What Is Polyvagal Theory? Sympathetic and Parasympathetic Activation

To understand the polyvagal theory, it is important to have a basic understanding of the sympathetic and parasympathetic nervous systems and the vagus nerve. The vagus nerve belongs to the parasympathetic nervous system, often referred to as the rest-and-digest system, which promotes a state of calmness in the body. Porges identified a hierarchy of responses within the autonomic nervous system, including ventral vagal social engagement, sympathetic nervous system activation, and dorsal vagal shutdown.

The ventral vagal social engagement is the state in which humans can connect and relate to others. It is characterised by openness, compassion, joy, mindfulness, and curiosity. This state enhances various bodily processes such as digestion, immunity, circulation to the extremities, and the ability to form relationships while reducing defensive responses.

Sympathetic nervous system activation, which evolved approximately 400 million years ago, triggers a state of mobilisation known as fight-or-flight. In this state, the body prepares to confront a threat by increasing arousal and activating various physiological responses. Heart rate, blood pressure, adrenaline levels, and blood circulation all increase, while digestion, immunity, relational ability, and fuel storage decrease.

However, sympathetic activation cannot be sustained indefinitely, as it would be detrimental to health. The body self-regulates and eventually adopts dorsal vagal shutdown, a more primal state characterised by freezing, lethargy, hopelessness, and reduced basic bodily functions. This shutdown state decreases heart rate, blood pressure, temperature regulation, and immune response, and it also affects social functioning, such as eye contact, facial expressions, and intonation.

According to Polyvagal Theory, the ANS forms the foundation for all human experiences. It explains how individuals engage with the world through various states of activation, including connection, disconnection, and attunement. However, some people may experience a mismatch, perceiving the environment as dangerous even when it is safe.

Polyvagal Theory helps us understand how stress is stored and processed in the body. Chronic stress can alter the brain’s perception of stimuli, leading to increased sensitivity to threats and the interpretation of non-threatening input as dangerous. This heightened perception of danger can be emotionally and physically exhausting, affecting various aspects of life, including work, relationships, hobbies, and studies. It can also impact social interactions, causing individuals to perceive benign stimuli as threatening, which can strain relationships. Recognising the different states of activation and understanding individuals’ needs in each state is crucial for supporting their well-being.2

Polyvagal Theory and Trauma

Polyvagal Theory is particularly relevant in trauma recovery. Trauma, whether experienced in early childhood or later in life, disrupts the autonomic nervous system’s regulation and can lead to hypersensitivity to perceived threats. Dysregulation of the autonomic nervous system can result in a range of physical and psychological symptoms, such as chronic pain, digestive issues, depression, anxiety, PTSD, and substance use disorders. Traumatic experiences can also impact future relationships, as individuals may develop a fear of intimacy and connection due to past experiences of danger or uncertainty with primary caregivers or trusted individuals.

By understanding the dysregulation of the autonomic nervous system (ANS) caused by trauma, we can better comprehend the physical and emotional consequences individuals may experience.

Trauma and chronic stress, particularly in early childhood, can lead to ANS dysregulation. A dysregulated ANS may overreact to perceived threats or dangers that do not actually exist. Living in a constant state of mobilisation or immobilisation can be debilitating, leading to chronic pain, digestion issues, and difficulties in connecting and socialising. Maladaptive coping mechanisms like substance use, gambling, and unhealthy eating habits may develop as a result.

Trauma, which is understood as an experience rather than an event, can arise from various causes such as childhood neglect, abuse, parental drug use or incarceration, and adverse childhood experiences (ACEs) like living in dangerous or impoverished neighbourhoods. These traumatic experiences can lead to relational or developmental trauma. Research shows that individuals who experience three or more ACEs are at increased risk of asthma, heart disease, depression, anxiety, and obesity.3 The compounded stress and trauma affect the central nervous system, disrupting ANS functioning and communication through the vagus nerve, which connects the brain to the digestive system and heart. This chronic dysregulation of the ANS results in physical and emotional symptoms as the system continuously searches for threats. Digestive disorders, autoimmune diseases, chronic fatigue, depression, anxiety, PTSD, and substance use disorders are among the common health issues associated with trauma or chronic stress.

Furthermore, early childhood experiences significantly impact future relationships, as the ANS becomes overprotective in adulthood due to chronic feelings of danger or uncertainty around primary caregivers. Adults who experienced violence, neglect, or inconsistent and inattentive parenting may reject intimacy and connection, viewing them as dangerous despite their deep desire for love and connection. The need for connection is often replaced by a need for protection.

