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Polyvagal theory in practice

By Dee Wagner June 27, 2016

Picturing brain chemistry can be something like picturing a hurricane. Although we can imagine bad weather, it is difficult to imagine changing that weather. But Stephen Porges’ polyvagal theory gives counselors a useful picture of the nervous system that can guide us in our efforts Branding-Images_chemistryto help clients.

Porges’ polyvagal theory developed out of his experiments with the vagus nerve. The vagus nerve serves the parasympathetic nervous system, which is the calming aspect of our nervous system mechanics. The parasympathetic part of the autonomic nervous system balances the sympathetic active part, but in much more nuanced ways than we understood before polyvagal theory.

Our three-part nervous system

Before polyvagal theory, our nervous system was pictured as a two-part antagonistic system, with more activation signaling less calming and more calming signaling less activation. Polyvagal theory identifies a third type of nervous system response that Porges calls the social engagement system, a playful mixture of activation and calming that operates out of unique nerve influence.

The social engagement system helps us navigate relationships. Helping our clients shift into use of their social engagement system allows them to become more flexible in their coping styles.

The two other parts of our nervous system function to help us manage life-threatening situations. Most counselors are already familiar with the two defense mechanisms triggered by these two parts of the nervous system: sympathetic fight-or-flight and parasympathetic shutdown, sometimes called freeze-or-faint. Use of our social engagement system, on the other hand, requires a sense of safety.

Polyvagal theory helps us understand that both branches of the vagus nerve calm the body, but they do so in different ways. Shutdown, or freeze-or-faint, occurs through the dorsal branch of the vagus nerve. This reaction can feel like the fatigued muscles and lightheadedness of a bad flu. When the dorsal vagal nerve shuts down the body, it can move us into immobility or dissociation. In addition to affecting the heart and lungs, the dorsal branch affects body functioning below the diaphragm and is involved in digestive issues.

The ventral branch of the vagal nerve affects body functioning above the diaphragm. This is the branch that serves the social engagement system. The ventral vagal nerve dampens the body’s regularly active state. Picture controlling a horse as you ride it back to the stable. You would continue to pull back on and release the reins in nuanced ways to ensure that the horse maintains an appropriate speed. Likewise, the ventral vagal nerve allows activation in a nuanced way, thus offering a different quality than sympathetic activation.

Ventral vagal release into activity takes milliseconds, whereas sympathetic activation takes seconds and involves various chemical reactions that are akin to losing the horse’s reins. In addition, once the fight-or-flight chemical reactions have begun, it can take our bodies 10–20 minutes to return to our pre-fight/pre-flight state. Ventral vagal release into activity does not involve these sorts of chemical reactions. Therefore, we can make quicker adjustments between activation and calming, similar to what we can do when we use the reins to control the horse.

If you go to a dog park, you will see certain dogs that are afraid. They exhibit fight-or-flight behaviors. Other dogs will signal a wish to play. This signaling often takes the form that we humans hijacked for the downward-facing-dog pose in yoga. When a dog gives this signal, it cues a level of arousal that can be intense. However, this playful energy has a very different spirit than the intensity of fight-or-flight behaviors. This playful spirit characterizes the social engagement system. When we experience our environment as safe, we operate from our social engagement system.

Trauma’s effect on nervous system response

If we have unresolved trauma in our past, we may live in a version of perpetual fight-or-flight. We may be able to channel this fight-or-flight anxiety into activities such as cleaning the house, raking the leaves or working out at the gym, but these activities will have a different feel than they would if they were done with social engagement biology (think “Whistle While You Work”).

For some trauma survivors, no activity successfully channels their fight-or-flight sensations. As a result, they feel trapped and their bodies shut down. These clients may live in a version of perpetual shutdown.

Peter Levine, a longtime friend and colleague of Porges, has studied the shutdown response through animal observations and bodywork with clients. In Waking the Tiger: Healing Trauma, he explains that emerging from shutdown requires a shudder or shake to discharge suspended fight-or-flight energy. In a life-threatening situation, if we have shutdown and an opportunity for active survival presents itself, we can wake ourselves up. As counselors, we might recognize this shift from shutdown to fight-or-flight in a client’s move from depression into anxiety.

But how can we help our clients move into their social engagement biology? If clients live in a more dissociative, depressed, shutdown manner, we must help them shift temporarily into fight-or-flight. As clients experience fight-or-flight intensity, we must then help them find a sense of safety. When they can sense that they are safe, they can shift into their social engagement system.

