A Comprehensive Review of Psychophysiological Applications for Ecological Momentary Assessment in Psychiatric Populations

Psychophysiological assessment is a core method used in psychopathology research that has led to important insights in relation to the etiology and maintenance of many disorders. However, laboratory psychophysiology has limited ecological validity. This limitation has resulted in the field moving toward ambulatory recordings of psychophysiology paired with ecological momentary assessment (EMA). This review uses the results of a comprehensive review of EMA psychophysiology studies to discuss applications, advantages, limitations, and future use of this methodology, including electrocardiography, blood pressure, electroencephalography, and more. Mobile psychophysiology has several advantages, including ecological validity, temporal precision, and concurrent evaluation of internally and externally generated contexts that influence physiological response. However, it is limited by the difficulty of conducting such studies and reduced experimental control. Future research using EMA psychophysiology should aim to record over longer periods, better integrate with everyday life, determine the utility of ecological momentary interventions based on psychophysiology, create guidelines for standardization, and aim to establish reliability and validity. EMA psychophysiology is a promising direction for the field and provides novel avenues for research and treatment of psychopathology, although methodological shortcomings must be addressed.

[1]  T. Wykes,et al.  Using wearable technology to detect the autonomic signature of illness severity in schizophrenia , 2017, Schizophrenia Research.

[2]  Nicholas Tarrier,et al.  Autonomic Regulation and Auditory Hallucinations in Individuals With Schizophrenia: An Experience Sampling Study , 2017, Schizophrenia bulletin.

[3]  A. Sherwood,et al.  Trauma and Autonomic Dysregulation: Episodic—Versus Systemic—Negative Affect Underlying Cardiovascular Risk in Posttraumatic Stress Disorder , 2017, Psychosomatic medicine.

[4]  Shamim Nemati,et al.  Heart rate-based window segmentation improves accuracy of classifying posttraumatic stress disorder using heart rate variability measures , 2017, Physiological measurement.

[5]  Enzo Pasquale Scilingo,et al.  Longitudinal monitoring of heartbeat dynamics predicts mood changes in bipolar patients: A pilot study. , 2017, Journal of affective disorders.

[6]  Nicholas Tarrier,et al.  The optimisation of experience sampling protocols in people with schizophrenia , 2016, Psychiatry Research.

[7]  M. Dennis,et al.  Circadian Contrasts in Heart Rate Variability Associated With Posttraumatic Stress Disorder Symptoms in a Young Adult Cohort. , 2016, Journal of traumatic stress.

[8]  A. Sherwood,et al.  Examining the Crux of Autonomic Dysfunction in Posttraumatic Stress Disorder: Whether Chronic or Situational Distress Underlies Elevated Heart Rate and Attenuated Heart Rate Variability , 2016, Psychosomatic medicine.

[9]  A. Schwerdtfeger,et al.  When rumination counts: Perceived social support and heart rate variability in daily life. , 2016, Psychophysiology.

[10]  D. Nutt,et al.  Reduced heart rate variability in remitted bipolar disorder and recurrent depression , 2016, The Australian and New Zealand journal of psychiatry.

[11]  Julian F. Thayer,et al.  Prolonged Non-metabolic Heart Rate Variability Reduction as a Physiological Marker of Psychological Stress in Daily Life , 2016, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[12]  Eva-Maria Rathner,et al.  The ecological validity of the autonomic-subjective response dissociation in repressive coping , 2016, Anxiety, stress, and coping.

[13]  R. Sinha,et al.  Cumulative stress and autonomic dysregulation in a community sample , 2016, Stress.

[14]  Enzo Pasquale Scilingo,et al.  Predicting mood changes in bipolar disorder through heartbeat nonlinear dynamics: A preliminary study , 2015, 2015 Computing in Cardiology Conference (CinC).

[15]  M. Faurholt-Jepsen,et al.  State-related differences in the level of psychomotor activity in patients with bipolar disorder – Continuous heart rate and movement monitoring , 2016, Psychiatry Research.

[16]  A. Sherwood,et al.  Exploring the relationship between posttraumatic stress disorder symptoms and momentary heart rate variability. , 2016, Journal of psychosomatic research.

