2025 Maureen Noteboom – The Wanderer: A Music-Thanatologist’s Guide to the Vagus Nerve.pdf

The Wanderer: A Music-Thanatologist’s Guide to the Vagus Nerve
Accorda Music Thanatology Institute
Maureen Noteboom
April 8, 2025

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Acknowledgements
I would like to acknowledge and thank all of the faculty, staff and Board of Directors, past and
current, of Accorda Music-Thanatology Institute for creating the organization to train new
music-thanatologists and assure the growth and development of the profession and discipline. It
had to be a labor of love given the difficulties in creating a new academic institution. I thank you
all.
I also acknowledge and thank the 2025 cohort, those who will complete the program this year as
well as those who started with us. Our mutual support and friendships have been critical to me
in my study of music-thanatology.
I thank Tony Pederson, my internship mentor, for his patience in facilitating my development in
the clinical practice of music-thanatology (to date). Although I reference myself as an immature
music-thanatologist, I’ve had the opportunity to learn from one of the most experienced.
In my development as a music-thanatologist I acknowledge and thank Kieran Schnabel and
Laura Moya for their patience and perseverance in helping me overcome some of my bad habits
in music delivery and enhancing my skills in harp and voice.
And finally I would like to acknowledge and thank the thoughtful and supportive first reader of
this paper, Ruth Kittleson. Her guidance was crucial as I learned and committed to the page my
understanding of this topic and how it applies to music-thanatology.

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Introduction
The human nervous system is the control center of the human body. All movement and all
bodily processes are facilitated by the nervous system. As such, the nervous system may be a
potential avenue of influence by music thanatology. Awareness of the nervous system, and
particularly the autonomic nervous system component can impact our music-thanatology practice
and possibly inform delivery of prescriptive music within the vigil.
In this paper I will review the structure and function of the human nervous system with attention
to the autonomic nervous system, the vagus nerve and the current understanding of the vagus
nerve within Western medicine. I’ll also discuss Polyvagal Theory, a relatively new conception
about how the autonomic nervous system impacts our physiology and psychology. Finally, I will
explore the experience of the music-thanatologist as well as that of participants in the music-
thanatology vigil.

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The structure and function of the human nervous system.
This paper will focus on the involuntary activities that are directed by the autonomic nervous
system. In order to put the autonomic nervous system and its components into perspective,
within the human body, here is a summary of the human nervous system:
1. Central Nervous System: brain stem and spinal cord, for central processing of nerve
information
2. Peripheral nervous system: nerves going to and from all organs of the body
a. Somatic nervous system controls voluntary movement and sensory perception
b. Autonomic nervous system (ANS): regulates involuntary physiologic processes
such as heart rate, respiration, blood pressure
i. Sympathetic nervous system (SNS)
ii. Parasympathetic nervous system (PNS) including the vagus nerve
iii. Enteric nervous system (ENS)
The autonomic nervous system innervates (receives and sends information via electrical signals)
our face, ears and all of our neck and torso, including our larynx, heart, lungs and all of the
organs of digestion. The ANS works in a continuous, ongoing, automatic way. It keeps us alive
without our active participation.
The ANS connects the viscera to the brain. Sensations through this system are visceral; visceral
feelings are not impacted by cognition. Many of our clients in the music-thanatology vigil are
not outwardly cognizant, yet they still have actively functioning (although likely not optimally
functioning) autonomic nervous systems until their moment of transitus. One way we connect

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with patients during a music-thanatology vigil is viscerally, through their autonomic nervous
system.
This paper will focus on two components of the ANS: the SNS and PNS; the ENS is an extensive
web-like structure capable of functioning independently of the remainder of the nervous system.
It is chiefly responsible for regulation of digestive processes.
The ANS is responsible for well-being and maintaining homeostatic balance within the human
body. The last two systems to fail as a patient nears death are the cardiac (heart) and respiratory
(lungs) systems. When a music-thanatologist phenomenologically observes these systems in a
patient to make prescriptive decisions it is the status and workings of the ANS that is under
observation. While I cannot determine if one precedes the other, the ANS fails as the body fails.
During a music-thanatology vigil the patient’s heart and respiratory rates and patterns may
change. These changes reflect changes in the ANS. While it is hard to ascertain causation
between the music-thanatology vigil and observed changes in the ANS, it is reasonable to state
the two events are concurrent. Later in this paper some possibilities about how these changes
may occur will be discussed.
Sympathetic Nervous System (SNS)
The SNS functions to increase blood flow throughout the human body. It causes the heart to beat
and lungs to expand and contract to facilitate breath. Eighty-percent of the neurons in the SNS
are afferent, sensory neurons; these collect information from the visceral organs and
communicates this electronically to the brain stem. These neurons are very sensitive. If there
are changes within an organ, such as an imbalance in blood composition and flow, this is