The body-awareness techniques that are part of cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) can help clients move out of dissociative, shutdown responses by encouraging them to become more embodied. When clients are more present in their bodies and better able to attend to momentary muscular tension, they can wake up from a shutdown response. As clients activate out of shutdown and shift toward fight-or-flight sensations, the thought-restructuring techniques that are also part of CBT and DBT can teach clients to evaluate their safety more accurately. Reflective listening techniques can help clients feel a connection with their counselors. This makes it possible for these clients to feel safe enough to shift into social engagement biology.

Specific aspects of ventral vagal nerve functioning

Porges chose the name social engagement system because the ventral vagal nerve affects the middle ear, which filters out background noises to make it easier to hear the human voice. It also affects facial muscles and thus the ability to make communicative facial expressions. Finally, it affects the larynx and thus vocal tone and vocal patterning, helping humans create sounds that soothe one another.

Since publishing The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation in 2011, Porges has studied the use of sound modulation to hierarchytrain middle-ear muscles. Clients with poor social engagement system functioning may have inner ear difficulties that make it hard for them to receive soothing from others’ voices. As counselors, we can be conscious of our vocal patterns and facial expressions and curious about the effects those aspects of our communication have on our clients.

Based on his understanding of the effects of the vagus nerve, Porges notes that extending exhales longer than inhales for a period of time activates the parasympathetic nervous system. Porges was a clarinet player in his youth and remembers the effect of the breath patterns required to play that instrument.

As a dance therapist, I am aware that extending exhales helps clients who are stuck in forms of fight-or-flight response to move into a sense of safety. For clients stuck in some form of shutdown, I have found that conscious breath work can stir the fight-or-flight response. When this occurs, the fight-or-flight energy needs to be discharged through movement for clients to find a sense of safety. For instance, these clients might need to run in place or punch a pillow. The hierarchy of defense system functioning explains these therapeutic techniques.

Respiratory sinus arrhythmia is a good index of ventral vagal functioning. This means we now have methods to study the effectiveness of body therapies and expressive arts therapies.

Polyvagal theory in my practice

What follows is an example of how I used polyvagal theory with a client who experienced medical trauma during her birth.

The client, whom I have been seeing for some time, described feeling very sleepy and acknowledged having difficulty getting to our session on this day. Her psychiatrist had prescribed her Zoloft as a way of treating anxiety stirred by the birth of her daughter’s first child. The client and I had previously normalized her anxiety as a trauma response.

During the years before coming to see me, this client had attempted suicide, which resulted in medical procedures that added to her trauma. Through our work, she has come to understand that the panic attacks she has when in contained situations are also trauma responses. She has lived much of her life in perpetual fight-or-flight response mode.

On this day, she was relieved to be less emotional, but she feared the tiredness that accompanied Zoloft’s help in calming her fight-or-flight sensations. I saw this fear of the tiredness as a fear of dorsal vagal shutdown. We discussed the possibility that this tiredness could allow her a new kind of activation. I asked if she would like to do some expressive art that would allow gentle, expressive movement. She shuddered, naming her preference for things that were less subjective.

We talked about the existence of a kind of aliveness that still feels safe. We talked about the possibility of existing in a playful place in which there is no right and wrong, only preference. We acknowledged that since her birth, she and her parents had feared that her health would fail again. This environment in which she had grown up had supported nervous system functioning designed for life-threatening situations. With the Zoloft calming her fight-or-flight activation, I suggested that perhaps she could explore some calmer, more playful kinds of subjective experiences.

“It feels like you are trying to create a different me,” she responded. I acknowledged that it might sound as if I were thinking she could be someone she wasn’t. But I explained that what I was actually suggesting was the possibility that she could be herself in a different way.

The client told me she had a new book on grandparenting that contained a chapter on play. She said she would consider reading it. At the same time, she said that she might not be able to tolerate the Zoloft and might have to get off of it. Regardless, the idea of this different, more playful way of being has been introduced to her and, for a moment or two, experienced.

Getting the picture

As counselors armed with polyvagal theory, we can picture defense mechanism hierarchy. We can recognize shifts from fight-or-flight to shutdown when clients feel trapped. We can also recognize the movement from shutdown into fight-or-flight that offers a possible shift into social engagement biology if and when the client can gain a sense of safety.

Before polyvagal theory, most counselors could probably recognize fight-or-flight and shutdown behaviors. They could probably sense a difference between defense responses designed for life-threatening situations and responses that characterize what Porges calls the social engagement system. Polyvagal theory deepens that awareness with the knowledge that playful arousal and restorative surrender have a unique nervous system influence.

