The Vagus Nerve, State and Story. The Polyvagal Theory in Therapy and the Autonomic Nervous System – Deb Dana * Stimulating the pathway connecting body and brain can change patients’ lives – Zoe Fisher and Andrew H Kemp.

“The mind narrates what the nervous system knows. Story follows state.”

“Our Autonomic Nervous System fires muscular tensions, triggered by feedback signals from the external & internal world at millisecond speeds below conscious awareness. These muscles tensions fire our Thoughts.”

In her new book, The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, Deb Dana offers a window into the inner life of a traumatized person and a way out of trauma and back to finding joy, connection, and safety through enlightening theory, rich experiential practice, and practical steps.

Developing present moment awareness and the ability to detect autonomic nervous system states opens the door for clients to experience state and story as separate experiences and ultimately reshape their nervous system.

The explanatory power of the Polyvagal Theory provides therapists with a language to help their clients reframe reactions to traumatic events. With the theory, clients are able to understand the adaptive functions of their reactions.

The hope polyvagal theory offers is that, in time, clients feel attuned to their autonomic nervous systems, develop a sense of self-compassion that allows them to see their responses as attempts at survival and not simply clinical diagnoses, and honor the innate wisdom of the autonomic nervous system to find their way back to safety, connection, and the rhythm of regulation.

In each of our relationships, the autonomic nervous system is “learning” about the world and being toned toward habits of connection or protection. Hopefulness lies in knowing that while early experiences shape the nervous system, ongoing experiences can reshape it.

The theory transforms the clients narrative from a documentary to a pragmatic quest for safety with an implicit bodily drive to survive. Through the lens of Polyvagal Theory, we see the role of the autonomic nervous system as it shapes clients’ experiences of safety and affects their ability for connection.

Polyvagal Theory demonstrates that even before the brain makes meaning of an incident, the autonomic nervous system has assessed the environment and initiated an adaptive survival response. Neuroception precedes perception. Story follows state.

The clues to a client’s present-time suffering can be found in their autonomic response history.

“The autonomic nervous system,” Deb writes, “responds to challenges in daily life by telling us not what we are or who we are, but how we are.”

Informing, guiding, and regulating our experiences, the autonomic nervous system tells us when we are safe and can proceed forward and when we are under threat and should retreat.

However, when trauma disrupts our experience, it also disrupts the autonomic nervous system, and the result is dysregulation, the interruption of the ability to feel safe.

“Trauma compromises our ability to engage with others by replacing patterns of connection with patterns of protection,” Dana explains.

Because our lived experience relies on our autonomic nervous system’s ability to detect safety, a term known as neuroception, when the autonomic nervous system becomes disrupted, it affects everything about how we move through the world, interact with those around us, and attune to ourselves and the world around us.

Yet trauma survivors are often judged by their actions. Dana writes, ”We still too often blame the victim if they didn’t fight or try to escape but instead collapsed into submission. We make a judgement about what someone did that leads to a belief about who they are.”

The polyvagal theory, however, sees every response as an action in service of survival. In trauma, safety has been threatened, and the system that helps to regain a sense of safety is no longer able to regulate, detect safety, or restore connection.

Dana writes, “If we think of trauma as Robert Macy (president of the International Trauma Center) defined it, ”an overwhelming demand placed upon the physiological human system,” then we immediately consider the autonomic nervous system.”

And because the autonomic nervous system is shaped over time through the experiences we have, we develop a habitual pattern known as a personal neural profile that then guides our actions and responses.

“We live a story that originates in our autonomic state, is sent through autonomic pathways from the body to the brain, and is then translated by the brain into the beliefs that guide our daily living. The mind narrates what the nervous system knows. Story follows state,” writes Dana.

A Polyvagal theory describes the neural experience as well as the expectations for reciprocal connection it holds. When those connections are violated, the result is what is known as “biological rudeness” and an immediate feeling of threat.

The work of the therapist using polyvagal theory is to interrupt the traumatized client’s neural expectations in positive ways.