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detected and communicated by these sensory neurons. The SNS also communicates to the
brain when a person feels viscerally that “all is well”.
If threatened, the SNS senses that “all is not well” and reacts accordingly, activating the organs it
innervates. Some of the mechanisms of an activated SNS include an increase in blood pressure
and heart rate to send additional oxygen to the musculoskeletal system and enable “fight or
flight” responses. At the same time additional sugar is released into the blood stream for energy
while the GI system is shut down. Activation of the SNS is an evolutionary development as a
life-saving defense mechanism. It is usually a short-term event, however, it is possible to
become stuck in a high level of SNS activation. If the ANS is stuck in SNS activation, fight or
flight, the ANS is no longer regulated.
It is easy to imagine the threats perceived and fear experienced by patients and others within the
vigil setting, and how these may activate their SNS. Fear comes from perceived threats. With
impending death the patient and family may perceive threats that result in fears of death, fears of
the unknown, fears of how the patient’s death (the process and the outcome) will impact the
family. These fears may stimulate the SNS, keeping the patient and family members in a state of
SNS hyper-activation. This may be reflected in a faster heart rate and/or faster respirations, and
possibly interruptions in sleep patterns. It may also be reflected in a quick “trigger” to stimuli.
The Parasympathetic Nervous System (PNS)
The PNS promotes “rest and digest” processes. Activating the PNS is an antidote to an activated
SNS. Physiological mechanisms of an activated PNS include the lowering of heart rate and
blood pressure and the restart of digestion.

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Seventy-five percent of the PNS is Cranial Nerve X (10), the Vagus Nerve (VN), which
innervates the muscles of the throat (pharynx and larynx), lungs, the heart, the organs of
digestion (stomach, liver, pancreas, duodenum, small intestine and the ascending and transverse
section of the large intestine) and the kidneys.
The term Vagus Nerve comes from Latin and means “vagrant” or “the wanderer”. The VN was
identified and named by a Greek philosopher, Claudius Galen, who lived from 130-200 CE.
Galen noted certain disfunctions that occurred when the VN was severed in gladiators. Galen’s
writings served as the foundation of European medicine for 1500 years.
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Eighty percent of VN fibers are sensory (afferent) fibers; these collect visceral information from
nearly all major organs and transmits this to the medulla oblongata which is situated between the
brain stem and the brain. In the medulla oblongata afferent signals are received, processed, and
responding efferent signals, motor neurons, are sent to direct activities of the targeted organs.
The VN promotes cardiac relaxation by decreasing contractility in the atria of the heart so that
less blood flows into the ventricles and from there into the circulatory system. It aides
digestion by promoting salivation. It impacts respiration and blood flow by firing
parasympathetic nerves during expiration (outbreath) and contracting and stiffening airways to
prevent collapse.
Regulation of the Autonomic Nervous System.
Interaction between the SNS and PNS determines the level of homeostasis, or balance, within the
body. Homeostasis reflects the neural and neurochemical processes through which our body
regulates visceral organs to optimize health, growth and restoration. The SNS and PNS work

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antagonistically to each other to maintain homeostasis within the ANS. Using an analogy of a
car, the SNS is the gas pedal and the PNS is the brake. Both are necessary to drive safely.
Dysautonomia, or ANS disfunction, occurs when the ANS does not regulate properly.
Autonomic dysfunction can affect heart rate, blood pressure regulation, digestion, temperature
control, sweat glands, urinary function and sexual function. As will be described with Polyvagal
Theory, ANS disfunction can also impact a person’s emotional state.
A well-regulated ANS can prevent disautonomy as the SNS reacts to threats appropriately and
then “stands down” as the PNS is activated. As music-thanatologists, a well-regulated ANS can
impact our lives as well as our work in vigil.
Heart Rate Variability as one measure of Autonomic system function.
Heart Rate Variability (HRV) is a measurable example of the inter-working of the SNS and PNS.
HRV is a measure of slight fluctuations in the amount of time between heart beats. A healthy
heart does not beat with a constant rate.
During the exhalation phase of breathing, vagal motor fibers send an inhibitory signal (called the
vagal brake) to the heart’s pacemaker to slow the heart rate. During the inhalation phase the
vagal influence on the heart is diminished and heart rate increases. The impact of exhalation on
the vagal brake is why many practices to activate the PNS involve breathwork.
Heart Rate Variability is the measure of these two actions together, giving an indication of the
adaptability or resilience of the heart. According to the Cleveland Clinic, people with high HRV
experience less stress and are happier while people with low HRV display less resilience in their
body which struggles to handle changing situations. Low HRV is common in people with higher