Although adverse childhood experiences have profound effects on development and health, trauma at any stage of life can disrupt the autonomic nervous system. Accidents, assaults, natural disasters, and chronic stress are some examples of events that can cause ANS dysregulation. For individuals with a history of trauma, the ANS reacts not only to the perceived safety or danger in their immediate environment but also to the internal interaction between the present environment and the fear or stress triggered by past life events.4

The Polyvagal Theory provides valuable insights into therapy and community support. By recognising the importance of safety, understanding defence mechanisms, and adapting interventions based on the individual’s autonomic responses, therapists can effectively assist clients in their healing journey. Additionally, by incorporating the principles of the Polyvagal Theory into community practices, we can foster a more supportive and empathetic society better equipped to assist individuals dealing with stress and trauma.

Endnotes

1. Porges S. W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic journal of medicine, 76 Suppl 2(Suppl 2), S86–S90. https://doi.org/10.3949/ccjm.76.s2.17
2. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W.W. Norton.
3. Herzog, J. I., & Schmahl, C. (2018). Adverse Childhood Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan. Frontiers in psychiatry, 9, 420. https://doi.org/10.3389/fpsyt.2018.00420
4. Steimer T. (2002). The biology of fear- and anxiety-related behaviours. Dialogues in clinical neuroscience, 4(3), 231–249. https://doi.org/10.31887/DCNS.2002.4.3/tsteimer

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Polyvagal Theory is based on the idea that there are three main branches of the nervous system: the sympathetic nervous system, the parasympathetic nervous system,  these three systems work together to regulate our emotions and behaviour, and they are all interconnected in complex ways.

The sympathetic nervous system is responsible for our fight or flight response. This is the response that kicks in when we are faced with a threat or danger. It causes our heart rate to go up, our breathing to become faster and shallower, and our muscles to tense up. This response is designed to help us survive in dangerous situations, but it can also cause us to feel anxious, stressed, and overwhelmed.

The parasympathetic nervous system, on the other hand, is responsible for our rest and digest response. This is how we enter into a relaxed state. It helps to slow down our heart rate, regulate our breathing, and relax our muscles. This response is important for maintaining good health and well-being, but it can also cause us to feel lethargic and unmotivated if it is overactive.

The social engagement system is responsible for our ability to connect with other people and form social bonds. It is activated when we are interacting with others in a positive and meaningful way. This system helps us to feel safe and secure, and it is important for our mental and emotional well-being.

So, what does all of this mean for people in psychotherapy? Well, Polyvagal Theory has some important implications for how we understand and treat mental health issues. For example, many mental health disorders are thought to be related to an overactive sympathetic nervous system. This means that people with anxiety disorders, for example, may be stuck in a state of hyperarousal, where their fight or flight response is constantly activated.

Understanding Polyvagal Theory can help therapists to develop more effective treatment plans for these types of disorders. By helping clients to activate their parasympathetic nervous system, therapists can help them to calm down and feel more relaxed. This can be done through techniques like deep breathing, progressive muscle relaxation, and guided imagery.

The social engagement system is also an important aspect of Polyvagal Theory when it comes to treating mental health disorders. People who struggle with social anxiety, for example, may have a hard time activating this system. By helping clients to feel safe and secure in social situations, therapists can help them to overcome their anxiety and build stronger social connections.

Being Polyvagal Informed as a clinical practice or treatment center can also help to improve treatment outcomes. By understanding the intricacies of the nervous system, therapists can develop more targeted and effective treatment plans. They can also help clients to understand how their nervous system is affecting their mental and physical health, which can be empowering and motivating.

For example, a treatment center that is Polyvagal Informed might offer a range of different therapies that are designed to activate different parts of the nervous system. They might offer yoga and mindfulness classes to help clients activate their parasympathetic nervous system, and they might offer group therapy sessions to help clients activate their social engagement system.

Ultimately, Polyvagal Theory is all about understanding the complex interplay between our nervous system, our emotions, and our behavior. By learning more about how these systems work together, we can develop more effective treatments for mental health disorders and help people to live happier, healthier lives. Whether you are a therapist, a client, or just someone who is interested in learning more about the fascinating world of psychology, the polyvagal theory is definitely worth exploring in more detail.

