Polyvagal Therapy

Science about the vagus is an exciting new trend, it gets marketed as having almost magical powers to help people feel better. So I get quite a lot of emails asking for ways to ‘strengthen’ the vagus or how to ‘stimulate’ it. I think that this is based on a misunderstanding. Let me clarify.

 

The vagus is a nerve, not a muscle. You cannot train it to strengthen it. And I cannot recommend a certain massage technique that stimulates the vagus as if you could touch it somehow to make it work better or remove a blockage. It is like an electric cord between the brain and the body. It doesn’t make much sense to stimulate an electric cord. Massages can help our well-being and the vagus plays a role, but for completely different reasons. Your vagus is probably ok, it doesn’t need any fixing.

There is no such thing as polyvagal therapy, we cannot ‘treat’ the vagus. But we can have polyvagal-informed therapy.

 

To get there the first step is to understand what is happening in our bodies.

The vagus is important because it connects our brain and our body. An image that is regularly used to explain it, is a highway. There is much more information coming from the body and going to the brain than information from the brain going to the body. Like 4 lanes going body-brain and one lane going brain-body. They create a feedback loop.

Our sensory system notices something new, the information goes to the brain. The brain needs more information and signals back to the body to move the head to orient. The body goes still and we look and listen for cues of safety or danger. Our muscles go tight, we collect more sensory information. These physical signals go back to the brain, the brain interprets it and signals back…

Our inner states of regulation (or dysregulation) are a result of that feedback loop.

 

 

The second step to polyvagal-informed therapy is to understand the polyvagal ladder and our stress systems. It shows us when to intervene and how to recognize dysregulation. Probably half of polyvagal-informed interventions is to learn how to recognize when we enter flight/fight or freeze, what the body does, how our emotions and thought patterns change, what it feels like when there is a shift in arousal and when we move from ventral vagal activation to sympathetic arousal or dorsal vagal influence. If we are not aware of what is happening we cannot change it. The polyvagal theory has given us a new vocabulary to address changes in arousal levels.

The goal is to learn to move with and influence the rhythm of regulation.

 

 

The rest of what polyvagal-informed therapy does is find bottom-up and top-down ways to influence the feedback loop between body and brain. That is not done by somehow meddling with the vagus itself. We are trying to create safe cues so our neuroception will interpret the situation as safe. Because of the strong feedback from the body it makes sense to work with our sensory system and awareness for safety cues from the outside but also from the inside of our body.

(This is why it is a logical step from the polyvagal theory to body work.)

 

Bottom-up

We have already found a few promising places for interventions when we look at where the ventral vagus reaches.

• heart
• lungs
• throat
• vocal cords
• esophagus
• face/eyes
• inner ear
• …

Again, it is not the vagus itself, we are looking for body parts where we can change sensory input so that we can influence the feedback to the brain through the vagus.

 

One of the fastest ways to influence our heart beat and lungs is to regulate our breathing. That is why breathing exercises are at the top of bottom-up interventions. Every inhale comes with a small activation of the SNS, every exhale activates the PNS a bit. That is why we always elongate the exhale and make sure to pause for a moment before inhaling again. Breath-related therapies are not an invention of the polyvagal theory. They have been known to be helpful for a long time.

 

All kinds of things we can do with our throat and vocal cords can be helpful. Humming, singing, speaking, taking a sip of water, eating a snack, sucking hard candy. Some people came up with exercises to activate these areas but doing plain old humming that vibrates in our throat gets the job done just fine.

Creating sound is always closely related to hearing sounds. Listening to music sends feedback to our brain. Choose something soft, no deep bass drums, no high-pitched screaming and generally something that invited to sway more than it invites to bob your head to the beat. Like breathing therapies, music therapy is nothing new. We just use it with more understanding of why it works.

 

Our senses of sight and touch offer easy ways to influence our well-being.

It is proven the looking at nature (especially natural water sources, but any nature will work) calms our nervous system. We need to go for more walks! And a walk in the city won’t do.

We can also look at pictures of nature to get a calming effect. It could be wise to redecorate our home a little, add plants, pictures, a small indoor fountain etc. Looking at wooden furniture is proven to be more calming than to look at artificial materials.

Touch can be difficult for trauma survivors. It will only work when it is perceived as safe. Then things like massages, functional relaxation or feldenkrais could be helpful.

 

The perception of other people in the room sends information back to our brain. It is mostly subconscious, but we notice the state of someone elses nervous system quickly and it gives us either safety or danger cues. Being around a regulated person is one of the strongest perceptions that will influence our feedback loop, so that we will relax. Making eye contact with someone is part of that.

Co-regulation will influence every kind of polyvagal-informed intervention we try. Singing or humming in a group or breathing in sync with someone else will increase the positive effect on the feedback loop. Humans are gregarious animals. When the group is calm and we feel like we are safely connected to the herd through a shared rhythm, we will calm down too.

 

Instead of feeding the hype about possible poyvagal interventions I will invite you to think about it for yourself, based on what you know so far. More than any fancy exercise, we need a neuroception of safety.

 

Top-down

The influence of our mind on the body is smaller, but it exists.

Using imagery is probably the most effective way to influence the feedback loop top-down. When we look at the activity in the brain we can see that when we imagine doing something, the brain shows the same activation as when we really do the things. The body reacts accordingly.

Imagine a super juicy burger in your hand, how the warm bun feels in your fingers, the smell of it and how you will bite into it any moment, how it will taste… You might start salivating. The body reacts.

If we use calming imagery like the inner garden or a water-related exercise or even just the plain old safe place, we can hack the feedback loop and our body responds with relaxation. Youtube is full of relaxing imagery instructions. Just pick one.

 

Similarly to classic imagery exercises we can use positive memories of safety, connection and feeling at home. We take time to remember the good times and our body calms down.

We can also use our imagination to create inner pictures of a positive future event, like being with loved ones, a vacation at the beach, sitting in the pool after work…

 

Because our dysregulation is directly connected to an (inner) event, we can try to change our thoughts about it. It needs practice to be able to change the direction of our thoughts and mindful meditation could increase our abilities to do so. Then we can use positive self-talk and a friendly, calm, prosodic inner voice to tell ourselves that everything will be ok. Sometimes simply explaining the situation to ourselves, talking with compassion about the stress reaction we experience, noticing mindfully how it affects us and promising that it will be ok, can help reduce stress and relax our body a bit.

 

 

You can’t base a whole new type of therapy on this. Most of it has been known and used for decades, some of it for centuries. We just gain a better understanding through the polyvagal theory.

The modern therapist will use this knowledge to weave it into their usual therapy work. They will create a safe environment in their office, offering safety cues. They will pay attention to a clients stress responses and offer co-regulation and small interventions like mentioned above.

 

When we look for a type of therapy that really exists that is heavily based on the polyvagal theory, we have to look at body work in general and at Somatic Experiencing in particular. It works closely with polyvagal concepts. It is also specifically for trauma patients. So if you found this article searching for stress relief in your every-day life, I would ask you to please leave this limited treatment option to those who need it the most. Mindful yoga is scientifically proven to have a positive influence through the vagal system. Try that.

If you live with complex trauma I would invite you to look into the concepts of somatic experiencing. It is very different from other trauma treatment and a wonderful addition to cognitive approaches.