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resting heart rates, diabetes, high blood pressure, heart arrhythmia, asthma, anxiety and
depression.
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There are many means of enhancing HRV including biofeedback, breathing
exercises, physical fitness and meditation. These stimulate the PNS and specifically the vagus
nerve.
Historically HRV required medical devices for accurate measurement. Now consumer devices
such as smart watches are able to accurately measure HRV. As accurate HRV measurement
becomes available additional attention may be paid to HRV, as a biofeedback mechanism as well
as a tool of diagnosis.
Current interest in the vagus nerve in Western medicine
Vagus Nerve Stimulation (VNS) is receiving increased attention in traditional medicine. These
therapies include small devices that deliver electrical impulses to the VN from areas near the
chest, ear, head and neck. The exact mechanism by which VNS works isn’t entirely clear. It is
thought to involve changes in levels of various neuro transmitters in the brain including serotonin
and norepinephrine.
I include these here to both inform about these emerging therapies and for their potential
imaginal value when considering the possibility of stimulating the VN within a music-
thanatology vigil.
Reduction of inflammation in Rheumatoid Arthritis: Vagus Nerve Stimulation (VNS) has been
shown to effectively limit inflammation. Electrical stimulation to the whole VN bundle in the
neck has been applied successfully to reduce the inflammatory response of Rheumatoid Arthritis
or prevent development of full-blown sepsis in experimental research. In one trial to treat

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Rheumatoid Arthritis improvement in disease markers was achieved with VNS for one minute a
day, using an implanted device. VNS may also help to modulate the immune system.
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Improvement of heart function: Cardiovascular disease is often treated by using pharmacology to
inhibit over-excitement of the SNS. Vagus nerve stimulation (VNS) is being investigated as a
potential treatment for heart disease, particularly heart failure. Researchers postulate that an
abnormal imbalance between the sympathetic and parasympathetic nervous systems exists during
heart failure, in which the SNS becomes overactive and worsens heart failure. Researchers are
exploring the use of VNS to restore autonomic balance and suppress inflammation, potentially
improving heart function and reducing mortality.
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The mechanisms of action for these cardiac-focused therapies include increased vagal tone
leading to a slower heart rate and improved heart function. Another mechanism of action is in
reduced sympathetic activity (down-regulation of the SNS) which can be overactive in heart
failure. A dysregulated ANS characterized by higher sympathetic and blunted parasympathetic
response is the hallmark of heart failure.
Transcutaneous Auricular Vagal Nerve Stimulation (taVNS): The Auricular Branch of the Vagus
Nerve (ABVN) connects with the VN in the medulla oblongata (MO) ; the MO is a relay station
for visceral sensations. It receives sensations from the ABVN which can then adjust other
functions of the body as motor neurons in the VN control multiple peripheral organs and balance
the ANS. External stimulation of the tragus of the ear (the little piece of cartilage that covers the
ear canal and points away from the nose), called Low Level Tragus Stimulation (LLTS) is
emerging as a non-invasive neuromodulation strategy.
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Wondering Question: Do vibrations issued from harp and voice during a music-thanatology
vigil provide low level tragus stimulation and activation of the VN?
This is not an exhaustive list of conditions that are being treated or considered for treatment by
VNS, but a small sample that may be most interesting to music-thanatologists.
In all such therapies, so far, the stimulation is accomplished by attaching vibrational devices
either directly or indirectly to the VN. The consistency between all of these mechanical
therapies is vibration. While music-thanatologists do not physically touch patients and others in
the room during a vigil, the vibration of the harp and voice touches everyone within hearing
range. The imaginal value of vibration stimulating the VN may inform prescriptive thinking as
well as the intention of the music-thanatologist.
Polyvagal Theory – a bridge between physiology and psychology
The Polyvagal Theory (PVT), an expansion of prior thought on the workings of the ANS, was
developed in the 1990s by Stephen W. Porges, PhD, a neuroscientist and psychologist. This
theory describes the physiological and psychological states of our ANS which underlie much
human behavior and challenges related to our wellness and mental health. PVT provides a
neurobiological link between body and brain and between body and emotions.
Before describing PVT I will acknowledge that traditional western medicine has not completely
accepted PVT; it is a theory. I consider it to be a paradigm shift – a different way to look at
human physiology, psychology and behavior as well as how to stay well and respond (treat)
when unwell. The most informative resources on PVT, for me, were written by three medical
professionals who are not MDs: Dr. Stephen Porges, a neuroscientist and psychologist,
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Stanley

