Polyvagal Theory: The Hydra's Head of Chronic Illness
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Introduction
Polyvagal Theory, once a “fringe” concept, has been floating around the collective consciousness lately when it comes to things like trauma, chronic illness and psychology. What exactly is it, and why are it’s implications so profound? In the article below, I will attempt to make this very complex subject matter accessible to you, and come away with not only a firm grasp on the essentials of Polyvagal theory, but practical ways to incorporate the power of this tool in your life.
Note: this article may get a little technical, but I’ve attempted to reduce a very complex subject in an accessible manner, in service to those who it will benefit from it.
Polyvagal Theory Defined
A good introduction to Polyvagal theory begins with the recognition that there are three circuits, or branches, of the autonomic nervous system, instead of the traditionally recognized two branches, which are divided into the sympathetic and parasympathetic. The sympathetic chain is recognized as our fight or flight response, and connected to the nerves in our spinal cord, evolved in mammals as a primary defense strategy. The parasympathetic system consists of the vagus nerve, responsible for rest and restitution, conserving energy and relaxation. Polyvagal Theory recognizes that the parasympathetic chain consists of two biologically and functionally distinct pathways, and not just a single pathway known as the parasympathetic, introduced into our nervous system at two different stages of our evolution. The earlier evolved pathway, present in reptiles and amphibians, is the dorsal vagus. The physiological state that corresponds to the activation of the dorsal vagus is fear, shut-down and immobilization. This is the primary defense strategy of reptiles, who freeze in response to danger. Mammals who “play dead” also utilize the dorsal vagus as a final resort to predation in the wild. Humans respond in this capacity when confronted with real or perceived threats, as when the fight-or-flight response is registered as inadequate to contend with danger.
The second, more recent, pathway of the vagus nerve is the ventral vagus nerve, specific only to mammals, which corresponds to feelings of safety, security and immobilization without fear. When this state is activated, via cues of neuroception (a concept I will go into later), or when the “vagal brake” is applied to the other two states, we are better able to process new information, change our narrative and confront danger with a sense of immunity. We are able to relax and engage socially with others, hence, the ventral vagus corresponds to what is known as our “social engagement system”.
The autonomic nervous system, overall, can me likened to a thermostat. Since our autonomic nervous system connects to all our visceral organs, our autonomic “dial” corresponds to profound changes in our physiological state. For instance, the activation of either the sympathetic chain or the dorsal vagal chain will regulate the blood pressure. In response to danger, the dorsal vagus will signal blood pressure to drop, and muscles go flaccid and display depressive behavior, go “flat”, as a defensive strategy of immobilization, or freeze. In extreme scenarios, we will faint or have to lie down from the drop in blood pressure. We conserve metabolic energy in our core to make up for the decrease in our visceral organ functions, blood flow is moved away from the periphery and stored in the center. Many chronic conditions are exacerbated or even caused by a chronic state of dorsal vagus activity.
Although state affects physiological and automatic functions, it also profoundly influences behavior based on the emotional changes that shift according to whichever state we are in. In the recognition of state affecting emotions and behavior, we can orient the approach to changing patterns of emotions and behavior in the recognition that physiological state affects these patterns profoundly, and match our approach to recognize this basic fact. It allows us to understand that we are not fundamentally responsible for the emotional state we find ourselves in, and that feelings of withdrawal, shame and inadequacy are directly linked to a biological cue to respond to a particular set of cues in our environment. It recognizes the fundamental truth that we are human. From this understanding, we can move towards strategies to change physiological state, with the help of higher cortical functions, as opposed to maintaining that if we could only cognitively recognize and process our emotions we can overcome them, or simply given into the narrative that the state produces. When we recognize that a particular script is driven by an autonomic defensive strategy, we can take steps to move away from that and bracket a space to change the script.
There are fundamentally five states that can be ascertained from the autonomic nervous system, which consist of the ventral vagus (characterized by immobilization without fear), sympathetic chain (mobilization), dorsal vagal (immobilization with fear), and the combination of the ventral-sympathetic (mobilization without fear) and dorsal-ventral (immobilization without fear). The spinal sympathetic branch inhibits the dorsal branch.
The somatopsychological implications of this correspond to how we can approach chronic conditions of depression, PTSD, muscle tonus, chronic illness and much more.
