Grounding Techniques & Vagus Nerve Exercises for Clients
This three-page handout helps clients understand their autonomic nervous system and gives them simple ways to calm it. It explains the system’s two branches in plain terms: the sympathetic “fight or flight” state and the parasympathetic “rest and digest” state. A side-by-side table shows how each state affects the eyes, ears, heart, breathing, digestion, and more, so clients can start to notice which state they’re in.
The rest of the handout is practical. It lists simple activities that stimulate the vagus nerve, a major nerve of the parasympathetic system, such as slow breathing, humming, and cool water on the face. It also walks through nine grounding practices, from 5-4-3-2-1 to a guided “contact support” exercise. Use it with clients who experience autonomic dysregulation from a chronic condition, a stressful transition, or persistent pain, and who need tools they can use in the moment and at home.
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This handout is the client-facing companion to Autonomic Nervous System Regulation for OT Professionals, a one-page refresher for clinicians. That refresher points OT professionals to tools they can use in sessions or give clients for home use, and this handout contains those tools. Both were created with Emily Rich, PhD, OTR/L, an occupational therapist whose research and clinical work focus on POTS.
Resource Utilization
The handout works well across several sessions rather than all at once. Page 1 is for building awareness. Go through the table with the client and ask which signs they recognize in themselves, such as light or sound sensitivity, a racing heart, or cold, clammy hands. Pages 2 and 3 are for action. Practice one or two strategies together in session, then add them to the client’s home program.
None of the practices need equipment, so the handout fits outpatient, mental health, and telehealth sessions equally well.
Instructions and Tips
Don’t hand over all nine grounding practices at once. Pick one or two that match the client’s interests and tolerance, practice them together, and circle them on the page before the client leaves. A client who doesn’t connect with abdominal breathing might do better with sensory grounding or orienting to the present moment. If a client isn’t comfortable closing their eyes for the contact support exercise, they can keep a soft, downward gaze.
The handout presents these tools as ways to reinforce a sense of safety when the client is in fact in a safe environment. Keep that framing when you introduce it. The page 1 example is written in the first person, which gives clients a model for describing their own signs out loud.
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