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Rosenberg, a body therapist including Rolfing and craniosacral therapy
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and Dr. Navaz Habib, a
Chiropractor and Functional Medicine practitioner.
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I’ve reviewed articles evaluating PVT by medical doctors and the overwhelming conclusion is
that it cannot be proven. One such review concluded that “PVT may have heuristic value”.
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According to Merriam Webster, heuristic means serving as an aid to learning and problem-
solving by experimental or trial and error methods including using self-educating techniques
such as evaluation and feedback. While PVT may not be proven, it may allow one to learn,
discover and problem solve using self-educating techniques.
In developing PVT, Porges identified the single nerve described by Claudius Galen as two
different nerves, the dorsal (back) VN and the ventral (front) VN. The dorsal vagal chain is the
older of these nerves. It is a remnant of the neural system humans inherited from cold-blooded
vertebrates such as the ancestors we have in common with reptiles. This old vagus nerve
originates at the rear of the brainstem, is unmyelinated, and innervates organs below the
diaphragm. It innervates the lower 2/3 of the esophagus, regulates stomach function, digestion
glands, the liver and gall bladder. It facilitates movement of food through the intestines
(excluding the descending colon).
The ventral vagus chain emerged with the evolutionary development of mammals. It is the
“new” vagus nerve. It is myelinated and innervates or controls the upper third of the esophagus,
most of the pharyngeal muscles (neck), the heart and the bronchi (lungs).
PVT builds upon and expands our knowledge of the ANS. The theory articulates 3 primary
principles and describes 3 primary states of the ANS.
The three primary principles of PVT are:
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1) Three primary ANS states: the ANS has three primary states which function and adapt
and change according to how we feel (what we sense) at any moment. These states form
an underlying neurophysiological foundation for our feelings and emotions. This is an
expansion of the physiologically-focused two-state understanding of the ANS with
opposition between the SNS and PNS.
2) Unconscious shifting between states: shifting between these states occurs beneath the
level of conscious awareness. Porges coined the term Neuroception for how the body,
without conscious thought, constantly monitors for clues about risk and safety and shifts
between ANS states in response. Using Neuroception, our nervous system continuously
scans other people, our body and our environment.
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3) Co-regulation: Humans naturally send signals of safety or danger to each other.
PVT explains how this occurs through our ‘social engagement system’. Facial
expressions, head movements, and vocal intonations can communicate a sense of safety
to another. These movements are controlled by various cranial nerves, including cranial
nerve X, the VN. This safety co-regulation connection is paramount to a healthy human
experience; in other words, we need to feel safe to be well. Safety in PVT is a model of
visceral sensitivity.
PVT articulates three principal states of the ANS. They are:
1)The State of Social Engagement
The state of social engagement is an expansion of the “rest and digest” state which is facilitated
by the ventral VN. In addition to the VN, the state of social engagement includes some portions
of other cranial nerves that impact communication via facial movements. Physiologically this
state is characterized by normal heart rate and muscle tone. Psychologically this state is

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associated with positive emotions of relaxation, engagement and curiosity and feelings of safety,
trust and connection. This state is associated with positive social interaction, emotional
regulation and resilience to stress. Externally, this state is communicated by the eyes, facial
expressions and tone of voice. Activation of this state has a calming, soothing effect which
promotes rest and restoration. When the ventral VN and associated social engagement system
are optimally functioning the ANS supports health, growth and restoration.
When the ventral VN emerged in mammals the area of the brain that regulates the newer
myelinated VN was linked in the brainstem areas that control the muscles of the face and head.
It controls our ability to listen through middle-ear muscles, our ability to articulate through the
laryngeal-pharyngeal muscles and our ability to express emotion and intonation through the face.
This linkage between the vagal regulation of the heart and regulation of the muscles of the face
and head enable one to see indications of physiological state in faces and hear physiological state
in voices. This face-heart linkage is reflected in an integrated social engagement system. When a
music-thanatologist phenomenologically observes a patient’s countenance they are observing
this aspect of the state of social engagement.
2) The Mobilized State
The mobilized state is the “fight or flight” state of traditional ANS understanding. We are
mobilized with fear when we are not safe or do not feel safe. This state is driven by the SNS.
Physiologically it is characterized by increased heart rate, increased blood pressure, increased
hormone flow and increased muscle tone as adrenaline and stress hormones are released
preparing the body for action. Psychologically, when feeling unsafe, feelings of anger, stress,
anxiety, and fear are associated with this state. The mobilized state is expressed in behaviors

