Predictive Value of Heart Rate Measures on Posttraumatic Stress Disorder: A Critical Review of Select Recent Studies

Predictive Value of Heart Rate Measures on Posttraumatic Stress Disorder: A Critical Review of Select Recent Studies

Samantha L. Hemingway, M.A.

School of Psychology, Fielding Graduate University, 2020 De La Vina St, Santa Barbara, CA 93105

Posttraumatic stress disorder (PTSD) is characterized by maladaptive psychophysiological changes, such as a reduced vagal tone and hyperarousal, indicating autonomic nervous system dysfunction. In particular, physiological measures of heart rate, and heart rate variability (HRV) have been linked with PTSD expression, indicating that these measures may have diagnostic value. It remains unclear, however, whether altered heart rate and HRV contribute to the risk of PTSD development. This paper provides an overview of the present understanding of psychophysiological factors that may causally contribute to the manifestation of PTSD. The predictive value of heart rate and HRV measures are evaluated. The following sources of evidence are critically reviewed: relationships between momentary HRV components and PTSD symptom severity, predictions of PTSD development from post-trauma heart rate, and predictions of PTSD development from pre-trauma HRV. Available data challenge preliminary findings that abnormalities in heart rate and HRV currently offer reliable insight into PTSD development, but suggest that with additional research, there is a promising role for physiological biomarkers of autonomic dysregulation in risk prediction of future psychopathology.

Keywords: Posttraumatic stress disorder; Trauma; Heart rate; Heart rate variability; Psychophysiology; Autonomic nervous system; Risk

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How to cite this article:
Samantha L. Hemingway. Predictive Value of Heart Rate Measures on Posttraumatic Stress Disorder: A Critical Review of Select Recent Studies. International Journal of Psychological Research and Reviews, 2021; 4:44. DOI: 10.28933/ijprr-2020-12-1905


