Anxiety Mood.  2025 Apr;21(1):1-9. 10.24986/anxmod.2025.21.1.001.

Understanding Heart Rate Variability and Its Application in the Assessment and Treatment of Anxiety Disorders

• Kang JI

• KMID: 2568057
• DOI: http://doi.org/10.24986/anxmod.2025.21.1.001

Abstract

Anxiety disorders are among the most prevalent psychiatric disorders worldwide. The importance of neurophysiological markers in their diagnosis and treatment is increasing. This review aims to explore character- istics of heart rate variability (HRV), a physiological marker that reflects the balance of the autonomic ner- vous system, and its relevance to anxiety disorders. Additionally, it discusses how HRV measurements can be practically applied in the assessment and treatment of anxiety disorders. HRV has been subjected to timedomain analysis, frequency-domain analysis, and non-linear analysis. Numerous studies have reported re- duced HRV and changes in its indexes for patients with anxiety disorders, although findings have been inconsistent. Particularly, HRV indexes that reflect low parasympathetic nervous system activity could be used to understand biological characteristics in the assessment and treatment of pathologic anxiety as a transdiagnostic biomarker of anxiety disorders. HRV biofeedback training has shown promising effects in alleviating anxiety symptoms and restoring autonomic balance, positioning it as a potentially important therapeutic intervention for anxiety regulation and management. With recent advancements in digital therapeutics, HRV- based interventions are becoming increasingly accessible. However, individual differences in HRV, influence of various confounding variables observed in HRV research, complexities of study design, and limited speci- ficity of HRV for psychiatric diagnoses hinder its clinical application. This paper highlights the potential role of HRV in the assessment and treatment of anxiety disorders and proposes directions for future research.

Keyword

Heart rate variability; Anxiety; Autonomic nervous system; Biomarker; Biofeedback