Elsevier

Biological Psychology

Volume 90, Issue 1, April 2012, Pages 105-111
Biological Psychology

Cardiac vagal control as a prospective predictor of anxiety in women diagnosed with breast cancer

https://doi.org/10.1016/j.biopsycho.2012.02.019Get rights and content

Abstract

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 (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.

Highlights

► Low cardiac vagal control is associated with anxiety. ► Cardiac vagal control is examined as a predictor of anxiety in breast cancer. ► Participants with higher baseline RSA evidence a decrease in anxiety. ► Participants with lower baseline RSA evidence an increase in anxiety. ► Cardiac vagal control may facilitate modulation of anxiety in coping with illness.

Section snippets

Study design

The present study added a specific aim to a larger prospective, longitudinal investigation of the association of close personal relationships with biobehavioral outcomes in patients newly diagnosed with breast cancer. This aim was based on the literature reviewed above, to test the hypothesis that higher baseline RSA would predict a more beneficial trajectory of change in anxiety whereas lower baseline RSA would predict an increase in anxiety over the ensuing year.

The participants were

Self-report measures

Participants completed questionnaires at the initial visit and then again approximately every 3 months. Data collected every 3 months for up to a year after the initial visit (up to 5 assessments) were used in the analyses. Some subjects missed one or more assessments due to illness related constraints or other factors. The participants filled out a short version of the Taylor Manifest Anxiety Scale (TMAS; Bendig, 1956), which has been shown to have a comparable reliability to the longer

Statistical analyses

RSA was examined as a predictor of change in anxiety as measured by TMAS over the year following the initial ECG assessment. One RSA assessment obtained at baseline and up to five self-report assessments of stress and anxiety obtained approximately every 3 months were used in analyses. Demographic and treatment variables (race, ethnicity, education, marital status, disease severity, current disease status, type of treatment, time from diagnosis to initial assessment, use of antidepressant

RSA and age

A preliminary analysis revealed the expected significant negative correlation between RSA and age (r = −.48, p < .01), consistent with that reported in the RSA literature (Masi et al., 2007, DeMeersman and Stein, 2007). Because of this association, RSA values were age-adjusted to account for age-related variance in RSA, and age-adjusted values were used in all subsequent analyses. Age at recruitment was entered in a regression model as a predictor of RSA, and non-standardized residuals were

Cardiac vagal control as a predictor of anxiety

Consistent with the study hypothesis, the results of this study indicated that RSA at baseline was significantly and prospectively associated with the trajectory of change in anxiety over the follow-up period, such that those participants with higher baseline RSA evidenced a decrease in anxiety, whereas participants with lower baseline RSA were more likely to have increasing anxiety during the follow-up period. This suggests that RSA may index the ability to modulate anxiety in this sample of

Study limitations

One of the limitations of this study is a relatively small sample size. More than half of the participants in the parent study used medications with anticholinergic properties or medications with a general effect on cardiac functioning (i.e., medications for hypertension); therefore, many of the participants were excluded from analyses since the effect of these medications could potentially obfuscate the RSA assessment. Another important limitation in the present study was heterogeneity in

Conclusion

The present study revealed promising findings in a relatively small but clinically relevant sample of women following the diagnosis of breast cancer. These findings suggest that future investigations might examine the extent to which higher vagal control would be similarly associated with a more favorable trajectory in other stressful medical conditions. Moreover, the findings suggest that the role of CVC in adjustment and coping with illness might provide important implications for clinical

Acknowledgements

The authors are grateful to Laura Eparvier, RN, for data collection and management of the study, to Roisin O’Donnell, BA, and Amanda Brody, MA, for their work on the ECG data reduction, and to Jean Lynne, RN, Christina Kim, MD, Michele Ley, MD, and Amy Waer, MD, for referring their breast cancer patients to the study.

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    Work supported by USA Med Research & Materiel Command, Breast Cancer Research Program. Award Type/#: W81XWH-04-1-0603 - Idea Award to Karen Weihs.

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