1. Adams, S. W., Allwood, M. A., & Bowler, R. M. (2019). Posttraumatic stress trajectories in world trade center tower survivors: Hyperarousal and emotional numbing predict symptom change: World trade center-related PTSD trajectories. Journal of Traumatic Stress, 32(1), 67–77.
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
3. Beauchaine, T. (2001). Vagal tone, development, and Gray’s motivational theory: Toward an integrated model of autonomic nervous system functioning in psychopathology. Development and Psychopathology, 13(2), 183–214.
4. Beauchaine, T. P., & Thayer, J. F. (2015). Heart rate variability as a transdiagnostic biomarker of psychopathology. International Journal of Psychophysiology, 98(2), 338–350.
5. Berntson, G. G., Bigger, J. T., Jr, Eckberg, D. L., Grossman, P., Kaufmann, P. G., Malik, M., Nagaraja, H. N., Porges, S. W., Saul, J. P., Stone, P. H., & van der Molen, M. W. (2007). Heart rate variability: Origins, methods, and interpretive caveats. Psychophysiology, 34(6), 623–648.
6. Billman G. E. (2011). Heart rate variability – a historical perspective. Frontiers in Physiology, 2(86), 1–3.
7. Careaga, M. B. L., Girardi, C. E. N., & Suchecki, D. (2016). Understanding posttraumatic stress disorder through fear conditioning, extinction and reconsolidation. Neuroscience and Biobehavioral Reviews, 71, 48–57.
8. Carnevali, L., Koenig, J., Sgoifo, A., & Ottaviani, C. (2018). Autonomic and brain morphological predictors of stress resilience. Frontiers in Neuroscience, 12, 1–13.
9. Carter, J. R., & Goldstein, D. S. (2015). Sympathoneural and adrenomedullary responses to mental stress. Comprehensive Physiology, 5(1), 119–146.
10. 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), 1–11.
11. Chou, C., Marca, R. L., Steptoe, A., & Brewin, C. R. (2014). Heart rate, startle response, and intrusive trauma memories. Psychophysiology, 51(3), 236–246.
12. Chou, C., Marca, R. L., Steptoe, A., & Brewin, C. R. (2018). Cardiovascular and psychological responses to voluntary recall of trauma in posttraumatic stress disorder. European Journal of Psychotraumatology, 9(1472988), 1–13.
13. Clausen, A. N., Francisco, A. J., Thelen, J., Bruce, J., Martin, L. E., McDowd, J., Simmons, W. K., & Aupperle, R. L. (2017). PTSD and cognitive symptoms relate to inhibition‐related prefrontal activation and functional connectivity. Depression and Anxiety, 34(5), 427–436.
14. 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.
15. Dennis, P. A., Dedert, E. A., Van Voorhees, E. E., Watkins, L. L., Hayano, J., Calhoun, P. S., Sherwood, A., Dennis, M. F., & Beckham, J. C. (2016). Examining the crux of autonomic dysfunction in posttraumatic stress disorder: Whether chronic or situational distress underlies elevated heart rate and attenuated heart rate variability. Psychosomatic Medicine, 78(7), 805–809.
16. Dennis, P. A., Watkins, L. L., Calhoun, P. S., Oddone, A., Sherwood, A., Dennis, M. F., Rissling, M. B., & Beckham, J. C. (2014). Posttraumatic stress, heart rate variability, and the mediating role of behavioral health risks. Psychosomatic medicine, 76(8), 629–637.
17. Ehlers, A., Suendermann, O., Boellinghaus, I., Vossbeck-Elsebusch, A., Gamer, M., Briddon, E., Martin, M. W., & Glucksman, E. (2010). Heart rate responses to standardized trauma-related pictures in acute posttraumatic stress disorder. International Journal of Psychophysiology, 78(1), 27–34.
18. Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6(4), 459–473.
19. Foa, E. B., & Rothbaum, B. O. (2001). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.
20. Fulton, J. J., Calhoun, P. S., Wagner, H. R., Schry, A. R., Hair, L. P., Feeling, N., Elbogen, E., & Beckham, J. C. (2015). The prevalence of posttraumatic stress disorder in operation enduring freedom/operation Iraqi freedom (OEF/OIF) veterans: A meta-analysis. Journal of Anxiety Disorders, 31, 98–107.
21. Ge, F., Yuan, M., Li, Y., & Zhang, W. (2020). Posttraumatic stress disorder and alterations in resting heart rate variability: A systematic review and meta-analysis. Psychiatry Investigation, 17(1), 9–20.
22. Gillie, B. L, & Thayer J. F. (2014). Individual differences in resting heart rate variability and cognitive control in posttraumatic stress disorder. Frontiers in Psychology, 5, 758.
23. Green, K. T., Dennis, P. A., Neal, L. C., Hobkirk, A. L., Hicks, T. A., Watkins, L. L., Hayano, J., Sherwood, A., Calhoun, P. S., & Beckham, J. C. (2016). Exploring the relationship between posttraumatic stress disorder symptoms and momentary heart rate variability. Journal of Psychosomatic Research, 82, 31–34.
24. Goodman, B. F., & Griffin, M. G. (2018). Prospectively predicting PTSD status with heart rate reactivity and recovery in interpersonal violence survivors. Psychiatry Research, 259, 270–276.
25. Haag, K., Hiller, R., Peyk, P., Michael, T., Meiser-Stedman, R., Fearon, P., Ehlers, A., & Halligan, S. L. (2019). A longitudinal examination of heart-rate and heart rate variability as risk markers for child posttraumatic stress symptoms in an acute injury sample. Journal of Abnormal Child Psychology, 47(11), 1811–1820.
26. Lee, S. M., Han, H., Jang, K., Huh, H. J., Huh, S., Joo, J., & Chae, J. (2018). Heart rate variability associated with posttraumatic stress disorder in victims’ families of Sewol ferry disaster. Psychiatry Research, 259, 277–282.
27. Lehavot, K., Katon, J. G., Chen, J. A., Fortney, J. C., Simpson, T. L. (2018) Post-traumatic stress disorder by gender and veteran status. American Journal of Preventative Medicine, 54(1), e1–e9.
28. Levine, A., B., Levine, L. M., & Levine, T. B. (2014). Posttraumatic stress disorder and cardiometabolic disease. Cardiology, 127, 1–19.
29. Lakusic, N., Fuckar, K., Mahovic, D., Cerovec, D., Majsec, M., & Stancin, N. (2007). Characteristics of heart rate variability in war veterans with post-traumatic stress disorder after myocardial infarction. Military Medicine, 172(11), 1190–1193.
30. Malik, M., Bigger, J. T., Camm, A. J., Kleiger, R. E., Malliani, A., Moss, A. J., & Schwartz, P. J. (1996). Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. European Heart Journal, 17(3), 354–381.