Most counselors appreciate brain science but may find it difficult to picture how to use the information. Thanks to polyvagal theory’s clarification of the role of the ventral branch of the vagus nerve, we now have a map to guide us.

 

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Dee Wagner has worked as a licensed professional counselor and board-certified dance therapist at The Link Counseling Center in Atlanta for 22 years.
Her book/workbook Naked Online: A DoZen Ways to Grow From Internet Dating helps clients use their online dating experiences to shift from attachment trauma to social engagement system functioning. Contact her at mdeewag@gmail.com.

Letters to the editor: ct@counseling.org

 

23 Comments

  1. Keith Myers

    Dee,

    This is such an important article, especially in the counseling profession. So many counselors will work with clients who are survivors of trauma, even if it’s not a specialty per se (like you and me). Thank you for writing it.

    We should connect here in Atlanta!
    Keith

    1. Dee Wagner

      Thanks, Keith! Yes, let’s connect and talk trauma work. We are in such a rich time know that Porges has made his discoveries and his wife Sue Carter is helping us understand the role of oxytocin and vasopressin and Peter Levine and Bessel van der Kolk are completing the theoretical puzzle that explains how people heal!
      Dee

  2. OCD Patient

    Thank you so much for this article. There are so many therapists who are unaware of Polyvagal Theory; so many clinicians who do not consider the role of potential trauma in their clients’ struggles. This information, if taken seriously & used by those who come across it, can be life changing for patients. I am one of them. I have OCD (along w/ BPD traits) & I have been “stuck” for so long, despite having been exposed to the “Gold Standard” treatment for OCD, ERP, for many, many years.

    I am recently discovering, w/ the help of a wonderful new [to me] therapist, that a huge piece in figuring out my puzzle is that trauma in my past has never been addressed as such. Through creating a safe space – that actually feels safe – for me by being willing to take my comments seriously [vs trying to redirect things that I said I experienced into existing models that didn’t take into account those experiences], by being validating b/c of this, & by showing me genuine empathy by showing me she was open to looking at things from my shoes; through all that, we ~together~ have been able to identify that trauma has been a part of my history and that it is something that continues to affect me to this day. And b/c we have been able to identify this, in addition to learning about things like Polyvagal Theory & its implications for treatment, we have hope that I can overcome. Thank you for using the word “heal” in the comment above, as well. The one (& only) time prior to my current therapist that I breathed that word in therapy, I was looked at w/ bewilderment, like “what does such a thing even mean?” But healing [vs “curing”, “fixing”] is a real thing. I wish more clinicians understood this.

    This article, the work you are doing, & that you are sharing this information w/ others is so appreciated. Thank you very much.

  4. angel 16

    Please I wanted to know when did Stephen Porges published his polyvagal theory for the first time? if you have any idea please….

    1. Dee Wagner

      I do not know when the theory was published for the first time. His book is from 2011. Clinically speaking, the publishing of the book might be considered the first publishing of the theory because it pulls together so many different aspects of the theory.

  5. Nancy

    My therapist has studied the polyvagal theory but he also uses Pat Ogden’s Sensorimotor Psychotherapy for grounding techniques in complex trauma and dissociative clients. These two theories work together well, and when I get in that “collapsed” child like state, he now uses physical grounding techniques instead of the older “pick out 3 colors” or the older grounding techniques. It’s revolutionized my therapy sessions in a way that nothing else has over the years. It would work for any complex PTSD client, and not just the dissociative disordered people. Thought you might want to look into it and practice on your clients. My therapist and I always do the techniques together in a session. These work every time, even for your complex cases.

    The freeze, or collapse, response is the first response to trauma in children. So if the body responds physically and goes into collapse as an adult, why are we still using mental techniques to get out of the collapsed state? My therapist and I don’t and its changed my life at home, too. It’s taken me a LOT of prompting in sessions and at least a year of using them in sessions to catch my dissociative physical responses at home and use these techniques. My life has been improving over time as I dissociate less.