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such as fighting to overcome a threat, fleeing to avoid a threatening situation and hyper-vigilance
to possible threats.
3)The Immobilized/Collapsed State

The immobilized/collapsed state is also called the dorsal vagal state. It is activated when we face
overwhelming force and immanent destruction; we immobilize/withdraw/shut down to conserve
resources. This state is also driven by the PNS and specifically the dorsal vagal pathways of the
VN. It is activated in response to threats and stressors. Physiologically it is characterized by low
heart rate, low muscle tone and low energy. Psychologically, when feeling unsafe, feelings of
helplessness, hopelessness, apathy, depression, unhappiness, and loneliness are associated with
this state. Sudden and extreme activation of this state can lead to a state of shock or shutdown as
musculature loses tonus, BP drops, and fainting or syncope occurs. This situation can be life
threatening.
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PVT also includes some combination states, but for simplicity, this paper will focus on the 3
primary states.
As described by PVT these three states regulate the functions of our inner organs and relate to
our emotional states which in-turn drive behavior. A central tenet of PVT is that the 3 states of
the ANS are hierarchical. Newer circuits regulate and control older circuits. The relaxed/state of
social engagement involves the most recently evolved nerve circuit, the ventral VN; it is at the
top of the hierarchy as it promotes peaceful immobilization and a sense of well-being. The
mobilized state in which the SNS is activated is the next rung down on the hierarchy, with
activation causing the fight/flight response. The immobilized/collapsed state caused by

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activation of the dorsal VN is the lowest rung and the oldest evolutionary circuit. This state
triggers defensive responses of immobilization with fear.
Shifting between states: When the ANS is functioning well it moves from one state to another
fluidly, flexibly; responding appropriately to stimuli presented from both outside and inside our
bodies and mind. A feeling of safety is crucial to maintaining a well-functioning ANS. Trauma
and chronic stress can keep the ANS from maintaining homeostasis; it can get stuck in the
survival states of immobilized/collapsed or mobilized. Getting stuck in either of these states has
significant implications for health, wellness, disease treatment response and mental health.
Activation of the relaxed state of social engagement by activating the ventral VN inhibits the two
lower levels. It can lift one out of chronic activation of the SNS (mobilization) as well as the
dorsal state of shutdown (immobilization with fear). Ventral vagal circuit activity can move a
person directly from shutdown and emotional depression to a relaxed ventral vagal state.
Polyvagal Theory emphasizes the importance of proper functioning of the ventral branch of the
VN in achieving optimal physical and psychological health.
As the 2
nd
rung of the hierarchy, activation of the SNS, the mobilized state, inhibits the dorsal
vagal circuit; therefore running, swimming, and other forms of exercise that raise the heart rate
and simulate fight or flight exertions can alleviate immobility/collapsed state.
Understanding the three physical/emotional states, and their hierarchy, can be informative in the
music-thanatology vigil. When feeling unsafe, patients and family members in a mobilized state
(activated SNS) may feel anger, stress, anxiety and fear. When feeling unsafe, patients in an
immobilized/collapsed state (activated dorsal VN) may feel helpless, hopeless, apathetic,
depressed, unhappy and lonely. All music-thanatologists have experienced these feelings

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coming up within the vigil. The hierarchical nature of the states doesn’t require the music-
thanatologist to determine which state the patient (or family member) is in. Activating the
ventral VN can move someone toward the desired relaxed/safe state.
Application of PVT to music-thanatology.
Safety is embedded in human neurological systems. Feeling safe is a requirement for the
relaxed/state of social engagement. Feeling unsafe is a driving factor in both the defensive states
of mobilization and immobilization. Safety is defined by feeling safe and not by removing
external threats. PVT expanded the state of social engagement to include some nerves that
regulate facial muscles because the face of another can offer cues to safety; facial expressions
can also reflect a person’s physiological state. If our nervous system detects safety then it is no
longer defensive; the most important thing to our nervous system is that we are safe.
Here are some actions that can be included in a music-thanatology vigil to help the patient and
possibly family members move toward a relaxed/safe state by activating the ventral VN and
supporting feelings of safety:
Co-regulation: Co-regulation is the neural regulation of physiological states between individuals.
Safety through co-regulation is a biological imperative for humans. Cues from a safe individual
enable the sick or compromised person to move from a defensive state to a relaxed state.
Humans automatically mirror the state of others around us. Only when we are in a relaxed state
can we convey cues of safety to another. Entering into the vigil in a state of social engagement,
communicated through presence, voice, eyes and countenance, can facilitate connections with
others in the vigil. It can also support ANS regulation by participants in the vigil. This may

