Regulating a Dysregulated Nervous System: How Psychotherapy Can Support Those Living with Chronic Health Conditions that Lead to Dysautonomia
Introduction
Living with chronic illnesses can feel like being trapped in a body that’s constantly sounding the alarm, and never allowing you to rest. Many conditions, like Ehlers Danlos Syndrome (EDS), Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS), are a cluster of diagnoses often linked to autonomic nervous system dysregulation, also known as dysautonomia. The term ‘dysautonomia’ encompasses any disorder affecting the autonomic nervous system’s ability to regulate automatic body functions including heart rate, digestion, temperature regulation, and blood pressure. Symptoms can include fainting or almost fainting, nausea and vomiting, fast heart rate (tachycardia) or slow heart rate (bradycardia), GI issues, chest pain, shortness of breath, hyperactive bladder or incontinence, sleep issues, migraines and headaches, and the list goes on and on.
For many, symptoms go far beyond the physical. Brain fog, chronic fatigue, spikes in anxiety and panic, hypervigilance and extreme startle responses, depressive symptoms seemingly out of nowhere, and a feeling of being "stuck in survival mode" are common. That’s because when the autonomic nervous system (ANS) is in a chronic state of fight, flight, or freeze, it impacts not just the body, but also mood, cognition, and emotional regulation.
I’m There Too
This isn’t just something I understand clinically—I live it every day. I’ve been diagnosed with POTS, EDS, and MCAS, and I know firsthand the frustration of trying to find answers, the emotional rollercoaster of unpredictable symptoms, and the deep exhaustion that comes with feeling dismissed or misunderstood.
Over the years, I’ve learned how powerful it is to work with the nervous system, not against it. As both a therapist and a person living with these conditions, I’ve experienced how transformative nervous-system-focused therapy can be. It’s not a cure, but it’s a way to create more stability, capacity, and peace in a body that often feels anything but.
Why Do These Health Conditions Impact the Autonomic Nervous System?
More information is needed to understand exactly why there is such an impact on nervous system functioning, but here is a breakdown of common theories about why and how these specific conditions affect the nervous system:
POTS (Postural Orthostatic Tachycardia Syndrome)
POTS is “disorder of the autonomic nervous system,” a form of dysautonomia where the ANS fails to regulate blood flow and heart rate properly, especially when standing. This results in excessive heart rate increases, dizziness, and fatigue. It could be due to issues with blood vessel tone, blood volume, or nerve signaling.
Ehlers-Danlos Syndrome (EDS)
In hypermobile EDS (hEDS), the connective tissue is too stretchy or fragile, which affects blood vessels and organs. The vascular instability can strain the ANS, leading to poor blood pressure regulation and frequent triggering of fight-or-flight responses. Joint instability and chronic pain also constantly signal the nervous system, keeping it activated in fight or flight mode.
MCAS (Mast Cell Activation Syndrome)
Mast cells play a critical role in the immune system by releasing histamine and other inflammatory mediators. In Mast Cell Activation Syndrome (MCAS), these chemicals are released inappropriately and excessively, which can disrupt multiple systems in the body. This dysregulated release can impact cardiovascular function, norepinephrine regulation, gut and brain health, and skin reactivity. It can also reduce vagal tone and allow neuroinflammatory molecules to cross into the central nervous system. Together, these effects can significantly influence autonomic function—often leading to symptoms like flushing, rapid heart rate, brain fog, gastrointestinal distress, anxiety, depression, and more.
Neurological or Autoimmune Conditions
Conditions like MS, lupus, or autoimmune autonomic ganglionopathy directly attack nerves or the structures that regulate autonomic function, leading to dysregulation.
Post-Viral Triggers (e.g., Long COVID, EBV)
Certain viruses may damage autonomic nerves or trigger autoimmune responses that affect ANS signaling. They can leave lingering dysfunction in how the brainstem and vagus nerve manage the body’s baseline functions.
Chronic Illness and Pain Conditions
Chronic illnesses like fibromyalgia or ME/CFS involve persistent nervous system hyperarousal, sometimes called central sensitization. The brain and spinal cord become overly responsive to stimuli, disrupting pain regulation and keeping the ANS in overdrive. Its also important to note that pain keeps you in a fight or flight response, so chronic pain alone can lead to chronic nervous system dysregulation.
Physical Trauma or Injury
Injuries to the spine, brain, or cervical spine (like whiplash or conditions like Chiari malformation) can physically impair autonomic nerve pathways or blood flow to the brain, leading to dysautonomia.
