Polyvagal Theory in Therapy:
Implications for Treatment of Nervous System Dysregulation
& Traumatic Stress
Safety in the therapeutic setting.
“From a Polyvagal perspective, feeling safe is an important moderator influencing the effectiveness of many therapeutic manipulations including medical procedures, psychotherapy, and psycho-education.
The theory assumes that physiological autonomic state functions as an intervening variable influencing the effectiveness of treatment.
More specifically the theory assumes that for treatments to be effective and efficient it is necessary to keep the autonomic nervous system out of states of defense.
Activating the social engagement system with the ventral vagal pathways enable the autonomic nervous system to support health, growth, and restoration.
In the state of safety, the autonomic nervous system is not easily recruited in defense.” (Deb Dana, 2018).
Deb Dana’s Polyvagal Theory in Therapy
Once you understand the role of the autonomic nervous system in shaping our lives, you could never again not see the world through that lens.
(Dana, 2018 page XVII through XIx. 6).
Deb Dana’s 4 “Rs” for A Polyvagal Approach to Therapy
- Recognize your autonomic state
- Respect your adaptive survival response
- Regulate or co-regulate into a ventral vagal state
The Autonomic Ladder/Hierarchy
The Sympathetic nervous system and the two branches of the Parasympathetic nervous system form the “autonomic ladder or hierarchy” evolutionarily built from oldest to newest.
We all move through the states– it’s a matter of paying attention to your experiences and tracking your states. Deb Dana’s book (and her therapy approach) teaches you how to recognize where you are on your “ladder,” how and why you end up in particular states, and how to intentionally move through them. This is incredibly empowering! She also teaches you to identify what your triggers are for danger and mobilization and what your “glimmers” are for finding safety and connection. All the information below is from her book, The Polyvagal Theory in Therapy (2018).
Autonomic “Place” and “State”
Dorsal Vagal (Pathway of the PSNS) and its immobilization response is the oldest pathway/first to develop in human species (reptilian brain); it responds to cues of extreme danger/life-threat; takes us out of connection and safety, out of awareness, and into state of protective collapse/frozen, numb, “not here” dissociative states. When all else fails we end up here; a path of last resort. This is where people feel alone with their despair and escape into not knowing, not feeling, almost not being; hopeless, abandoned, foggy, too tired to think or act; where the world feels empty, dead and dark. The body has moved into conservation mode; problems may include dissociation, problems with memory, depression, isolation, no energy for the task of daily living. Health problems may include: chronic fatigue; fibromyalgia, stomach problems, low blood pressure, type 2 diabetes, and weight gain.
Sympathetic (Branch of the ANS): located in the middle part of the spinal cord; prepares us for action; responds to cues of danger which fuels fight-or-flight response; sympathetic has a pattern of mobilization. It activates when we neurocept danger, even a stirring of unease.
*We can mobilize to respond to cues of danger and take action then return to ventral vagal state (homeostasis), or we can stay in hyper-vigilant, chronic arousal state (which wreaks havoc on our health like heart disease, high blood pressure, high cholesterol, sleep problems, weight gain, memory impairment, headache, chronic neck, shoulder and back tension, stomach problems and increased vulnerability to illness). This is the place we might experience panic attacks, anxiety, anger, inability to focus or follow through, and distress in relationships.
*If we feel trapped and cannot escape danger in the fight-or-flight state of SNS, we can fall further into the dorsal vagal state (see above) where we shut down to survive. Dana says “it’s a long way back to ventral vagal from here.” Shut down does not mean our system isn’t still stressed– it is!
Ventral Vagal (Pathway of the PSNS) and its patterns of social engagement (unique to mammals) is where we feel safe, connected, calm, and social; responds to cues of safety, and supports feelings of safe engagement and socially connected. Heart rate is regulated, breath is full, we take in faces of friends, and we can tune into conversations and tune out distracting noises. We see the “big picture,” and connect to the world and the people in it. The world is safe, interesting, full of people I want to interact with, fun and peaceful. I am connected to my experiences and can reach out to people. Organized, following through with plans, taking care of myself, taking time to play, doing things with others, feeling productive at work, having a general feeling of regulation and sense that life is manageable. Health benefits include: healthy heart, regulated blood pressure, healthy immune system decreasing vulnerability to illness, good digestion, quality sleep, and overall sense of well-being.
Additional Definitions for Understanding Polyvagal Theory
and its applications in mental health below taken from Porges’ The PocketGuide to Polyvagal Theory.
For PTSD, Polyvagal theory focuses on the response to the event and not the qualities of the event. There are great variations in individual reactions to a common “traumatic“ event. A common traumatic event may be devastating to an individual while others may be more resilient and less effective.
Adaptive behavior Polyvagal theory’s perspective is based on revolutionary model in which behavior is interpreted as adaptive if it enhances survival, minimizes the stress, or influences physiological state in a manner that would optimize health, growth, and restoration. At times, behaviors that are initially adaptive may become maladaptive; for example, this would occur if an acute behavior that initially enhance survival or minimize the stress during threat is chronically recruited when there is no threat. Trauma may result in reactions that are initially adaptive in a life threat situation, for example immobilizing and passing out, which if repeated or slightly modified (e.g. dissociation) in less threatening situations will be maladaptive. (Porges, Page 1).