[17]  Kevin Kampschroer,et al.  Gender differences in the impact of daily sadness on 24-h heart rate variability. , 2015, Psychophysiology.

[18]  D. Johnston,et al.  Stressors, Appraisal of Stressors, Experienced Stress and Cardiac Response: A Real-Time, Real-Life Investigation of Work Stress in Nurses , 2015, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[19]  J. Gruber,et al.  Heart rate variability as a potential indicator of positive valence system disturbance: A proof of concept investigation. , 2015, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[20]  J. Thayer,et al.  Heart rate variability as a transdiagnostic biomarker of psychopathology. , 2015, International Journal of Psychophysiology.

[21]  X. Bornas,et al.  Ecological assessment of heart rate complexity: Differences between high- and low-anxious adolescents. , 2015, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[22]  E. D. de Geus,et al.  Psychological Distress and Physiological Reactivity During In Vivo Exposure in People With Aviophobia , 2015, Psychosomatic medicine.

[23]  F. Wilhelm,et al.  Metabolic decoupling in daily life in patients with panic disorder and agoraphobia. , 2015, Journal of psychiatric research.

[24]  W. Chaplin,et al.  Self-Esteem and the Acute Effect of Anxiety on Ambulatory Blood Pressure , 2015, Psychosomatic medicine.

[25]  Cristina Ottaviani,et al.  Cognitive rigidity is mirrored by autonomic inflexibility in daily life perseverative cognition , 2015, Biological Psychology.

[26]  Betina Martau,et al.  Lack of exposure to natural light in the workspace is associated with physiological, sleep and depressive symptoms , 2015, Chronobiology international.

[27]  M. Faurholt-Jepsen,et al.  Electronic monitoring of psychomotor activity as a supplementary objective measure of depression severity , 2015, Nordic journal of psychiatry.

[28]  D. Shapiro,et al.  Cognitive, behavioral, and autonomic correlates of mind wandering and perseverative cognition in major depression , 2015, Front. Neurosci..

[29]  T. Mellman,et al.  Nocturnal autonomic balance and sleep in PTSD and resilience. , 2014, Journal of traumatic stress.

[30]  W. Roth,et al.  Autonomic arousal during actigraphically estimated waking and sleep in male veterans with PTSD. , 2014, Journal of traumatic stress.

[31]  A. Sherwood,et al.  Posttraumatic Stress, Heart Rate Variability, and the Mediating Role of Behavioral Health Risks , 2014, Psychosomatic medicine.

[32]  Weisong Shi,et al.  The Relationship of Chronic and Momentary Work Stress to Cardiac Reactivity in Female Managers: Feasibility of a Smart Phone–Assisted Assessment System , 2014, Psychosomatic medicine.

[33]  G. Alpak,et al.  Circadian Blood Pressure Variation in Normotensive Patients With Panic Disorder , 2014, Angiology.

[34]  Enzo Pasquale Scilingo,et al.  Wearable Monitoring for Mood Recognition in Bipolar Disorder Based on History-Dependent Long-Term Heart Rate Variability Analysis , 2014, IEEE Journal of Biomedical and Health Informatics.

[35]  M. Trimmel,et al.  Treatment of fear of flying: behavioral, subjective, and cardiovascular effects. , 2014, Aviation, space, and environmental medicine.

[36]  W. Roth,et al.  Worried sleep: 24-h monitoring in high and low worriers , 2013, Biological Psychology.

[37]  Amit J. Shah,et al.  Posttraumatic Stress Disorder and Impaired Autonomic Modulation in Male Twins , 2013, Biological Psychiatry.

[38]  R. Lu,et al.  Cardiac autonomic dysregulation in acute schizophrenia , 2013, Acta Neuropsychiatrica.

[39]  Bahattin Karagozoglu,et al.  Ambulatory monitoring , 2013, 2013 The International Conference on Technological Advances in Electrical, Electronics and Computer Engineering (TAEECE).

[40]  E. D. de Geus,et al.  Anxiety sensitivity moderates the relationship of changes in physiological arousal with flight anxiety during in vivo exposure therapy. , 2013, Behaviour research and therapy.

