ardiac vagal control as a prospective predictor of anxiety in women diagnosed ith breast cancer

Low cardiac vagal control (CVC) has been associated with state and trait anxiety and anxiety spectrum disorders. Studies indicate that diagnosis and treatments for breast cancer may be associated with anxiety. The current study examined whether CVC prospectively predicted a trajectory of change in anxiety following breast cancer diagnosis. Forty-three women diagnosed with non-metastatic breast cancer completed the Taylor Manifest Anxiety Scale and the Perceived Stress Scale, and a 5-min resting electrocardiographic espiratory sinus arrhythmia ardiac vagal control eart rate variability nxiety reast cancer olyvagal theory (ECG) segment was recorded. Self-report measures were completed approximately every 3 months for a year. Respiratory sinus arrhythmia (RSA) significantly predicted the trajectory of change in anxiety over the follow-up period: participants with higher baseline RSA evidenced decreasing anxiety, whereas those with lower baseline RSA had increasing anxiety. These results are consistent with the hypothesis that CVC facilitates the modulation of anxiety in women coping with significant stressors of breast cancer diagnosis and treatment. Cardiac vagal control (CVC), as measured by respiratory sinus rrhythmia (RSA), has been proposed as one of the indices of emoion regulation (Porges, 1995, 1997, 2007). In the literature, CVC as been found to predict outcomes in a variety of psychiatric (e.g., eauchaine, 2001; Chambers and Allen, 2002; Licht et al., 2008) and edical conditions (e.g., Lindmark et al., 2003; Licht et al., 2010; asi et al., 2007; Vanninen et al., 1993). Data suggest that higher esting RSA is associated with positive emotionality (Oveis et al., 009), social engagement (Horsten et al., 1999), and coping with ife stressors (Fabes and Eisenberg, 1997). RSA, a measure of heart rate variability related to respiration, as been conceptualized as an index of physiological and psyhological flexibility (Friedman and Thayer, 1998). RSA has been roposed to reflect integration and efficiency of central-peripheral eural feedback mechanisms implicated in flexibility and ability o adjust to environmental demands (Friedman, 2007). Given that nxiety is often marked by quick activation of threat responses and oor inhibition, this theoretical framework suggests reduced RSA in nxiety. Consistent with this view, studies indicate that low RSA is Work supported by USA Med Research & Materiel Command, Breast Cancer esearch Program. Award Type/#: W81XWH-04-1-0603 Idea Award to Karen eihs. ∗ Corresponding author. Tel. : +1 520 621 7086; fax: +1 520 621 9306. E-mail addresses: apovzner@email.arizona. edu (A.V. Kogan), allen@u.arizona. edu (J.J.B. Allen), weihs@email.arizona. edu (K.L. Weihs). 301-0511/$ – see front matter © 2012 Elsevier B.V. All rights reserved. oi:10.1016/j.biopsycho. 2012.02. 019 © 2012 Elsevier B.V. All rights reserved. associated with clinical forms of anxiety, as well as state and trait anxiety (Cohen and Benjamin, 2006; Friedman, 2007). In a study of adolescents (Greaves-Lord et al., 2010), lower baseline RSA was predictive of anxiety in girls 2 years later. There are reports of a negative association between RSA and trait anxiety in healthy individuals (Fuller, 1992; Watkins et al., 1998). Among college students, reduced RSA during sleep was associated with self-reported state anxiety (Sakakibara et al., 2008). There is evidence indicating that reduced RSA is also associated with both trait (Delgado et al., 2009) and state worry (Hofmann et al., 2005). Additionally, lower RSA has been detected in individuals diagnosed with posttraumatic stress disorder (Blechert et al., 2007; Jovanovic et al., 2009; Woodward et al., 2009) and other anxiety disorders (Johnsen et al., 2003; Licht et al., 2009) as compared to healthy controls. Despite numerous examinations of CVC and anxiety-related phenomena, CVC has been understudied in cancer patients. Despite improvements in cancer treatments, breast cancer remains a life-threatening condition and cancer patients often experience emotional turmoil and symptoms of depression and anxiety immediately after the diagnosis (Derogatis et al., 1983; Ganz et al., 1998; Nosarti et al., 2002; Palesh et al., 2006; Spiegel and GieseDavis, 2003; Zabora et al., 2001). Even though studies of women with metastatic breast cancer identified the association between reduced RSA and depression (Giese-Davis et al., 2006) as well as sleep disruptions (Palesh et al., 2008), to date, there are no prospective studies examining whether CVC, as indexed by RSA, is associated with differences in coping with non-metastatic breast