Anxiety is frequently defined from a psychological perspective as emotional feelings of fear or uneasiness or psychiatric e.g. anxiety disorders perspective. Polyvagal theory emphasizes the autonomic state that underlies the psychological feelings that define anxiety. Polyvagal theory assumes that anxiety is dependent on an autonomic state characterized by concurrent activation of the sympathetic nervous system with a down regulation of the ventral vagal circuit in the social engagement system. (Porges, p. 2).
Dissociation is a process of losing a sense of presence, resulting in experiencing a disconnection and a lack of continuity between thoughts, memories, surroundings, and actions. For many people, dissociation is within the range of normal psychological experiences and is manifested as daydreaming. For others, dissociation is sufficiently disruptive that it results in a loss of personal identity and creates severe difficulties and relationships and functioning and every day life. Trauma history is frequently associated with the severe disruptive affects of dissociation and may result in a psychiatric diagnosis. Polyvagal theory interprets dissociation in response to life threat as a component of an immobilization or death-feigning defense response. Polyvagal Theory interprets dissociation as an adaptive reaction to life threat challenges. One could speculate that there may be gradations in reactions to life threat from total shut down and collapse, mimicking the death feeling responses of small mammals to an immobilization of the body during which muscles lose tension and the mind dissociates from the physical event. (Porges, p.12).
Depression is a common and serious mood disorder that influences feelings, thoughts and behavior. Polyvagal Theory assumes that depression has a physiological-state profile that could be explained by the Polyvagal theory. Hypothetically, the profile would include a down-regulation of the social engagement system and atypical coordination between sympathetic and dorsal vagal pathways. The latter point may lead to behavior oscillating between high levels of motor activity coincident with sympathetic activation and lethargy coincident with depressed sympathetic activity and increase dorsal vagal activity. (Porges, p.11)
Death feigning/shutdown system. Mammals, under certain conditions, the nervous system reverts to a primitive defensive response characterized by appearing to be inanimate. This massive depression of autonomic function is due to activation of the dorsal vagal circuit which depresses respiration apnea and slows heart rate bradycardia. Polyvagal theory proposes that death feigning is an adaptive response to life threat when options for a fight-fight behaviors are minimized, such as during restraint or when there is an inability to escape. During conditions of life threat, the nervous system, through neuroception, may revert to the ancient immobilization defense system. Polyvagal theory emphasizes aspects of this life force response and understanding trauma reactions. The theory, functionally operationalizes a trauma response as the body’s physiological response to life threat that would include features of death feigning such as fainting, defecation, and disassociation. (Porges, p11).
Interoception is the process describing both conscious feelings and unconscious monitoring of bodily processes by the nervous system. Interoception, similar to other sensory systems has four components: (1) sensors located in internal organs to evaluate internal conditions; (2) sensory pathways conveying information from the organs to the brain; (3) brain structures to interpret sensory information and to regulate the organ’s response to the changing internal conditions; and (4), motor pathways that communicate information from the brain to the organs and to change the state of the organs. In Polyvagal Theory, interoception is the process providing signals to the brain of changes and physiological state. In contexts in which there are cues of safety or risk, interoception would occur after the process of neuroception. Interoception may result in a conscious awareness of a bodily response. In contrast, neuroception occurs outside conscious awareness. (Porges, p.15)
Homeostasis reflects the neural chemical processes through which our body regulates visceral organs to optimize health, growth, and restoration. Although the word is derived from the Greek word meaning same or steady, homeostasis is better understood as the product of a negative feedback system that also leads around a “set“ point.
Neural exercises provide opportunities to optimize the regulation of physiological state. According to the Polyvagal Theory, neural exercises consisting of transitory disruptions and repairs of physiological state through social interactions would promote greater resilience. For example, play such as peekaboo is an example of a neural exercise parents frequently employ with their children. (Porges, p.19).
Neural expectancy refers to the predisposition wired into our nervous system that anticipates a reciprocal response to a spontaneous social engagement behavior. Neural expectancies promote social interactions, bonding, and trust. When neural expectancies are met, states are supported, while violations of these expectancies may triggers physiological states of defense. (Porges, p.19)
Self-regulation (and as it relates to co-regulation) is a term frequently used to describe an individual’s ability to regulate their own behavior without the aid of another person. Self-regulation is often a defining feature of a child’s ability to deal in the classroom or in a novel situation. Polyvagal Theory does not treat self-regulation as a learned skill but interprets self-regulation skills as a product of the nervous system that can maintain feelings of safety in the absence of receiving cues of safety from another person. The theory emphasizes that through processes of co- regulation, an individual develops a capacity to self regulate. The theory emphasizes that the mutual, synchronous, and reciprocal interactions between individuals define co-regulation function as a neural exercise enhancing the ability to self-regulate in the absence of opportunities to co-regulate.
Yoga and the social engagement system. Polyvagal theory deconstructs yoga practice as involving breath into specific neural exercises of the vagal break. Pranayama yoga is functionally a yoga of the social engagement system, since it involves neural exercises of both breath and the striated muscles of the face and head (Porges).
I recommend the title above if interested in learning more about how to manage mind-body balance and regulation of one’s nervous system through yoga practice (and this isn’t merely stretching on a yoga mat. It’s much more!)