Your Nervous System Needs a Toolkit. Here's Where to Start.
If you've tried nervous system regulation tools and found they didn't work, or only worked sometimes, or made things worse — that's not a failure of effort. The right tool for your body on a given day depends on what's available to you physiologically and what you're trying to shift.
Most tools for nervous system regulation work through the same underlying pathway: the vagus nerve. The vagus is the main highway of the parasympathetic nervous system — the "rest and digest" counterpart to the sympathetic nervous system, which is the system responsible for the fight-or-flight stress response. The vagus runs from the brainstem through the chest and into the abdomen, connecting the brain to the heart, lungs, gut, and immune system. When vagal tone is adequate, the sympathetic stress response has a brake. When it isn't, the system stays activated — responding to inputs it should be filtering, slow to return to baseline after a stressor, and running hotter than the situation warrants.
Vagal activation is how you engage that brake deliberately. There are many ways to do it — breathwork, humming, cold exposure, grounding, and others — and they work through slightly different entry points, which is why having more than one option matters. This post covers the most accessible starting points. One of them may become your daily practice. All of them are worth having available.
Why this matters more in this population
Nervous system dysregulation isn't just a downstream effect of living with a chronic condition. For many people in this community, it may be closer to the root.
An overactive autonomic nervous system — one that stays in a state of heightened alert, responds more readily to threat, and struggles to return to baseline — is closely linked to both the immune system reactivity seen in MCAS and the cardiovascular instability seen in POTS. Mast cells are innervated by the autonomic nervous system and respond to its signals directly. When the system is chronically activated, the immune system follows. When the immune system is reactive, it feeds back into autonomic activation. The two are frequently co-occurring and mutually reinforcing.
What sits upstream of that pattern? The literature on trauma and adverse childhood experiences in this population is growing. Published data from EDS clinic cohorts document PTSD rates ranging from 4.7% to 34.8%, and lifetime psychiatric diagnoses in 58.6% of a German hEDS/HSD cohort — with PTSD among the most common. A large meta-analysis found a 2.7-fold increase in somatic syndromes in people with a trauma history, and within hypermobile populations specifically, higher ACE counts have been associated with greater symptom burden, such as gastrointestinal distress and chronic pain. We explored this connection in depth in a previous post. The nervous system that learned to stay vigilant early on doesn't easily unlearn it — but it can be retrained, slowly and with the right inputs.
That's what these tools are for. Not relaxation for its own sake. Not managing symptoms after they arrive. Building the pathway that lets the nervous system shift states — so the fight-or-flight response fires when it's actually needed, and quiets when it isn't.
Vagal activation: finding your entry point
The tools below work through different entry points into the same pathway. On a good day you might use more than one. On a hard day, choose the one that feels most accessible right now.
Breathwork
Slow, diaphragmatic breathing is the most studied vagal activation tool available. Unlike other domains of the autonomic nervous system, such as digestion and heart rate, we can easily control our breath. Before starting, choose whichever body position is most comfortable. Count out about six breaths per minute — around a five-second inhale and five-second exhale. This respiratory rate produces a measurable increase in heart rate variability, which is a common measurement of vagal tone.
A longer exhale than inhale (for example, 4 counts in and 6 counts out) is a common variation that may add additional benefit. Done daily as a consistent anchor point, breathwork builds capacity over time. But it can also be employed as needed, offering a quicker route back to baseline.
One caveat: 6 breaths per minute can produce mild over-breathing in some people. If slow breathing makes you feel lightheaded, adjust your rate until you find a cadence that feels genuinely relaxing. And if attending to your breath amplifies your alarm bells rather than settling them, the tools below may be better entry points.
Vagal activation techniques
These work through the same pathway but without requiring focused attention — useful on high-symptom days or when concentration is limited.
Neck, shoulder, and head massage. Massage to this area reliably shifts heart rate variability toward parasympathetic dominance and lowers heart rate. Gentle self-massage of the neck and shoulders is accessible and low-risk. One important caution: avoid firm pressure on the front of the neck over the pulse point. That area sits over the carotid artery, and pressing it can cause a sudden drop in heart rate and blood pressure.
