Supporting Nervous System Regulation and Recovery in Long COVID

Polyvagal Informed Approaches for Healing
Eric Hulsing, MA, LPC

This article is adapted from a presentation delivered to a Long COVID support group at UCHealth.

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Introduction

Long COVID is increasingly recognized as a complex and often debilitating condition that can affect people long after the initial infection. Symptoms like fatigue, brain fog, anxiety, and sleep disruption are common, and many of these can reflect underlying nervous system dysregulation (Centers for Disease Control and Prevention [CDC], 2025).

Polyvagal informed approaches offer a framework for understanding these symptoms and supporting recovery by targeting the body’s physiological sense of safety and regulation (Porges, 2025).

These approaches are meant to support nervous system regulation and symptom management and are not treatments for Long COVID itself.

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Nervous System Dysregulation in Long COVID

Individuals with Long COVID commonly experience:

• Brain fog and impaired concentration
• Chronic fatigue
• Anxiety and emotional dysregulation
• Sleep disturbances
• Sensory sensitivity

These symptoms may persist for months or years and significantly impact daily functioning (CDC, 2025).

Therapists and healthcare providers play a critical role in:

• Supporting symptom management
• Providing psychoeducation
• Advocating for clients
• Collaborating with multidisciplinary teams

In clinical practice, many individuals with Long COVID describe feeling “stuck” in a dysregulated state, even when they are trying to rest. Interventions that target the nervous system directly can sometimes help shift that pattern.

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Neurodivergence and Long COVID

Some clinicians and researchers have started to describe Long COVID as a form of “acquired neurodivergence.” In other words, people may find their brain and nervous system functioning differently than they did before. Brain fog, executive functioning challenges, sensory sensitivity, and autonomic dysregulation can start to look a lot like patterns we see in neurodivergent populations. This isn’t a formal diagnosis, but it can be a helpful way of understanding what’s happening and how to adapt supports (Doyle, 2022).

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A Polyvagal Perspective

Polyvagal Theory describes how the autonomic nervous system shifts between three primary states:

• Ventral vagal (safe and socially engaged)
• Sympathetic (fight or flight)
• Dorsal vagal (shutdown)

These shifts are guided by neuroception, the nervous system’s unconscious detection of safety or threat (Porges, 2025).

Key Principles

Hierarchy
The nervous system prioritizes survival based on perceived safety.

Neuroception
Subconscious detection of safety or danger shapes physiological and emotional responses (Porges, 2025).

Co regulation
Humans regulate most effectively in safe, supportive relationships (Onderko and Porges, 2025).

While Polyvagal Theory has clinical utility, some aspects remain debated, and it should be used alongside established medical and psychological treatments.

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Music, Neuroplasticity, and Regulation

Music engages multiple brain systems, including emotional, cognitive, and sensory networks, and can support neuroplasticity and emotional regulation (Levitin, 2024; National Institutes of Health and National Endowment for the Arts, 2023).

Research suggests that music based interventions can support attention, reduce anxiety, enhance emotional expression, and support social engagement.

Levitin (2024) emphasizes that neurodivergent individuals may particularly benefit from music as a tool for regulation and connection.

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Recognizing Survival States

Symptoms of nervous system dysregulation may include:

• Difficulty connecting with others
• Persistent anxiety or loneliness
• Reduced concentration and creativity
• Sleep disruption
• Digestive difficulties

These patterns often reflect a nervous system operating in a defensive or survival state rather than a regulated, restorative state.

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Supporting Nervous System Regulation

Interventions that promote nervous system regulation are associated with:

• Improved stress response
• Enhanced emotional regulation
• Stronger social engagement
• Increased resilience and well being

Key Interventions

Safe and Sound Protocol (SSP)

The Safe and Sound Protocol (SSP) is a music based listening intervention developed by Unyte, a company headquartered in Littleton, Colorado. It uses specially filtered music to help the nervous system respond more easily to cues of safety and social connection (Porges, 2025). The idea is that by changing how the brain processes sound, people may have an easier time regulating, tolerating sensory input, and engaging socially.

Reported outcomes from large scale data include:

• 85% reduction in anxiety (GAD-7)
• 81% improvement in depression (PHQ-9)
• 87% reduction in trauma symptoms (PCL-5)
• Improved social communication and reduced auditory hypersensitivity in autistic children, as observed in clinical trials (Porges et al., 2019)

These findings are based on aggregated provider reported data and should be interpreted as preliminary real world evidence (Unyte, 2025).

In practice, some individuals notice small shifts first, such as improved tolerance for sound, better sleep, or feeling slightly less on edge, before larger changes occur.

Rest and Restore Protocol (RRP)

The Rest and Restore Protocol (RRP) is a music based listening program that uses specially designed acoustic tracks to support relaxation and nervous system regulation (Unyte, 2025). It’s designed to work more in the background, helping the body shift toward balance by influencing things like heart rate and breathing rhythms. Many people experience it as a more passive intervention, where the nervous system responds without needing to actively “do” anything.