References

1. Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74(2), 116-
143. https://doi.org/10.1016/j.biopsycho.2006.06.009

2. Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. WW
Norton & Company.

3. Korn, L., & Langer, E. (2019). Polyvagal theory and mind–body medicine. Explore: The
Journal of Science and Healing, 15(4), 251-258. https://doi.org/10.1016/j.explore.2019.01.004

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Studies have shown that “There is a shortage of suitably qualified therapists able to deliver evidence-based treatment for Post-traumatic Stress Disorder (PTSD), precluding timely access to intervention.” ^[1] While this continues to improve, it is crucial that sufferers learn some helpful techniques they can employ at any time, in conjunction with a Guided Self-Help (GSH) programme of psychological treatment, developed by mental health professionals with expertise in the fields of GSH or PTSD.

Flashbacks or intrusive memories are a key feature of PTSD which cause the subject to lose touch with reality.^[2] They return the sufferer to the source of trauma, dissociating them from their current reality and can be triggered by anything from sounds to smells to changes in light or by people or places. Grounding techniques use the senses to divert attention back to the present and can be perceptual (such as smells or textures) or cognitive in the form of grounding statements or mental challenges, which serve to reassure an individual that they are safe and the trauma has passed. This is also referred to as earthing as it helps sufferers reconnect to their surroundings or get their feet back on the ground. Being able to feel safe is a key element in the recovery process for PTSD sufferers. While it might be hard to imagine something as innocuous as sniffing a lemon or rubbing ice on your arm could be of material benefit, the practice is so effective that it is used in the first stage of specialist treatment for PTSD.

Senses Working Overtime

When it comes to grounding techniques for PTSD, a person’s senses (sight, sound, smell, touch, and taste) can be their best asset.

Here are some examples which can help to reconnect with the present and, most importantly, safety.

Sight

In the spirit of those eye spy or numberplate games played on long and tedious car journeys as a child, the idea is to scan the environment and choose something, then see how many other examples can be found. It could be someone in a blue coat or a red car etc. Spotting something intricate and describing it in detail is another option. This is often a skill we lose as adults anyway, so it can also help with creativity and recall. Similarly, completing puzzles can also be of help.

Sound

It can often be a sound that has caused your flashback into trauma in the first place, and sound is equally powerful at pulling you back out. Speak to someone you’re close to on the phone or in person, put on your favourite music (especially calming music), listen to the wind in the trees or birdsong. If you’re in a very urban area, it is possible to get birdsong on CD or download so you can have some feathered friends on hand at all times.

Smell

The most powerful of all the human senses, smells have the ability (for better or worse) to transport us in time and evoke powerful memories, with one of the most well-known examples of this being Proust’s Madeleine.^[3] Reaching for something with a robust and zingy scent such as citrus fruit or even a ripe soft cheese, especially if you are partial to the taste and smell, can be highly comforting, and if all else fails, you can always take a bite! Scented candles can provide comforting smells for more extended periods, but it’s important not to go overboard as you could become immune to the fragrance.

Touch

Something like ice can be highly effective but is not always at hand. Carrying around a stress ball to squeeze, especially if it is textured like the spikey ones that are available, can be really helpful in offsetting anxiety. They don’t call ‘em stress balls for nothing! Popping bubble wrap is not just the preserve of children and can also serve the same purpose as a stress ball, though this might not be ideal for people who have suffered violent trauma in the form of terrorism or warzones. For others, it can be both satisfying and useful. If you have nothing to hand, clenching a fist as tightly as possible to crush the negative feelings before opening your hand and casting them away can also be very powerful symbolically as well as in the sensation of the clenching, along with wiggling your fingers and toes.

Taste

While biting into the lemon you were smelling might be a bridge too far for some people, sharp or sour tastes can jettison you into the present moment, along with strong peppermints, cough drops etc. If you have a sweet tooth, let some chocolate melt in your mouth or suck on one of those fruit drops your grandmother used to buy in tins (which can make having one to hand very convenient as long as you save them for when they’re needed!).

Another slightly more involved method is mindfulness meditation, either guided by someone or done alone. Studies have shown these to reduce both mental and physical symptoms of PTSD and help build resilience in sufferers.^[4]

To try this technique:

• Place your feet firmly on the ground, slightly apart (say, at hip width).
• Say the time and date clearly and out loud.
• Take three slow, deep breaths filling your abdomen with air, not just your chest.
• Look around and say out loud what you can see in the current setting.
• Tell yourself you are in a safe place right here and right now.
• Describe in detail and out loud items in the room or environment.
• Try using visualisation techniques like closing the door on past trauma.
• Sing something, recite a poem, rap, or even say your times tables to bring yourself into the present.
• Visualise a safe place or somewhere you’d like to go, like a tropical island or focus on things you need to do or future plans that you’re looking forward to.

