Vagal toning refers to the stimulation and strengthening of the vagus nerve, a key component of the parasympathetic nervous system. This nerve plays a vital role in regulating stress responses, emotional balance, and overall mental health.

What Is the Vagus Nerve?
The vagus nerve, the tenth cranial nerve, connects the brainstem to various organs, including the heart, lungs, and digestive tract. It supports functions such as heart rate regulation, digestion, and emotional modulation (Breit et al., 2018).

Vagal Tone and Mental Health
Vagal tone is a measure of the nerve’s activity and is closely tied to heart rate variability (HRV). Higher vagal tone is associated with emotional regulation, resilience, and adaptive stress responses (Porges, 2007). Lower tone is often linked to anxiety, depression, and dysregulated stress systems (Thayer & Lane, 2000).

Benefits of Vagal Toning

• Stress Reduction: Enhances parasympathetic response and reduces cortisol levels (Tracey, 2002).
• Emotional Regulation: Facilitates adaptive emotional processing (Porges, 2011).
• Improved Sleep: Associated with deeper, more restorative sleep (Kraus et al., 2007).
• Enhanced Social Engagement: Supports feelings of connection and safety (Porges, 2003).

Ways to Improve Vagal Tone

• Breathwork: Deep, slow breathing increases vagal activity (Zaccaro et al., 2018).
• Cold Exposure: Brief cold exposure activates the vagus nerve (Sierra-Fonseca & Gosselink, 2018).
• Meditation: Mindfulness practices improve vagal tone and emotional regulation (Gerritsen & Band, 2018).
• Singing or Humming: Stimulates the vagus via vocal cords (Porges, 2011).
• Exercise: Regular movement enhances HRV and vagal tone (Sandercock et al., 2005).
• Social Connection: Supportive relationships positively influence vagal function (Kok et al., 2013).

The Role of Therapy
Psychotherapy can play a central role in supporting vagal toning. Through various modalities—such as cognitive-behavioral therapy (CBT), somatic experiencing, or polyvagal-informed therapy—clients learn to regulate stress, process emotions, and develop greater body awareness. Therapists may incorporate breathwork, guided relaxation, or mindfulness techniques that directly engage the vagus nerve.
In particular, therapy helps by:

• Enhancing self-awareness of physiological and emotional states
• Teaching coping strategies that promote parasympathetic activation
• Creating a safe relational space, which itself can improve vagal tone through co-regulation

​Vagal toning is a foundational aspect of mental wellness. By combining physiological techniques with therapeutic support, individuals can cultivate greater emotional resilience, reduce stress, and improve overall psychological functioning.

References

• Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in Psychiatry, 9, 44.
• Gerritsen, R. J., & Band, G. P. (2018). Breath of life: The respiratory vagal stimulation model of contemplative activity. Frontiers in Human Neuroscience, 12, 397.
• Kok, B. E., et al. (2013). How positive emotions build physical health: Perceived positive social connections account for the upward spiral between positive emotions and vagal tone. Psychological Science, 24(7), 1123–1132.
• Kraus, T., et al. (2007). BOLD fMRI deactivation of limbic and temporal brain structures during vagus nerve stimulation in epileptic patients. Brain Stimulation, 1(1), 27–35.
• Porges, S. W. (2003). The polyvagal theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42(2), 123–146.
• Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74(2), 116–143.
• Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. Norton.
• Sandercock, G. R., Bromley, P. D., & Brodie, D. A. (2005). Effects of exercise on heart rate variability: Inferences from meta-analysis. Medicine and Science in Sports and Exercise, 37(3), 433–439.
• Sierra-Fonseca, J. A., & Gosselink, K. L. (2018). Tau and cold stress-induced suppression of the hypothalamic-pituitary-gonadal axis. Neuroendocrinology, 107(3), 270–282.
• Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61(3), 201–216.
• Tracey, K. J. (2002). The inflammatory reflex. Nature, 420(6917), 853–859.
• Zaccaro, A., et al. (2018). How breath-control can change your life: A systematic review on psychophysiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.

The hypothalamic-pituitary-adrenal (HPA) axis is a central component of the body’s stress response system. It governs the release of cortisol, which helps manage acute stress. However, prolonged or repeated exposure to stress can lead to HPA axis dysfunction—a state of dysregulation that affects the brain, body, and emotional well-being.

Effects of Chronic Stress on the HPA Axis
When stress is chronic, the HPA axis can become either overactive or underactive. This may lead to sustained high cortisol levels or a flattened cortisol rhythm, impairing sleep, energy levels, immune function, and emotional regulation. HPA axis dysfunction has been linked to conditions such as depression, anxiety, PTSD, and chronic fatigue (Yaribeygi et al., 2017).

