What’s the deal with Polyvagal Theory?

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:

  1. 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.
  2. 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.
  3. Mindfulness/Yoga: Helping the client regulate their breathing. This helps the body understand that they are not under threat. It changes the feedback loop.
  4. 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.