A combination of techniques will be most helpful, so experiment and work out what is most beneficial for you or go with what you have to hand when necessary. These techniques are very powerful and form the first line of treatment when working with a mental health professional. Still, it may be necessary to get regular support from a trained PTSD specialist to decide on an appropriate treatment plan for your specific issues, which could include guilt or shame, as these go hand-in-hand with PTSD.

Sticking to a routine, socialising, and working are all important for helping sufferers achieve a sense of normality and build supportive relationships. Connecting with people and the environment can facilitate a disconnection from the past and the distressing emotions and memories that go with it and help balance mental, emotional, and physical energies for a happier reality.

If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

^[1] Lewis, Catrin et al. “DEVELOPMENT OF A GUIDED SELF-HELP (GSH) PROGRAM FOR THE TREATMENT OF MILD-TO-MODERATE POSTTRAUMATIC STRESS DISORDER (PTSD)”. Depression And Anxiety, vol 30, no. 11, 2013, pp. 1121-1128. Wiley, doi:10.1002/da.22128. Accessed 2 Aug 2021.

^[2] Jones, Edgar et al. “Flashbacks And Post-Traumatic Stress Disorder: The Genesis Of A 20Th-Century Diagnosis”. British Journal Of Psychiatry, vol 182, no. 2, 2003, pp. 158-163. Royal College Of Psychiatrists, doi:10.1192/bjp.182.2.158. Accessed 2 Aug 2021.

^[3] Troscianko, Emily T. “Cognitive Realism And Memory In Proust’S Madeleine Episode”. Memory Studies, vol 6, no. 4, 2013, pp. 437-456. SAGE Publications, doi:10.1177/1750698012468000. Accessed 2 Aug 2021.

^[4] Smith, Bruce W. et al. “Mindfulness Is Associated With Fewer PTSD Symptoms, Depressive Symptoms, Physical Symptoms, And Alcohol Problems In Urban Firefighters.”. Journal Of Consulting And Clinical Psychology, vol 79, no. 5, 2011, pp. 613-617. American Psychological Association (APA), doi:10.1037/a0025189. Accessed 2 Aug 2021.

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Because it is baked into our evolutionary past, it is not a desire, but a need – one developed to facilitate survival. As humans, we therefore are programmed to seek interpersonal connection: it is a biological imperative.

Neuroplasticity and Tone

Today, modern society places a premium on resilience and independence; the mastering of ones’ self.  Yet just as neuroception precedes the brain, self-regulation finds its root in coregulation. The former simply cannot happen without the latter. It is why a baby or child looks to a parent for safety, and in turn they are reassured through a signal of safety such as an embrace[1]. That process of mutual reinforcement shapes the autonomic nervous system, affording the investment of trust in others[2]. And it is why healthy relationships formed in early development generally breeds a flexibility that assists the navigation of later life challenges.

On the other hand, a mistuned autonomic nervous system bears the imprint of neglect. Without connection, we may remain fixed in defensive states (mobilised or immobilised). Signals are indiscriminately received as dangerous; patterns of connections are replaced with patterns of protection[3]. Because coregulation is what we bring to our relationships, their emergence becomes difficult in its absence.

Fortunately, just as nervous systems have been shaped, so too can they be reshaped. Insights from neuroplasticity – how neural networks rewire themselves – continues to provide more detail on how this takes place. Coregulation is at its core. From this privileged position, atop the ladder, new vistas open. The entire system is regulated, tuning it to deal appropriately with the challenges ahead. It can be thought of as toning, as with any healthy muscle.

Trauma

In highly traumatic situations, the autonomic nervous system can overload with stress and shut down. Subsequent stressful events can trigger may trigger a full shut down or a modification of immobilization such as freezing with dissociation.  The shutdown is mediated through the parasympathetic reaction, while the freeze is a hybrid state requiring sympathetic tone in addition to the parasympathetic reaction. A common example may be the sounds of fireworks for those suffering from Post-Traumatic Stress Disorder following military service. The nervous system is recognising a familiar and lethal cue from the past and intuiting from it what is happening in the present. It takes a protective action: a perfectly rational move within the logic of autonomic nervous system[4].