Humming and singing. Humming naturally slows and lengthens the exhale, producing a similar effect to paced breathing without the same level of attention. If counting breaths feels effortful, humming achieves a similar respiratory pattern without the cognitive load.
Physiologic sigh. Two quick inhales through the nose followed by a single long, slow exhale. This is the pattern the body already produces spontaneously every few minutes to reinflate collapsed air sacs in the lungs. In the largest head-to-head comparison of brief daily breathwork practices, cyclic sighing produced the greatest improvement in mood. One breath, done when you notice dysregulation starting, is enough.
Cold water to the face. Brief cold exposure to the face triggers the diving reflex — a vagally-mediated response that slows heart rate. A cool washcloth held to the forehead or around the eyes for 30 seconds activates it. Avoid icy cold temperatures, which can trigger mast cell degranulation in people with cold sensitivity.
Grounding
Grounding works through a different entry point — not the breath or vagal activation, but the sensory-attentional pathway. Time outside with sensory attention directed toward the external environment — feet on earth, hands in soil or water, slow noticing of what's around you — redirects the nervous system's attention outward and interrupts the internal amplification loop that keeps the stress response running.
For people with hypermobility, this outward direction is particularly relevant. When internal body signals are harder to interpret accurately, external sensory input offers a more reliable anchor. Inward-focused attention can amplify rather than settle symptoms in bodies where those signals are unreliable. Grounding sidesteps that by using the outside world as the input.
The formal evidence for grounding as a vagal activation tool is limited and not well-studied in controlled trials. With that said, there is good evidence that time in nature improves mood, reduces anxiety, and lowers stress — which adds a gentle attentional layer to counter dysregulation.
The bigger picture
These tools come early in the nervous system module of The BENDY Method — and they're sequenced before other habits for a reason. A nervous system with regulation tools available to it responds to every other input differently. Sleep improves. Pain signals modulate. Capacity for new habits increases.
This isn't about forcing calm or ignoring negative emotions. It's about having options when you begin to notice the fight-or-flight response taking over.
The BENDY Method is a 12-week habit-based course for perimenopause and menopause in bodies with hEDS, HSD, MCAS, POTS, dysautonomia, and related presentations.
Join the waitlist to be first to know when enrollment opens.
References
Afari N, Ahumada SM, Wright LJ, et al. Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis. Psychosomatic Medicine. 2014;76(1):2–11.
Bae D, Matthews JJL, Chen JJ, Mah L. Increased Exhalation to Inhalation Ratio During Breathing Enhances High-Frequency Heart Rate Variability in Healthy Adults. Psychophysiology. 2021;58(11):e13905.
Balban MY, Neri E, Kogon MM, et al. Brief Structured Respiration Practices Enhance Mood and Reduce Physiological Arousal. Cell Reports Medicine. 2023;4(1):100895.
Brandt L, De Prisco M, Nocera D, et al. Climate-Related and Nature-Based Interventions for Mental Health. JAMA Psychiatry. 2026:2845752.
Delaney JP, Leong KS, Watkins A, Brodie D. The Short-Term Effects of Myofascial Trigger Point Massage Therapy on Cardiac Autonomic Tone in Healthy Subjects. Journal of Advanced Nursing. 2002;37(4):364–371.
Forsythe P. The Parasympathetic Nervous System as a Regulator of Mast Cell Function. Methods in Molecular Biology. 2015;1220:141–154.
Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Frontiers in Human Neuroscience. 2018;12:397.
Henning M, Hock M, Shukri A, et al. Prevalence and Management of Mental Health Comorbidities in a German Cohort of Patients With Ehlers-Danlos Syndromes and a Generalized Hypermobility Spectrum Disorder. Orphanet Journal of Rare Diseases. 2026;21(1):83.