• 76% of individuals report improved sleep
• Reductions in insomnia severity
• Increased physiological resilience
• Improved engagement with or tolerance for other treatments (Unyte, 2025)

Amplitude Modulation Music and Attention

Some newer research is also looking at how structured, non distracting music can support attention. Music with targeted amplitude modulation, such as that used in platforms like Brain.fm, is designed to give the brain steady, predictable stimulation without the distraction of lyrics or complex melodies.

Studies suggest this type of music may help sustain attention by engaging brain networks involved in cognitive control. People with attentional difficulties performed better on sustained attention tasks when listening to this kind of music compared to other conditions, and brain imaging showed increased activity in executive functioning networks (Woods et al., 2024).

Biofeedback and Heart Rate Variability

Heart Rate Variability reflects the flexibility and adaptability of the autonomic nervous system (McCraty and Shaffer, 2015).

Higher HRV → greater resilience
Lower HRV → potential dysregulation

Biofeedback helps individuals build self regulation skills by providing real time feedback on physiological signals such as heart rate, breathing patterns, and nervous system activation. Through guided practice, individuals can learn to shift their physiological state toward greater balance and stability.

Heart rate variability training is a commonly used form of biofeedback. This may include wearable devices or structured programs such as HeartMath, which combine breathing techniques, attention training, and real time feedback to support emotional regulation and autonomic balance. These tools can increase awareness of internal states and support more consistent regulation over time.

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Why Regulation Matters in Long COVID

Recovery from Long COVID may involve supporting the nervous system’s shift from a defensive state toward a more regulated and restorative state.

This way of looking at it helps explain how autonomic functioning can shape symptoms such as fatigue, brain fog, and stress sensitivity.

This approach highlights the importance of addressing underlying autonomic function alongside symptom focused care.

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Case Examples

Case examples drawn from Unyte’s published case study library highlight the potential impact of regulation focused interventions using the Safe and Sound Protocol and related approaches. These case studies reflect real world clinical experiences and are presented in de identified or composite form for illustrative purposes.

• Anne: Improved sleep and resilience
• Teresa: Reduced fatigue and brain fog
• Gabriella: Improved emotional regulation
• Maggie: Enhanced daily functioning

These examples are intended to illustrate potential outcomes rather than predict individual results. Additional case studies and full descriptions are available at integratedlistening.com/resource-center.

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Access and Implementation

SSP and RRP are delivered by trained and certified providers. These providers may include licensed mental health clinicians, occupational therapists, speech language pathologists, and other healthcare professionals who have completed specialized training.

Providers may offer services in person or via telehealth, and these approaches may be used as standalone supports or integrated into ongoing therapy. Delivery is typically paced based on individual tolerance and clinical need.

A growing number of providers in Larimer County and surrounding areas are offering these modalities. Individuals interested in these approaches can search for trained providers through the Unyte provider directory at integratedlistening.com, which allows filtering by location, provider type, telehealth availability, and protocol offered.

When selecting a provider, it may be helpful to ask about training and experience, how protocols are integrated into care, expected costs, and whether any portions may be eligible for insurance reimbursement.

Typical Structure

SSP: Five hours of filtered music delivered through the MyUnyte app and guided by a trained provider. The protocol is titrated over time based on the individual’s response and may utilize different playlists and pathways.

RRP: A structured listening program typically delivered across ten sessions, often in approximately 30 minute segments, to support autonomic stability and restoration.

Payment and Insurance Considerations

SSP and RRP are not typically covered as standalone services by insurance or Medicaid.

They may be integrated into covered services such as psychotherapy when clinically appropriate, though coverage depends on provider credentials and payer policies.

Out of pocket payment is typically required for access to these protocols. Sliding scale options and payment plans may be available depending on the provider.

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Conclusion

Long COVID presents real, multi system challenges, and many people are left trying to figure out what actually helps.

Approaches that focus on the nervous system, including polyvagal informed work, music based interventions, and regulation strategies, may offer meaningful support alongside medical care.

The research is still developing, but one consistent theme is this:

Supporting safety, connection, and nervous system regulation can play an important role in recovery.

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References

• Centers for Disease Control and Prevention. (2025). Long COVID or post COVID conditions.
• Doyle, N. (2022, March 10). Acquired neurodivergence, long COVID, and brain fog. Forbes.
• Levitin, D. J. (2024). I heard there was a secret chord: Music as medicine. Dutton.
• McCraty, R., & Shaffer, F. (2015). Heart rate variability: Global Advances in Health and Medicine.
• National Institutes of Health & National Endowment for the Arts. (2023). Music as medicine.
• Onderko, K., & Porges, S. W. (2025). Safe and sound. Norton.
• Porges, S. W. (2025). Polyvagal theory. Clinical Neuropsychiatry.
• Porges, S. W., et al. (2019). Frontiers in Psychology.
• Unyte. (2025). Evidence summary.
• Wachsman, M. W. (2025). ADDitude Magazine.

Disclosure

This article is for educational purposes only and is not a substitute for medical advice or treatment. Polyvagal informed approaches and interventions such as SSP and RRP are considered complementary supports and should be used alongside appropriate medical and mental health care.

The author is trained in these protocols and provides them in clinical practice but has no financial interest in Unyte.