However, the system is mistuned. Yet through revisiting these painful memories whilst resisting disassociation via cues of safety and trust, powerful new patterns can be rewired. Spending time in coregulation, or ventral vagal, allows for the reshaping – or regulation – of the autonomic nervous system.

Rape victims may dissociate when reencountering their initial trauma, mirroring their protective response at the time. Dr Stephen Porges states that survivors are mistakenly shamed because they didn’t mobilise and fight[5]. But once the victim understands that this was a physiological response – hardwired into human body as evolutionary inheritance – it can rid those feelings of shame (‘why did I freeze?’) that can prevent resolution of the initial traumatic episode.

Clearing the mist of shame may also unleash anger. This is a good thing: it is a mobilising response away from numbness and disconnection. The victim is climbing the ladder. They are closer to the ventral vagal state in which unresolved issues surrounding the episode can be explored. This can also be concluded from the fact small movements whilst exploring the original trauma can also help to temper a slide to dissociation[6].

Polyvagal for Everyone

All individuals’ nervous system brings past experience to bear in interpreting situations. It is the shape of the autonomic nervous system – that accumulation of past experience – that affects how everyone digests stimuli. So understanding polyvagal theory can help all to better navigate everyday life.

Grasping how the nervous system shapes lived experience is key. Simply being able to interpret which state you are in offers a path to a different one. A systematic questioning is useful. It may go as follows.

First you must know where you are (“I am angry so I must be in a mobilised state”). How did I get here? Is it something in the environment or the way somebody talks to me that chimes with past experience? How can I get out of here? Is it a removal of the triggers? Or are there conscious mechanisms I can use to activate a ventral vagal response?

Furthermore, it may not always be a shift that is sought. Ventral vagal is where we naturally want to be. Bringing awareness to the situation helps us to savour it in its fullness. The question may arise: how can I stay here?

Sources:

[1] https://fpg.unc.edu/sites/fpg.unc.edu/files/resources/reports-and-policy-briefs/Co-RegulationFromBirthThroughYoungAdulthood.pdf

[2] Cozolino, L. (2006). The neuroscience of human relationships: Attachment and the developing brain. New York: W. W. Norton & Co.

[3] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[4] ibid.

[5] https://www.theguardian.com/society/2019/jun/02/stephen-porges-interview-survivors-are-blamed-polyvagal-theory-fight-flight-psychiatry-ace

[6] van der Kolk, B. 2014. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin

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Deb Dana encourages us to think of these states as a ladder[1]. We move up or down it through activating the stimulating (sympathetic) or relaxing (parasympathetic) branches of the autonomic nervous system, based on the reception of various stimuli (neuroception).

The ladder is a predictable hierarchy: the states can only be moved through in sequence. For example, if you’re immobilised, you cannot simply leapfrog to safe and social, but must first pass through mobilisation – however briefly. It explains why a PTSD sufferer may suddenly experiencing extreme levels of stress before tipping into immobilisation. But predictability – one of the key insights of Polyvagal theory – offers a platform from which to target appropriate interventions. This, as the next article explains, has important implications for clinical application.

Because the movement through these states are anchored in our evolutionary past, the ladder also doubles as a chronological timeline. These developments have layered one on top of the last, forming the sequenced response mechanism. Freezing is the most primitive and shared with our reptilian ancestors – the defence mechanism of final resort – whilst social connection appeared latest in humanity’s evolutionary past. This is vital: it encourages a focus on the biological plumbing we all share, rather than conflating various disorder with something inherent in different individuals.

Safe and Social/Rest-and-Digest

To arrive in the safe and social state, a parasympathetic response is activated through the vagal ventral pathway (as previously stated, this dampening response takes place through the vagus nerve, of which ventral is a branch).

It is humans’ most evolutionary complex state of being. In this place, we thrive. Naturally then, individuals want to be here unless there really is an immediate threat. The safe and social rung of the ladder is also a biological imperative. It is fundamentally what makes us human.

Here the autonomic nervous system identifies a safe environment. We feel closeness, trusting of others and our environment and can form positive attachments. Normal bodily functions are regulated for optimisation: blood is available around the stomach for metabolization and the immune system is recharged. It explains why prolonged periods of time away from this peak state – for instance loneliness[2] – are associated with decreased life expectancy.

