Anxiety Mood.  2024 Oct;20(2):35-40. 10.24986/anxmod.2024.20.2.001.

Heart Rate Variability Reactivity and Avoidance in Social Anxiety Disorder

• Kim SW
• Lee D
• Kim JH
• Kwak SJ
• Kang DH
• Choi SH
• Kim SY

• KMID: 2561315
• DOI: http://doi.org/10.24986/anxmod.2024.20.2.001

Abstract

Objective
: Reduced resting heart rate variability (HRV) is well-documented in anxiety and mood disorders; however, limited research exists on HRV reactivity during emotional processing. This study examined HRV reactivity to angry faces in social anxiety disorder (SAD) patients and its association with symptom severity.
Methods
: Twenty-six SAD patients and 35 controls participated. HRV was measured using the root mean square of successive differences (RMSSD). RMSSD reactivity was calculated by subtracting RMSSD during angry and neutral face processing from baseline RMSSD. Group differences in RMSSD reactivity and its relationship with social anxiety symptoms were analyzed.
Results
: SAD patients exhibited lower RMSSD reactivity compared to controls during both angry (t_54.829 = 3.03, p=0.004) and neutral face processing (t_52.877 =2.18, p=0.034). In the SAD group, RMSSD reactivity dur- ing angry face processing significantly explained variance in performance avoidance subscale scores of the Liebowitz Social Anxiety Scale (R² =0.208, β=-0.456, F_1,23 =6.054, p=0.022).
Conclusion
: Reduced HRV reactivity in SAD may reflect impaired autonomic flexibility and difficulty responding to emotionally relevant stressors. Lower HRV reactivity is associated with greater symptom se- verity, specifically performance-related avoidance, highlighting HRV’s potential as a physiological marker for identifying specific symptoms in SAD.

Keyword

Social anxiety disorder; Heart Rate Variability; HRV reactivity; Performance avoidance