Nervous System Regulation Tools for Recovery
Restoring balance to the HPA axis often involves regulating the autonomic nervous system and increasing parasympathetic (rest-and-digest) tone. Evidence-based tools include:

• Breathwork, such as slow diaphragmatic breathing, which can decrease cortisol and activate the vagus nerve.
• Mindfulness and meditation, shown to reduce stress-related activation of the HPA axis (Pascoe et al., 2017).
• Somatic therapies, including body-based approaches like yoga or grounding exercises, to reconnect with internal bodily cues.
• Biofeedback and neurofeedback, offering real-time data to support physiological regulation.
• Trauma-informed psychotherapy, which often integrates nervous system awareness to resolve patterns of dysregulation.

Conclusion
Addressing HPA axis dysfunction requires a multidimensional approach, with nervous system regulation at its core. Regular use of these tools may support both physiological and psychological recovery, promoting resilience and mental clarity over time.

​References
Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI Journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480
Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., & Ski, C. F. (2017). Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. Journal of Psychiatric Research, 95, 156–178. https://doi.org/10.1016/j.jpsychires.2017.08.004
The Huberman Lab Podcast. Episode: "How to Control Your Stress Response" by Dr. Andrew Huberman. Accessed at: https://www.hubermanlab.com/episode/how-to-control-your-stress-response

Chronic pain is often thought of as a purely physical problem, but emerging research suggests that the brain plays a significant role in how pain is experienced. Pain Reprocessing Therapy (PRT) is a groundbreaking approach that aims to retrain the brain’s response to pain, particularly in cases where chronic stress and emotional factors contribute to persistent discomfort.  

The Brain’s Role in Chronic Pain
Pain serves as a protective mechanism, alerting us to injury or danger. However, when pain persists long after an injury has healed—or arises without clear physical damage—it often becomes a problem of misfiring neural pathways rather than ongoing tissue damage. Neuroscientist Dr. Tor Wager explains:  
“Pain is not just something that happens to us—it’s something the brain constructs based on a variety of inputs, including past experiences, emotions, and expectations.”
When chronic stress heightens the nervous system’s sensitivity, the brain can misinterpret normal sensations as pain. PRT works by helping individuals recognize and change these misinterpretations.  

How Pain Reprocessing Therapy Works
PRT is based on the idea that chronic pain is often the result of learned neural patterns rather than structural damage. By changing the way the brain perceives pain, people can significantly reduce their discomfort. Dr. Yoni Ashar, a clinical psychologist and researcher, explains:  “Pain Reprocessing Therapy helps people understand that their pain is coming from the brain, not the body. When they learn to view their pain as non-threatening, their brain stops generating it.”

PRT involves five key steps:  
1. Educating the Mind – Learning that chronic pain is often due to the brain’s misinterpretation of danger signals.  
2. Shifting Beliefs About Pain – Recognizing pain as a reversible condition rather than a permanent disorder.  
3. Reducing Fear and Avoidance – Engaging in normal movement and activities to rewire the brain’s pain response.  
4. Using Mindfulness and Somatic Techniques – Practicing relaxation and awareness to calm the nervous system.  
5. Reinforcing Positive Outcomes – Noticing and celebrating pain reduction to further retrain the brain.  

Scientific Support for PRT
A 2021 study published in JAMA Psychiatry found that PRT significantly reduced chronic back pain in participants, with many experiencing lasting relief. As Dr. Ashar, one of the study’s lead researchers, noted: “Two-thirds of participants in our study were pain-free or nearly pain-free after just four weeks of Pain Reprocessing Therapy.”
This offers hope to the millions of people suffering from chronic pain linked to stress and emotional factors.  

The Connection Between Chronic Stress and Pain
Chronic stress activates the body’s fight-or-flight response, leading to muscle tension, inflammation, and heightened pain sensitivity. Dr. Howard Schubiner, a physician specializing in mind-body medicine, states:  
*“When we’re under stress, our brains create pain as a distraction from emotional distress. But when we address these emotions, the pain often fades.”
PRT teaches individuals to recognize and process these emotional triggers, breaking the cycle of stress-induced pain.  

A New Path to Healing 
For those struggling with chronic pain, PRT offers a new perspective—one that shifts the focus from endless medical treatments to the power of the mind-body connection. While not a quick fix, retraining the brain’s pain response can be a transformative process. As Dr. Schubiner emphasizes: “The pain is real—but so is recovery.”
By understanding the brain’s role in chronic pain and applying techniques from Pain Reprocessing Therapy, many individuals can find relief and reclaim their lives.  

Final Thoughts
Chronic pain can feel like an inescapable cycle, but new research is proving that healing is possible. If stress and emotional factors contribute to your pain, exploring PRT might be the key to lasting relief. Instead of focusing solely on physical treatments, addressing the brain’s role in pain could be the breakthrough you’ve been looking for.

In May 2025, I will be getting certified in Pain Reprocessing Therapy. Please fill out the contact form, under contact me, if you are interested in seeing if this model could help you. 

Resources
The Pain Reprocessing Podcast
The Way Out: A revolutionary, scientifically proven approach to healing chronic pain. Alan Gordon, Alon Ziv. (2021).