Vagus Nerve Toning: Sensate

Vagus nerve stimulation (VNS) is becoming a popular method for improving mental wellness. There is increasing awareness of the benefits of activating the parasympathetic nervous system, and Sensate is a well-regarded contending technology. They contacted me and requested I trial their device as compared to others I've reviewed: Pulsetto, Xen, and Omnipemf. Of note, they consider Sensate a Vagus Nerve Toning (VNT) device - more on this below.

Disclaimer, before we begin: While these products are not FDA regulated medical devices, which some may interpret as implying they don't carry risk, any product and probably particularly medical devices carry a degree of risk. This leads to the second part of my disclaimer - I am not a medical professional. I cannot speak to these risks, I am not claiming any medical expertise about these devices, how they work or medical health. I am not endorsing these items from a medical health or consumer standpoint. I am a professional affiliate of these companies and receive devices at low or no cost, but I do not receive any compensation for this article, nor was I asked to write it. This article simply reflects my perspective as a psychologist, the (small) foundation of information I have attained about this, and my experience as an intermittent user testing these devices. Any determination to use these devices is made solely on your personal account and I would encourage consultation of a medical professional.

Understanding Vagus Nerve Stimulation

VNS involves activating the vagus nerve to promote relaxation and alleviate stress. Doing so 'turns on' our parasympathetic nervous system, which is a counterbalance to our sympathetic nervous system - I think of it like a see-saw: we are down regulating our level of arousal that may be unnecessarily activated or chronically left turned-on. See other blog articles on this subject!

This process can impact various body functions, including heart rate, digestion, inflammation and emotional regulation. Products like Sensate harness the benefits of activating the vagus nerve, providing users with tools to improve their mental and physical health. Research shows that VNS can reduce anxiety levels by up to 30% in some studies, highlighting its potential.

Sensate: Features and Specifications

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Sensate is a wearable device designed to assist it's user in activating the parasympathetic nervous system. This is achieved through gentle pulses of soothing vibration to assist in accessing a meditative state. Practicing parasympathic activation strengthens this nervous system pathway, hence Sensate's term "Toning" which they liken to muscular toning or strength-based exercise: strengthening a neural pathways can be thought of as analogous to strengthening a muscular one. It's user-friendly, designed to be worn around the neck like a pendant, and paired with soothing audio.

Notable features of Pulsetto include:

• Form-Factor: Sensate feels sturdy and lighter than expected, and is comfortable to be worn around the neck. A slightly reclined position helps it to rest more firmly on your chest, transferring more of the sensation from its pulsing vibrations.

• Multiple intensities and audio tracks: The device offers multiple intensity levels. I found I liked the highest intensity. You can pair it with built in audio tracks with soothing sounds - the sounds remind me of other companies that focus on binaural stimulation for parasympathetic activation. The duration of sessions is also adjustable from 10, 20 and 30 minutes.

  
  

• Long Battery Life: Seems adequate, Sensate reports it lasts about a week with daily use (7-10 meditation sessions, depending on the duration).

  
  

Pulsetto

Conclusion

I could see Sensate being a valuable tool the arsenal of meditative devices for those devoted to meditative practices or otherwise want to increase calm and focus. My critiques are mostly about the setup instructions and software. The setup does not direct users to charge the device, and it did not come charged. When the device is off, there is no light to indicate if it is charging, and when on, a blue light indicates it is mostly charged, but nothing to indicate when fully charged. Consequently, I found myself twiddling my thumbs before I could use it, and ultimately leaving it plugged in until the morning to ensure it was charged and would give a good representative experience. Once I got it up and working, the app was straightforward and intuitive, but I had two qualms. First, a pop-up offered me a free trial of the premium service, but there was no way to access it - clicking it did nothing, and eventually it disappeared with no way to access the free trial. Second, while I appreciate the simplicity of only having toggles for intensity and duration, I found myself wanting control over the pulses, such as the waveform or even making the vibration consistent rather than oscillating or undulating. I'm not sure if the premium version offers this, but I think it is just a wider array of soothing audio tracks to pair with your meditation.

