An autonomic flexibility–neurovisceral integration model of anxiety and cardiac vagal tone

Research on heart rate variability (HRV), cardiac vagal tone, and their relationship to anxiety is reviewed in the context of the autonomic flexibility and neurovisceral integration models of adaptive functioning. These perspectives address the qualities of response flexibility and inhibition across multiple levels, incorporating central and autonomic nervous system mechanisms of environmental engagement, as well as principles derived from non-linear dynamics. These models predict reduced HRV and vagal tone in anxiety, and the literature has generally supported this prediction, with exceptions as are noted. State, trait, and clinical expressions of anxiety are considered, along with the clinical, methodological, and theoretical implications of this research. A portrayal of anxiety as a restricted response range across biological and behavioral realms of functioning is drawn from the literature on anxiety and HRV.