31. Marshall, G. N., Jaycox, L. H., Engel, C. C., Richardson, A. S., Dutra, S. J., Keane, T. M., Rosen, R. C., & Marx, B. P. (2019). PTSD symptoms are differentially associated with general distress and physiological arousal: Implications for the conceptualization and measurement of PTSD. Journal of Anxiety Disorders, 62, 26–34.
32. McCorry L. K. (2007). Physiology of the autonomic nervous system. American Journal of Pharmaceutical Education, 71(4), 1–11.
33. McKinnon, M. C., Boyd, J. E., Frewen, P. A., Lanius, U. F., Jetly, R., Richardson, J. D., & Lanius, R. A. (2016). A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions. Neuropsychologia, 90, 210–234.
34. Minassian, A., Maihofer, A. X., Baker, D. G., Nievergelt, M., Geyer, M. A., & Risbrough, V. B. (2015). Association of predeployment heart rate variability with risk of postdeployment posttraumatic stress disorder in active-duty marines. JAMA Psychiatry, 72(10), 979–986.
35. Morris, M. C., Hellman, N., Abelson, J. L., & Rao, U. (2016). Cortisol, heart rate, and blood pressure as early markers of PTSD risk: A systematic review and meta-analysis. Clinical Psychology Review, 49, 79–91.
36. Murdoch, M., Spoont, M. R., Kehle-Forbes, S. M., Harwood, E. M., Sayer, N. A., Clothier, B. A., & Bangerter, A. K. (2017). Persistent serious mental illness among former applicants for VA PTSD disability benefits and long-term outcomes: Symptoms, functioning, and employment: Serious mental illness in PTSD-disabled veterans. Journal of Traumatic Stress, 30(1), 36–44.
37. Nöthling, J., Lammers, K., Martin, L., & Seedat, S. (2015). Traumatic dissociation as a predictor of posttraumatic stress disorder in South African female rape survivors. Medicine, 94(16), e744.
38. Park, J. E., Lee, J. Y., Kang, S., Choi, J. H., Kim, T. Y., So, H. S., & Yoon, I. (2017). Heart rate variability of chronic posttraumatic stress disorder in the Korean veterans. Psychiatry Research, 255, 72–77.
39. Price, M., Kearns, M., Houry, D., & Rothbaum, B. O. (2014). Emergency department predictors of posttraumatic stress reduction for trauma-exposed individuals with and without an early intervention. Journal of Consulting and Clinical Psychology, 82(2), 336–341.
40. Quintana, D. S., Alvares, G. A., & Heathers, J. A. (2016). Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH): Recommendations to advance research communication. Translational Psychiatry, 6(5), e803.
41. Rahman, F., Pechnik, S., Gross, D., Sewell, L., & Goldstein, D. S. (2011). Low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Clinical Autonomic Research, 21(3), 133–141.
42. Remch, M., Laskaris, Z., Flory, J., Mora-McLaughlin, C., & Morabia, A. (2018). Post-traumatic stress disorder and cardiovascular diseases: A cohort study of men and women involved in cleaning the debris of the world trade center complex. Cardiovascular Quality and Outcomes, 11(7), e004572-e004572.
43. Rissling, M. B., Dennis, P. A., Watkins, L. L., Calhoun, P. S., Dennis, M. F., Beckham, J. C., Hayano, J., Ulmer, C. S. (2016). Circadian contrasts in heart rate variability associated with posttraumatic stress disorder symptoms in a young adult cohort. Journal of Traumatic Stress, 29(5), 415¬–421.
44. Santiago, P. N., Ursano, R. J., Gray, C. L., Pynoos, R. S., Spiegel, D., Lewis-Fernandez, R., Friedman, M. J., & Fullerton, C. S. (2014). A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: Intentional and non-intentional traumatic events. PloS one, 8(4), e59236.
45. Schiweck, C., Piette, D., Berckmans, D., Claes, S., & Vrieze, E. (2019). Heart rate and high frequency heart rate variability during stress as biomarker for clinical depression. A systematic review. Psychological Medicine, 49(2), 200–211.
46. Schmidt, U., Willmund, G. D., Holsboer, F., Wotjak, C. T., Gallinat, J., Kowalski, J. T., & Zimmermann, P. (2015). Searching for non-genetic molecular and imaging PTSD risk and resilience markers: Systematic review of literature and design of the German Armed Forces PTSD biomarker study. Psychoneuroendocrinology, 51, 444–458.
47. Shaffer, F., & Ginsberg, J. (2017). An overview of heart rate variability metrics and norms. Frontiers in Public Health, 5(258), 1–17.
48. Shaffer, F., McCraty, R., & Zerr, C. L. (2014). A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Frontiers in Psychology, 5(1040), 1–19.
49. Shah, A. J., Lampert, R., Goldberg, J., Veledar, E., Bremner, J. D., & Vaccarino, V. (2013). Posttraumatic stress disorder and impaired autonomic modulation in male twins. Biological Psychiatry, 73(11), 1103–1110.
50. Shah, A., & Vaccarino, V. (2015). Heart rate variability in the prediction of risk for posttraumatic stress disorder. JAMA Psychiatry, 72(10), 964–965.
51. Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: The neurobiological impact of psychological trauma. Dialogues in clinical neuroscience, 13(3), 263–278.
52. Tan, G., Dao, T. K., Farmer, L., Sutherland, R. J., & Gevirtz, R. (2011). Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study. Applied Physiological Biofeedback, 36(1), 27–35.
53. 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.
54. Tucker, P., Pfefferbaum, B., Jeon-Slaughter, H., Khan, Q., & Garton, T. (2012). Emotional stress and heart rate variability measures associated with cardiovascular risk in relocated Katrina survivors. Psychosomatic medicine, 74(2), 160–168.
55. Wahbeh, H., & Oken, B. S. (2013). Peak high-frequency HRV and peak alpha frequency higher in PTSD. Applied Psychophysiology and Biofeedback, 38(1), 57–69.
56. Won, E., & Kim, Y. K. (2016). Stress, the autonomic nervous system, and the immune-kynurenine pathway in the etiology of depression. Current Neuropharmacology, 14(7), 665–673.×14666151208113006
57. Yehuda, R., McFarlane, A. C., & Shalev, A. Y. (1998). Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event. Biological Psychiatry, 44(12), 1305–1313.
58. Ziegler, M. G. (2012). Psychological stress and the autonomic nervous system. In D. Robertson, I. Biaggioni, G. Burnstock, P. A. Low, & J. F. R. Paton (Eds.), Primer on the autonomic nervous system (3rd ed., pp. 291–293). Elsevier Inc. https:doi/org/10.1016/B978-0-12-386525-0.00061-5

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