Mobilisation/Fight-or-Flight

A sympathetic reaction – one that mobilises energy – brings people into a fight-or-flight state. We might feel flush, perspire, or the heart beating faster. Stress and tension are detectable. Anger, anxiety or panic may be the felt experienced. The world is no longer safe, but unfriendly and dangerous. The autonomic nervous system is telling us to protect ourselves. Defensive behaviours – manifested in various way – follow.

Because the body is physiologically gearing up to fight-or-flight, internal resources –occurring independently of our conscious awareness – are redirected. Blood shifts away from the digestive system and to muscles and limbs. Cortisol is released from the adrenal gland. It is the reason highly anxious periods are often accompanied with digestive issues[3] and stressed individuals always seem to have a cold (too much cortisol diminishes the effectiveness of the immune system[4]).

Resources are not evenly spread across the body for optimal function but instead are rallied in service of survival. The nourishing functions humans need ticking away in the background are temporarily suspended.

Immobilisation/Freeze/Shutdown

Immobilisation is the most ancient mechanism of defence. When faced with a potential life-threatening situation – which the sympathetic branch cannot resolve or is simply overwhelmed by stimuli – the autonomic nervous system shuts the body down: self-preservation through the conservation of energy. The heartrate falls dramatically along with blood pressure. Movement is all but extinguished, reducing metabolism and the need for food. Pain in numbed, with only so-called vegetative process continuing in the background.

Freezing is a hybrid state with powerful adaptive benefits.  In a freeze state, although being immobilized, there is sufficient sympathetic activation to maintain muscle tone and blood flow to maintain consciousness.  For survivors of trauma this state is often the ‘go to’ state if there is a history of total shutdown and collapse.  Under severe life threat the nervous system may shift reflexively and adaptively to a total collapse that has been described as death feigning in other mammals.  This state triggers a massive activation of the dorsal vagus resulting in fainting and potentially defecation.  However, the state of collapse is potentially lethal to humans, since the collapsed state many not provide sufficient oxygenated blood to our brain.  Thus, our nervous system adapts and puts us in a state of freeze when experiencing the cues that had previously triggered a shutdown. Experiences of dissociation are frequently associated with freeze and freezing often serves as internal signal to ‘awaken’ a different ‘part’ of the individuals complex mental structure of self.

This is the dorsal vagal pathway of parasympathetic response. Operating through the calming vagus nerve, but separately to the ventral vagal social system, it is experienced as an extreme energy deficit[5]. The world doesn’t make sense. Depression, numbness and dissociation are commonly felt. William Styron, in his memoir of a bout of depression, captures the essential difference between this and the mobilised (fight-or-flight) survival state:

“it is, generally speaking, the antithesis of violence. It is a storm indeed, but a storm of murk. Soon evident are the slowed-down responses, near paralysis, psychic energy throttled back close to zero.”[6]

Life – it seems – is elsewhere. And this can feel hopeless. But to counter this, Deb Dana recalls a patient who telling her a simple truth: it is useful to remember that you are still on the ladder. The physiology may be against you now, but you can still climb up. When we understand neurobiological states, so too can we understand how to change them.

Sources:

[1] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[2] Rico-Uribe LA, Caballero FF, Martín-María N, Cabello M, Ayuso-Mateos JL, Miret M. Association of loneliness with all-cause mortality: A meta-analysis. PLoS One. 2018;13(1)

[3] https://www.health.harvard.edu/newsletter_article/stress-and-the-sensitive-gut

[4] Morey JN, Boggero IA, Scott AB, Segerstrom SC. Current Directions in Stress and Human Immune Function. Current Opinion in Psychology. 2015; 5:13‐17.

[5] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[6] Styron, W. 1990. Darkness Visible: A Memoir of Madness. Random House

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Pre-perception

Neuroception is observable in all living species with a nervous system.  It precedes the evolution of the cortex. Evolutionary speaking, it lies in our primitive past, the reason autonomic nervous systems responses are more readily identified in animals – less muddied by awareness and perceptions. Dr Stephen Porges explains this is “why a baby coos at a familiar caregiver but cries at the approach of a stranger”, despite the immaturity of the spinal cord and brain[1]. The autonomic nervous system responds through brain structures outside the realm of cognitive awareness, functionally recognizing features of safety or threat before we think.

