Neurovisceral Integration: A Systematic Review of Cardiac Vagal Control and Emotion Regulation in Healthy Populations

Sammanfattning

Background: Emotion regulation has increasingly been linked to brain–body integration through cardiac vagal control (assessed by heart rate variability, HRV). This relationship can be understood within the neurovisceral integration model, which links brain–heart communication through autonomic regulation and self-regulatory processes. Aim: This systematic review examined the association between cardiac vagal control, measured by HRV, and emotion regulation in healthy adults within the neurovisceral integration model. Methods: The review followed PRISMA guidelines. Literature searches were conducted in PubMed and Web of Science. 14 empirical studies were included, reporting measures of vagal activity together with an operationalized measure of emotion regulation. Inclusion criteria targeted healthy adults aged 18 years and older, while sports science applications, pregnant women, couples and individuals on beta-blockers were excluded. Results: The search identified 978 records, of which 14 studies met the inclusion criteria. Most studies (11/14) reported statistically significant positive associations, generally ranging from weak to moderate effect sizes, while 3 studies reported mixed or non-significant findings. Higher resting HRV was associated with better emotion regulation outcomes in 6 of 7 studies, and significant HRV modulation during emotional challenges was reported in 5 of 6 studies. Positive associations were more consistent in observational studies, including both cross-sectional and longitudinal designs, than in experimental studies. Conclusions: The findings generally support cardiac vagal control, as assessed by HRV, as a potential non-invasive correlate of emotion regulation capacity within the neurovisceral integration model. However, the included studies did not show consistent relationships and the associations were dependent on contextual factors. The evidence is limited by methodological constraints and restricted population variability, as samples primarily consisted of younger female participants, making generalization difficult. Future research should prioritize standardized methods, improved HRV measurement protocols and more diverse and heterogeneous populations to further clarify the mechanisms linking vagal activity and emotion regulation.