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require the music-thanatologist to maintain a state of VN regulation, or to execute practice(s)
immediately before the vigil to activate their VN.
Attention to breath: most music-thanatology vigils begin with phenomenological observation of
the patient’s breath rate and pattern. When possible and appropriate, support or companion the
breath with the pace of the music while encouraging long exhalation. Deep exhalations can
stimulate the ventral VN. A sung piece at a slow pace can require deeper respirations by the
music-thanatologist which a patient may mirror. Supporting the patient’s breath rate and pattern
with the pace of the music may lead to increased feelings of safety.
Safety: Environments that are felt to be safe have a certain amount of structure and
predictability. Music offered with short phrases and considerable repetition may increase
participants’ feelings of safety as they become familiar with the music being offered
(predictable). As Laura Moya says, the repetition is the medicine. Offering music that
acknowledges or meets feelings of interiority, allowing safe expression of that interiority, may be
perceived as supportive and facilitate feelings of safety. Conversely, mirroring feelings of
exteriority with music may also be perceived as supportive and increase feelings of safety.
Prosody: Porges writes at length about the impact of prosody on cues of safety. While prosody
in speech or music is a complicated subject, Porges’ uses the term to describe a modulated
melodic voice or song. Lullaby’s are especially prosodic. Mothers talk to their children with
prosodic voices. Prosody is intonation in voice or instrument that conveys emotion; it conveys
information about physiological state (for co-regulation). We use prosody in our voice to
communicate to the biology of the other person, not to their cognition. Prosody provides the

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nervous system with acoustic cues that trigger feelings of safety. Human’s ears are “tuned” to
hear prosodic voice in speech or song.
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Relaxation: Porges described a healing event which started with relaxation. The relaxation was
sufficient to reorganize neural muscular regulation and transmit signals of safety to the brain.
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A
frequent intention and outcome of the music-thanatology vigil is relaxation. Musical flow, in
melody, harmony and tempo can promote healing relaxation.
Within each music-thanatology vigil we can use our eyes and facial muscles, as well as prosodic
singing and harping to enhance feelings of safety for our patients and their families. Safety is
required for movement to a state of social engagement with an activated ventral VN. Whether
the patient is outwardly cognizant or not, whether others are in the room, the presence of the
music-thanatologist in the vigil is an opportunity for social engagement and to enhance feelings
of safety. “I am here with you”.
Polyvagal Theory includes descriptions of many dysfunctions of the VN which present as
symptoms which are beyond the scope of this paper. The references included in the bibliography
can provide much detail about the presentation of disease due to VN dysfunction.

Our Vagus Nerve – a user’s guide for the Music-Thanatologist
I recently attended a weekend-long Kirtan retreat. Kirtan is a yoga practice that focuses on sung
music. Being an eastern practice, most of the music is of Hindu or Sikh origin although western
music was included as well.

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We sang simple syllables, most in Sanskrit. They were sung in a call and response style, led by a
woman playing the harmonium providing chordal accompaniment. Guitar and drum often
accompanied the singing. We sang each short phrase repeatedly, for many minutes per song.
Volume and tempo varied and individual singers added harmony. Each song was very beautiful
to sing and listen to.
At the retreat the music alternated with meditation. The group sang, meditated and ate together
with strong social cohesion. It was a bath for my vagus nerve and state of social engagement!
The chant coming through my larynx, the deep exhalations required of singing, meditation to
quiet the mind and being with pleasant, open, engaged people in a rural wooded environment led
to feelings of safety and inclusion and a well activated VN in a relaxed state.
We can’t go to Kirtan retreats all the time, but we can modulate our ANS, allowing fluid
movement between mobilized and immobilized states while remaining in a relaxed state of social
engagement as much as possible. Here are some possibilities for activating the ventral VN to
modulate our ANS; developing neural circuits necessary to become more resilient, safer, and to
better help our clients in vigil move into a state of safety by reflecting our feelings of safety.
Each practice is a portal to changing our physiology and psychology.
Co-regulation: We automatically mirror the state of others around us. To connect and co-
regulate with others is a biological imperative of mammals. Connecting with others who are
safe, attuned and present is one of the best ways to improve ANS regulation. Building social
connections with others exercises our social engagement system and helps regulate our
emotional state. Positive social connections help us feel safe and secure, reduce stress and sooth
our nervous system.