Jessen NH, Løvschall C, Skejø SD, et al. Effect of Nature-Based Health Interventions for Individuals Diagnosed With Anxiety, Depression and/or Experiencing Stress: A Systematic Review and Meta-Analysis. BMJ Open. 2025;15(7):e098598.
Kawji MM. Carotid Sinus Massage Is the Message. JAMA Internal Medicine. 2022;182(8):872–873.
Kim T, Lee S, Woo M. Humming Breathing and Autonomic Regulation: A Preliminary Study of Resonance Frequency and Vibratory Mechanisms. Applied Psychophysiology and Biofeedback. 2026.
Laborde S, Allen MS, Borges U, et al. Effects of Voluntary Slow Breathing on Heart Rate and Heart Rate Variability: A Systematic Review and a Meta-Analysis. Neuroscience and Biobehavioral Reviews. 2022;138:104711.
Little AL. The A52 Breath Method: A Narrative Review of Breathwork for Mental Health and Stress Resilience. Stress and Health. 2025;41(4):e70098.
Maltseva N, Borzova E, Fomina D, et al. Cold Urticaria — What We Know and What We Do Not Know. Allergy. 2021;76(4):1077–1094.
Marchant J, Khazan I, Cressman M, Steffen P. Comparing the Effects of Square, 4-7-8, and 6 Breaths-Per-Minute Breathing Conditions on Heart Rate Variability, CO2 Levels, and Mood. Applied Psychophysiology and Biofeedback. 2025;50(2):261–276.
Riedl EM, Bracklo T, Wimmer K, et al. Simply Breathing Anxiety Away? A Pilot Study of One-Minute Cyclic Sighing Versus Box Breathing for Acute Anxiety Reduction. Anxiety, Stress, and Coping. 2026:1–15.
Russo MA, Santarelli DM, O'Rourke D. The Physiological Effects of Slow Breathing in the Healthy Human. Breathe. 2017;13(4):298–309.
Severs LJ, Vlemincx E, Ramirez JM. The Psychophysiology of the Sigh: I: The Sigh From the Physiological Perspective. Biological Psychology. 2022;170:108313.
Sevoz-Couche C, Laborde S. Heart Rate Variability and Slow-Paced Breathing: When Coherence Meets Resonance. Neuroscience and Biobehavioral Reviews. 2022;135:104576.
Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope. Journal of the American College of Cardiology. 2017;70(5):e39–e110.
Silvernale C, Garcia-Fischer I, Staller K. Relationship Between Psychological Trauma and Irritable Bowel Syndrome and Functional Dyspepsia in a Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Patient Population. Digestive Diseases and Sciences. 2024;69(3):870–875.
Slepian PM, Axenova K, McCarthy M, et al. Rates of Mental Health Concerns Among Individuals Assessed at the GoodHope Ehlers-Danlos Syndrome Clinic. Orphanet Journal of Rare Diseases. 2025;20(1):75.
Theoharides TC, Twahir A, Kempuraj D. Mast Cells in the Autonomic Nervous System and Potential Role in Disorders With Dysautonomia and Neuroinflammation. Annals of Allergy, Asthma & Immunology. 2024;132(4):440–454.
Theoharides TC. Neuroendocrinology of Mast Cells: Challenges and Controversies. Experimental Dermatology. 2017;26(9):751–759.
Wang E, Ganti T, Vaou E, Hohler A. The Relationship Between Mast Cell Activation Syndrome, Postural Tachycardia Syndrome, and Ehlers-Danlos Syndrome. Allergy and Asthma Proceedings. 2021;42(3):243–246.
Woo M, Kim T. Effects of Slow-Paced Breathing and Humming Breathing on Heart Rate Variability and Affect: A Pilot Investigation. Physiology & Behavior. 2025;299:114972.
Xu H, Shi X, Li X, et al. Neurotransmitter and Neuropeptide Regulation of Mast Cell Function: A Systematic Review. Journal of Neuroinflammation. 2020;17(1):356.
Zaccaro A, Piarulli A, Laurino M, et al. How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Frontiers in Human Neuroscience. 2018;12:353.
