Combining top-down and bottom-up interventions targeting the vagus nerve to increase resilience

Chronic stress has dramatically increased over the last years and is one of the major health concerns of the 21st century. Targeted interventions are traditionally based on inducing cognitive changes and enhancing control with the aim to promote adaptive emotion regulation, ultimately enhancing stress resilience. Crucially, bodily functions have received little attention in this quest, despite increasing evidence on the impact of mind-body interactions on resilience. An exemplary model is constituted by accumulating empirical support on the vagus nerve, which enables two-way communication between heart and brain, allowing to engage in an adaptive stress response in a context-appropriate manner. Yet, research on such bidirectional communication is mainly corre- lational. We propose to consider resonance breathing (bottom-up approach, heart > brain), and neuro- modulation (top-down approach, brain > heart) as evidence-based ways to increase vagal nerve inhibitory control and hence increase stress resilience. These promising, likely cost-effective and easily employable tech- niques can be used alone or in combination, harnessing neurobiological scientific advances to select treatment options with the greatest likelihood of success.