Understanding Autonomic Dysregulation
The autonomic nervous system has 3 main states of functioning (2 well known states and an additional posed by Dr. Stephen Porges in Polyvagal Theory):
Parasympathetic Nervous System (PNS) – the "brake" that helps us rest, digest, and heal. In this state we feel safe to engage socially. Also known as the Ventral Vagal Response in Dr. Stephen Proges’s Polyvagal Theory. Our body is functioning as it should.
Sympathetic Nervous System (SNS) – the "gas pedal" responsible for fight-or-flight responses. Also the “mobilization” state, our nervous system activates in order to survive and uses only necessary bodily functions to “survive,” while other organs are less active or inactive. You experience greater anxiety and adrenaline in this state. When the sympathetic system kicks in, your body prepares for immediate action by the following responses:
Brain:
Increases alertness, scanning for danger
Shifts resources away from reasoning and toward reflexive survival responses (less prefrontal cortex, more amygdala)
Heart:
Heart rate and blood pressure increase
Blood flow is redirected to muscles and away from non-essential organs
Lungs:
Breathing becomes rapid and shallow
Oxygen intake increases to fuel quick action
Gut/Digestion:
Digestive activity slows or halts completely
Blood flow is diverted away from the GI tract (leading to nausea, bloating, or constipation)
Bladder/Reproductive Organs:
Suppressed function (less urination, lower libido)
Reproductive processes are considered non-essential during threat
Polyvagal Theory, developed by Stephen Porges PhD, also identifies a third sate that is the Dorsal Vagal Response, an “immobilized” or “collapsed,” state. In this state, our body shuts down and we may feel numb or disconnected from our surroundings. The body is essentially trying to “get through death with as minimal pain as possible.” This shutdown mode is activated when fight-or-flight fails or the threat feels inescapable. In this state we feel hopeless, depressed and experience dissociation. The body responds in the following ways:
Brain:
Disconnection or dissociation (feeling numb, foggy, or detached)
Decreased energy to executive functions
Heart:
Heart rate slows (bradycardia)
Blood pressure may drop
Lungs:
Breathing becomes shallow or even restricted
May feel like it’s hard to take a full breath
Gut/Digestion:
Digestion nearly stops
May experience nausea, cramping, or diarrhea
Bladder/Reproductive Organs:
Loss of tone or control (urinary urgency or incontinence in extreme states)
Reproductive function continues to be suppressed
With Dysautonomia, your body can stay stuck in these states with the above listed symptoms existing chronically. The body can easily default to these states even when no real danger is present, which leads to chronic physical symptoms including GI disorders, hormonal imbalances, fatigue and cognitive dysfunction, further chronic pain and inflammation even beyond the baseline of these disorders, and then the cycle continues. When your nervous system gets stuck in chronic sympathetic arousal or dorsal vagal shutdown, it creates a self-reinforcing loop that can gradually worsen over time. Below is an example of the vicious cycle of dysautonomia:
Initial Trigger (Stress, Illness, Pain Flare, Trauma, Injury)
→ The body shifts into fight/flight or freeze to protect itself.Physiological Dysregulation
→ Blood flow shifts away from digestive and reproductive systems.
→ Heart rate, blood pressure, and cortisol spike (or crash).
→ Inflammation increases, gut function worsens, hormones become dysregulated.Symptoms Escalate
→ Fatigue, worsened pain, GI issues, brain fog, dizziness, anxiety, insomnia, etc.Neuroception Reinforces Threat
→ Because the body feels so unstable, the nervous system interprets internal signals as unsafe, even when the physical environment might actually be safe.Avoidance, Shutdown, or Overdrive
→ You might push through (sympathetic overdrive) or shut down completely (dorsal vagal).
→ Social withdrawal, fear of activity, or medical avoidance can occur.Nervous System Becomes Less Flexible
→ The longer you stay in dysregulation, the harder it becomes to access the ventral vagal state (connection, calm, regulation).
→ The system gets “stuck” in survival mode, and even small triggers can cause major reactions.Chronic Stress & Illness Feedback Loop
→ This loop increases inflammation, decreases immune function, and makes healing more difficult.
→ You may start to fear your symptoms, which further dysregulates your system—and the cycle deepens.
Psychotherapy as Nervous System Care
For those of us living with dysautonomia and related conditions, therapy is about finding safety in our bodies again. It’s about increasing our capacity to cope, feel, and function, even when our physical symptoms persist.
Bottom-up approaches like EMDR, SSP, and Somatic Experiencing go beyond traditional talk therapy. A bottom-up approach starts with the body and the nervous system—not thoughts or beliefs. It focuses on regulating the physiological responses first, which then allows the brain and emotions to follow. A bottom-up approach teaches the nervous system to recognize safety, build capacity, and recover from chronic activation.