  6. Shannon

    Wow. I am in the early stages of healing from early childhood trauma. I have a wonderful therapist, thank goodness. I find that in addition to therapy and mindfulness meditations, the more I read and learn, the more I am able to recognize and label my true feelings. After years and years of dissociating and blaming that state of mind on things like allergies and gluten intolerance and fatigue, I am finally acknowledging the real origins of my “collapsed state”.
    I find myself very motivated to face the trauma from my past. And during this past holiday vacation week, I have to think that I went too fast, plowed too far into new emotional territory, and made a little too much “progress”. :) And the straw that broke the camel’s back – the emotional piece that proved to be just a bit too much to allow myself to take the necessary processing time for all these new experiences – was looking at a photo (with my newfound perspective) at my elderly parents’ house. It was a photo of my abuser, in its place of honor on the shelf. And bam. I went straight to a collapsed state. That was just too much, the tipping point. But I recognize my collapse for what it really is! And that’s a victory. I struggled to drag myself back to an organized mental state, and I guess my whole point is THANK YOU. Stumbling across this website has been incredibly helpful. It is validating. It makes so much sense. I just want to say thank you for the work you do, thank you for putting this information out there, and please know that you make a world of difference, :-)

  7. Lora

    Hi,
    My boyfriend and I have been going through this dorsal Vagus shut down. I discovered about a year ago that Literally constant massage all over my body is the only thing that is relieving my chronic pain of 10 years.

    When I massage the area between my ears, in the back my head, I feel like I am alleviating trauma that I’ve had since I was a little kid. The back of my neck also is hard and strained.

    He is in a similar boat except he is more of a fight or flight person and I am more often shut down. He has been going to and listen as of doctors who are not helping, and my method of dealing with it is to sit through intense physical and emotional trauma that I’m forcing myself to face in my brain until my body feels better. Both methods are calming and healing our bodies but there must be a less painful and terrifying way to do it. Can you recommend anyone in New York City we could talk to you? Waking up our vagus nerve is saving our lives

  8. Manuel Royal

    Fascinating subject, and your clear explanation makes me think it’s related to the anxiety-related dissociation I feel whenever I essay a creative project. For years it’s bothered me that: if I give up and don’t even try, I feel like myself, but if I push through and achieve something (as a fiction writer), it feels like the accomplishment of somebody else.

    Thank you for presenting this information.

    (Minor note: it’s “loosing the horse’s reins”.)

  9. Linda Bresgi

    Thank you for this very well written and enlightening article I have been in intensive psychotherapy for more than 4 years (2 to 3 sessions a week) and often fund myself shutting down in sessions. I have never known why but always feel intense anxiety and then have absolutely nothing to say. This feels debilitating. Could this be a polyvgal response? Thank you

    1. John Carter

      It could be that your therapy is retraumatizing you needlessly. Naturally, I know nothing about your situation but if you can find a trauma therapist trained in Somatic Experiencing, that might better work around your body remembering the trauma and shutting down. Cognitive approaches seem to often miss the mind-body connection. Quite a few therapists shouldn’t be doing trauma therapy because they lack the training for what to do with complex trauma or how to avoid triggering it. [caveat, I only have an academic interest, not an expert of any sort]

    2. Aware

      Immediately after reading your post, I thought the same as John. I had an episode during couples counseling. Our therapist recommended an excellent trauma therapist that is knowledgeable about polyvagal theory and uses EMDR as well as other trauma techniques. Our couples therapist was humble enough to know that he lacked the knowledge to help me. Not all therapists, doctors, etc. are able to admit something like this and tend to do more harm than good.

  10. Mel

    I’ve been searching for a doctor/provider/therapist who is knowledgable in trauma treatment and the Polyvagal theory in the area of Bloomington, IN. This is extremely frustrating trying to find help when you really don’t know where to start. Then insurance puts another kink in as well since they need to be in-network to qualify for insurance. The hardest part is finding someone who is taking new patients. The one place that does reportedly know about Polyvagal and somatic treatment, has providers that either are not seeing new patients or it will be 4-5 months on their waiting list before being seen and they do not recommend anyone else in the area – go online was the response when asked. Suggestions for finding help would be greatly appreciated…and thank you for allowing me to vent.

  11. Marya Barker

    I am in Columbia, SC and am desperate to find someone to heal my daughter’s trauma. She’s struggled for years, been diagnosed with depression, anxiety, borderline, ADHD and despite medication and some (not enough) therapy, she’s just floundering. Can you recommend anyone who can help?

  13. twyrl

    insightful article! my body began shaking imperceptibly a couple of months ago….”anxiety induced” says a neurologist. yestrday i worked with a “TRE” practitioner for the first time and was introduced to the vegas nerve and this theory….upon reading your article and mention of the inner ear connection, i realize the trembling began around the time i went to an audiologist and found i have profound hearing loss in one ear, so began trying hearing aids…the world is quite a cacophonous place! then another comment mentions the disassociation they experience with creative endeavors! it is just so marvelous when we can all put our heads together like this! thank you everyone!

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