[41]  I. Myin-Germeys,et al.  Mobile assessment guide for research in schizophrenia and severe mental disorders. , 2012, Schizophrenia bulletin.

[42]  A. Schwerdtfeger,et al.  Self-esteem fluctuations and cardiac vagal control in everyday life. , 2012, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[43]  Frank H. Wilhelm,et al.  Do Unexpected Panic Attacks Occur Spontaneously? , 2011, Biological Psychiatry.

[44]  Shih-Jen Tsai,et al.  Reduced physiologic complexity is associated with poor sleep in patients with major depression and primary insomnia. , 2011, Journal of affective disorders.

[45]  W. Roth,et al.  Methodological considerations in ambulatory skin conductance monitoring. , 2011, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[46]  D. Malaspina,et al.  Paternal age related schizophrenia and cardiac autonomic regulation profiles , 2011, Schizophrenia Research.

[47]  Achim Elfering,et al.  Ambulatory Assessment of Skin Conductivity During First Thesis Presentation: Lower Self-Confidence Predicts Prolonged Stress Response , 2011, Applied psychophysiology and biofeedback.

[48]  Chung-Kang Peng,et al.  Sleep state instabilities in major depressive disorder: Detection and quantification with electrocardiogram-based cardiopulmonary coupling analysis. , 2011, Psychophysiology.

[49]  W. Roth,et al.  Twenty-four hour skin conductance in panic disorder. , 2010, Journal of psychiatric research.

[50]  Hongshik Ahn,et al.  Concurrent measurement of "real-world" stress and arousal in individuals with psychosis: assessing the feasibility and validity of a novel methodology. , 2010, Schizophrenia bulletin.

[51]  Frank H Wilhelm,et al.  Physical activity and respiratory behavior in daily life of patients with panic disorder and healthy controls. , 2010, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[52]  F. Wilhelm,et al.  Emotions beyond the laboratory: Theoretical fundaments, study design, and analytic strategies for advanced ambulatory assessment , 2010, Biological Psychology.

[53]  Lilianne R. Mujica-Parodi,et al.  Ambulatory and Challenge-Associated Heart Rate Variability Measures Predict Cardiac Responses to Real-World Acute Emotional Stress , 2010, Biological Psychiatry.

[54]  M. Maclachlan,et al.  Naturalistic monitoring of the affect-heart rate relationship: a day reconstruction study. , 2010, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[55]  Daniel J Buysse,et al.  Low life purpose and high hostility are related to an attenuated decline in nocturnal blood pressure. , 2010, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[56]  V. Vaccarino,et al.  Common Genes Contribute to Depressive Symptoms and Heart Rate Variability: The Twins Heart Study , 2010, Twin Research and Human Genetics.

[57]  J. Bigger,et al.  Cardiac Autonomic Control and Treatment of Hostility: A Randomized Controlled Trial , 2010, Psychosomatic medicine.

[58]  F. Wilhelm,et al.  Respiratory Pathophysiology of Panic Disorder: An Ambulatory Monitoring Study , 2009, Psychosomatic medicine.

[59]  J. Schwartz,et al.  Trait hostility and ambulatory blood pressure among traffic enforcement agents: the effects of stressful social interactions. , 2009, Journal of occupational health psychology.

[60]  S. Hofmann,et al.  Changes in respiration mediate changes in fear of bodily sensations in panic disorder. , 2009, Journal of psychiatric research.

[61]  Ilkka Korhonen,et al.  Relationship of Psychological and Physiological Variables in Long-Term Self-Monitored Data During Work Ability Rehabilitation Program , 2009, IEEE Transactions on Information Technology in Biomedicine.

[62]  M. Dennis,et al.  Ambulatory Cardiovascular Activity and Hostility Ratings in Women with Chronic Posttraumatic Stress Disorder , 2009, Biological Psychiatry.

[63]  W. Chaplin,et al.  The misdiagnosis of hypertension: the role of patient anxiety. , 2008, Archives of internal medicine.

[64]  D. Mathalon,et al.  Event-related EEG time-frequency analysis: an overview of measures and an analysis of early gamma band phase locking in schizophrenia. , 2008, Schizophrenia bulletin.