Dana writes, “Repeatedly violating neural expectations in this way within the therapist-client dyad influences a client’s autonomic assumptions. As a client’s nervous system begins to anticipate in different ways, the old story will no longer fIt and a new story can be explored.”

Humans are social animals dependent on connection and coregulation for a sense of safety. Yet trauma makes connection dangerous and interrupts the process of coregulatory development.

While trauma can make clients feel as if they no longer need or want connection, their autonomic nervous system relies on connection, and it suffers.

“Chronic loneliness sends a persistent message of danger, and our autonomic nervous system remains locked in survival mode,” writes Dana.

Through mapping their autonomic states, clients begin to understand what triggers move them into a state of sympathetic activation and perception of danger, and what glimmers help restore them to a state of safety, hope and growth.

Developing present moment awareness and the ability to detect autonomic nervous system states opens the door for clients to experience state and story as separate experiences and ultimately reshape their nervous system.

The nervous system is relational in nature and Dana describes how therapists can help clients build their capacity for connection, reciprocity and repair: “When a rupture in the therapeutic relationship occurs, look for the moment when the work became too big of an autonomic challenge, name it for your clients, and take responsibility for the misattunement.”

Ruptures, much like trauma itself, can be opportunities for change, growth, and a deeper understanding. While the experience can feel uncertain and the path unknown, the ability to intertwine states and disrupt the all-or-nothing responses so common in trauma is crucial to experiencing play, intimacy, awe, and elevation.

The hope polyvagal theory offers is that, in time, clients feel attuned to their autonomic nervous systems, develop a sense of self-compassion that allows them to see their responses as attempts at survival and not simply clinical diagnoses, and honor the innate wisdom of the autonomic nervous system to find their way back to safety, connection, and the rhythm of regulation.

Psych Central

A BEGINNER’S GUIDE TO POLYVAGAL THEORY

Deb Dana

We come into the world wired to connect. With our first breath, we embark on a lifelong quest to feel safe in our bodies, in our environments, and in our relationships with others. The autonomic nervous system is our personal surveillance system, always on guard, asking the question “Is this safe?” Its goal is to protect us by sensing safety and risk, listening moment by moment to what is happening in and around our bodies and in the connections we have to others.

This listening happens far below awareness and far away from our conscious control. Dr. Porges, understanding that this is not awareness that comes with perception, coined the term neuroception to describe the way our autonomic nervous system scans for cues of safety, danger, and life-threat without involving the thinking parts of our brain.

Because we humans are meaningmaking beings, what begins as the wordless experiencing of neuroception drives the creation of a story that shapes our daily living.

The Autonomic Nervous System

The autonomic nervous system is made up of two main branches, the sympathetic and the parasympathetic, and responds to signals and sensations via three pathways, each with a characteristic pattern of response. Through each of these pathways, we react “in service of survival.”

The sympathetic branch is found in the middle part of the spinal cord and represents the pathway that prepares us for action. It responds to cues of danger and triggers the release of adrenaline, which fuels the fight-or-flight response.

In the parasympathetic branch, Polyvagal Theory focuses on two pathways traveling within a nerve called the vagus. Vagus, meaning “wanderer,” is aptly named. From the brain stem at the base of the skull, the vagus travels in two directions: downward through the lungs, heart, diaphragm, and stomach and upward to connect with nerves in the neck, throat, eyes, and ears.

The vagus is divided into two parts: the ventral vagal pathway and the dorsal vagal pathway. The ventral vagal pathway responds to cues of safety and supports feelings of being safely engaged and socially connected. In contrast, the dorsal vagal pathway responds to cues of extreme danger. It takes us out of connection, out of awareness, and into a protective state of collapse. When we feel frozen, numb, or “not here,” the dorsal vagus has taken control.

Dr. Porges identified a hierarchy of response built into our autonomic nervous system and anchored in the evolutionary development of our species. The origin of the dorsal vagal pathway of the parasympathetic branch and its immobilization response lies with our ancient vertebrate ancestors and is the oldest pathway. The sympathetic branch and its pattern of mobilization, was next to develop. The most recent addition, the ventral vagal pathway of the parasympathetic branch brings patterns of social engagement that are unique to mammals.

