Integrative neuro-cardiovascular dynamics in response to test anxiety: a brain-heart axis study

Test anxiety (TA), a recognized form of social anxiety, is the most prominent cause of anxiety among studentsand, if left unmanaged, can escalate to psychiatric disorders. TA profoundly impacts both central and autonomicnervous systems, presenting as a dual manifestation of cognitive and autonomic components. While limitedstudies have explored the physiological underpinnings of TA, none have directly investigated the intricateinterplay between the CNS and ANS in this context. In this study, we introduce a non-invasive, integrated neurocardiovascularapproach to comprehensively characterize the physiological responses of 27 healthy subjectssubjected to test anxiety induced via a simulated exam scenario. Our experimental findings highlight that anisolated analysis of electroencephalographic and heart rate variability data fails to capture the intricate informationprovided by a brain-heart axis assessment, which incorporates an analysis of the dynamic interactionbetween the brain and heart. With respect to resting state, the simulated examination induced a decrease in theneural control onto heartbeat dynamics at all frequencies, while the studying condition induced a decrease in theascending heart-to-brain interplay at EEG oscillations up to 12Hz. This underscores the significance of adopting amultisystem perspective in understanding the complex and especially functional directional mechanisms underlyingtest anxiety.