Polyvagal Theory in Practice
Originally published in Counseling Today - June 2016, an American Counseling Association Publication
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 to 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. Now with polyvagal theory, we can picture a three-part system. Polyvagal theory identifies a third type of nervous system response which Porges calls the social engagement system, a playful mixture of activation and calming that operates out of unique nerve influence.
When we are in our social engagement system, with its playful mixture of activation and calming, more nuanced relating is possible. Helping our clients shift into use of their social engagement system helps them become more flexible in their coping styles.
Using our social engagement system biology requires a sense of safety. Our other two systems are available to manage life-threatening situations. Most counselors are familiar with the two defense mechanisms available for life-threatening situations—sympathetic fight/flight and parasympathetic shut down which is sometimes called freeze or faint. The social engagement system helps us navigate relationships. The kind of nuanced relating that characterizes use of social engagement system biology is only possible when our lives are not at stake.
Polyvagal theory helps us understand that both branches of the vagus nerve calm the body but they calm the body in different ways. Shut down is part of the dorsal branch of the vagus nerve and can feel like the fatigued muscles and light-headedness of a bad flu. Because the dorsal vagal nerve shuts down the body, it can move us into immobility or dissociation. Besides effecting the heart and lungs, this branch effects body functioning below the diaphragm and is involved in digestive issues. The ventral vagal nerve effects body functioning above the diaphragm.
The ventral branch of the vagus nerve 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 for feeding. You pull back on the reins to keep the horse from going too fast, releasing the pull and tightening the pull in nuanced ways to maintain an appropriate speed. Because the ventral vagal nerve can allow activation in a nuanced way, it offers a different quality of activation than sympathetic activation.
Ventral vagal release into activation takes milliseconds, while sympathetic activation takes seconds and includes various chemical reactions that are like losing the reins of the horse. Once fight/flight chemical reactions have begun, it can take our bodies ten to twenty minutes to return to our pre-fight/flight state. Ventral vagal release into activation does not involve these sorts of chemical reactions. Therefore, we can make faster adjustments between activation and calming like we can when we use the reins to control the horse.
If you watch dogs in a dog park, you see that sometimes dogs are afraid. Fearful dogs exhibit fight or flight behaviors. At other times, a dog will signal a wish to play. This signaling often takes the shape we humans hijacked for downward-facing-dog pose in yoga. When a dog gives the down-dog signal, it cues a level of arousal that can be intense. However, while this playful energy is intense, the intensity has a very different spirit than the intensity of fight/flight behaviors. This playful spirit characterizes the social engagement system.
When we are in life-threatening danger, our first defense reaction is fight/flight. If neither fleeing nor fighting is possible, dorsal vagal shut down occurs. So in situations of life-threatening danger, we shift first into fight/flight and if that is not effective, we shift into shut-down. 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/flight. We may be able to channel the fight/flight anxiety into activities like cleaning the house, raking the leaves, working out at the gym but these activities will have a different feel than they would have if they were done with social engagement biology. Think whistle while you work. For some trauma survivors, no activity successfully channels the fight/flight sensations, they feel trapped and their bodies shut down. These clients may live in a version of perpetual shut-down
A long-time friend and colleague of Stephen Porges, Peter Levine has studied the shut-down response through animal observations and body work with clients. In Waking the Tiger, he explains that coming out of shut-down requires a shutter or shake to discharge suspended fight/flight energy. In a life-threatening situation, if we have shut down and an opportunity for active survival presents itself, we can wake ourselves up. As counselors, we might recognize this shift from shut down to fight/flight in a client’s move from depression into anxiety.
How can we help our clients move into their social engagement biology? If clients live in a more dissociative, depressed, shut-down manner, we must help them shift temporarily into fight/flight. As clients experience fight/flight intensity, we must 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 Behavioral Therapy and Dialectical Behavioral Therapy help clients move out of dissociative, shut down responses by helping them become more embodied. When clients are more present in their bodies, more able to attend to momentary muscular tension, they can wake up from a shut-down response. As clients activate out of shut down, and shift toward fight/flight sensations, the thought-restructuring techniques that are part of CBT and DBT help clients to evaluate safety more accurately. Reflective listening techniques help clients feel a connection with their counselor that can make it possible for them 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 affects facial muscles and thus the ability to make communicative facial expressions. It also affects the larynx and thus vocal tone and vocal patterning, helping humans create sounds that soothe one another. Since publishing The Polyvagal Theory, Porges has studied the use of sound modulation to train 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 other’s voices. As counselors, we can be conscious of our vocal patterns and facial expressions and be curious about the effect those aspects of our communication have on our clients.
From 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 the clarinet. As a dance therapist, I am aware that extending exhales helps clients stuck in forms of fight/flight response move into a sense of safety. For clients stuck in some form of shut down, I have found that conscious breath work can stir fight/flight. When this occurs, the fight/flight energy will need to be discharged through movement in order for clients to find a sense of safety. Those 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 for scientific study of the effectiveness of body therapies and expressive arts therapies.
Polyvagal theory in my practice
Here is an example of how I used polyvagal theory with a client who experienced medical trauma during her birth. My client had been recently prescribed Zoloft. She described feeling very sleepy and having had difficulty getting to our session. Her psychiatrist had given her Zoloft as a way of treating anxiety stirred by the birth of her daughter’s first child. She and I had normalized her anxiety as a trauma response.
During the years before coming to see me, this client had a suicide attempt that resulted in medical procedures that added to her trauma. Through our work, she has come to understand that panic attacks which she currently has when in contained situations are also trauma responses. She lives much her life in perpetual fight/flight.
On this day, she was relieved to be less emotional. Also, she feared the tiredness that accompanied Zoloft’s help in calming her fight/flight sensations. I saw her fear of the tiredness as fear of dorsal vagal shut-down. We discussed the possibility that this tiredness could allow a new kind of activation. I wondered if she might like to do some expressive art which would allow gentle, expressive movement. She shuttered, naming her preference for things that are less subjective.
We talked about the existence of a kind of aliveness that feels so safe that it is possible for preference. We talked about the possibility of existing in a playful place where there is no right and wrong, only preference. We acknowledged that since birth, she and her parents had feared that her health would fail again. The environment she grew up in had supported nervous system functioning designed for life-threatening situations. With the Zoloft calming the fight/flight activation, perhaps she could explore some calmer, more playful kinds of subjective experiences.
She said, “It feels like you are trying to create a different me.” I acknowledged how it might sound like I was thinking she could be someone she wasn’t and what I was actually suggesting was the possibility that she could be herself in a different way. She told me she had a new book for grandparents that had a chapter on play and perhaps she would read it. Of course, she may not be able to tolerate the Zoloft and may have to get off of it. However, the idea of this different, more playful way has been introduced 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/flight to shut-down when clients feel trapped. We can also recognize the movement from shut-down into fight/flight that is the path toward 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/flight behaviors and even shut-down behaviors. Counselors 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.