[65]  V. Vaccarino,et al.  Depressive Symptoms and Heart Rate Variability: Evidence for a Shared Genetic Substrate in a Study of Twins , 2008, Psychosomatic medicine.

[66]  Janice R. Kuo,et al.  Distress and Affective Dysregulation in Patients With Borderline Personality Disorder: A Psychophysiological Ambulatory Monitoring Study , 2008, The Journal of nervous and mental disease.

[67]  M. Craske,et al.  Sleep-based heart period variability in panic disorder with and without nocturnal panic attacks. , 2008, Journal of anxiety disorders.

[68]  S. Shiffman,et al.  Ecological momentary assessment. , 2008, Annual review of clinical psychology.

[69]  W. Roth,et al.  Sympathetic activation in broadly defined generalized anxiety disorder. , 2008, Journal of psychiatric research.

[70]  E. Granholm,et al.  Feasibility and Validity of Computerized Ecological Momentary Assessment in Schizophrenia , 2007, Schizophrenia bulletin.

[71]  U. Ebner-Priemer,et al.  Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder , 2007, Psychiatry Research.

[72]  Janice R. Kuo,et al.  State affective instability in borderline personality disorder assessed by ambulatory monitoring , 2007, Psychological Medicine.

[73]  Dirk Hoyer,et al.  Altered diurnal autonomic variation and reduced vagal information flow in acute schizophrenia , 2006, Clinical Neurophysiology.

[74]  Daniel J Buysse,et al.  Ecological Study of Sleep Disruption in PTSD , 2006, Annals of the New York Academy of Sciences.

[75]  S. Luck An Introduction to the Event-Related Potential Technique , 2005 .

[76]  M. Khader,et al.  The relationship of hostility, negative affect and ethnicity to cardiovascular responses: an ambulatory study in Singapore. , 2005, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[77]  D. Malaspina,et al.  Nonlinear Complexity and Spectral Analyses of Heart Rate Variability in Medicated and Unmedicated Patients with Schizophrenia1 , 2005, Neuropsychobiology.

[78]  Rudolf Hoehn-Saric,et al.  Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder: an ambulatory monitor study. , 2004, Archives of general psychiatry.

[79]  R. Sloan,et al.  Hostility, Interpersonal Interactions, and Ambulatory Blood Pressure , 2003, Psychosomatic medicine.

[80]  Julian F Thayer,et al.  Heart rate response is longer after negative emotions than after positive emotions. , 2003, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[81]  S. Vrana,et al.  Ambulatory Monitoring and Physical Health Report in Vietnam Veterans with and Without Chronic Posttraumatic Stress Disorder , 2003, Journal of traumatic stress.

[82]  C. Shapiro,et al.  Correlates of Therapeutic Response in Panic Disorder Presenting with Palpitations: Heart Rate Variability, Sleep, and Placebo Effect , 2003, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[83]  Lluís Mont,et al.  Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[84]  Matthew F. Muldoon,et al.  Psychosocial demands and ambulatory blood pressure: a field assessment approach , 2002, Physiology & Behavior.

[85]  Rollin McCraty,et al.  Analysis of twenty-four hour heart rate variability in patients with panic disorder , 2001, Biological Psychology.

[86]  D Shapiro,et al.  Striking a chord: moods, blood pressure, and heart rate in everyday life. , 2001, Psychophysiology.

[87]  S. Rucki [Ambulatory monitoring of blood pressure--focus on childhood]. , 2000, Casopis lekaru ceskych.

[88]  A Steptoe,et al.  Stress, social support and cardiovascular activity over the working day. , 2000, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[89]  D. Nutt,et al.  Sleep changes during long-term treatment of depression with fluvoxamine – a home-based study , 2000, Psychopharmacology.

[90]  A. Sherwood,et al.  Emotional responsivity during daily life: relationship to psychosocial functioning and ambulatory blood pressure. , 2000, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[91]  J. Davidson,et al.  Ambulatory cardiovascular activity in Vietnam combat veterans with and without posttraumatic stress disorder. , 2000, Journal of consulting and clinical psychology.

[92]  John L. Andreassi,et al.  Psychophysiology: Human Behavior & Physiological Response , 2000 .