Neuroception plays an important role in how physiology changes in response to our environment. Neuroception describes cues of safety or danger, and are usually not consciously processed or regulated. They are linked to specific biological cues of safety or danger. When registering cues of safety linked to eye contact, facial expression, prosody, and touch, our ventral vagus branch becomes stimulated and turns our social engagement system online. One of the most important features of our humanness is to be witnessed. Cues of danger linked to certain facial expressions, perception of neglect or abandonment, lack of touch, are registered as a threat, and our physiological state changes automatically, without conscious control. Although we are not responsible for how we feel in the moment our physiology changes automatically, we can be responsible for the behaviors that follow, by recognizing and understanding what has happened, and become aware that how we feel does not always correspond to the reality. The technique of awareness is brought into play to respond to the event in order to best match the reality. This is the time it takes to digest and understand what is happening and why one feels the way they do, changing the script, as opposed to giving in to the feelings that put pressure on the need to act in accordance with the old script, weather it be a self-critical or extra-critical manner (acting out of expectations motivated by fear or hope, for example).
Somatopsychological Problems
Often, people talk about how the mind affects the body, regarding psychosomatic conditions. However, the reverse is also true; that our body affects our emotions and psyche.
Co-regulation keeps us in a state of accessibility and openness. The importance of having a social outlet, chatting with a friend, or other activities, should not be underplayed. Activating our social engagement system is the best way to co-regulate our autonomic nervous systems, and help put the vagal brake on the sympathetic stress chain (anger, anxiety) and the dorsal vagus branch. When we lack adequate social engagement, we can seek the help of professionals to provide us with the attention we need to help activate our ventral vagus. Regular contact is critical to our mental, emotional and physical health. Instead of looking solely at features from our past through talk therapy, or cognitive-behavioral approaches, in order to shift depressive or anxious behavior, we can leverage our ability to regulate our autonomic nervous systems by attempting to change how we feel in our bodies at the present moment. A polyvagal lens allows us to recognize the importance of co-regulation to maintain our emotional and psychological health.
Social Regulation of Anxiety States
Because we live in a world that naturally provokes anxiety, which can become chronic when it’s unregulated, we usually try to numb ourselves to the pain of confronting the cause of our anxiety. Anxiety is a result of the dorsal or sympathetic nervous branches stimulated in response to a trigger, event or memory. A polyvagal lens allows us to introduce co-regulating, or body-therapy techniques, to help us move out of a state of perceived threat to a state of calm and safety. Are we able to sit still? One of the insights of PVT is that our anxiety or response to our feelings of threatening situations have been lifesaving, and help us cope with the events that have befallen us. From this vantage point, we can determine how the coping strategies of defense which have helped save us when the going gets rough continue to inform the narrative and continue to drive us in ways that are detrimental to ourselves and relationships. It takes much less time to feel threatened than it does to recover from a traumatic injury. In a sense, we learn to cope too well. In avoiding the process of letting go of these holding patterns and narratives when they lead to the detriment of our health, we suffer neurotically. The applied movement towards solving these issues may be difficult and overwhelming, but it is a form of legitimate suffering. In bringing our social engagement system back online, from applying the vagal brake through self-regulating (body-therapy) or co-regulating strategies, we can learn to live without the coping mechanisms that run our default script, and expand ourselves and our feelings of wellbeing.
Diaphragmatic Breathing
After prolonged non-diaphragmatic breathing, the intestines become flabby and soft, pulling the lungs down with it. The inbreath engages the abdomen, but fails to exert the muscles of the respiratory diaphragm. This causes a different set of nerve receptors to activate the sympathetic, stress response. Ideally, the abdomen and chest expand and contract rhythmically, at the same time. The two lower ribs move to the sides, down, and back with expansion. The next five ribs up swing out to the sides; this lateral movement is likened to that of a “bucket handle”. The next group of ribs above those lifts straight upward, along with the sternum, in a movement described as a “pump handle”.
Immune Connection
Many visceral organ dysfunctions, such as stomach, heart and lung issues, create the conditions that perpetuate inflammation, chronic disease and infection. Regulating our ventral vagus branch helps bring these systems back into alignment, thereby lessening the duration and intensity of these issues. The ventral vagus nerve plays a major role in regulating body functions to help keep us in homeostasis.
For more on tools for self-regulation, see my previous blog on stress management for chronic illness, where I outline some techniques that you can use to tone your vagus nerve for better balance.