Whence the signals come

The senses are constantly scanning for cues of safety and danger every microsecond. Based on the signals, neurobiological mechanisms will be triggered spontaneously: either activating a parasympathetic (calming) or sympathetic (arousing) response. Deb Dana identifies the three places we receive signals from[2].

1. Outside

The most obvious is perhaps signals from the outside environment. The sight of fire may trigger the sympathetic system; whereas the sound of soothing music may activate a sympathetic response, relaxing tension and informing the mind and body that it is safe.

2. Within

The nervous system listens internally for signs of safety or danger, sensing information about your organs. Fever, pain or any physical illness can all cause a shift in our autonomic nervous system.

3. Between

These signals come from the interplay between nervous systems (usually humans but also mammals, given the closeness of their system). Evidently, a smiling face is a signal of safety, an angry face one of danger. In turn, they trigger reactions in our own system. When cues of safety are received, it can trigger a neurobiological reaction that transmits a safety signal back.

With mutually reinforcing cues, connection is facilitated. The physiological response is manifested in a variety of ways: facial expressions grow more animated; voice modulation and inflection increases; and ear drums zone into a range that better distinguishes human voices from background din[3]. This is coregulation in action.

Humans are ultimately social beings[4]. Spending time in this ‘between’ social state connection is essential to both our mental and physical health.

The Importance of Identifying Triggers

Sometimes we may not recognise the triggers that precede a nervous system response, even when they dramatically change our mood, such as a state shift from connection to fight-or-flight. It’s why many people often confusedly ask themselves “why did I react that way?”. From a place of calm and safety, it may seem irrational. Feelings of shame may also cloud experience, hindering proper reflection. Understanding what is really happening is the springboard for change.

The explanatory power of polyvagal theory lies in its systematisation of the three states – and the shifts between them – based on neurobiological processes[5] that have been essential to evolutionary survival. Shades of shame are alleviated when we understand behaviours as contingent on and constituted by physiological reactions: the ‘how-we-are’. Seen in its proper context, it can help us to forgive ourselves when we have perhaps overreacted.

Awareness must be brought to situations and states. Firstly, merely identifying triggers can help change reactions to them, a practice familiar in approaches like CBT. Understanding why we feel a certain way gives a sense of perspective and lifts confusion. If triggers can be viewed with clarity, the response may change. Just as our neuroception is always listening to our environment, so also should more attention be brought to listening to what the physiological states are trying to tell us and how to form a more enabling story. For instance, anger through the lens of physiology, rather than a seemingly intractable issue of psyche.

Secondly, recognising triggers as they happen enables the use of conscious coping mechanisms. An individual recognising in real-time a trigger they know will cause a sympathetic reaction could immediately ask themselves if they can do anything to provoke a parasympathetic reaction.

Thirdly, if – on reflection – the responses to triggers are not necessarily a result of a mistuned neuroception, it encourages contemplation of whether environments should be changed (whether outside, inside or between). Understanding the biological basis of responses – rather than something inherent in the psyche – can encourage individuals to be bold in changing their lives.

Looking solely at the individual for answers is limiting. Instead they must be seen in context: a collection of experience and memory, much of which is outside conscious availability. Yet that collection is instinctively known by the autonomic nervous system we all share. It is continuously shaping experience on this basis.

New experiences can either reinforce or remould how people respond to stimuli. Understanding must be brought to the autonomic nervous system needs, given its role in all lived experience. It can give us clarity on how to can stay anchored in social connection.

 Sources:

[1] Porges, Stephen W.Neuroception: A Subconscious System for Detecting Threats and Safety. Zero to Three (J), v24 n5 p19-24 May 2004

[2] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[3] Porges, Stephen W.Neuroception: A Subconscious System for Detecting Threats and Safety. Zero to Three (J), v24 n5 p19-24 May 2004

[4] Young SN. The neurobiology of human social behaviour: an important but neglected topic. J Psychiatry Neurosci. 2008;33(5):391‐392.

[5] Porges, S., 2011. The Polyvagal Theory. New York: W.W. Norton.

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In essence, Polyvagal theory unpacks how our nervous system responds to stimuli. It is how the body scans, evaluates and reacts to cues of safety and danger. As it is biologically active in all human experience, it also provides a rich framework for understanding why people behave the way they do.