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Practice self-regulation: the ability to manage emotional states and physiological response to
stressors. Many possibilities for self-regulation are described below.
Breathwork: Activate the ventral VN with slow, diaphragmatic breathing. Good diaphragmatic
breathing is important; if tonus of the diaphragm is reduced or lost, the entire musculoskeletal
system is impacted. Some of the afferent functions of cranial nerves X and XI monitor the
amount of oxygen and carbon dioxide in the blood. By improving the pattern of breathing,
impacting blood chemistry, the brain learns the person is safe and visceral organs are functioning
properly, facilitating the relaxed state of social engagement.
Sing! Singing is a neural exercise for the social engagement system. It requires slow
exhalations as well as control of muscles of the face, head and diaphragm to produce modulated
vocalizations. Singing requires longer exhalations than inhalations. Slow exhalations calm
autonomic state by increasing the impact of ventral vagal pathways on the heart. This includes
muscles of the middle ear required to listen and muscles of the larynx and pharynx required for
vocal intonation. Listening increases the neural tone of the middle ear muscles.
Singing, chanting, humming, oral reading, and playing wind instruments all offer the practice of
elongating exhalation and shortening inhalation.
Physical Activity: Engage in physical activities that promote body awareness and relaxation such
as yoga and personal “flow” activities which can include artistic self-expression. Pranayama
yoga is a yoga of social engagement combining the neural exercises of breath and control of the
striated muscles of the face. Regular practices such as Tai Chi, Qi Gong, dancing and
meditation can accomplish this as well. Being in a state of safety is embedded in mindfulness.

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Regular physical activity helps regulate the ANS, promoting a balanced relaxed state of social
engagement. Exercise can lift someone in an immobilized state into a mobilized state. If safety
is present the mobilized state will regulate into the relaxed/safe state. Physical exercise in nature
is particularly effective ( this last is an editorial comment from my own experience).
Minimize/manage triggers: Identifying triggers, those events and situations that threaten you,
allows for understanding what stimulates/activates your stress response; avoid or manage these.
Ear tug: A craniosacral (energy) therapist advised that gently tugging outward on the ears
stimulates the VN.
Basic VN exercise: The Basic Exercise as described in the book Accessing the Healing Power of
the Vagus Nerve by Stanley Rosenberg can improve the function of cranial nerves X and XI.
This exercise repositions the atlas (C1, the first cervical/neck vertebra) and the axis (C2) and
increases mobility in the neck and the entire spine. It increases blood flow to the brainstem,
where the five cranial nerves necessary for social engagement originate. The goal of this
exercise is to enhance social engagement. Here is a link to a YouTube video called The Basic
Exercise by Stanley Rosenberg. It is a very simple exercise.

15

Laugh: Laughter, activating the gag reflex, and gargling can stimulate the ventral VN and other
cranial nerves that facilitate the state of social engagement.
Sleep hygiene: Practice good sleep hygiene as a restful night of sleep has been shown through
HRV studies to improve autonomic balance.

23
Professional support: Seek professional support if you find yourself stuck in either mobilized or
immobilized states if you are unable to self-regulate back to a state of rest and relaxation. Here
is a link to a video created by The Polyvagal Institute about the long-lasting impact of trauma on
the ANS: https://youtu.be/uH5JQDAqA8E?list=TLGGs778TJPLSswxNjAzMjAyNQ
16
The goal of all of these activities and practices is to maintain a ventral vagal state of social
engagement, or return to it quickly after stress or emotional withdrawal, in order to achieve
optimal health and well-being and best serve our clients in the music-thanatology vigil.