When we are firmly grounded in our ventral vagal pathway, we feel safe and connected, calm and social. A sense (neuroception) of danger can trigger us out of this state and backwards on the evolutionary timeline into the sympathetic branch. Here we are mobilized to respond and take action. Taking action can help us return to the safe and sociaI state. It is when we feel as though we are trapped and can’t escape the danger that the dorsal vagal pathway pulls us all the way back to our evolutionary beginnings. In this state we are immobilized. We shut down to survive. From here, it is a long way back to feeling safe and social and a painful path to follow.

The Autonomic Ladder

Let’s translate our basic knowledge of the autonomic nervous system into everyday understanding by imagining the autonomic nervous system as a ladder. How do our experiences change as we move up and down the ladder?

The Top of the Ladder

What would it feel like to be safe and warm? Arms strong but gentle. Snuggled close, joined by tears and laughter. Free to share, to stay, to leave . . .

Safety and connection are guided by the evolutionarily newest part of the autonomic nervous system. Our social engagement system is active in the ventral vagal pathway of the parasympathetic branch. In this state, our heart rate is regulated, our breath is full, we take in the faces of friends, and we can tune in to conversations and tune out distracting noises.

We see the “big picture” and connect to the world and the people in it. I might describe myself as happy, active, interested and the world as safe, fun, and peaceful. From this ventral vagal place at the top of the autonomic ladder, I am connected to my experiences and can reach out to others. Some of the daily living experiences of this state include being organized, following through with plans, taking care of myself, taking time to play, doing things with others, feeling productive at work, and having a general feeling of regulation and a sense of management. Health benefits include a healthy heart, regulated blood pressure, a healthy immune system decreasing my vulnerability to illness, good digestion, quality sleep, and an overall sense of well-being.

Moving Down the Ladder

Fear is whispering to me and I feel the power of its message. Move, take action, escape. No one can be trusted. No place is safe . . .

The sympathetic branch of the autonomic nervous system activates when we feel a stirring of unease, when something triggers a neuroception of danger. We go into action. Fight or flight happens here. In this state, our heart rate speeds up, our breath is short and shallow, we scan our environment looking for danger, we are “on the move.” I might describe myself as anxious or angry and feel the rush of adrenaline that makes it hard for me to be still. I am listening for sounds of danger and don’t hear the sounds of friendly voices. The world may feel dangerous, chaotic, and unfriendly.

From this place of sympathetic mobilization, a step down the autonomic ladder and backward on the evolutionary timeline, I may believe, “The world is a dangerous place and I need to protect myself from harm.”

Some of the daily living problems can be anxiety, panic attacks, anger, inability to focus or follow through, and distress in relationships. Health consequences can include 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.

The Bottom of the Ladder

I’m far away in a dark and forbidding place. I make no sound. I am small and silent and barely breathing. Alone where no one will ever find me . . .

Our oldest pathway of response, the dorsal vagal pathway of the parasympathetic branch, is the path of last resort. When all else fails, when we are trapped and action taking doesn’t work, the “primitive vagus” takes us into shutdown, collapse, and dissociation.

Here at the very bottom of the autonomic ladder, I am alone with my despair and escape into not knowing, not feeling, almost a sense of not being. I might describe myself as hopeless, abandoned, foggy, too tired to think or act and the world as empty, dead, and dark.

From this earliest place on the evolutionary timeline, where my mind and body have moved into conservation mode, I may believe, “I am lost and no one will ever find me.”

Some of the daily living problems can be dissociation, problems with memory, depression, isolation, and no energy for the tasks of daily living. Health consequences of this state can include chronic fatigue, fibromyalgia, stomach problems, low blood pressure, type 2 diabetes, and weight gain.

The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation

The polyvagal theory presented in client friendly language.