While I do not enjoy the conduction gel from the Pulsetto, it is the most effective device for quick reduction in anxiety and would be my recommendation for anyone looking to supplement any clinical condition such as panic, PTSD or Generalized Anxiety disorder (GAD). Omnipemf is a great option if you want to avoid conduction gel and don't mind milder and slower-onset VNS than Pulsetto. However, if you wish to build your own parasympathetic activation skills and prefer assistive devices, Sensate's VNT is a great option. Some people indicate that VNS could be problematic: it activates the vagus nerve for you, so you don't build the coping skills to activate it yourself, such as if away from your device or if it runs out of battery. We might liken this to leaning on a benzodiazapine for panic disorder and not learning coping skills to eventually discontinue the medication - in other words, people worry about depending on VNS devices. However, I would challenge this notion. I'm not aware of any evidence-basis in the literature to say that VNS reduces our ability to activate our own parasympathetic nervous system. In fact, there is no reason to believe they don't strengthen that pathway. I often use the Pulsetto along with deep breathing, not instead of other skills. Additionally, any break from sympathetic activation helps our HPA (hypothalamic pituitary adrenal) axis re-regulate or reduce dysregulation of that system, reducing baseline stress and anxiety, and increasing our buffer or resilience. To my knowledge, there is not enough information for a consensus on this. However, if you are concerned about learning on a device and want assistance with meditative states, Sensate would be a good choice.

From a mental health standpoint, as a psychologist, I have found it to be quite soothing and lasting, as if stress left my motor running at high RPM and these devices downregulate that in a short session length. It seems to last quite a while, possibly until reactivated by a stressful trigger or liquid-stress (coffee). However, there are several caveats.

• These are newer devices and not medical, so they may not replace other treatments. As mentioned in the disclaimer, I cannot speak to their safety, but we shouldn't just assume safety of any medication or device that affects our body.

• This is not a replacement for psychotherapy and psychotherapeutic coping skills. Deep breathing, muscle relaxation, guided imagery and grounding, and mindfulness meditations are equally effective (in my opinion) parasympathetic activation techniques, and there is something to be said about learning a skill to manage this on your own. What if you don't have your Vagus Nerve Stimulator or it runs out of batteries? I'm consistently surprised that my clients aren't very engaged in practicing and consistently utilizing these copings skills - I felt it was diligent to practice what I preach when learning these skills as a therapist-in-training, and they have helped me through rough patches. Check out my YouTube channel for Parasympathetic Activation.

• Resistance to relaxation is well documented in psychological literature. Frequently we have ambivalence about changing the things that bring us into therapy - when that isn't the case, people are much more successful at solving their hurdles without the support of a therapist. See my article on uncertainty in psychotherapy. People with overbearing superego's or parental internalizations (including the IFS notion of a protector/manager) often unconsciously invite this part to take control, giving them a sense of control, but ultimately losing control to that part, pattern and rigid way of coping. Yet it is familiar, and creates a homeostasis or stable system of functioning. On the surface, they want to change this, but as we dig deeper, fears of letting go of that familiar coping and consequently sense of control are scary. It may feel reckless or sociopathic, and out of control. Over the course of therapy, these individuals learn to trust themselves without the internal critic, but this is a process. Medications and devices like a vagus nerve stimulator do this automatically and nearly immediately without the therapeutic process, which can cause resistance: the internal protective mechanism resists being forcefully shut of and rises up stronger. While I suspect this presentation is not the norm, it would need to be navigated. This is analogous to the phenomonen in which individuals with fragile egos related to narcissistic personality traits had adverse reactions to meditation. Classic meditation techniques involves stripping away layers of conscious experience until we reach a core, but people with a fragile sense of self are naturally terrified to acknowledging the things they cling to for identity are only effervescent thoughts we have about ourselves. This topic is discussed in Epstein's Psychotherapy without the Self. When meeting with a representative of Neuvana (co-founder?), we discussed this potential complication and that she had been surprised the notion was familiar in discussion with other psychologists as well. If you find yourself fearful of giving up a sense of self-control, consider consulting a therapist, and remember an overbearing internal critic only provides a sense of control - your core self or true ego is perfectly capable of providing this services and fulfilling this function. A brief moment of calm is good for you and does not mean you are reckless or out of control. Consider attempting other parasympathetic activation skills first (see link above for my YouTube videos) and attend to any resistance. If you notice resistance, open up an internal dialogue with that part of yourself and give it space to answer what it's fears are (of relaxing) and if it maybe wants a break from being in control all the time?

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