24
Conclusion
In summary, a well-regulated autonomic nervous system is critical to health and well-being.
Maintaining a well-regulated ANS is facilitated by recognizing things that trigger fears and
activate the SNS, and by developing strategies and practices to activate the PNS and support a
state of social engagement. Many of these strategies and practices involve stimulating the
ventral vagus nerve. When maintaining a state of social engagement we are most available to
clients in the music-thanatology vigil. We can communicate in such a way that participants in
the vigil may experience feelings of safety with our presence, attention, prescriptive delivery
decisions and the vibrations of our musical instruments of harp and voice. When feeling safe
patients may also receive the benefits of relaxation and changes in physiological processes
reflected in heart and breath rates and patterns.
While mentioning vibration, I haven’t attempted to explain how vibration of harp and voice
impact those in a music-thanatology vigil. Vagal Nerve Stimulation, which involves stimulating
the VN with electrical vibrations, is being tested based on cause and effect, but the mechanism of
exactly what occurs between initiation and response isn’t understood. If the scientists don’t
understand it I’m not going to try to explain it.
My belief is that there is enough known about the ANS to validate that seeking and maintaining
autonomic regulation is an appropriate goal for music-thanatologists as a means of both self-care
and best serving their patients in the vigil.
One of my goals for this paper is to offer music-thanatologists a greater understanding of the
physiological operation and related psychological effects of the vagus nerve and the entire
autonomic nervous system. Perhaps some “ah ha” moments may occur to experienced music-

25
thanatologists. “Oh – that’s what’s going on”. If this happens I’d love to learn about your
experiences and understanding.

26
Notes

1
Stanley Rosenberg, Accessing the Healing Power of the Vagus Nerve, (North Atlantic Books,
Berkeley CA, 2017) p 137

2
https://my.clevelandclinic.org/health/symptoms/21773-heart-rate-variability-hrv

3
John M. Karemaker, The Multibranched Nerve: Vagal Function Beyond Heart Rate
Variability, (Biological Psychology, 2022) p 7

4
Michael J. Capilupi, Samantha M. Kerath, Lance B. Becker Vagus Nerve Stimulation and the
Cardiovascular System. (Cold Spring Harbor Perspectives in Medicine
https://pmc.ncbi.nlm.nih.gov/articles/PMC6996447 2020)

5
Tarun Dasari, Praloy Chakraborth, et.al. Non-invasive low level tragus stimulation attenuates
inflammation and oxidative stress in acute heart failure. (Clin Auton Res,
https://pubmed.ncbi.nlm.nih.gov/37943335/) 2023

6
Stephen W. Porges, The Pocket Guide to The Polyvagal Theory, (W.W. Norton and Company)
2017

7
Stanley Rosenberg, see
1
above

8
Navaz Habib, Activate Your Vagus Nerve, (Ulysses Press, Berkeley CA)2019

9
Winifred L Neuhuber and Hans-Rudolf Berthaud, Functional Anatomy of the Vagus Nerve,
How does Polyvagal Theory Comply? (Biological Psychology Vol174,) Oct 2022.
https://pubmed.ncbi.nlm.nih.gov/36100134/

10
Stephen Porges, https://www.polyvagalinstitute.org

11
Rosenberg, see
1
above , pp. 57-63

12
https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527

13
Stephen Porges, see
6
above, p109

14
Rosenberg, above, Forward by Stephen Porges, PhD

15
Stanley Rosenberg, see
1
above

16
Polyvagal institute see
10
above

27

Bibliography

1) Accessing the Healing Power of the Vagus Nerve, Stanley Rosenberg, 2017

2) Activate your Vagus Nerve: Dr. Navaz Habib, 2019

3) The Anatomy of the Central Nervous System, Joshua A. Waxenbaum, Vamsi Reddy,
Matthew Varcallo, July 24, 2023, ncbi.nim.nih.gov

4) Closed Loop Transcutaneous Auricular Vagal Nerve Stimulation: current situation and
future Possibilities. Yutian Yu, JingLing, Lingling Yu, Pergfei Liu, MinJiang. Frontiers
in human neuroscience, Jan 4, 2022

5) Disautonomia/autonomic dysfunction: Stanfordhealthcare.org

6) Functional Anatomy of the Vagus Nerve, How does Polyvagal Theory Comply? Winifred
L Neuhuber and Hans-Rudolf Berthaud, Biological Psychology Vol174, Oct 2022.
https://pubmed.ncbi.nlm.nih.gov/36100134/

7) Non-invasive low level tragus stimulation attenuates inflammation and oxidative stress in
acute heart failure. Pmc.ncbi.nlm.nih.gov

8) The Pocket Guide to The Polyvagal Theory: Stephen W. Porges, 2017

9) Polyvagal Theory: polyvagalinstitute.org

10) Regarding Heart Rate Variability: Cleveland Clinic.org

11) Vagus nerve stimulation may tame autoimmune diseases. NPR Morning Edition Feb 3,
2025. NPR.org

12) Vagus Nerve Stimulation and the Cardiovascular System. Michael J. Capilupi, Samantha
M. Kerath, Lance B. Becker, Feb 2020
https://pmc.ncbi.nlm.nih.gov/articles/PMC6996447