D., et al. (2007). Panic attacks and risk of incident cardiovascular events among postmenopausal women in the Women’s Health Initiative Observational Study. Archives of General Psychiatry, 64(10), 1153–1160.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B., Gibbon, M., & First, M. B. (1992). The structured clinical interview for DSM-III-R (SCID): I: History, rationale, and description. Archives of General Psychiatry, 49(8), 624–629.

    Article  PubMed  Google Scholar 

  • Stein, M. B., & Asmundson, G. J. (1994). Autonomic function in panic disorder: Cardiorespiratory and plasma catecholamine responsivity to multiple challenges of the autonomic nervous system. Biological Psychiatry, 36(8), 548–558.

    Article  PubMed  Google Scholar 

  • Stein, P. K., & Kleiger, R. E. (1999). Insights from the study of heart rate variability. Annual Review of Medicine, 50(1), 249–261.

    Article  PubMed  Google Scholar 

  • Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). Heart rate variability. Standards of measurement, physiologic interpretation, and clinical use. Circulation, 93(5), 1043–1065.

    Article  Google Scholar 

  • Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61(3), 201–216.

    Article  PubMed  Google Scholar 

  • Thayer, J. F., & Lane, R. D. (2009). Claude Bernard and the heart–brain connection: Further elaboration of a model of neurovisceral integration. Neuroscience and Biobehavioral Reviews, 33(2), 81–88.

    Article  PubMed  Google Scholar 

  • Thayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2010). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International Journal of Cardiology, 141(2), 122–131.

    Article  PubMed  Google Scholar 

  • Wang, S.-M., Lee, H.-K., Kweon, Y.-S., Lee, C. T., Chae, J.-H., Kim, J.-J., et al. (2016). Effect of emotion regulation training in patients with panic disorder: Evidenced by heart rate variability measures. General Hospital Psychiatry, 40, 68–73.

    Article  PubMed  Google Scholar 

  • Winchell, R. J., & Hoyt, D. B. (1996). Spectral analysis of heart rate variability in the ICU: A measure of autonomic function. Journal of Surgical Research, 63(1), 11–16.

    Article  PubMed  Google Scholar 

  • Wittchen, H.-U. (1993). Strukturiertes klinisches Interview für DSM-III-R: SKID: Beltz.

  • Woodward, S. H., Arsenault, N. J., Voelker, K., Nguyen, T., Lynch, J., Skultety, K., et al. (2009). Autonomic activation during sleep in posttraumatic stress disorder and panic: A mattress actigraphic study. Biological Psychiatry, 66(1), 41–46.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yeragani, V. K., Balon, R., Pohl, R., & Ramesh, C. (1995a). Depression and heart rate variability. Biological Psychiatry, 38(11), 768–770.

    Article  PubMed  Google Scholar 

  • Yeragani, V. K., Balon, R., Pohl, R., Ramesh, C., Glitz, D., Weinberg, P., et al. (1990). Decreased R-R variance in panic disorder patients. Acta Psychiatrica Scandinavica, 81(6), 554–559.

    Article  PubMed  Google Scholar 

  • Yeragani, V. K., Berger, R., Pohl, R., Srinivasan, K., Balon, R., Ramesh, C., et al. (1992). Effects of yohimbine on heart rate variability in panic disorder patients and normal controls: A study of power spectral analysis of heart rate. Journal of Cardiovascular Pharmacology, 20(4), 609–618.

    Article  PubMed  Google Scholar 

  • Yeragani, V. K., Berger, R., Songer, D. A., & Yeragani, S. (1997). Power spectrum of the QRS complex in patients with panic disorder and normal controls. Psychiatry Research, 66(2), 167–174.

    Article  PubMed  Google Scholar 

  • Yeragani, V. K., Pohl, R., Berger, R., Balon, R., Ramesh, C., Glitz, D., et al. (1993). Decreased heart rate variability in panic disorder patients: A study of power-spectral analysis of heart rate. Psychiatry Research, 46(1), 89–103.

    Article  PubMed  Google Scholar 

  • Yeragani, V. K., Pohl, R., Srinivasan, K., Balon, R., Ramesh, C., & Berchou, R. (1995b). Effects of isoproterenol infusions on heart rate variability in patients with panic disorder. Psychiatry Research, 56(3), 289–293.

    Article  PubMed  Google Scholar 

  • Yeragani, V. K., Srinivasan, K., Balon, R., Ramesh, C., & Berchou, R. (1994). Lactate sensitivity and cardiac cholinergic function in panic disorder. American Journal of Psychiatry, 151(8), 1226–1228.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Katja Petrowski & Martin Siepmann

  2. Department of Psychology, Technische Universitaet Dresden, Dresden, Germany

    Susann Wichmann

  3. Department of Neurology, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany

    Timo Siepmann

  4. Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Gloria-Beatrice Wintermann

  5. Department of Internal Medicine, Technische Universitaet Dresden, Dresden, Germany

    Stefan R. Bornstein

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  1. Katja Petrowski
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  2. Susann Wichmann
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  3. Timo Siepmann
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  4. Gloria-Beatrice Wintermann
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  5. Stefan R. Bornstein
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  6. Martin Siepmann
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Correspondence to Katja Petrowski.

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All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Additional information

The original version of this article was revised: The co-author Gloria-Beatrice Wintermann was not listed in the author group. This has been corrected in this version.

An erratum to this article is available at http://dx.doi.org/10.1007/s10484-017-9357-1.

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Petrowski, K., Wichmann, S., Siepmann, T. et al. Effects of Mental Stress Induction on Heart Rate Variability in Patients with Panic Disorder. Appl Psychophysiol Biofeedback 42, 85–94 (2017). https://doi.org/10.1007/s10484-016-9346-9

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