Deb Dana

This book offers therapists an integrated approach to adding a polyvagal foundation to their work with clients. With clear explanations of the organizing principles of Polyvagal Theory, this complex theory is translated into clinician and client-friendly language. Using a unique autonomic mapping process along with worksheets designed to effectively track autonomic response patterns, this book presents practical ways to work with clients’ experiences of connection. Through exercises that have been specifically created to engage the regulating capacities of the ventral vagal system, therapists are given tools to help clients reshape their autonomic nervous systems.

Adding a polyvagal perspective to clinical practice draws the autonomic nervous system directly into the work of therapy, helping clients re-pattern their nervous systems, build capacities for regulation, and create autonomic pathways of safety and connection. With chapters that build confidence in understanding Polyvagal Theory, chapters that introduce worksheets for mapping, tracking, and practices for repatterning, as well as a series of autonomic meditations, this book offers therapists a guide to practicing polyvagal-informed therapy.

The Polyvagal Theory in Therapy is essential reading for therapists who work with trauma and those who seek an easy and accessible way of understanding the significance that Polyvagal Theory has to clinical work.

FOREWORD

By Stephen W. Porges

Since Polyvagal Theory emerged in 1994, I have been on a personal journey expanding the clinical applications of the theory. The journey has moved Polyvagal concepts and constructs from the constraints of the laboratory to the clinic where therapists apply innovative interventions to enhance and optimize human experiences.

Initially, the explanatory power of the theory provided therapists with a language to help their clients reframe reactions to traumatic events. With the theory, clients were able to understand the adaptive functions of their reactions.

As insightful and compassionate therapists conveyed the elements of the theory to their clients, survivors of trauma began to reframe their experiences and their personal narratives shifted to feeling heroic and not victimized.

The theory had its foundation in laboratory science, moved into applied research to decipher the neurobiological mechanisms of psychiatric disorders, and now through the insights of Deb Dana and other therapists is informing clinical treatment.

The journey from laboratory to clinic started on October 8, 1994 in Atlanta, when Polyvagal Theory was unveiled to the scientific community in my presidential address to the Society for Psychophysiological Research. A few months later the theory was disseminated as a publication in the society’s journal, Psychophysiology (Porges, 1995). The article was titled “Orienting in a Defensive World: Mammalian Modifications of Our Evolutionary Heritage. A Polyvagal Theory.” The title, crafted to crypticaIIy encode several features of the theory, was intended to emphasize that mammals had evolved in a hostile environment in which survival was dependent on their ability to down regulate states of defense with states of safety and trust, states that supported cooperative behavior and health.

In 1994 I was totally unaware that clinicians would embrace the theory. I did not anticipate its importance in understanding trauma-related experiences. Being a scientist, and not a clinician, my interests were focused on understanding how the autonomic nervous system influenced mental, behavioral, and physiological processes. My clinical interests were limited to obstetrics and neonatology with a focus on monitoring health risk during delivery and the first days of life. Consistent with the demands and rewards of being an academic researcher, my interests were directed at mechanisms.

In my most optimistic dreams of application, I thought my work might evolve into novel assessments of autonomic function. In the early 1990’s I was not interested in emotion, social behavior, and the importance of social interactions on health and the regulation of the autonomic nervous system; I seldom thought of my research leading to strategies of intervention.

After the publication of the Polyvagal Theory, I became curious about the features of individuals with several psychiatric diagnoses. I noticed that research was reliably demonstrating depressed cardiac vagal tone (i.e., respiratory sinus arrhythmia and other measures of heart rate variability) and atypical vagal regulation of the heart in response to challenges. I also noticed that many psychiatric disorders seem to share symptoms that could be explained as a depressed or dysfunctional Social Engagement System with features expressed in auditory hypersensitivities, auditory processing difficulties, flat facial affect, poor gaze, and a lack of prosody.