This is in contrast to top-down approaches (like traditional talk therapy or CBT), which start with the cognitive mind—thoughts, stories, logic—and work their way downward to try to influence emotional or physical responses.
How Psychotherapy with Nervous System Regulation Interventions Can Help
While these are medical conditions that need proper diagnosis and treatment, psychotherapy can play a crucial role in supporting nervous system regulation and improving quality of life. The following are three interventions I offer at Brighter Minds Therapy to support nervous system regulation.
1. Safe and Sound Protocol (SSP)
Developed by Dr. Stephen Porges, the SSP is a listening-based intervention developed by Dr. Stephen Porges, grounded in the Polyvagal Theory, which explains how the autonomic nervous system responds to cues of safety or danger. SSP uses specially filtered music to stimulate the vagus nerve through the auditory system, gently training the nervous system to recognize and respond to cues of safety. For individuals with trauma, chronic illness, and dysautonomia, who often live in a persistent state of fight, flight, or freeze—this tool can help “retune” the nervous system, reducing hypervigilance and improving tolerance to sensory input and emotional stress. By activating the ventral vagal pathway (responsible for social engagement and calm), SSP supports a shift out of survival states and into regulation. Many clients report feeling more grounded, connected, and resilient in the face of everyday stressors after using SSP. Over time, this increased access to safety in the body can lead to improvements in mood, digestion, sleep, immune function, and overall well-being. For more information you can visit https://integratedlistening.com/products/ssp-safe-sound-protocol/
2. EMDR (Eye Movement Desensitization and Reprocessing)
EMDR helps process trauma—both big and small. Traumatic or overwhelming experiences often get “stuck” in the nervous system—locked in fight, flight, or freeze responses. EMDR helps by activating both sides of the brain through bilateral stimulation (often through eye movements or tapping), allowing the brain to digest and integrate unprocessed memories and bodily sensations. As the nervous system completes these unfinished stress responses, symptoms like hypervigilance, anxiety, panic, or shutdown often begin to ease. Over time, clients may find they can return to a ventral vagal (regulated) state more easily, with less reactivity and more internal safety. For people living with dysautonomia or chronic illness, EMDR can also help process the trauma of medical experiences, misdiagnoses, or the grief of physical limitations—offering both emotional and physiological relief. It can also help process and shift negative core beliefs developed from the trauma of chronic illness including thoughts like, “I can’t trust my body,” “I don’t fit in,” “something is wrong with me,” “I am permanently damaged,” “I am not lovable,” etc. EMDR can calm the body’s threat response and help rewire unhelpful thinking patterns that can also contribute to keeping us stuck in survival mode. For more information you can visit https://www.emdria.org/about-emdr-therapy/experiencing-emdr-therapy/
3. Somatic Experiencing (SE)
SE is a body-based therapeutic approach designed to gently release the effects of trauma and chronic stress stored in the nervous system. Rather than diving into the story of what happened, SE helps clients tune into the sensations, impulses, and subtle shifts in their body—allowing the nervous system to process and complete survival responses that were interrupted or frozen during overwhelming experiences. For individuals with autonomic dysregulation SE can support the re-establishment of felt safety, enhance interoceptive awareness, and help restore the body’s natural capacity to move between states of activation and calm. Over time, this builds nervous system resilience, so that everyday stressors no longer trigger overwhelming fight, flight, or shutdown responses. It’s a gentle, titrated process that respects the body’s pace and helps foster a sense of empowerment, presence, and inner stability. For more information visit: https://www.somaticexperiencing.com/somatic-experiencing
You’re Not Broken—Your Body Is Trying to Protect You
If you live with POTS, EDS, MCAS, or other forms of dysautonomia know this: your symptoms are real. Your body is not failing you—it’s trying to protect you in the only way it knows how. And while that protection can feel like chaos, there are ways to gently guide your system back into balance. If you are looking for some immediate relief, check out this worksheet I made for Nervous System Regulation Exercises you can do at home!
You’re living in a body that’s been through a lot, and you deserve trauma-informed, body-aware support.
Resources:
· https://www.ehlers-danlos.com/dysautonomia/
· https://www.dysautonomiainternational.org/page.php?ID=180
· https://www.polyvagalinstitute.org/whatispolyvagaltheory
· https://my.clevelandclinic.org/health/diseases/6004-dysautonomia
· https://thedysautonomiaproject.org/mast-cell-activation-simplified/
· https://www.eds.clinic/articles/mast-cells-mcas-dysautonomia-vagus-nerve
· https://pmc.ncbi.nlm.nih.gov/articles/PMC10672129/
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