[93]  J F Thayer,et al.  Ambulatory blood pressure responses and the circumplex model of mood: a 4-day study. , 1999, Psychosomatic medicine.

[94]  W. Roth,et al.  Taking the laboratory to the skies: ambulatory assessment of self-report, autonomic, and respiratory responses in flying phobia. , 1998, Psychophysiology.

[95]  Frank H Wilhelm,et al.  Using minute ventilation for ambulatory estimation of additional heart rate , 1998, Biological Psychology.

[96]  H. Stampfer,et al.  The Relationship between Psychiatric Illness and the Circadian Pattern of Heart Rate , 1998, The Australian and New Zealand journal of psychiatry.

[97]  V. Yeragani,et al.  Decreased heart-period variability in patients with panic disorder: a study of Holter ECG records , 1998, Psychiatry Research.

[98]  I. Goldstein,et al.  Daily mood states and ambulatory blood pressure. , 1997, Psychophysiology.

[99]  A. Christensen,et al.  Hostility, Social Support, and Ambulatory Cardiovascular Activity , 1997, Journal of Behavioral Medicine.

[100]  Alexander Glassman,et al.  Diminished cardiac vagal tone in schizophrenia: Associations to brain laterality and age of onset , 1997, Biological Psychiatry.

[101]  S. Cerutti,et al.  Cardiac autonomic regulation during sleep in panic disorder. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[102]  C. Morin,et al.  Sleep and psychopathology , 1996 .

[103]  S. Melamed Emotional Reactivity, Defensiveness, and Ambulatory Cardiovascular Response at Work , 1996, Psychosomatic medicine.

[104]  K. Light,et al.  Social support and hostility interact to influence clinic, work, and home blood pressure in black and white men and women. , 1996, Psychophysiology.

[105]  Bonnafoux Auscultatory and oscillometric methods of ambulatory blood pressure monitoring, advantages and limits: a technical point of view. , 1996, Blood pressure monitoring.

[106]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[107]  Georg Brügner,et al.  Occupational stress and strain of female students: results of physiological, behavioral, and psychological monitoring , 1996, Biological Psychology.

[108]  M. Craske,et al.  Ambulatory monitoring of panic patients during regular activity: A preliminary report , 1995, Biological Psychiatry.

[109]  L. Ferini-Strambi,et al.  Cardiac autonomic function during sleep of never-depressed borderline subjects: a pilot study. , 1995, Journal of psychiatric research.

[110]  S. Schachter,et al.  EEG abnormalities in patients with atypical panic attacks. , 1995, The Journal of clinical psychiatry.

[111]  P. Emmelkamp,et al.  The Role of Negative Self-Statements During Exposure in Vivo , 1994, Behavior modification.

[112]  J. Ruskin,et al.  Panic Disorder, Palpitations, and the Awareness of Cardiac Activity , 1994, The Journal of nervous and mental disease.

[113]  W. Linden,et al.  Sex differences in social support, self-deception, hostility, and ambulatory cardiovascular activity. , 1993, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[114]  N. Khawaja,et al.  Comparison Between the Panic Disorder with Agoraphobia Patients and Normal Controls on the Basis of Cognitions Affect and Physiology , 1993, Behavioural and Cognitive Psychotherapy.

[115]  L. Ferini-Strambi,et al.  Ambulatory polysomnography of never-depressed borderline subjects: A high-risk approach to rapid eye movement latency , 1993, Biological Psychiatry.

[116]  R. Kirkpatrick,et al.  Ambulatory Blood Pressure Monitoring , 1993, The Journal of the American Board of Family Medicine.

[117]  T. Pickering,et al.  Ambulatory monitoring of blood pressure and heart rate in panic patients , 1992 .

[118]  I. Goldstein,et al.  Ambulatory blood pressure and heart rate in paramedics: effects of cynical hostility and defensiveness. , 1991, Psychosomatic medicine.

[119]  B. Garssen,et al.  Hyperventilation and panic attacks , 1990, Biological Psychology.

[120]  W. Agras,et al.  Motor activity and tonic heart rate in panic disorder , 1990, Psychiatry Research.

