Transcutaneous auricular vagus nerve stimulation for anxiety symptoms across fear, trauma, and disease contexts: a narrative review of clinical evidence and mechanisms.

BACKGROUND AND

aimsAnxiety symptoms occur in primary anxiety disorders as well as fear-, trauma-, and disease-related contexts, creating a need for safe and accessible non-pharmacological interventions. Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation approach that may influence central and autonomic networks through auricular vagal pathways. This narrative review summarizes clinical evidence, stimulation parameters, safety findings, and potential mechanisms of taVNS for anxiety symptoms across these contexts.

methodsPeer-reviewed studies were identified through searches of PubMed, Web of Science, Embase, Cochrane Library, and Scopus up to June 2026. Eligible original human studies examining taVNS in anxiety symptoms, anxiety disorders, fear-learning paradigms, post-traumatic stress disorder (PTSD)-related symptoms, and comorbid or disease-related anxiety were synthesized narratively. Key methodological features, stimulation protocols, comparators, safety findings, and quantitative outcomes were extracted when available. MAIN CONTENT AND

findingsCurrent evidence suggests that taVNS may improve selected anxiety-related symptoms, fear-extinction processes, PTSD-related hyperarousal, sleep outcomes, and autonomic nervous system parameters. Short-term studies generally report acceptable tolerability, with mostly mild adverse events. However, stimulation protocols, control designs, and outcome measures varied across studies.

conclusiontaVNS may be a promising adjunctive approach for anxiety symptoms across heterogeneous clinical and experimental contexts. Larger sham-controlled studies with standardised parameters and longer follow-up are needed to clarify efficacy, optimal stimulation protocols, and long-term safety.