Regulation as modulation: autonomic flexibility as a physiological buffer in bipolar II disorder - a perspective on somatic regulation and mood stability.
Frontiers in psychiatry January 1, 2025 Kyndra Purcell
Bipolar II disorder involves not only mood dysregulation but also autonomic nervous system function, which shapes the depth and duration of depressive episodes. The paper introduces regulation as modulation, where autonomic flexibility acts as a physiological buffer influencing mood stability. Heart-rate variability, vagal tone, and neurovisceral integration are key biomarkers linking emotional resilience and physiological coherence. When these systems are compromised, recovery from depressive episodes slows; when strengthened through breathwork, interoception, grounding, and somatic awareness, recovery accelerates. The argument integrates existing studies and longitudinal self-monitoring data, noting consistent patterns between autonomic dysregulation and bipolar lows. Somatic regulation should be regarded as a core therapeutic pathway alongside medication and psychotherapy.