I had heard about it before and after reading about the fact that polyvagal theory can explain why some clients find relationships threatening, it felt like something worth investing some time in.
It was actually much harder to understand than I
thought. I think it’s because more of the descriptions are very physiological
so the leap to the implications it has for clinicians isn’t always that clear.
So here goes my understanding. Hoping it will
make it a little easier for others navigating this intriguing area!
Polyvagal, refers to the fact that
there are two vagal systems. We were taught in our undergraduate studies that
there were two ways the autonomic nervous system was regulated – through the
parasympathetic and the sympathetic. Turns out there are two systems in the
parasympathetic system.
So in
total there are three systems. Firstly there is the sympathetic system, which
is the one responsible for our fight or flight response. It is a system of
mobilisation and it activates the body to get ready to fight the danger or flee
for it’s life. If you think of the gazelle in the savannah, at the slightest
rustling of leaves, it will suspect a lion and will orient to the sound. It’s
body will get ready to react as soon as necessary to escape the lion. Every
organ in the body gets affected by this system.
However,
what happens if the lion catches the gazelle? A separate system will then get
activated. This is one of the parasympathetic systems which leads to
immobilisation. In clients this can look like dissociation/numbness. This is
where we see the gazelle ‘play dead’. But in reality the system also affects
every organ in the body. The heart rate slows down, the digestive system slows
down, as does breathing and the brain also goes into shut down. This can be seen as
the tonicity of the muscles dissipate – the head flops, the body drops, eyes droop. These are
signs that the primitive vagus system has been activated. Immobility makes us
less appetising for a predator – this is an old evolutionary
system. Immobility suggests illness which puts off the predator . Also getting
immobilised reduces the violence of the perpetrator. This state also creates a
cushion around us as we stop breathing as much and reduce mobility this also
reduces emotion.
It’s an
incredibly old system which is regulated with one of the vagus nerves. It’s
unmyelinated however, so it tends to be inflexible and dominate. This is a
protective mechanism. It gets activated when the animal fears the worst and
this is a way for it to save energy in case it does get an opportunity to
escape. We also release endorphins in this state. It helps us cope with the
physical pain we may be experiencing. Often clients describe feeling floaty. Clients report it
feeling peaceful and this is due to the
vagus being activated – creating like an anaesthesia and the endorphins being released
elsewhere. We can
see this clinically when clients appear to switch off in session or become
almost frozen.
Finally,
the third system also a parasympathetic system is known as the ‘rest and digest’
status. This is when the body feels safe. It is able to tend and befriend with
others, it’s content and the organs and various bodily systems are working as
clockwork. This is also regulated by a vagus nerve. However this is the newest
system and has a myelinated vagus nerve. Which means it is more flexible and
less reactive.
Why is
this relevant clinically? As humans we also have these three systems. We want
our clients to spend as much time as possible in the third system. This is the
place where we feel connected to our loved ones, we can rest and digest and we
can reach out to others.
However,
many of our clients spend a lot of their time in the other two systems and
therefore can’t feel connected or at ease. Instead, they may find relationships
very dysregulating often getting into fight or flight or dissociation.
Sometimes dissociation can last days or weeks. Until they get thrown into
another system by a trigger in their environment or internally.
In their history,
if some clients have felt physically in danger the immobilisation system will
have been activated. If children have consistently experienced a parent as
unavailable, this too could have felt life threatening. In their history, if
they felt it was too dangerous to fight or flight then the immobilisation
system takes over. With such a history of trauma or early issues with anxious
ambivalent attachment, a persons unmyelinated system may dominate so that they
perceive even neutral signals as threatening – even neutral faces. We see it in clients who have difficulties
trusting. From a survival point of view – better safe than sorry.
With a client, we need to get a sense of which system of the three is
being activated
in the moment. As we work with our clients, continuing to provide a safe and
non threatening therapeutic alliance, we help the client to move from states of
threat and dissociation, to states of safety.
Some
examples of possible interventions:
- Therapeutic
Alliance:
Making sure you work on the trust in your relationship. Don’t start any trauma
work, especially if they get into the shutdown mode, before you have a good
solid alliance.
- Normalise: the polyvagal theory
explains why clients have shutdown in the moments of threat – such as in the
case of a rape or Attack. This was the best and most adaptive response they
could do. It’s not due to weakness.
- Mindfulness/Yoga: Helping the client regulate
their breathing. This helps the body understand that they are not under threat.
It changes the feedback loop.
- Assertiveness/interpersonal
effectiveness skills:
This helps clients be more assertive when they need to influence the behaviours
of others. Instead of the state of passivity/dissociation. Help clients find
they’re anger. It helps them realise that boundaries have been crossed.