This curiosity led to an expanded research program in which I conducted studies evaluating clinical groups (e.g., autism, selective mutism, HIV, PTSD, Fragile X syndrome, borderline personality disorder, women with abuse histories, children who stutter, preterm infants). In these studies Polyvagal Theory was used to explain the findings and confirm that many psychiatric disorders were manifest in a dysfunction of the ‘ventral’ vagal complex, which included lower cardiac vagal tone and the associated depressed function of the striated muscles of the face and head resulting in flat facial affect and lack of prosody.

In 2011 the studies investigating clinical populations were summarized in a book published by Norton, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation.

The publication enabled Polyvagal Theory to become accessible to clinicians; the theory was no longer limited to the digital libraries linked to universities and research institutes. The publication of the book stimulated great interest within the clinical community and especially with traumatologists. I had not anticipated that the main impact of the theory would be to provide plausible neurophysiological explanations for experiences described by individuals who had experienced trauma. For these individuals, the theory provided an understanding of how, after experiencing life threat, their neural reactions were retuned towards a defensive bias and they lost the resilience to return to a state of safety.

This prompted invitations to talk at clinically oriented meetings and to conduct workshops on Polyvagal Theory for clinicians. During the past few years, there has been an expanding awareness of Polyvagal Theory across several clinical areas. This welcoming by the clinical community identified limitations in my knowledge. Although I could talk to clinicians and deconstruct their presentations of clinical cases into constructs described by the theory, I was not a clinician. I was limited in how I related the theory to clinical diagnosis, treatment, and outcome.

During this period, I met Deb Dana. Deb is a talented therapist with astute insights into trauma and a desire to integrate Polyvagal Theory into clinical treatment. For Deb, Polyvagal Theory provided a language of the body that paralleled her feelings and intuitive connectedness with her clients. The theory provided a syntax to label her and her client’s experiences, which were substantiated by documented neural mechanisms.

Functionally, the theory became a lens or a perspective in how she supported her clients and how she reacted to her clients.

The theory transformed the client’s narrative from a documentary to a pragmatic quest for safety with an implicit bodily drive to survive.

As the theory infused her clinical model, she began to develop a methodology to train other therapists. The product of this transition is the current book. In The Polyvagal Theory in Therapy, Deb Dana brilliantly transforms a neurobiologically based theory into clinical practice and Polyvagal Theory comes alive.

INTRODUCTION

Deb Dana

When I teach Polyvagal Theory to colleagues and clients, I tell them they are learning about the science of safety, the science of feeling safe enough to fall in love with life and take the risks of living. Polyvagal Theory provides a physiological and psychological understanding of how and why clients move through a continual cycle of mobilization, disconnection, and engagement.

Through the lens of Polyvagal Theory, we see the role of the autonomic nervous system as it shapes clients’ experiences of safety and affects their ability for connection.

The autonomic nervous system responds to the challenges of daily life by telling us not what we are or who we are but how we are. The autonomic nervous system manages risk and creates patterns of connection by changing our physiological state. These shifts are slight for many people, and, in the moments when large state changes happen, their system is resilient enough to help them return to a regulated state.

Trauma interrupts the process of building the autonomic circuitry of safe connection and sidetracks the development of regulation and resilience.

Clients with trauma histories often experience more intense, extreme autonomic responses, which affects their ability to regulate and feel safe in relationships. Polyvagal Theory helps therapists understand that the behaviors of their clients are autonomic actions in service of survival, adaptive responses ingrained in a survival story that is entered into automatically.

Trauma compromises our ability to engage with others by replacing patterns of connection with patterns of protection. If unresolved, these early adaptive survival responses become habitual autonomic patterns. Therapy through a polyvagal lens, supports clients in repatterning the ways their autonomic nervous systems operate when the drive to survive competes with the longing to connect with others.

This book is designed to help you bring Poiyvagal Theory into your therapy practice. It provides a comprehensive approach to intervention by presenting ways to map autonomic response and shape the autonomic nervous system for safety. With this book, you will learn Poiyvagal Theory and use worksheets and experiential exercises to apply that knowledge to the nuts and bolts of practice.

