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Objective We aimed to examine the effect of emotion regulation training in patients with panic disorder (PD) by measuring heart rate variability (HRV). Methods Forty-eight patients with PD were randomly divided into emotion regulation group ( n = 25) and no-regulation group ( n = 23). Three five-minute ECG recordings were taken in the following states: 1) baseline, 2) while subjects viewed 15 aversive pictures (active stimulus), 3) resting state after aversive pictures (post-stimulus). The emotion regulation group briefly received acceptance technique training for five minutes before performing the experimental task. Spectral analysis measures included a high-frequency (HF; 0.15–0.4 HZ) component, a low-frequency (LF; 0.04–0.15 Hz) component, and an LF/HF ratio. Results The mean change in LF/HF ratio from baseline to active stimulus was significantly lower in the emotion regulation group than in the no-regulation group (emotion regulation group, 0.13; no-regulation group, 2.31; t =− 2.67; P < .05). Conclusion This suggests that brief emotion acceptance training could decrease aversive stimulus-induced sympathetic hyperactivity in patients with PD. [ABSTRACT FROM AUTHOR]