Before Polyvagal Theory

Everybody knows the central nervous system. Polyvagal theory deals with its lesser known counterpart: the autonomic nervous system. Outside the brain and spinal cord, it connects to the central nervous system and regulates glands and internal organs[1]. Instinctive and physiological, it operates outside our conscious awareness, and necessarily so: the system must decide, at every moment, whether we are in safety or danger – whether to rest-and-digest or fight-or-flight. It is like a personal surveillance system, scanning for signs of danger and shifting our body as appropriate.[2]

Social behaviour is limited by human physiology, much of which is shared with our mammalian cousins[3]. Consider the antelope. Grazing, she is at ease. A crack of the branch, a whisper of uncertainty, and her ears are pricked. Pupils dilate, the heartbeat quickens, and glucose is pumped into the bloodstream[4]. A swathe of stimulating hormones has been released. These hormones will be required for a potential getaway.

This process of activation – or mobilisation – is a result of the sympathetic nervous system at work: the animal has readied herself for survival, fuelled by a release of adrenaline. Its opposite is the parasympathetic nervous system, acting to quell this aroused mode. The antelope has gone back to grazing; she is calm, safe and at peace in the world. Blood swells the digestive system, reserves are replenished, and the internal system recalibrates itself. These two processes – the sympathetic and the parasympathetic – form the basis of the autonomic nervous system.

Enter Polyvagal Theory

Polyvagal theory’s insight has been a matter of breadth. Before it was thought that these systems worked only in a reciprocal manner. Sympathetic readied for survival whilst the parasympathetic subdued; enabling healing, restoration and social connection.

Dr Stephen Porges’ theory identified another state of survival produced by the interplay of these two systems[5]. The dampening response (parasympathetic) not only prompts a social mood but can also impel a state of immobilisation at the other end of the spectrum. Yet both are the result of the vagus nerve at work – hence the name Polyvagal theory.

Return to the antelope. The flight has been in vain: the predator has struck. Sensing mortal danger, the animal feigns death, immobilising herself and extinguishing the aroused state. The hormones that had been released for fight-or-flight will not resolve the situation. Yet an opportunity arises when the predator’s clutch loosens. The antelope makes a break for it and escapes. That freeze-or-faint reaction – whilst perhaps not as obviously as fight-or-flight – has been critical to the antelope’s survival: it has conserved the energy needed for its deferred getaway.

Why is this relevant? Because that nervous system is also part of human neural wiring – fundamentally how we are. It shapes every lived experience[6]. Understanding those states and how shifts from one to the other occur therefore has obvious value.

The coming articles will explore three pillars of Polyvagal theory:

Neuroception – the fundament of feeling

The autonomic nervous system is constantly evaluating cues in our environment, absorbing signals beneath awareness and before cognition. It is taking place in ancient and primitive mechanisms developed in the service of survival through our evolution, detecting whether it is safe or dangerous. But neuroception can misread signals based on past experiences that may be inappropriate for understanding the present. Fortunately, the nervous system can change.

These signals come from three directions: outside (the lived environment), within (the internal organs) and between (signals of safety or danger from another living nervous system).

A ladder of nervous states

The three states form a hierarchy – or ladder. Movement through them can happen only in sequence:

i. Connection – or rest-and-digest; feed-and-breed. An impala grazing. The nervous system has told us we are safe. Social connections can be made.

ii. Mobilisation – or fight-or-flight. A kudu bolting. The nervous system has detected danger. It marshals all its energies to survive.

iii. Immobilisation – or freeze. A gazelle feigning death. The nervous system has detected mortal danger. The body shuts down, conserving energy for a potential escape.

Co-regulation

Co-regulation lies at the heart of relationships. It is the mutual reinforcement that comes from the sending and receiving of cues of safety with another nervous system. Although it is not geared to serve immediate survival needs, it assists – evolutionary speaking – survival in the longer-term. In other words, there is a biological imperative to co-regulate.

Once it is understood that all human experience has a physiological basis, people can start to understand how to identify which state they are in, and what they can do to shift to another more conducive state.

Sources:

[1] https://opentextbc.ca/anatomyandphysiology/chapter/12-1-basic-structure-and-function-of-the-nervous-system/ accessed 26/05/2020

[2] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[3] Barré-Sinoussi F, Montagutelli X. Animal models are essential to biological research: issues and perspectives. Future Sci OA. 2015;1(4)

[4] http://www.qmedical.com/dtr_ans_overview.htm accessed 26/05/2020

[5] Porges, S., 2011. The Polyvagal Theory. New York: W.W. Norton.

[6] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

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