Section I, “Befriending the Nervous System,” introduces the science of connection and creates basic fluency in the language of Poiyvagal Theory. These chapters present the essential elements of Poiyvagal Theory, building a solid foundation of knowledge and setting the stage for work with the clinical applications presented in the remainder of the book.

Section II, “Mapping the Nervous System,” focuses on learning to recognize patterns of response. The worksheets presented in these chapters create the ability to predictably identify individual placement along the autonomic hierarchy.

Section III, “Navigating the Nervous System,” builds on the newly gained expertise in identifying autonomic states and adds the next steps in the process: learning to track response patterns, recognize triggers, and identify regulating resources. A variety of “attending” practices are presented to support a new way of attuning to patterns of action, disconnection, and engagement.

Section IV, “Shaping the Nervous System,” explores the use of passive and active pathways to tone the autonomic nervous system and reshape it toward increased flexibility of response. These chapters offer ways to engage the regulating capacities of the ventral vagal system through both in-the-moment interventions and practices that begin to shift the system toward finding safety in connection.

Through the ideas presented in this book, you will discover how using Polyvagal Theory in therapy will increase the effectiveness of your clinical work with trauma survivors. In this process, not only will your therapy practice change, but also your way of seeing and being in the world will change.

My personal experience, and my experience teaching Polyvagal Theory to therapists and clients, is that there is a “before-and-after” quality to learning this theory. Once you understand the role of the autonomic nervous system in shaping our lives, you can never again not see the world through that lens.

SECTION I

BEFRIENDING THE NERVOUS SYSTEM

“The greatest thing then, in all education, is to make our nervous system our ally as opposed to our enemy.” WILLIAM JAMES

If you do a Google search for “Polyvagal Theory,” more than 500,000 results pop up, and if you search for “Stephen Porges,” more than 150,000 results appear. Polyvagal Theory has made a remarkable journey from a relatively unknown and controversial theory to its wide acceptance today in the field of psychotherapy.

Polyvagal Theory traces its origins to 1969 and Dr. Porges’s early work with heart rate variability and his “vision that monitoring physiological state would be a helpful guide to the therapist during the clinical interaction”

(Porges, 2011a, p. 2). As Dr. Porges wrote, at that time he “looked forward to new discoveries applying these technologies to clinical populations. I had no intention of developing a theory” (p. 5). Polyvagal Theory was born out of the question how one nerve, the vagus nerve, and its tone, which Dr. Porges was measuring, could be both a marker of resilience and a risk factor for newborns. Through solving this puzzle, now known as the vagal paradox, Dr. Porges created the Polyvagal Theory.

Three organizing principles are at the heart of Polyvagal Theory.

Hierarchy: The autonomic nervous system responds to sensations in the body and signals from the environment through three pathways of response. These pathways work in a specified order and respond to challenges in predictable ways. The three pathways (and their patterns of response), in evolutionary order from oldest to newest, are the dorsal vagus (immobilization), the sympathetic nervous system (mobilization), and the ventral vagus (social engagement and connection).

Neuroception: This is the term coined by Dr. Porges to describe the ways our autonomic nervous system responds to cues of safety, danger, and life-threat from within our bodies, in the world around us, and in our connections to others. Different from perception, this is “detection without awareness” (Porges, n.d.), a subcortical experience happening far below the realm of conscious thought.

Co-regulation: Polyvagal Theory identifies co-regulation as a biological imperative: a need that must be met to sustain life. It is through reciprocal regulation of our autonomic states that we feel safe to move into connection and create trusting relationships.

We can think of the autonomic nervous system as the foundation upon which our lived experience is built. This biological resource (Kok et al., 2013) is the neural platform that is beneath every experience. How we move through the world-turning toward, backing away, sometimes connecting and other times isolating, is guided by the autonomic nervous system. Supported by co-regulating relationships, we become resilient. ln relationships awash in experiences of misattunement, we become masters of survival. In each of our relationships, the autonomic nervous system is “learning” about the world and being toned toward habits of connection or protection.

