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Vagus Nerve

Tapping the Healing Rhythms of the Vagal Nerve

Self-regulation is found through the sound of your internal beat.

©2020 Cathy Malchiodi PhD
"Gershwin's Rhythms," oil pastel by Cathy Malchiodi
Source: ©2020 Cathy Malchiodi PhD

When friends call or text to ask how I am doing these days, I often say, “just trying to stay in a good rhythm.” Social isolation, physical distancing, and an unpredictable future have challenged everything, including the familiar cadence of work and relationships. Anything that disrupts safety, impacts relationships, and changes previous routines results in a sense of not being able to find one’s “beat.”

Rhythm plays an essential role in our lives because if our bodies cannot generate the most fundamental rhythm of life—the heartbeat—we cannot survive. Our heart rate must increase to initiate fight or flight and it must maintain its rhythmic pulse despite any demands placed on it. Regulating heart rate during stress and controlling stress hormones are two critical tasks that require that the brain and body keep proper time.

The regulation of the body’s internal rhythms can be best understood through the lens of polyvagal theory (Porges, 2011). In particular, the ventral vagal network that runs from the diaphragm to the brain stem is key because it can be influenced by breathing patterns and social cues such as smiling and making eye contact to generate a sense of calm and safety. Experiences that generate sounds such as gargling, humming, prosody, and specific vocalizations can also be self-regulatory. These practices can help us find ways to “rest and digest” when hyperactivation or dissociation overtake brain and body.

Rhythm is a core foundation of expressive arts therapy, especially when introduced to help individuals regulate and stabilize (Malchiodi, 2020). One concept that is relevant to supporting “good rhythms” is found in entrainment. Entrainment is also called rhythmic synchronization and is an expressive arts approach that can support self-regulation, co-regulation, and shared regulation. This synchronization occurs when the rhythm of one experience actually synchronizes with the rhythm of another. For example, babies hear their first rhythm in utero while listening to their mothers’ heartbeats; the natural way to calm infants is to sway, rock, or pat them to the rhythm of a resting heart rate. Motor and brain activity can also fall into synchronous rhythms through the therapist’s voice and through sensory experiences that match a resting heart rate (60 to 80 beats a minute), slow it down, or speed it up and energize individuals.

While many expressive arts approaches include aspects of rhythmic synchronization through group interaction, music and sound are two that can be practiced individually in this time of social isolation. The core of all singing and even listening is rhythm, thus making it one of the most effective forms to tap the ventral vagal network. These experiences can not only bring about a reparative internal rhythm, but actually may help individuals shift away from activating memories. Similarly, a therapist’s voice and prosody can be utilized to promote entrainment via tempo and rhythm, thus promoting self-regulation.

There are many simple ways to influence your internal beat through sound and music. Here are a few that activate the vagal nerve and can help with finding a good rhythm during times of stress:

Just Make Sounds. If you think you are not very musical and singing is just not your thing, then one of the easiest ways to rhythmically regulate is found in making various sounds. For example, vigorous gargling is one way to stimulate the ventral vagal nerve. Peter Levine suggests gentle growling like an animal on your exhale during rhythmic breathing can calm the body and mind. And it may make you laugh, another set of sounds that naturally help us self-regulate.

Humming. Because the vagal nerve passes through the vocal chords and the inner ear, humming creates the necessary rhythmic vibrations to generate a calming influence on the nervous system. If you have some favorite tunes, just try humming them (and don’t worry if you hum off-key). Notice the sensations in your head, throat and chest; try changing the volume and location.

Vocal Toning. Vocal toning is a natural form of expression that occurs whether we are aware of it or not. A sigh of relief or the sound you make when you stub your toe are forms of vocal toning. You can also use toning to consciously energize your body or to calm it down when anxious. In order to calm the body, try this sequence:

· Breathe in, to the count of four.

· Hold your breath for a few moments.

· Exhale slowly to the count of eight while making one of the following sounds—oooo, ahh or vooo. Try each tone to see what feels calming to you. What is important is to make your exhale approximately twice as long as your inhale.

· When you complete your exhale and toning, repeat the process at least five times.

During toning, be aware of your diaphragm and try to relax into the rhythm of your breathing. As you become comfortable with the process of expressing yourself vocally through toning, you will naturally be able to slow down your internal rhythm and if practicing mindfulness, you will deepen that experience too, reaching a more peaceful state of being.

Toning with the Alphabet. One particular practice that I find helpful involves toning with vowels. Follow the breathing process described above, inhale as deeply as is comfortable, hold briefly, and on the exhale, tone A-E-I-O-U. Repeat this sequence at least five times. I often use this practice along with rhythmic walking as a value-added rhythm experience to recalibrate my own internal beat when anxious.

You can also simply play with the letters in the alphabet, both vowels and consonants. Try the letter “M” which is most closely related to humming. While you are exhaling, see if you can move the vibration of your toning to various parts of your body—your head, your chest, your belly, and the seat of your spine.

Those who use the OM mantra when meditating, there are three important tones that make it up—AH-UH-MM. These tones not only stimulate healing rhythms when combined to tone the OM, they also have deeper meanings. The first tone, AH, is related to opening up the experience of love and a higher power than ourselves; the UH draws in energy to us; and the MM is a resonant tone that is sensed deep within us.

This is a brief list of rhythm activities based in sound, tone and vibration that can be practiced any time you feel either fatigued or hyperactivated. While these experiences can help you find your good rhythm during times of distress, there is another equally important way to “change your beat” through synchrony and entrainment—movement. Movement addresses immobility, one of the most tenacious trauma reactions, and is the subject of my next post.


Malchiodi, C. A. (2020). Trauma and expressive arts therapy: Brain, body, and imagination in the healing process. NY: Guilford Publications.

Porges, S. (2011). The polyvagal theory. New York: Norton.

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