Examining the Crux of Autonomic Dysfunction in Posttraumatic Stress Disorder: Whether Chronic or Situational Distress Underlies Elevated Heart Rate and Attenuated Heart Rate Variability

Abstract

Objective Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart-rate variability (HRV) in cross-sectional research. Using ecological momentary assessment (EMA) and minute-to-minute HRV/HR monitoring, we examined whether cross-sectional associations between PTSD symptom severity and HRV/HR were due to overall elevations in distress levels or to attenuated autonomic regulation during episodes of acute distress. Methods Two hundred nineteen young adults (18–39 years old), 99 with PTSD, underwent one day of Holter monitoring and concurrently reported distress levels via EMA. Using multilevel modeling, we examined the associations between momentary distress and the 5-minute means for low-frequency (LF) and high-frequency (HF) HRV and HR immediately following distress ratings, and whether PTSD symptom severity moderated these associations. Results Compared to controls, participants with PTSD recorded higher ambulatory distress (M=1.7±SD=0.5 vs. 1.2±0.3, p < .001) and HR (87.2±11.8 vs. 82.9±12.6 bpm, p = .011), and lower ambulatory LF HRV (36.9±14.7 vs. 43.7±16.9 ms, p = .002) and HF HRV (22.6±12.3 vs. 26.4±14.6 ms, p = .043). Overall distress level was not predictive of HR or HRV (ps > .27). However, baseline PTSD symptom severity was associated with elevated HR, t(1257) = 2.76, p = .006, and attenuated LF, t(1257) = −3.86, p < .001, and HF, t(1257) = −2.62, p = .009, in response to acute momentary distress. Conclusions Results suggest that PTSD is associated with heightened arousal following situational distress and could explain prior findings associating PTSD with HR/HRV. Implications for treatment and cardiovascular risk are discussed.

Characterizing anger-related affect in individuals with posttraumatic stress disorder using ecological momentary assessment

“…Research has linked hostility in individuals with PTSD to physiological hyperarousal (Beckham et al, 2009, 2002; Vrana et al, 2009), and improved arousal regulation has been found to be the one of the primary mechanisms of change in anger management therapy for veterans with PTSD (Mackintosh et al, 2014a, 2014b). Considered in the context of these prior studies, our findings may suggest that directly targeting the PTSD-related physiological arousal (Beckham et al, 2009, 2002; Dennis et al, 2016, 2017; Mackintosh et al, 2014a, 2014b; Vrana et al, 2009) and hostile cognitions (Van Voorhees et al, 2016) that contribute to irritability and anger may be an important part of a holistic approach to minimizing the functional impact of the disorder. Current empirically support therapies specifically target the avoidance symptoms that are understood to maintain PTSD (Cahill et al, 2003; Foa et al, 2006; Resick et al, 2010), while less attention is given to directly targeting physiological arousal and hostile interpersonal attributions cued by trauma triggers.…”

Trauma and Autonomic Dysregulation: Episodic—Versus Systemic—Negative Affect Underlying Cardiovascular Risk in Posttraumatic Stress Disorder

“…The present paper builds on prior publications from on a broader study examining health risks associated with PTSD in young adults (6, 17–21). For the present analysis, potential participants were 211 young adults (18–39 years old), 93 of whom (44%) met DSM-IV criteria for PTSD.…”

Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: a meta-analysis

“…Moreover, PTSD measure (clinical interview v. self-report) was examined. PTSD symptom severity might be connected to diminished LF-HRV and HF-HRV in acute distress (Dennis et al, 2016 ), thus constituting potential moderators. Furthermore, medication use and comorbidities were examined as moderators.…”

“…Alterations in arousal may also change cardiovascular stress activity and reactivity. This can lead to either increased or blunted responsiveness of individuals with PTSD to challenging and stressful tasks (Cohen et al, 2000 ; Dennis et al, 2016 ; Jovanovic, Norrholm, Sakoman, Esterajher, & Kozarić-Kovačić, 2009 ).…”