Hopefulness lies in knowing that while early experiences shape the nervous system, ongoing experiences can reshape it. Just as the brain is continually changing in response to experiences and the environment, our autonomic nervous system is likewise engaged and can be intentionally influenced.

As individual nervous systems reach out for contact and co-regulation, incidents of resonance and misattunement are experienced as moments of connection or moments of protection. The signals conveyed, the cues of safety or danger sent from one autonomic nervous system to another, invite regulation or increase reactivity. In work with couples, it is easy to observe the increased reactivity that occurs when a disagreement quickly escalates and cues of danger communicated between the two nervous systems trigger each partner’s need for protection. In contrast, the attunement of the therapist-client relationship relays signals of safety and an autonomic invitation for connection.

Humans are driven to want to understand the “why” of behaviors. We attribute motivation and intent and assign blame. Society judges trauma survivors by their actions in times of crisis.

We still too often blame the victim if they didn’t fight or try to escape but instead collapsed into submission. We make a judgment about what someone did that leads to a belief about who they are. Trauma survivors themselves often think “It’s my fault” and have a harsh inner critic who mirrors society’s response.

In our daily interactions with family, friends, colleagues, and even the casual exchanges with strangers that define our days, we evaluate others by the ways they engage with us.

Polyvagal Theory gives therapists a neurophysiologioal framework to consider the reasons why people act in the ways they do. Through a polyvagal lens, we understand that actions are automatic and adaptive, generated by the autonomic nervous system well below the level of conscious awareness. This is not the brain making a cognitive choice. These are autonomic energies moving in patterns of protection. And with this new awareness, the door opens to compassion.

A working principle of the autonomic nervous system is “every response is an action in service of survival.” No matter how incongruous an action may look from the outside, from an autonomic perspective it is always an adaptive survival response. The autonomic nervous system doesn’t make a judgment about good and bad; it simply acts to manage risk and seek safety. Helping clients appreciate the protective intent of their autonomic responses begins to reduce the shame and self-blame that trauma survivors so often feel. When offered the lens of Polyvagal Theory, clients become curious about the cues of safety and danger their nervous systems are sensing and begin to understand their responses as courageous survival responses that can be held with compassion.

Trauma-trained therapists are taught that a foundation of effective work is understanding “perception is more important than reality.” Personal perception, not the actual facts of an experience, creates posttraumatic consequences.

Polyvagal Theory demonstrates that even before the brain makes meaning of an incident, the autonomic nervous system has assessed the environment and initiated an adaptive survival response. Neuroception precedes perception. Story follows state.

Through a polyvagal framework, the important question “What happened?” is explored not to document the details of an event but to learn about the autonomic response. The clues to a client’s present-time suffering can be found in their autonomic response history.

The goal of therapy is to engage the resources of the ventral vagus to recruit the circuits that support the prosocial behaviors of the Social Engagement System (Porges, 2009a, 2015a). The Social Engagement System is our “face-heart” connection, created from the linking of the ventral vagus (heart) and the striated muscles in our face and head that control how we look (facial expressions), how we listen (auditory), and how we speak (vocalization) (Porges, 2017a). In our interactions it is through the Social Engagement System that we send and search for cues of safety. In both the therapy setting and the therapy session, creating the conditions for a physiological state that supports an active Social Engagement System is a necessary element. “If we are not safe, we are chronically in a state of evaluation and defensiveness” (Porges, 2011b, p. 14). It is a ventral vagal state and a neuroception of safety that bring the possibility for connection, curiosity, and change. A polyvagal approach to therapy follows the four R’s:

– Recognize the autonomic state.

– Respect the adaptive survival response.

– Regulate or co-regulate into a ventral vagal state.

– Re-story.

. . .

*

from

The Polyvagal Theory in Therapy. Engaging the Rhythm of Regulation

by Deb Dana

get it at Amazon.com

See also:

The Vagus Nerve. Stimulating the pathway connecting body and brain can change patients’ lives – Zoe Fisher and Andrew H Kemp.

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