[121]  A. Sparrow,et al.  Laboratory stress testing to assess real‐life cardiovascular reactivity. , 1989, Psychosomatic medicine.

[122]  W. Agras,et al.  Autonomic changes after treatment of agoraphobia with panic attacks , 1988, Psychiatry Research.

[123]  W. Roth,et al.  Treadmill exercise test and ambulatory measures in panic attacks. , 1987, The American journal of cardiology.

[124]  W. White,et al.  Ambulatory blood pressure monitoring in patients with panic disorder. , 1987, Archives of internal medicine.

[125]  H. Folgering,et al.  Hyperventilation and panic attacks. , 1987, The Journal of clinical psychiatry.

[126]  W. Agras,et al.  Panic Attacks in the Natural Environmet , 1987, The Journal of nervous and mental disease.

[127]  W. Agras,et al.  Ambulatory heart rate changes in patients with panic attacks. , 1986, The American journal of psychiatry.

[128]  R. Freedman,et al.  Ambulatory monitoring of panic disorder. , 1985, Archives of general psychiatry.

[129]  R. Cohen,et al.  Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. , 1981, Science.

[130]  P. Lang The Cognitive Psychophysiology of Emotion , 2019, Anxiety and the Anxiety Disorders.

[131]  M. Faurholt-Jepsen,et al.  State-related differences in heart rate variability in bipolar disorder. , 2017, Journal of psychiatric research.

[132]  Enzo Pasquale Scilingo,et al.  Complexity index from a personalized wearable monitoring system for assessing remission in mental health , 2018 .

[133]  H. Sabelli,et al.  Biotic patterns of heart rate variation in depressed and psychotic subjects. , 2011, Nonlinear dynamics, psychology, and life sciences.

[134]  J. Thayer,et al.  Daily worry is related to low heart rate variability during waking and the subsequent nocturnal sleep period. , 2007, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[135]  Y. Tseng Applications of 24-hour noninvasive ambulatory blood pressure monitoring. , 2006, Journal of the Formosan Medical Association = Taiwan yi zhi.

[136]  M. Sung,et al.  Objective physiological and behavioral measures for identifying and tracking depression state in clinically depressed patients , 2005 .

[137]  Grant L. Iverson,et al.  Reliability of Circadian Heart Pattern Analysis in Psychiatry , 2004, Psychiatric Quarterly.

[138]  H. Critchley Electrodermal responses: what happens in the brain. , 2002, The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry.

[139]  V. Yeragani,et al.  Nonlinear measures of heart period variability: Decreased measures of symbolic dynamics in patients with panic disorder , 2000, Depression and anxiety.

[140]  V. Yeragani,et al.  Major depression and long‐term heart period variability , 2000, Depression and anxiety.

[141]  K. Matthews,et al.  Effects of hostility on ambulatory blood pressure and mood during daily living in healthy adults. , 1999, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[142]  K. Matthews,et al.  Effects of optimism, pessimism, and trait anxiety on ambulatory blood pressure and mood during everyday life , 1999 .

[143]  M. Guyll,et al.  Trait Hostility and Ambulatory Cardiovascular Activity: Responses to Social Interaction , 1998 .

[144]  J. Gorman,et al.  Ambulatory monitoring of respiration in anxiety. , 1996, Anxiety.

[145]  J. Kenardy,et al.  Does ischemia occur with panic attacks? , 1995, The American journal of psychiatry.

[146]  A. Sherwood,et al.  Cognitive coping strategies and blood pressure responses to real-life stress in healthy young men. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[147]  D. Nutzinger,et al.  Anxiety induced by cardiac perceptions in patients with panic attacks: a field study. , 1991, Behaviour research and therapy.

[148]  W. Roth,et al.  Ambulatory Monitoring of Sleep-Related Panic Attacks , 1991 .

[149]  J. Kenardy,et al.  Cognitions and heart rate in panic disorders during everyday activity , 1989 .

[150]  P. Kligfield,et al.  Cardiac rate and rhythm in panic patients. , 1987, The American journal of psychiatry.

[151]  M. Telch,et al.  Ambulatory heart rate changes during panic attacks. , 1982, Journal of psychiatric research.