Nijdam, S.A. (2013) Fluctuations in Anxiety Symptoms and Heart Rate Variability in Patients With Panic Disorder With Agoraphobia: Application of Time Series Analysis During Individual Treatment. thesis, Medicine.
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Abstract
Background: The relationship between anxiety and heart rate variability (HRV) is bidirectional. HRV can be used as a marker for an individual’s capacity to regulate their emotions (anxiety symptoms), and anxiety symptoms have been associated with cardiovascular responses (HRV). Bidirectional relationships have also been found between anxiety symptoms and experienced stress. These findings mainly resulted from statistical analyses in which groups were compared with each other. This nomothetic approach leads to conclusions that apply to the average group member but are not necessarily generalizable to individual patients. Objective: In the first study in this thesis a relatively new methodological approach (the idiographic approach) is used to unravel the bidirectional relationship between anxiety symptoms and HRV within individuals. In the second part of the thesis the same methodological approach was used to unravel the bidirectional relationship between anxiety and stress. The primary aim of the studies conducted in this thesis was to elucidate the directionality of these associations, and the individual differences herein. Methods: A maximum of three patients with panic disorder with agoraphobia, would have been intensively measured with an ECG device and a paper diary for two separate weeks (before and after their treatment, and less intensively during their treatment). The two intensive weeks consisted out of seven, 24-h measurements of HRV with an ambulatory ECG device and diary entries every 3 hours to assess fluctuations in anxiety symptoms. During the treatment only a paper diary was needed to be filled out three times a day. Unfortunately no patients could be included in the given amount of time. Data analyses using vector autoregression (VAR-analyses) were therefore performed on anxiety and stress data from an existing dataset. In this dataset stress and anxiety was measured for twelve weeks, two times a day. Out of this dataset two participants were selected and time series analyses were done with a 24-h time interval. Results: Since no data were collected, no conclusions can be drawn for the first study of the thesis. In the second study, significant relationships were found between stress and anxiety. These directionality relationships differed strongly in each participant in different time lags. In one participant a positive autocorrelation was found for anxiety in the first lag, and a positive stress in the fifth lag. A positive correlation was found between stress and anxiety in the second lag. No relationship was found between anxiety and stress. In the other participant a positive autocorrelation was found for stress in the first lag and anxiety in the second, and a positive correlation was found between anxiety and stress in the second lag, and between stress and anxiety in the first lag. Conclusion: Findings of this study demonstrate that the idiographic design is suitable for detecting unique individual pathways in stress and anxiety. Use of this kind of study design is useful for the scientific community for creating new insights into the causes and consequences of day to day fluctuations of anxiety symptoms, and may be helpful to create more patient specific treatments.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Riese, Dr. H. and Schoevers, Prof. Dr. R.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2310 |
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